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Abstract
Objective To explore patients’ experience of receiving pain relief injection for suspected hip fracture from paramedics at the location of the injury.
Design Qualitative interviews within a feasibility trial about an alternative to routine prehospital pain management for patients with suspected hip fracture.
Setting Patients treated by paramedics in the catchment area of one emergency department in South Wales.
Participants Six patients and one carer of a patient who received fascia iliaca compartment block (FICB).
Intervention FICB administered to patients with suspected hip fracture by trained paramedics. 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.
Outcomes Acceptability and experience of receiving FICB, assessed through interview data. We audio-recorded, with participants’ consent, and conducted thematic analysis of interview transcripts. The analysis team comprised two researchers, one paramedic and one lay member.
Results Patients had little or no memory of being offered, consenting to or receiving FICB. They recalled the reassuring manner and high quality of care received. They accepted FICB without question. Partial or confused memory characterised experience of subsequent hospital care until surgery. They said their priorities when calling for emergency help were to receive effective care. After hospital treatment, they wanted to regain their health and mobility and resume the quality of life they experienced before their injury.
Conclusions This study did not raise any concerns about the acceptability of FICB administered at the scene of injury by paramedics to people with suspected hip fracture. It adds to existing evidence about patient and carer experience of on-scene care for people with suspected hip fracture. Further research is needed to assess safety, effectiveness and cost effectiveness of this health technology in a new setting.
Trial registration number ISRCTN60065373.
- hip fracture
- fractured neck of femur
- pain
- prehospital
- analgesia
- anaesthetic
- fascia iliaca compartment block
- patient experience
- patient acceptability
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Footnotes
Contributors BAE drafted the manuscript with editorial input from all authors—AB, JJ, GF, SF, KG, SJ, LK, AK, ML, IP, NR, ACS, ITR, AW, HS. BAE led qualitative analysis with JJ, SJ and LK. The research idea was conceived and developed by NR, IP and SF, with methodological advice from GF, HS and ITR. All authors read and approved the final manuscript.
Funding Health and Care Research Wales, part of the Welsh Government, funded RAPID through their Research for Patient and Public Benefit (RfPPB) stream (1003).
Patient consent for publication Not required.
Ethics approval We gained ethical approval from the Wales Research Ethics Committee 6 (reference 15/WA/0439). All respondents gave informed consent in writing to participate in this study.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement All data relevant to the study are included in the article.