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www.mountainmedicine.co.

uk

Tranexamic Acid
for Mountain Rescue

AIM
UK 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.

METHOD
The 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.

RESULTS

Dr Jo Organ
Trauma Fellow,
Royal London
Hospital
Dr Linda Dykes
Consultant in EM
Ysbyty Gwynedd,
Bangor

CONCLUSION
Minimum

Casualties with TXA-eligible injury

94

+ with eligible on-scene physiology

21

Maximum

41

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

Not at hospital by 6 hr post-injury

Not at hospital by 8 hr post-injury

TXA-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.
REFERENCE
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

Does
Mountain
Rescue need
CRASH-2 too?

Photo: Fiona Moore