Background NIHR funding is provided to studies which will produce evidence to inform policy and practice in healthcare. Exploratory or feasibility work can be difficult to find funding for. We present the timeline and steps in the process from first having an idea for research through to gaining funding for a definitive trial.

Objective To determine costs and effects of Fascia Iliaca Compartment Block delivered by paramedics at the scene of injury for suspected hip fracture.

Methods Literature review

1. Development and testing of tool to support identification of hip fracture by paramedics

2. Feasibility trial (RAPID 1)

3. Proposal for definitive trial (RAPID 2)

Results Funding was gained from local NHS ‘Pathway to Portfolio’ resources to carry out the first stages of the programme; then a grant was won through the Welsh ‘Research for Patient and Public Benefit’ scheme to undertake a feasibility study. Finally, NIHR HTA funding was awarded to carry out a definitive trial, in five ambulance services.

2015 – 16: A systematic review of the literature found that the effectiveness of FICB carried out by paramedics at the scene of injury is unknown, although nurse practitioners have been found to deliver this intervention safely in the Emergency Department.

2015 – 16: A tool for identifying hip fracture at the scene of injury was developed by orthopaedic clinicians and tested by ambulance service staff. Sensitivity and positive predictive value were high.

2015 – 18: Feasibility trial progression criteria related to methods and intervention safety and acceptability were met.

2019 – 20: A full trial proposal was submitted, shortlisted, rejected, amended, resubmitted and funded.

2020 – 2025: The RAPID 2 trial is now underway, with paramedic training and patient recruitment due to start in June 2021.

Conclusions Research funding systems can work to help to progress from idea to full trial, although timescales can be lengthy.