Background Routine pre-hospital pain management for hip fracture is inadequate, with risk of potentially fatal complications, particularly from morphine. Fascia Iliaca Compartment Block (FICB) is used in Emergency Department and orthopaedic wards. The RAPID trial tested feasibility of paramedics administering FICB to patients with suspected hip fracture at the scene of injury.
Objective To explore paramedics’ experience of delivering FICB pre-hospitally.
Methods We held three focus groups with 11 paramedics serving one district hospital, audio-recorded with participants’ consent. We conducted thematic analysis of interview transcripts. Two researchers, one paramedic and one lay member were in the analysis team.
Results Respondents believed FICB was a suitable intervention for paramedics to deliver. It aligned with their routine practice and was within people’s capabilities to administer, they reported. They said it took up to 10 min longer than usual care to prepare and deliver, in part due to nervousness and unfamiliarity with a new procedure. They praised the training provided but said they were anxious about causing harm by injecting into the wrong location. Confidence increased after one paramedic team successfully treated a patient for toxic reaction. Reported challenges related to the emergency context: patients often waited many hours for ambulance arrival; they sometimes needed to be moved from awkward locations which exacerbated pain; family and neighbours were present as paramedics administered treatment. Most respondents treated few or just one patient with FICB. Although uncertain whether FICB reduced patients’ pain more effectively than other pain relief options, respondents believed it was safer for elderly people at risk of pneumonia.
Conclusions Paramedics are willing and able to administer FICB to patients with suspected hip fracture before ambulance transport to hospital. Feasibility study findings will inform a research proposal for a definitive multi-centre trial of paramedic administered prehospital FICB.
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