Hemorrhage Treatment Adjuncts in a Helicopter Emergency Medical Service

Abstract

Hemorrhaging is the leading cause of preventable death after trauma. In our helicopter emergency medical service (HEMS), we introduced a bundle of 3 hemostatic adjuncts: 1) tourniquet, 2) hemostatic chitosan-based wound packings, and 3) tranexamic acid (TXA). The real-life frequency of applying these adjuncts in HEMS remains unclear. Therefore, we analyzed our electronic HEMS database regarding the use of these hemostatic adjuncts. We analyzed all subsequent dispatches of our HEMS "Lifeliner 1" within a searchable digital database (01.02.2013-22.05.2018). This HEMS operates 24/7, servicing ∼4.5 million inhabitants of the Netherlands. During the 75-month study period, we registered 15,759 dispatches, of which 8,658 were canceled, and 7,101 included on-site patient care, including 4,928 (69.4%) trauma cases. In total, we recorded 78 tourniquet applications (1.1% of patients), 104 hemostatic wound packings (1.5% of patients), and 1,379 cases with prehospital TXA administration (19.4% of patients). This difference in the use of hemostatics has several contributors, including a possible lack of awareness for tourniquets and procoagulant wound packing, a high proportion of blunt trauma with internal bleeding not accessible to tourniquet or wound packing, and a liberal use of TXA (eg, in patients with unproven hemorrhage). Besides creating awareness for those hemostatic adjuncts, the practical implications of our findings need further evaluation in future studies.