North Memorial Ambulance Adds TXA to Ground Ambulances

North Memorial Ambulance service has begun providing its paramedics with an important drug that can help save the life of a patient with major bleeding from trauma.

Tranexamic acid, or TXA, is administered by IV injection and helps stabilize clots that the body is trying to form at the site of bleeding from a traumatic injury.

TXA has been used in operating rooms for many years to help reduce blood loss during surgery. Several years ago the military began testing TXA in battlefield hospitals and found that it significantly helped reduce the rate of death in soldiers and civilians who had major bleeding from an injury. The results of that research were published in two reports, CRASH-2 (2010) and MATTERS (2012). Those studies showed that the earlier patients received TXA, the better they survived from major bleeding. Those studies helped demonstrate the value of using TXA in emergency settings outside a hospital.

North Memorial Air Care helicopters have been using TXA since 2013, but the North Memorial Ambulance service is the first in the state to deploy TXA on all of its ground ambulances.

According to Dr. John Lyng, medical director for the ambulance and an emergency physician at North Memorial Medical Center, “We’ve been using hemorrhage control techniques like applying direct pressure and tourniquets for several years, but those are only helpful if the patient is bleeding externally. TXA helps us reduce bleeding at any site of injury, whether internal or external.”

TXA is a safe drug that has few side effects and has very little risk of causing an allergic reaction. In addition to helping save lives, TXA may even help reduce the overall cost of care for a patient.

“Adding the drug to the ambulance doesn’t add to the patient’s bill, because ambulances can only bill patients for the level of care they receive and how far they are transported, not the individual treatments that are given,” Lyng stated. “Whether a patient needs to be treated with two drugs or 10, the cost is the same. In fact, because TXA helps stop bleeding, it can reduce the patient’s need to receive other more costly treatments in the hospital, making it a highly cost effective treatment that can help reduce the cost of care to the patient.”

According to Lyng, “This drug will allow us to step up our game when it comes to hemorrhage control, but it's also important for someone to provide first aid before 911 help can arrive.” He noted that the federal government has launched the “Stop the Bleed” campaign, aimed at helping to empower bystanders to become “by-doers.”

The campaign encourages people to learn how to stop external bleeding by applying steady direct pressure to a bleeding site, or to apply a tourniquet above the bleeding site.

“For several years tourniquets were viewed as a treatment of last resort. More recent research on the battlefield and in civilian settings has shown that early tourniquet use has saved both lives and limbs if the tourniquet is applied quickly after an injury that causes major bleeding,” Lyng said. “These simple first aid treatments that lay-people can perform can save a life.”

For more information, contact John Lyng, MD, FACEP, NRP, Medical Director, Office of the Medical Directors, North Memorial Ambulance & Air Care, Brooklyn Center, MN, john.lyng@northmemorial.com.

Resources

For more info on the “Stop the bleed” campaign see: https://www.dhs.gov/stopthebleed and https://www.whitehouse.gov/the-press-office/2015/10/06/fact-sheet-bystander-stop-bleed-broad-private-sector-support-effort-save.

Cost-Effectiveness Analysis of Administering Tranexamic Acid to Bleeding Trauma Patients Using Evidence from the CRASH-2 Trial PLoS One. 2011; 6(5) e18987. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3086904/