RAPID – Rapid Analgesia for Prehospital Hip Disruption
Principal / Lead Investigator
- Nigel Rees, Welsh Ambulance Service Trust (WAST).
Co-Investigators / Research Team
- Professor Helen Snooks, Swansea University Medical School
- Dr Jenna Bulger, Swansea University Medical School
- Dr Bridie Evans, Swansea University Medical School
- Professor Ian Pallister, Abertawe Bro Morgannwg University Health Board (ABMU)
- Dr Simon Ford, Abertawe Bro Morgannwg University Health Board (ABMU)
- Mr Alan Brown (Patient representative)
- Dr Katy Guy, Abertawe Bro Morgannwg University Health Board (ABMU)
- Dr Anne Seagrove, Swansea University Medical School
Type of study
Feasibility randomised controlled trial
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.
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.
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)
Health and Care Research Wales, Research for Patient and Public Benefit
Total grant value
Amount to Centre
Protocol: Rapid analgesia for prehospital hip disruption (RAPID): protocol for feasibility study of randomised controlled trial. Pilot and Feasibility Studies (2017)
Publication: 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
Publication: Bulger J, Seagrove A, Snooks H, Evans B, Fegan G, Ford S, Pallister I, Guy K, Brown A, Jones S, Keen L, Khanom A, Rees N. PP30 Rapid analgesia for prehospital hip disruption (rapid: feasibility study progress). Emerg Med J 2017;34:e12.
Poster presentation: 'Paramedics’ experiences of administering Fascia Iliaca Compartment Block to patients with suspected hip fracture (RAPiD)' presented at 999 EMS Conference, March 2018, Stirling.
Poster presentation: ‘I can’t remember’ Patients’ views of receiving pain management from paramedics for suspected hip fracture (RAPiD)' presented at 999 EMS Conference, March 2018, Stirling.
Poster presentation: 'RAPiD - fast pain relief for hip fracture: A study with paramedics' presented at 999 EMS Conference, March 2018, Stirling.