The Center for Disaster Medicine and Traumatology

National Research Center for Traumatology assigned by the Swedish National Board of Health and Welfare

Prehospital treatment of life-threatening bleeding in Sweden

Trauma is one of the most common causes of death globally and is the leading cause of death among individuals under the age of 45 years in Sweden. The majority of those who die as a result from trauma do so outside of hospital pre-hospital and often as a result by major bleeding. The ambulance services in Sweden was under a long time purely a transport organization and it was not until 1968 that it became part of the health care system. This, together with methodological problems to conduct prehospital research, has resulted in the area being unexplored from a Swedish point of view. Our aims with these projects are to map how the prehospital treatment of individuals with life-threatening bleeding is performed and contribute to increased knowledge in the area of prehospital emergency critical care on how we can improve the survival of these patients.

Several projects with interprofessional collaboration will be carried out where participants from Region Jönköping, Region Stockholm, Region Östergötland, Karolinska Institutet, Linköping University, the Swedish Armed Forces and the Center for Disaster Medicine and Traumatology will investigate different parts of the prehospital primary treatment of life-threatening bleeding, in order to map out and develop the prehospital emergency critical care of these patients.

Treatment guidelines
There is an increasing body of evidence and international guidelines on how the use of tranexamic acid, tourniquet, intraosseous access and fluid therapy affect the outcome of life-threatening bleeding. Our goal is to investigate and describe the Swedish prehospital treatment guidelines.

Prehospital whole blood
There is evidence for that early administration of blood products in life-threatening bleeding reduces the mortality of this patient group. Whole blood is used internationally in prehospital emergency critical care and is associated with reduced mortality. With this prospective study, we want to investigate the implementation of whole blood in a physician-staffed prehospital unit regarding patient outcomes, complications and cost-effectiveness.

Massive transfusion and prehospital treatment
This is a retrospective study in which patients in need of intra-hospital massive transfusion are identified, their journal reviewed and compared in terms of prehospital treatment of tranexamic acid, tourniquet, intraosseous access and fluid therapy between the cohort of survivors and the deceased.

Bleeding and mortality linked to demographics
A retrospective study in which we examine bleeding associated with mortality and demographics over a ten-year period to see if mortality differs geographically across Sweden and over time.

Compliance with treatment guidelines
A qualitative study in which ambulance medical care personnel are interviewed about the reasons why they follow / do not follow the current treatment guidelines for life-threatening bleeding. Interviews will be conducted at various prehospital units around Sweden.

Contact: Andreas Wladis