Paramedics’ experiences of administering fascia iliaca compartment block to patients in South Wales with suspected hip fracture at the scene of injury: results of focus groups

Abstract

ObjectivesTo explore paramedics’ experience of delivering fascia iliaca compartment block(FICB) to patients with suspected hip fracture at the scene of injury.DesignFocus groups within a randomised controlled trial.SettingParamedics based at ambulance stations in the catchment area of one Emergency Department in South Wales, recruited and trained in a feasibility study about an alternative to routine prehospital pain management for patients with suspected hip fracture.Participants11 paramedics.InterventionParamedic-administered FICB to patients with suspected hip fracture. We randomly allocated eligible patients to FICB, a local anaesthetic injection directly into the hip region—or usual care, most commonly morphine - using audited scratch cards.OutcomesParamedics’ experiences of administering FICB gathered through thematic analysis of interview transcripts by two researchers, one paramedic and one lay member.ResultsRespondents believed that FICB was a suitable intervention for paramedics to deliver. It aligned with routine practice and was within people’s capabilities. They said it took up to 10 minutes 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 local anaesthetic toxicity. Reported challenges related to the emergency context: patients often waited many hours for ambulance arrival; moving patients exacerbated their pain; family and neighbours were present as paramedics administered treatment.ConclusionsParamedics are willing and able to administer FICB to patients with suspected hip fracture before ambulance transport to hospital. Feasibility study findings will inform further research.Trial registration numberISRCTN60065373; Pre results.

Is fascia iliaca compartment block administered by paramedics for suspected hip fracture acceptable to patients? A qualitative study

“…It can also be administered by paramedics at the scene of injury although evidence of effectiveness in this setting is lacking 19 29 30 58. The RAPID study has demonstrated that paramedics are willing and able to administer FICB to patients with suspected hip fracture before ambulance transport to hospital 60. This study did not raise any concerns about the acceptability of FICB to patients and families for managing prehospital trauma.…”

Rapid Analgesia for Prehospital hip Disruption (RAPID): findings from a randomised feasibility study

“…Four themes were identified from the focus groups with paramedics: ability and acceptability, patient safety and experience, training, and scope of the paramedic practice [69]. Three themes were identified from patient interviews: memories of receiving pain management and care from ambulance teams, experience of paramedic care, and ongoing hospital treatment and rehabilitation.…”

Efficacy of adding Dexmedetomidine in Fascia Iliaca Compartment Block to provide analgesia for positioning femur fracture patients before spinal anesthesia

“…7,15 FICB can be easily performed and has been used as a good solution for managing femur fracture pain in emergency departments. 16 Evans, et al 2 reported prehospital administration of FICB for patients with suspected fractures at the scene of trauma, using the landmark technique with good results. Hards, et al 17 in their systematic review concluded that FICB is appropriate technique for prehospital pain management, with a high success rate and few adverse effects.…”

“…Additionally, patients reported inadequate analgesia for this severe painful fracture with up to 40% of patients did not receive any analgesics. 2,3 Poor pre-operative pain management in patients with femur bone fractures may be harmful, it can initiate physiological stress response which may lead to tachycardia, hypertension and arrythmias (may harm elderly and cardiac patients), an increase in the hemostatic system, deep venous thrombosis resulting from venous stasis, impaired immune system which result in increased infections, postoperative fatigue and delay in return of muscle function. 4 Disclosure: The authors have no financial interest to declare in relation to the content of this article.…”