A new professionally produced video released today highlights how tranexamic acid (TXA), a widely available and cost-effective medication, is having a life-saving impact on pre-hospital emergency care. Developed in collaboration by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration South West Peninsula (PenARC) and South Western Ambulance Service NHS Foundation Trust (SWASFT), the video highlights how ambulance clinicians across the region are using TXA in line with robust international evidence to improve outcomes for patients with major trauma.
In 2024 alone, 1,398 patients cared for by SWASFT were administered TXA, ranging in age from just two months to 102 years old. Around 40% of administrations were for time-critical injuries, 35% for head injuries, and 15% for patients following a major trauma pathway, with a further 3% given for post-partum haemorrhage. TXA continued to be administered predominantly via the intravenous route, which was used in 94% of cases.
TXA works by inhibiting the breakdown of blood clots, a process that can significantly worsen bleeding in cases of major trauma. Trauma remains one of the leading causes of preventable death. By rapidly administering TXA, ambulance clinicians can significantly reduce life-threatening bleeding before a patient reaches hospital, giving them a crucial chance of survival. The use of TXA in appropriate trauma patients is now embedded within ambulance service clinical practice guidelines across the NHS.
“This project showed how applied research can make a real difference to patient care. PenARC’s NIHR funding meant we were able to work with clinicians from the ambulance service and emergency departments to take evidence about the benefits of early use of tranexamic acid and embed it first responder care, improving outcomes for people with serious trauma.” Professor Stuart Logan, Director, Applied Research Collaboration South West Peninsula (PenARC)
The National Institute for Health and Care Research (NIHR) funded a large international study – the CRASH-2 trial – involving 20,211 trauma patients across 274 hospitals in 40 countries. Results from the trial published in 2010 showed that, when administered within three hours of injury, TXA can reduce the risk of death from bleeding by up to 30 per cent. Based on these findings, providing TXA to all appropriate trauma patients could save around 400 lives per year in the UK.
While the drug was rapidly adopted into routine practice by military trauma teams, a key challenge was ensuring timely use within NHS ambulance services and hospital trusts. PenCLAHRC (PenARC’s predecessor) supported the introduction of TXA by SWASFT ambulance crews across Cornwall and the Isles of Scilly, Devon, Somerset and Dorset in December 2011 – just 18 months after the publication of CRASH-2. Local guidelines and protocols were jointly agreed by emergency department clinicians and SWASFT.
The film showcases the impact that decision has had 15 years on, featuring frontline clinicians, expert commentary and real-world insights into how TXA has transformed trauma care workflows. It also highlights the importance of rapid decision-making and consistent protocols across ambulance services.
“Working with PenARC has been fantastic. I think we are very lucky regionally and nationally that the NIHR fund PenARC, because actually it makes a difference to patients. Research doesn’t just sit on the shelf; it makes a difference if you implement it.” Dr Sarah Black, Head of Research, Audit and Improvement, South Western Ambulance Service NHS Foundation Trust
The full video is available to watch at: Minutes Matter: How TXA Saves Lives After Trauma
Further information about TXA and the CRASH-2 trial is available on the PenARC website.