Support from advanced practitioners in critical care for ankle fracture dislocation

Analgesic imitations, under-recognition of injury severity and delayed restoration of neutral alignment are common problems around ankle fracture dislocation (AFD). Optimal prehospital management improves long-term outcomes. This study aimed to explore ambulance clinicians' experiences of AFD incidents when supported by advanced practitioners in critical care (APCCs). Semi-structured online interviews were conducted. Data sets were coded and grouped to identify themes via thematic content analysis. Six clinicians agreed to take part (response rate 42%). AFDs were encountered infrequently (once per year). Four themes were identified: clinicians' confidence in managing AFD; value-added role of APCCs; prehospital challenges; and reflections on the incident. Benefits of the APCC role include enhanced technical skills, including in ankle reduction and analgesia, and in non-technical skills, such as leadership and decision-making. Improvements in clinician recognition and management of AFD and better awareness of the APCC role are recommended, as is research on optimal prehospital AFD management.