Title

RAPID – Rapid Analgesia for Prehospital Hip Disruption

Principal / Lead Investigator
  • Nigel Rees, Welsh Ambulance Service Trust (WAST).
Co-Investigators / Research Team
Type of study

Feasibility randomised controlled trial

Summary

Background
Breaking a hip is very painful and moving a patient with a broken hip can cause high levels of pain and distress.  It has been found that patients attended by emergency ambulance paramedics following a 999 call for hip fracture may not receive adequate pain relief, and the usual analgesia given may cause side effects that affect patients’ general health and recovery.  Fascia Iliaca Compartment Block (FICB) is a procedure routinely undertaken by doctors and nurses in the emergency department for patients with hip fracture but has not been tested for use by paramedics at the scene of 999 calls.  The procedure involves injection of local anaesthetic into the hip area.

Aim of the research
In this small study we aim to find out whether FICB carried out by paramedics at the scene of 999 emergencies is feasible, safe and acceptable so that we can make a decision about whether we should proceed to a full randomised controlled trial that can answer questions about whether the procedure is effective for patients and worthwhile for the NHS.

Methods
In this feasibility study we will recruit approximately 10 paramedics in the Swansea area.  Paramedics will be trained to carry out the FICB procedure on patients they attend with hip fracture.  Eligible patients will be randomly allocated to FICB or usual care using sealed envelopes on ambulances, a method currently successfully being used by the Welsh Ambulance Service in another study – PARAMEDIC 2 (the ‘Adrenaline trial’).  We will follow up patients to assess accuracy of paramedic diagnosis, acceptability to patients and paramedics, compliance of paramedics and also measures of pain, side effects, time in hospital and quality of life in order to plan a full trial if appropriate.

Lay involvement

We involved public and patient contributors in designing, delivering, overseeing and disseminating the study. We recruited people with experience of prehospital hip fracture, as patients or carers, to the TMG and Trial Steering Committee (TSC).

One public TMG member attended meetings; the other contributed through emails and phone conversations because of inability to travel.  One public member attended TSC meetings. We provided briefing sessions before all TMG and TSC meetings.

Public members contributed to the study in several ways including:

  • Questioning practicalities of obtaining pain scores from injured patients
  • Amending content and layout of patient information sheets to simplify text, reduce content, add images and white space
  • Highlighting life-changing consequences of hip fracture, importance of treatment and care, during TMGs and qualitative analysis
  • Speaking at dissemination events about the priority and personal impact of hip fracture on vulnerable patients
  • Contributing to edits of study outputs and publications as named co-authors; lay sections in particular
  • Taking part in qualitative analysis, bringing the patient and carer’s viewpoint into consideration.
How can this research potentially benefit patients?

As a feasibility study, this is the first step in determining if using Fascia Iliaca Compartment Block (FICB) for patients with hip fracture in prehospital care is better for patients than normal practice.

Who is the study sponsor?

Welsh Ambulance Service Trust (WAST)

Funder

Health and Care Research Wales, through the Research for Patient and Public Benefit funding call 

Total grant value

£ 228,759

Amount to Centre

£ 220,670

Start date

01/10/2015

End date

30/09/2017

Outputs generated

'RAPID – Rapid Analgesia for Prehospital Hip Disruption'. Final Report: for Health and Care Research Wales, Welsh Government. Submitted 01/12/2017.

Bulger J, Brown A, Evans BA, Fegan GW, Ford S, Guy K, Keen L, Pallister I, Rees N, Russell D, Russell IT, Seagrove AC, Snooks HA. Rapid analgesia for prehospital hip disruption (RAPID): protocol for feasibility study of randomised controlled trial. Pilot and Feasibility Studies 2017 3:8 DOI: 10.1186/s40814-016-0115-6