Guideline 56 Section 3: Pre-hospital management

Prevention and Management of Hip Fracture on Older People
Section 3: Pre-hospital management

3.1 Communication on admission

Patients with a fractured hip require early admission to hospital. As much clinically relevant information as possible about the patient should be recorded on admission. For optimal management the essential information fields in the SIGN referral document⁵² should be recorded. Evidence level 4

When a patient is admitted all of the essential information fields in the SIGN referral document should be recorded, in particular:

history and examination findings
concurrent medical condition and relevant past medical history
current drug therapy
premorbid functional state, particularly mobility
premorbid cognitive function
social circumstances.

Any history of previous falls should also be recorded.

3.2 Transport to hospital

The literature search carried out for this guideline found no evidence to inform practice with regard to ambulance transport. However, good clinical practice suggests the following are important considerations in patients with fractured hip:

Transfer to hospital from the site of the injury should be undertaken as quickly as possible.

The training of all ambulance personnel should include the recognition of the possibility of a fractured hip in an elderly person, often signified by:

history of fall
presence of hip pain
shortening and external rotation of the lower limb.

If necessary, pain relief should be given as quickly as possible using intravenous opiate analgesia, carefully titrated and supervised for effect, starting with a low dose.

If this is not possible (e.g. due to lack of appropriate supervision) then analgesia using entonox should be considered.

If a patient faces a long journey or an irreducible delay before transfer, consideration should be given to the use of an indwelling urinary catheter.

Attention should be paid to pressure area care (see section 4.2).

Prevention and Management of Hip Fracture on Older People Section 3: Pre-hospital management

Prevention and Management of Hip Fracture on Older People
Section 3: Pre-hospital management