Development of a Prehospital Tranexamic Acid Administration Protocol

David S. Strosberg, Michelle C. Nguyen, Lisa Mostafavifar, Howard Mell, David C. Evans

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Abstract: Objective: Early administration of tranexamic acid (TXA) has been shown to reduce all-cause mortality and death secondary to trauma. Our objective was to develop a collaborative prehospital TXA administration protocol between a ground EMS and academic medical center. Methods: Physicians, pharmacists, and EMS and fire department personnel developed a prehospital TXA administration protocol between a local fire and EMS center with a Midwest tertiary care health system based on results from the CRASH-2 Trial. The protocol was initiated March 27, 2013 and the first dose of TXA was administered in September 2013. Results: Since September 2013, nineteen trauma patients received TXA. Survival rate was 89% (17/19); 2 patients expired immediately following arrival to the trauma bay. Seven patients did not receive the in-hospital maintenance dose due to the following: 3/7 (43%) due to miscommunication of pre-TXA administration; 2/7 (29%) did not meet inclusion criteria for TXA protocol; 1/7 (14%) due to protocol noncompliance; 1/7 (14%) due to a chaotic situation with an unstable patient. Conclusions: Prehospital TXA protocol based on the CRASH-2 trial is safe and feasible. The first dose of TXA administered under this protocol marks the first ground EMS administration in the USA. Conceivably, this will pose as a model to other trauma centers that receive patients from outlying areas without immediate access to care. Large multi-institutional analyses need to be performed to evaluate survival benefits of prehospital TXA administration protocol.

Original languageEnglish (US)
Pages (from-to)462-466
Number of pages5
JournalPrehospital Emergency Care
Issue number4
StatePublished - Jul 3 2016
Externally publishedYes


  • prehospital trauma care
  • tranexamic acid

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency


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