b'2023 Pennsylvania Department of Health Prehospital Protocol Updates: TXA and Blood Product Administration ProtocolsBy Christopher Berry, MD, FACEPsystolic blood pressure is 90 mmHg.this limitation left large populations Exclusion criteria include patient agein the Commonwealth without access less than 15 years, known TXA allergy,to this component of life sustaining isolated head injury, time elapsed fromtrauma care in urban environments, injury/bleeding initiation 3 hours,where a helicopter may not be able to For agencies interested inland or is otherwise impractical, and in implementing TXA in the field, it wouldrural environments on days where the be important that they coordinate withweather is not conducive to delivery their local trauma/receiving centersof HEMS team to a scene. This new on implementation of these protocolsprotocol may help to bridge this gap and communicate clearly when thisin care. However, operationalizing medication has been provided. Somethe appropriate storage, delivery and Christopher Berry, MD, FACEP centers may wish to administer a TXAadministration of blood products in PACEP EMS Committee Co-Chair infusion of an additional gram afterthe ground environment is complex, prehospital administration.requiring significant medical director oversight and coordination with The updated 2023 PA DOH PrehospitalBlood Products (New protocol,the local EMS council, blood bank optional, for Advanced Life Supportand trauma system. With the blood Protocols launched the end of theproviders):supply continuing to be critically low first week of October 2023. There arein many areas, several updates this cycle which arePacked Red Bloodit is imperative important for emergency medicineCells (PRBCs),This new protocol may helpto involve physicians or agency medical directorsPlasma or Lowto bridge this gap in care.stakeholders early to be aware of. This newsletter cycle, weTiter O+ WholeHowever, operationalizingin discussions. will look at two new optional protocolsBlood (LTOWB) areBlood product to supplement the treatment ofnow permitted forthe appropriate storage,carrying services hemorrhagic shock in the prehospitalagencies meetingdelivery and administrationand EMS regions environment.multiple criteriaof blood products in thewill need to have Tranexamic Acid (New protocol,to be providedground environment isin place strong optional, for Advanced Life Supportto both pediatriccomplex, requiring significantcontinuous providers): and adult patientsmedical director oversight andquality with evidencecoordination with the localimprovement Tranexamic Acid (TXA), anof hemorrhagicEMS council, blood bank andprograms to antifibrinolytic, is now an optionalshock. Prior totrauma system.ensure that treatment for patients with suspectedthe rollout ofproduct is being hemorrhagic shock. The chosen dosethis protocol,administered for TXA is 1 gram in 100 ml of NSS.blood product administration in theappropriately, safely, efficaciously, and Administration is allowable in patientsfield has been limited to Helicopterwithout waste. with traumatic bleeding in a non- Emergency Medical Services (HEMS)For medical directors or other compressible site (traumatic or post- and specialty physician response teams,emergency physicians interested in partum hemorrhage) who either havegenerally aligned with major healthfurther discussions of best practices signs/symptoms of shock OR if thenetworks or trauma centers. However,for setting up a prehospital blood 12 PACEP News | Fall 2023'