Related Experiment Video
Updated: Oct 13, 2025
Prehospital Thrombolysis: A Manual from Berlin
Published on: November 26, 2013
Barriers and facilitators to the administration of prehospital tranexamic acid: a paramedic interview study using the
Laura Goodwin1, Helen Nicholson2, Maria Robinson3
1Health and Applied Sciences, University of the West of England, Bristol, UK laura.goodwin@uwe.ac.uk.
Insights
Low rates of prehospital tranexamic acid (TXA) administration in trauma patients are linked to knowledge gaps, guideline confusion, resource limitations, and challenges in identifying bleeding risk. Addressing these barriers is key to improving TXA use by paramedics.
Area of Science:
- Emergency medicine
- Trauma care
- Pharmaceutical interventions
Background:
- Tranexamic acid (TXA) is an antifibrinolytic drug crucial for preventing bleeding in trauma patients.
- Despite evidence, prehospital TXA administration rates in the UK remain low.
- This study investigates barriers and facilitators to TXA use by UK paramedics.
Purpose of the Study:
- To identify barriers and facilitators to prehospital tranexamic acid (TXA) administration.
- To understand the factors influencing paramedics' decisions to administer TXA to trauma patients.
- To inform the development of interventions to increase TXA use in emergency medical services.
Main Methods:
- Conducted semistructured interviews with 18 UK paramedics.
- Utilized the Theoretical Domains Framework (TDF) to analyze interview data.
- Employed thematic analysis to identify behavioral theory-derived barriers and facilitators.
Main Results:
- Eleven TDF domains revealed barriers and facilitators to TXA administration.
- Key barriers include lack of knowledge/experience, guideline ambiguity, resource constraints, and difficulty identifying bleeding risk.
- Specific domains affected were Knowledge and Skills, Social/professional role and identity, Environmental context and resources, and Memory, attention and decision processes.
Conclusions:
- A behavioral theory-based approach identified key factors influencing prehospital TXA administration.
- Findings provide a foundation for developing targeted interventions to enhance TXA use in trauma care.
- Addressing identified barriers can improve the effectiveness of emergency medical services in managing traumatic hemorrhage.
Background:
Tranexamic acid (TXA) is an antifibrinolytic drug used to prevent bleeding. It was introduced as an intervention for post-traumatic haemorrhage across emergency medical services (EMS) in the UK during 2012. However, despite strong evidence of effectiveness, prehospital TXA administration rates are low. This study used the theoretical domains framework (TDF) to identify barriers and facilitators to the administration of TXA to trauma patients by EMS providers (paramedics) in the UK.
Methods:
Interviews were completed with 18 UK paramedics from a single EMS provider organisation. A convenience sampling approach was used, and interviews continued until thematic saturation was reached. Semistructured telephone interviews explored paramedics' experiences of administering TXA to trauma patients, including identifying whether or not patients were at risk of bleeding. Data were analysed inductively using thematic analysis (stage 1). Themes were mapped to the theoretical domains of the TDF to identify behavioural theory-derived barriers and facilitators to the administration of TXA to trauma patients (stage 2). Belief statements were identified and assessed for importance according to prevalence, discordance and evidence base (stage 3).
Results:
Barriers and facilitators to paramedics' administration of TXA to trauma patients were represented by 11 of the 14 domains of the TDF. Important barriers included a lack of knowledge and experience with TXA (Domain: Knowledge and Skills), confusion and restrictions relating to the guidelines for TXA administration (Domain: Social/professional role and identity), a lack of resources (Domain: Environmental context and resources) and difficulty in identifying patients at risk of bleeding (Domain: Memory, attention and decision processes).
Conclusions:
This study presents a behavioural theory-based approach to identifying barriers and facilitators to the prehospital administration of TXA to trauma patients in the UK. It identifies multiple influencing factors that may serve as a basis for developing an intervention to increase prehospital administration of TXA.
More Related Videos
06:59A Novel Approach for the Administration of Medications and Fluids in Emergency Scenarios and Settings
Published on: November 9, 2016
09:52Setting Up a Stroke Team Algorithm and Conducting Simulation-based Training in the Emergency Department - A Practical Guide
Published on: January 15, 2017
Related Concept Videos
01:21Barriers to Effective Communication II
Cultural barriers:
Differences in values, beliefs, religion, knowledge, and tradition can significantly impact communication. Awareness of nonverbal cues is critical, especially when conversing with a patient from a different culture. What appears appropriate in one culture may be inappropriate in another.
Semantic barriers:
As a result of their tendency to use...
01:20Measurement of Bioavailability: Pharmacodynamic Methods
01:14SBAR II: Application of SBAR
SBAR Report from a Nurse to a Health Care Provider
S: "Hello, Dr. Smith. This is Jane, RN, from the Med Surg unit. I am calling to tell you about Ms. White in Room 210, who is experiencing increased pain and redness at her incision site. Her recent...
01:23Cardiopulmonary Resuscitation III: AED Use
01:25Cardiopulmonary Resuscitation IV: Pharmacological Management
01:29Therapeutic Drug Monitoring: Affecting Factors