Paramedic perceptions of bleeding in trauma and the use of TXA

Study team

• Maria Robinson (South Western Ambulance Services NHS Foundation Trust), Chief Investigator
• Professor Jonathan Benger (UWE Bristol)
• Dr Sarah Voss (UWE Bristol)
• Dr Helen Nicholson (UWE Bristol), Study Coordinator
• Kim Kirby (UWE Bristol)
• Dr Hazel Taylor (RDS)
• Adam Bedson (South Western Ambulance Services NHS Foundation Trust)
• Dr Laura Goodwin, Research Fellow - Emergency Care (UWE Bristol)

Study summary

There are around 5,400 deaths each year from injuries in the UK, of which 2,400 occur before hospital arrival. Tranexamic acid (TXA) has been shown to reduce mortality from bleeding in trauma. Early administration of TXA improves effectiveness and the setting has a significant effect on the timing of administration; paramedics administer TXA earlier than in hospital (49 minutes versus 111 minutes).

TXA was introduced as an intervention across UK ambulance services during 2012. However, despite strong evidence of effectiveness and inclusion in Joint Royal Colleges Ambulance Liaison Committee (JRCALC) guidelines, only around 5% of all patients in the UK Trauma Audit and Research Network (TARN) who are at risk of haemorrhage receive prehospital TXA.

Determining a patient’s risk of bleeding in the early stages of pre-hospital care can be challenging, and paramedics rely on their clinical judgement when assessing this. It is not known whether they feel adequately equipped to decide who is at risk, and what factors determine whether or not they administer TXA.

This qualitative interview study with paramedics within the South Western Ambulance Services NHS Foundation Trust (SWAST) will explore the barriers to TXA administration to trauma patients, including the identification of those at risk of bleeding. The ultimate aim is to improve TXA administration rates by paramedics, thereby reducing mortality due to haemorrhage in trauma patients.

We will conduct semi-structured telephone interviews with approximately 20 paramedics from SWAST. Interviews will be designed to investigate the experiences of paramedics when attending trauma patients. They will be asked about the factors affecting their decision making when they are

• identifying patients at risk of bleeding, and
• administering TXA.

The interviews will generate qualitative data that will be transcribed and analysed thematically.

The findings are expected to provide an understanding of the factors that influence paramedic decision-making and the barriers to administering TXA. Themes will be generated from the data and these will be used to improve the understanding of paramedics' experiences of managing trauma patients and administrating TXA.

The results of this study will help to inform future research, with the ultimate aim of improving TXA administration rates by paramedics, thereby reducing mortality due to haemorrhage in trauma patients.

Funding

This project was funded by Research Capability Funding from the South Western Ambulance Service NHS Foundation Trust.