Pre-hospital Care and the Emergency Department

The majority of patients with fragility fracture have fallen and present with pain and immobility. The initial management varies enormously worldwide dependent on culture, access to healthcare and economic development. It is acknowledged that developing countries still face enormous challenges in access to healthcare and appropriate management of fragility fractures, but this chapter aims to describe some basic standards of care supported by a growing evidence base. A surgical approach to hip fracture is the most effective way of managing pain and restoring mobility affording the best outcomes and reducing complications. As such, rapid presentation to hospital to establish a definitive diagnosis and enable early surgery is recommended. In the following chapters, the management of patients with hip fracture, prior to surgery, is reviewed. This chapter looks at the roles of ambulance staff, paramedics and the emergency department. Subsequent chapters review pre-operative optimisation and anaesthetic review. It is appreciated that healthcare systems across the world will have different practitioners involved in the acute phase of care, but the principles of management and the evidence base behind recommendations remain similar.
(Copyright 2021, The Author(s).)