Fascia iliaca compartment blocks by paramedics for suspected proximal femoral fracture in the prehospital setting: a rapid scoping review

Introduction: Over 70,000 cases of Proximal Femoral Fracture (PFF) occur annually in the United Kingdom (UK), primarily affecting the elderly. These injuries are associated with high morbidity and mortality, and often see inadequate pain management in the prehospital setting. The Fascia Iliaca Compartment Block (FICB), a regional anaesthesia technique, is the gold standard of care in Emergency Departments (ED). This review aims to assess the literature on paramedic-performed FICB for suspected PFF in the prehospital setting, highlighting benefits and challenges to guide future practice and policy in the ambulance sector. 
\n 
\nMaterials and methods: A rapid scoping review was conducted following the Joanna Briggs Institute (JBI) methodology, with modifications for this project’s limitations. A systematic search of the databases CINHAL, PubMed, EMBASE, and Medline was performed. A synthesis matrix was created to extrapolate data from the included studies and allow for a coherent interpretation of results. Each included study was subject to a critical appraisal conducted using the Mixed Methods Appraisal Tool (MMAT). 
\n 
\nResults: Data was extracted from three studies and two reports which identified four key themes emerged: paramedic competency in performing FICB, patient perspectives, adverse events, and training and governance. Studies showed paramedics can competently perform FICBs in prehospital settings. Verbal pain scores were lower following an FICB compared to standard care with IV morphine, which required more supplementary morphine for break-out pain. Concern for causing harm was a consistent theme among the paramedics performing FICB, particularly in precipitating an adverse event sequela. Adverse events were more common in non-FICB groups, with only one case of local anaesthetic toxicity in the FICB group, which was correctly managed by the paramedic. 
\n 
\nConclusions: Paramedics can competently perform FICB in the prehospital setting, showing promising results in pain relief compared to intravenous morphine. However, higher-level research is needed for confirmation. Patients generally tolerated paramedic-led FICB well, with minimal concerns. Training and governance remain significant barriers to implementing FICB in local ambulance services.