In the UK, femoral neck fractures affect up to 75 000 elderly people per year, with up to a third of these patients dying within twelve months. While there is a paucity of research specific to the pre-hospital field, current evidence demonstrates that optimal treatments include appropriate and adequate analgesia, fluid management and correct immobilisation of the injured leg. Analgesia should be considered immediately in a stepwise approach, through the variety of options open to paramedics and should be progressive to the patients needs. Fluid management should be considered to stabilise the patient and prepare them for surgery. Transfer to the ambulance should be done in a safe manner, ensuring the patient is immobilised and remains pain free. This pre-hospital management of the patient with a femoral neck fracture ensures they receive appropriate management before initiation onto a care pathway in hospital.