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Adequate pain relief at the scene of injury and during transport to hospital is a major challenge in all acute traumas, especially for those with hip fractures, whose injuries are difficult to immobilize and long-term outcomes may be adversely affected by administration of opiate analgesics. Fascia Iliaca Compartment Block (FICB) is a procedure routinely undertaken by clinicians in emergency departments for hip fracture patients, but use by paramedics at the scene of emergency calls, is not yet evaluated (1).
We undertook a randomized controlled feasibility trial using novel audited scratchcard randomization to allocate eligible patients to FICB or usual care. Paramedics are recruited and trained to assess patients for hip fracture and carry out FICB. 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. The primary outcome measure is health related quality of life, measured using Short Form (SF)-12 at 1 and 6 months. Interviews and focus groups will be used to understand acceptability of FICB to patients and paramedics. This study was funded by Health and Care Research Wales (1003).
We have developed:
•paramedic pathway to assess patients for hip fracture and FICB
•paramedic training package, delivered by Consultant Anaesthetist
To date we have recruited nineteen paramedics; ten are fully trained and recruiting patients, the remainder are being trained. Fifty-four patients have been randomized and thirty-five have consented to follow-up. Thirteen 1-month and five 6-month follow-up questionnaires have been received.
This study will enable us to recommend whether to undertake a definitive multi-centre randomized controlled trial of FICB by paramedics for hip fracture to determine if the procedure is effective for patients and worthwhile for the National Health Service.
Niuean (ISO 639-3 code niu) is a Polynesian language spoken on the island of Niue, with an additional population of speakers living in New Zealand. Figure 1 indicates where Niue is located with respect to other neighboring islands in the South Pacific. The 2011 Niue Census of Populations and Households cited the number of individuals who had either basic or fluent spoken abilities at 1121 (with 101 non-speakers) (Statistics Niue 2012). English is the second most widely used language on the island. The 2013 New Zealand census cited 4548 individuals living in New Zealand who listed Niuean as one of their languages (Statistics New Zealand 2013). Niuean is classified as ‘definitely endangered’ by UNESCO (Moseley 2010). There are historically two distinct dialects: the older Motu dialect from the northern area, and the more recent Tafiti from the southern area. These dialect differences were once reflected in slight phonological differences in vocabulary items, but the differences have since eroded in the modern language (see McEwen 1970: ix). Previous research on Niuean phonetics and phonology includes a brief outline in Seiter (1980: x), two dictionaries (McEwen 1970, Sperlich 1997), and an article on vowel length (Rolle & Starks 2014). While these works provide an overview of some of the phenomena to be addressed below, this sketch attempts a more thorough documentation of the phonetic structures of Niuean, and provides novel acoustic and articulatory data from the language. Recordings accompanying this paper are of a male speaker (Mr. Krypton Okesene) and a female speaker (the second author).