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Paramedics in Poland mainly work in Emergency Medical Services without physicians on board. Currently they can administer 47 drugs on their own and perform Advanced Life Support based on European Resuscitation Council Guidelines. After the revision of Health Ministry Decret that increased their permissions, which project appeared on 25.05.2022, paramedics will have the possibility of using tranexamic acid on their own in prehospital environment. Tranexamic acid (TXA) is antifibrynolitic agent which inhibits or completly blocks massive hemmorhage after trauma. Administration of TXA results in statistically significant decrese of 28 or 30 day mortality depended on blood loss and decreses day-of-trauma mortality. Administration of TXA do not depend on blood transfusion rate, amount of infused blood units or number of surgical interventions. It is proven, that administration of TXA within 1 hour after injury and less than 1 to 3 hours after injury reduces mortality rate related to blood loss but administration after 3 hours increases patients’ mortality rate. Administration of TXA to patients with traumatic brain injury and without external bleeding decreases 28 or 30 day mortality but do not affect neurological outcome measured 6 months after injury. European Resuscitation Council Guidelines 2021 recommend administration of 1,0 g TXA in 100 ml 0,9% NaCl in 10 minutes infusion, continued with 8 hours infusion of 1,0 g TXA in 500 ml 0,9% NaCl. In case of lack of intravenous access, intramusular dosing of 0,5 g twice into non injured muscules is possible. There was no increased number of adverse effects, especially thromboembolic complications in patients, who received TXA within 3 hours after injury. Including tranexamic acid into the list of paramedics' drugs will let them practice prehospital medicine in line with the latest medical knowledge and international guidelines. It will probably result in better outcomes in patients with hemmorhage shock, traumatic brain injury and perinatal hemmorhage after prehospital delivery. |
