Background Adequate pain relief at the scene of injury and during transport to hospital is a major challenge in all acute traumas, especially for those with hip fractures, whose injuries are difficult to immobilise and whose long-term outcomes may be adversely affected by administration of opiate analgesics. Fascia Iliaca Compartment Block (FICB) is a procedure routinely undertaken by clinicians in emergency departments for hip fracture patients, but use by paramedics at the scene of emergency calls, is not yet evaluated. We report on study progress following six months of patient recruitment.
Methods We undertook a randomised controlled feasibility trial using novel audited scratchcard randomisation to allocate eligible patients to FICB or usual care. FICB is only administered to patients without contraindications. The primary measureable outcome is health related quality of life, measured using SF-12 at 1 and 6 months. Secondary outcome measures include mobility scores at 6 months (using Rivermead Mobility Index); patient satisfaction; pain scores; patient safety and length of hospital stay. Interviews and focus groups will be used to understand acceptability of FICB to patients and paramedics. We will also assess the accuracy of paramedic hip fracture recognition (using sensitivity and positive predictive value as indicators).
Results We have developed
paramedic pathway to assess patients for hip fracture and FICB
paramedic training package, delivered by Consultant Anaesthetist
To date we have recruited 19 paramedics; 10 are fully trained and recruiting patients, the remainder are being trained. Twenty-two patients have been randomised and 16 have consented to follow-up.
Discussion This study will enable us to recommend whether to undertake a definitive multi-centre randomised controlled trial of FICB by paramedics for hip fracture and the procedure is effective for patients and worthwhile for the NHS.
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