www.mountainmedicine.co.uk
Tranexamic Acid for Mountain Rescue
Dr Jo OrganTrauma Fellow,Royal London Hospital
Dr Linda Dykes Consultant in EMYsbyty Gwynedd, Bangor
Minimum Maximum
Casualties with TXA-eligible injury 94
+ with eligible on-scene physiology 21 41
and then looking at how quickly theyd have got TXA...and then
looking at how quickly theyd have got TXA...and then looking at how
quickly theyd have got TXA...
Not at hospital by 1 hr post-injury 17 18
Not at hospital by 3 hr post-injury 3 4
Not at hospital by 6 hr post-injury 1 2
Not at hospital by 8 hr post-injury 0 1
Does Mountain
Rescue need CRASH-2 too?
AIMUK Mountain Rescue Teams (MRTs) administer drugs according to
the Mountain Rescue England & Wales (MREW) formulary. In 2014,
MREW added IV Tranexamic Acid (TXA) to their formulary, although IV
access skills are generally unavailable to MRTs unless their
casualty carers happen to be doctors/paramedics/nurses. TXA should
be given as soon as possible after injury, with a maximum time
window of three hours. Our ED receives more mountain casualties
than any other unit in the UK, so we sought to estimate the
proportion of mountain casualties eligible for on-scene TXA by MREW
formulary criteria.METHODThe Bangor Mountain Medicine database
(1051 casualties brought to Ysbyty Gwynedd following contact with
MRTs and/or RAF SAR 20042014) was interrogated for injuries which
might cause significant haemorrhage. On-scene observations were
reviewed to identify CRASH2-eligible 1 patients. Due to unrecorded
data, numbers are represented as minimum where inclusion criteria
were met and maximum where exclusion criteria were not.
CONCLUSIONTXA-eligible mountain casualties in Snowdonia are rare
(2-4%). Almost all arrive in hospital within three hours of injury
& therefore dont need MRT to administer TXA at scene in order
to meet the time window in which to give the drug. Only 3-4
casualties in this 11-year series arrived at hospital more than 3
hours post-injury and hence we conclude that MRT administration of
TXA is not necessary, and numbers would be too low to support
maintaining the IV access skills of MRT lay medics. Should an
IV-trained HCP happen to be responding as an MRT medic, it would be
reasonable for them to administer TXA, but not at the expense of
delaying evacuation to hospital.We acknowledge that this data may
not be transferable to mountain areas with longer transit times to
hospital. However, in Snowdonia, we estimate that it would take 160
years for MRT casualty carers to save one life using TXA at scene
by delivering the drug at scene within one hour of injury cf.
casualties getting their TXA within three hours from hospital staff
or a SAR helicopter paramedic.
RESULTS
Photo: Fiona Moore
1. The importance of early treatment with tranexamic acid in
bleeding trauma patients: an exploratory analysis of the CRASH-2
randomised controlled trial. The CRASH-2 collaborators. The Lancet,
Vol. 377, No.9771, p1096-1101 REFERENCE
