Prehospital care in isolated neck of femur fracture: a literature review

Each year in the UK, around 65 000 people experience a fractured neck of femur (NOF) (National Institute for Health and Care Excellence (NICE, 2017). While there is no literature on these patients' mode of arrival at the emergency department (ED), because of the nature of their injuries and from anecdotal evidence of the author's colleagues, their first contact is with the ambulance service.

It is estimated that 10% of patients with an NOF fracture will die within 1 month, and 33% will die within 1 year. In addition, the cost of NOF fracture, not counting substantial social care expenditure, is £1 billion per year (NICE, 2017).

The main interventions given by paramedics for NOF fractures primarily concern analgesia; there is no official protocol in place within the service for standardised treatment of any kind. The pharmacological methods carried by ambulance crews are nitrous oxide (Entonox), intravenous (IV) paracetamol and IV morphine sulphate. While analgesia is a key component of the management of any NOF fracture, paramedics may be able to influence the use of other interventions. This literature review aims to examine all forms of evidence that may apply to prehospital care, including evidence that has been produced substantially in hospital, as it may have implications for prehospital care. This review concerning NOF fracture care in the prehospital environment is timely and needed urgently, and can also help inform areas for further research.