Pain is a typical sensory experience that may be described as the unpleasant awareness of a noxious stimulus. In the United States more than 300,000 patients a year suffer from fractured femurs. This can be a debilitating injury that can lead to major life style changes. Patients admitted to the Emergency Department of a critical access rural hospital with the diagnosis of a fractured femur are stabilized and transferred to a tertiary medical center for definitive treatment. Prior to this intervention, they were treated with intravenous pain medications. Further pain medications during transport were often denied due to the level of care that the transporting EMT could provide. An initial needs study was performed to determine the pain treatment for patients admitted to the Emergency Department with a diagnosis of a fractured femur. This initial study showed that patients were woefully undertreated for their pain. It was determined that this patient population needed more definite treatment for their pain prior to transfer. Femoral nerve blocks provided a method of treating the pain associated with a fractured hip. The question was how to increase the use of these blocks in the Emergency Department. An algorithm was developed and introduced to the medical and nursing staff of the Emergency Department. After the introduction of the algorithm a follow up study was performed to determine if the number of femoral nerve blocks for patients with fractured femurs was increased.