Okla. EMSA: Drug Boosts Patient Survival Odds

Jan. 24--EDMOND -- Say you're a medic responding to a reported 25-year-old male with gunshots. The patient has increased respirations and a thready radial pulse. You find a single gunshot wound to the mid-abdomen.

During your rapid head-to-toe-scan, done while your colleagues ready the stretcher for a rapid "load and go" to OU Medical Center's Trauma One Center in Oklahoma City, you see no exit wound. You've pre-alerted the trauma team, but factoring distance and traffic you're still 20 minutes out and you're patient is "hanging on the cliff." Plus, you're concerned about "blowing out the clots" the patient is hopefully forming on his own. You've run out of options as the patient's blood pressure continues to drop.

Local paramedics have a new option for helping severely traumatized patients.

Primary Edmond Fire Department vehicles are carrying tranexamic acid, a drug that helps stabilize clots patients are trying to form on their own as it works to inhibit natural clot breakdown, boosting a severely traumatized patient's survival chances, said the agency's Emergency Medical Services Director Maj. Brian Davis. Edmond Fire Department personnel routinely go out on medical calls across the city and often arrive on scene before an ambulance does.

Tranexamic acid is now routinely used in the United States and Britain to treat severe wartime injury and hemorrhage, according to the Mayo Clinic. The British military began using it for severely injured troops in Afghanistan.

In 2010, a British trial involving more than 20,000 people in 40 countries showed tranexamic acid could significantly reduce the risk of fatal bleeding events in trauma patients, potentially saving many lives each year.

In January 2013, the Medical Control Board, which provides physician oversight to the EMS system for metropolitan Oklahoma City and Tulsa, unanimously approved tranexamic acid for EMS use.

The cited scenario is adapted from an article on the role of tranexamic acid in EMS and preoperative trauma management from the April 2013 issue of JEMS, an information source for medical professionals, co-authored by Jeff Goodloe, medical director of the Oklahoma City and Tulsa EMS system.

In April, it became the first large urban system in the U.S. to use the government-approved drug as a standard of care. The Edmond Fire Department began carrying it at the time, Davis said. Local medics have not used it due to strict EMSA guidelines, which have been somewhat relaxed recently, Davis said.

Presently, before a qualified member of the Edmond Fire Department administers tranexamic acid they must certify that the metropolitan Oklahoma City criteria have been met:

--Patient is age 18 or older;

--Hemorrhagic shock due to trauma;

--Trauma less than three hours old;

--Patient has received one liter of normal saline;

--Sustained tachycardia (elevated heart rate) 120 beats per minute or greater;

--Sustained hypotension (low blood pressure) systolic 90 mmHg or less;

--Patient will be transported to OU Presbyterian; and

--Transport time will be 15-plus minutes to OU Presbyterian.

marks@edmondsun.com -- 341-2121, ext. 108

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