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Barriers and facilitators to the administration of prehospital tranexamic acid: a paramedic interview study using the theoretical domains framework
  1. Laura Goodwin1,
  2. Helen Nicholson1,
  3. Maria Robinson2,
  4. Adam Bedson3,
  5. Sarah Black2,
  6. Kim Kirby1,
  7. Hazel Taylor4,
  8. Sarah Voss1,
  9. Jonathan Benger1
  1. 1Health and Applied Sciences, University of the West of England, Bristol, UK
  2. 2Research and Audit, South Western Ambulance Service NHS Foundation Trust, Exeter, UK
  3. 3South Western Ambulance Service NHS Foundation Trust, Exeter, UK
  4. 4Research Design Service, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
  1. Correspondence to Dr Laura Goodwin, Health and Applied Sciences, University of the West of England, Bristol BS16 1DD, UK; laura.goodwin{at}uwe.ac.uk

Abstract

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.

  • trauma
  • clinical assessment
  • emergency ambulance systems
  • paramedics
  • prehospital care

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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Footnotes

  • Handling editor Ellen J Weber

  • Twitter @laurakgoodwin, @MariaRobo

  • Contributors LG participated in study coordination, performed and coded the interviews, analysed the data and drafted the manuscript. HN participated in study conception, design and coordination, coded the interviews, analysed the data and participated in editing the manuscript. MR participated in study conception, design and coordination and was the chief investigator with overall responsibility for the study. AB, SB, KK and HT participated in study conception and design. SV participated in study conception, design and coordination, and participated in interpretation of the results. JB participated in study conception, design and coordination and was responsible for the overall content as the guarantor. All authors were responsible for the critical revision of the manuscript for publication and approved the final version to be published.

  • Funding This study was supported by Research Capability Funding from the South Western Ambulance Service NHS Foundation Trust (SWASFT/RCF/2019).

  • Disclaimer The funder had no role in the collection or analysis of data, or in the interpretation of the results. Authors from the funding organisation were involved in the design of the study and reviewing the manuscript for submission.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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