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From TXA to REBOA: Advances in trauma care

Technological advances and training are moving hemorrhage control techniques from the battlefield to prehospital and emergency medicine

There have been multiple recent areas of advancement in prehospital trauma care. The MCHD Paramedic Podcast dives into several of these in a trio of episodes.


First, in Episode 22, the role of tranexamic acid (TXA) in hypotensive trauma patients is explored.

TXA is a medication that has been used across multiple medical disciplines for decades to assist in bleeding cessation via clot stabilization. Two of the initial trials exploring the use of TXA in trauma, CRASH-2 and MATTERS, are discussed along with the indications and contraindications for TXA use in the prehospital setting.

Simple thoracostomy

In Episode 24, the focus moves from pharmacologic to procedural: the simple thoracostomy. A traumatic cardiac arrest varies from medical cardiac arrest in that the causes are usually not cardiac ischemia or failure.

The approach to traumatic arrest must focus on hemorrhage, high cervical spine injury and obstructive shock. Peripheral access and a fluid challenge along with pelvic binding and long bone reduction are needed to address potential blood loss.

Airway management will correct hypoxia from paralysis due to a high cervical injury. Obstructive shock from major trauma, however, is often a result of tension physiology which must be remedied using thoracic decompression.

Classically, this has been treated in the prehospital arena using needle thoracostomy, but accumulating evidence demonstrates the frequent misplacement and inadequacy of this procedure.

Finger thoracostomy is a skill that is gaining prominence in the EMS setting and MCHD has been a leader in the field. This episode will touch on the training, setup and data behind a simple thoracostomy protocol implementation.


Finally, in Episode 58, a history of resuscitative endovascular balloon occlusion of the aorta (REBOA) is broken down from the Korean War to the present day.

REBOA is a percutaneous endovascular technique to occlude the descending aorta in hemorrhagic shock from bleeding below the diaphragm. This allows cerebral perfusion to be maintained while bridging care to the operating room for definitive surgical care.

Due to technological advances, REBOA has moved from the battlefield to the emergency department in certain centers. Learn the background anatomy, the literature basics and future potential of REBOA in this episode.

The MCHD Paramedic Podcast was launched in early 2018 in an effort to provide easily consumable core-content EMS education and insights from prehospital care thought leaders. The Clinical Services Department of The Montgomery County Hospital District EMS service developed the podcast as a tool to better engage and disseminate continuing education to our MCHD medics as well as first responders and EMS professionals nationwide.

Dr. Casey Patrick is the assistant medical director for Montgomery County Hospital District EMS and is a practicing emergency physician in multiple community emergency departments across Greater Houston. His EMS educational focus is on innovative paramedic teaching via the MCHD Paramedic Podcast. Dr. Patrick’s prehospital clinical research involves the investigation of paramedic use of bolus dose intravenous nitroglycerin for acute pulmonary edema and the implementation of lung protective ventilation strategies for intubated EMS patients. Casey and his wife, Alyssa, work and live in Conroe, Texas, and Spokane, Washington. Together they have five children: Mia, Ainsley, Brock, Dean and Will.

Dr. Dickson graduated with honors from the University of Texas Health Science Center San Antonio in 2001 and completed emergency medicine training at Indiana University in 2004. He serves as the EMS medical director at Montgomery County Hospital District EMS and an assistant professor of emergency medicine at Baylor College of Medicine in Houston, Texas. His academic interests include systems of care in stroke and other time-sensitive emergencies, neurologic emergencies and education. He is board certified in emergency medicine in both the U.S. and Australasia, and has subspecialty board certification in EMS medicine. He has authored multiple professional articles and presented at regional, national and international conferences on emergency medicine and EMS topics.