title: Development of a Prehospital Tranexamic Acid Administration Protocol.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.forename: David S
authors.initials: DS
authors.lastname: Strosberg
authors.forename: Michelle C
authors.initials: MC
authors.lastname: Nguyen
authors.forename: Lisa
authors.initials: L
authors.lastname: Mostafavifar
authors.forename: Howard
authors.initials: H
authors.lastname: Mell
authors.forename: David C
authors.initials: DC
authors.lastname: Evans
mesh_terms: D000933:Antifibrinolytic Agents / Q000008:administration & dosage*; D002985:Clinical Protocols; D032921:Consensus; D004632:Emergency Medical Services; D006801:Humans; D014148:Tranexamic Acid / Q000008:administration & dosage*; D014947:Wounds and Injuries / Q000188:drug therapy
chemical_list: D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid
keywords: prehospital trauma care; tranexamic acid