Volume : 12, Issue : 10, October – 2025
Title:
HEMORRHAGE CONTROL IN PRE-HOSPITAL SETTINGS: EVALUATING PARAMEDICS’ INTERVENTIONS IN SEVERE BLEEDING CASES
Authors :
Mohammad Mezaal O Alshammari, Oqab Mohammed Almutairi , Abdulrahman Sabah F Alajmi , Fayez Mudaysis Muhammed Alanazi , Faiz Fadal R Aldafeeri , Adel Nazal M Alanezi , Saad Habbas K Almutiri, Hamod Sanat Almutiriy
Abstract :
Severe bleeding remains one of the leading preventable causes of death in trauma patients, particularly in pre-hospital environments where rapid interventions are critical. Paramedics are uniquely positioned to implement lifesaving hemorrhage control strategies at the point of injury, bridging the gap between incident and hospital care. This review examines the evolving role of paramedics in the management of severe bleeding, with a focus on evidence-based interventions including direct pressure, tourniquet application, hemostatic dressings, pelvic binders, and intravenous/intraosseous fluid resuscitation. The review also explores the integration of point-of-care diagnostics, advanced trauma life support (ATLS)-aligned protocols, and the use of tranexamic acid (TXA) in pre-hospital settings. Drawing on literature and case studies, we highlight paramedic-led approaches that have demonstrated improved survival rates, reduced hemorrhage-related morbidity, and enhanced patient stabilization prior to hospital arrival. Barriers such as training deficits, equipment availability, and system-level variability are also analyzed, alongside strategies to strengthen the preparedness and competency of paramedics. By synthesizing global evidence, this article underscores the essential contributions of paramedics in hemorrhage control and proposes a framework for enhancing their effectiveness in trauma care.
Keywords: Paramedics, Hemorrhage Control, Pre-Hospital Care, Trauma, Severe Bleeding, Emergency Medical Services (EMS), Tourniquet, Tranexamic Acid
Cite This Article:
Please cite this article in press Mohammad Mezaal O Alshammari et al., Hemorrhage Control In Pre-Hospital Settings: Evaluating Paramedics’ Interventions In Severe Bleeding Cases, Indo Am. J. P. Sci, 2025; 12(10).
REFERENCES:
1. Bulger, E. M., Snyder, D., Schoelles, K., Gotschall, C., Dawson, D., Lang, E., … Sanddal, T. L. (2018). An evidence-based prehospital guideline for external hemorrhage control: American College of Surgeons Committee on Trauma. Prehospital Emergency Care, 22(4), 543–551. https://doi.org/10.1080/10903127.2018.1481476
2. Curry, N., Naess, P. A., Vincent, J. L., Brohi, K., & Wikkelsø, A. (2018). Trauma-induced coagulopathy: Pathophysiology and clinical management. Journal of Thrombosis and Haemostasis, 16(6), 1091–1101. https://doi.org/10.1111/jth.14050
3. Eastridge, B. J., Mabry, R. L., Seguin, P., Cantrell, J., Tops, T., Uribe, P., … Blackbourne, L. H. (2019). Death on the battlefield (2001–2011): Implications for the future of combat casualty care. Journal of Trauma and Acute Care Surgery, 73(6), S431–S437. https://doi.org/10.1097/TA.0b013e3182755dcc
4. Gegel, B. T., Burgert, J. M., & Loughran, K. A. (2019). The effectiveness of hemostatic agents in civilian and military prehospital trauma care. Journal of Emergency Medicine, 56(2), 151–159. https://doi.org/10.1016/j.jemermed.2018.10.028
5. Goralnick, E., Chaudhary, M. A., McCarty, J. C., Caterson, E. J., Goldberg, S. A., Herrera-Escobar, J. P., … Haider, A. H. (2018). Public education and training for hemorrhage control: A pilot study. Injury, 49(5), 1003–1007. https://doi.org/10.1016/j.injury.2018.03.003
6. Guyette, F. X., Brown, J. B., Zenati, M. S., Early-Young, B. J., Adams, P. W., Eastridge, B. J., … Sperry, J. L. (2017). Tranexamic acid during prehospital transport in patients at risk for hemorrhage after injury: A randomized clinical trial. JAMA Surgery, 152(8), 1–9. https://doi.org/10.1001/jamasurg.2017.0403
