Rapid analgesia for prehospital hip disruption (RAPID): protocol for feasibility study of randomised controlled trial

Abstract

BackgroundAdequate 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/designIn 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.DiscussionThis study will enable us to recommend whether to undertake a definitive trial of FICB by paramedics for hip fracture.Trial registration ISRCTN60065373

Femoral Nerve Block Intervention in Neck of Femur Fracture (FINOF): a randomised controlled trial

“…Although this is a potential unmeasured confounder, we believe that randomisation is likely to have balanced the groups. Trials of fascia iliaca compartment block delivered by paramedics 35 are taking place, and we await the results with interest. Although the exclusion of participants who were found not to have a fractured neck of femur meant that we did not reach our recruitment target, we do not believe further recruitment would have altered our results in a meaningful way.…”

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

“…We carried out a feasibility trial of paramedic-administered FICB for suspected hip fracture, the rapid analgesia for prehospital hip disruption (RAPID) trial described in our published protocol 31. We recruited and trained 19 paramedics based at ambulance stations in the catchment area of one emergency department in South Wales to administer FICB to patients with suspected hip fracture.…”

“…The Association of Anaesthetists of Great Britain and Ireland supports delivery of FICB by trained non-medical health professionals 28. FICB could potentially be delivered prehospitally, by nurses29 or paramedics 30 31…”

Prehospital recognition and antibiotics for 999 patients with sepsis: protocol for a feasibility study

“…It is acknowledged and accepted that it is not ethically appropriate to consent patients to research within the context of a medical emergency [ 14 ]. We have an experience of carrying out randomised trials in emergency care through the SAFER programme and TIER and RAPID feasibility trials [ 15 , 16 ] and have successfully gained ethical, research, and information governance approvals to inform people of their inclusion in research following their attendance by emergency ambulance. At the time of paramedic attendance, therefore, patients will only be asked to provide consent to have blood cultures collected and receive antibiotics, should they be randomly allocated to the intervention arm.…”