The challenge
In England and Wales there are approximate 16,000 trauma deaths a year. In over half the cause is bleeding. For patients with major trauma, the first few hours after injury are critical. Even before reaching hospital, uncontrolled bleeding can be fatal.
Tranexamic acid (TXA) is a widely available, low-cost drug that helps prevent the breakdown of blood clots, reducing life-threatening bleeding. Evidence shows that TXA is most effective when given as soon as possible after injury – ideally within three hours. However, translating this evidence into routine practice, particularly in pre-hospital emergency care, posed a major challenge.
The evidence
In 2010, results from the NIHR-funded CRASH-2 trial were published. This landmark international study involved 20,211 trauma patients treated in 274 hospitals across 40 countries. The trial demonstrated that giving TXA within three hours of injury could reduce deaths due to bleeding by up to 30%.
The implications were profound: if TXA were given promptly to all eligible trauma patients, it could save an estimated 400 lives each year in the UK.
From research to real-world care
While TXA was rapidly adopted by military trauma teams, introducing it safely and consistently into NHS ambulance services required coordination, agreement, and confidence among clinicians.
PenCLAHRC, the predecessor to PenARC and ARC South West, played a key role in bridging this gap between research and practice. Working closely with the South Western Ambulance Service NHS Foundation Trust (SWASFT) and local emergency departments, PenCLAHRC supported the rapid implementation of TXA use by ambulance crews across:
- Cornwall and the Isles of Scilly
- Devon
- Somerset
- Dorset
By December 2011 – just 18 months after publication of CRASH-2 – TXA was being routinely administered by SWASFT clinicians to appropriate trauma patients.
The impact
This project helped ensure that patients experiencing major trauma in the South West could receive life-saving treatment earlier, before hospital arrival, when it is most effective. By supporting timely adoption of TXA in pre-hospital care, PenCLAHRC contributed to improved survival outcomes and demonstrated how applied research partnerships can deliver rapid, meaningful benefits for patients.
In 2024, 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.
See the difference the implementation of TXA is having 15 year on from the research at the South Western Ambulance NHS Foundation Trust in this video.