Rapid analgesia for prehospital hip disruption (RAPID): protocol for feasibility study of randomised controlled trial.
BACKGROUND
Adequate pain relief at the point 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 doctors and nurses in the emergency department for patients with hip fracture but not yet evaluated for use by paramedics at the scene of emergency calls. In this feasibility study, we aim to test whether FICB administered by paramedics at the scene of participants' hip fractures is feasible, safe and acceptable. This will enable us to decide whether to proceed to a fully powered, multi-centre pragmatic randomised trial to evaluate whether the procedure is effective for patients and worthwhile for the NHS.


METHODS
In this study, we propose to recruit ten paramedics in an urban area of South Wales. We will train them to carry out FICB when they attend patients with hip fracture. We will randomly allocate eligible patients to FICB or usual care using audited scratch cards. We will follow up participants to assess measurability of key outcomes including quality of life, pain scores, adverse events, length of stay in hospital, acceptability to patients and compliance of paramedics. We will assess whether the findings meet specified feasibility criteria and, if so, plan a full trial.


CONCLUSIONS
This study will enable us to recommend whether to undertake a definitive trial of FICB by paramedics for hip fracture.


BACKGROUND
ISRCTN60065373.
Swansea University Medical School, ILS2, Singleton Campus, Swansea University, SA2 8PP Swansea, UK.
Jenna K
JK
Bulger
Patient Representatives, Swansea, UK.
Alan
A
Brown
Swansea University Medical School, ILS2, Singleton Campus, Swansea University, SA2 8PP Swansea, UK.
Bridie A
BA
Evans
Swansea University Medical School, ILS2, Singleton Campus, Swansea University, SA2 8PP Swansea, UK.
Greg
G
Fegan
Abertawe Bro Morgannwg University Health Board, Swansea, UK.
Simon
S
Ford
Abertawe Bro Morgannwg University Health Board, Swansea, UK.
Katy
K
Guy
Patient Representatives, Swansea, UK.
Sian
S
Jones
Welsh Ambulance Services NHS Trust, Swansea, UK.
Leigh
L
Keen
Swansea University Medical School, ILS2, Singleton Campus, Swansea University, SA2 8PP Swansea, UK.
Ashrafunnesa
A
Khanom
Abertawe Bro Morgannwg University Health Board, Swansea, UK.
Ian
I
Pallister
Welsh Ambulance Services NHS Trust, Swansea, UK.
Nigel
N
Rees
Swansea University Medical School, ILS2, Singleton Campus, Swansea University, SA2 8PP Swansea, UK.
Ian T
IT
Russell
Swansea University Medical School, ILS2, Singleton Campus, Swansea University, SA2 8PP Swansea, UK.
Anne C
AC
Seagrove
Swansea University Medical School, ILS2, Singleton Campus, Swansea University, SA2 8PP Swansea, UK.
Helen A
HA
Snooks
Analgesia; Fractured neck of femur; Hip fracture; Pain; Paramedic; Prehospital