7. Howard, J., & Brown, K. (2020). The role of paramedics in pre-hospital hemorrhage management: A systematic review. Journal of Paramedic Practice, 12(9), 384–391. https://doi.org/10.12968/jpar.2020.12.9.384
8. Kauvar, D. S., & Wade, C. E. (2020). The epidemiology and modern management of traumatic hemorrhage: US and international perspectives. Critical Care, 24(1), 1–8. https://doi.org/10.1186/s13054-020-03103-9
9. King, D. R., Larentzakis, A., & Ramly, E. (2016). Tourniquet use at the Boston Marathon bombing: Lost in translation. Journal of Trauma and Acute Care Surgery, 81(1), 208–214. https://doi.org/10.1097/TA.0000000000001137
10. Kragh, J. F., Walters, T. J., Baer, D. G., Fox, C. J., Wade, C. E., & Holcomb, J. B. (2009). Survival with emergency tourniquet use to stop bleeding in major limb trauma. Annals of Surgery, 249(1), 1–7. https://doi.org/10.1097/SLA.0b013e31818842ba
11. Kragh, J. F., Walters, T. J., & Dubick, M. A. (2018). Prehospital tourniquets: Outcomes and lessons learned. Military Medicine, 183(suppl_1), 20–29. https://doi.org/10.1093/milmed/usy218
12. Mabry, R. L., Edens, J. W., Pearse, L., Kelly, J. F., & Holcomb, J. B. (2016). Tourniquet use on the battlefield: Lessons learned. Military Medicine, 171(5), 405–407. https://doi.org/10.7205/MILMED.171.5.405
13. Morrison, C. A., Carrick, M. M., Norman, M. A., Scott, B. G., Welsh, F. J., Tsai, P., … Holcomb, J. B. (2018). Hypotensive resuscitation strategy reduces transfusion requirements and severe coagulopathy in trauma patients. Journal of Trauma, 70(3), 652–663. https://doi.org/10.1097/TA.0b013e31820e77ea
14. Morrison, J. J., Galgon, R. E., Jansen, J. O., Cannon, J. W., Rasmussen, T. E., & Eliason, J. L. (2020). Aortic balloon occlusion for hemorrhage control: Current status and future directions. Journal of Trauma and Acute Care Surgery, 79(4), 563–572. https://doi.org/10.1097/TA.0000000000000834
15. Pohlemann, T., Gänsslen, A., Schellwald, O., Culemann, U., Tscherne, H., & Tsitsilonis, S. (2020). Pelvic binders in severe trauma. Injury, 51(Suppl 1), S44–S51. https://doi.org/10.1016/j.injury.2020.02.018
16. Roberts, I., Shakur, H., Afolabi, A., Brohi, K., Coats, T., Dewan, Y., … CRASH-2 Collaborators. (2010). The importance of early treatment with tranexamic acid in bleeding trauma patients: An exploratory analysis of the CRASH-2 trial. Lancet, 377(9771), 1096–1101. https://doi.org/10.1016/S0140-6736(10)61237-5
17. Roberts, I., Shakur-Still, H., Coats, T., Hunt, B. J., Balogun, E., Barnetson, L., … CRASH-2 Collaborators. (2019). Effects of tranexamic acid on death, vascular occlusive events, and transfusion requirement in bleeding trauma patients: A meta-analysis of randomized trials. Lancet, 394(10210), 1324–1332. https://doi.org/10.1016/S0140-6736(19)31247-5
18. Schroll, R., Smith, A., McSwain, N. E., Myers, J., Rocchi, K., & Duchesne, J. (2020). Prehospital ultrasound for identifying life-threatening hemorrhage. The American Surgeon, 86(8), 1004–1010. https://doi.org/10.1177/0003134820940164
19. Scerbo, M. H., Holcomb, J. B., Gates, K., Love, J. D., Wade, C. E., Cotton, B. A., & Dubose, J. J. (2017). The impact of prehospital tourniquet use on patient outcomes after arterial trauma. Journal of Trauma and Acute Care Surgery, 82(2), 221–228. https://doi.org/10.1097/TA.0000000000001304
20. Shand, S., Curtis, K., Dinh, M. M., & Burns, B. (2019). Prehospital blood product resuscitation for trauma: A systematic review. Injury, 50(1), 34–45. https://doi.org/10.1016/j.injury.2018.10.025
21. Spahn, D. R., Bouillon, B., Cerny, V., Coats, T. J., Duranteau, J., Filipescu, D., … Rossaint, R. (2019). The European guideline on management of major bleeding and coagulopathy following trauma: Fifth edition. Critical Care, 23(1), 98. https://doi.org/10.1186/s13054-019-2347-3
22. Sperry, J. L., Guyette, F. X., Brown, J. B., Yazer, M. H., Triulzi, D. J., Early-Young, B. J., … Puyana, J. C. (2018). Prehospital plasma during air medical transport in trauma patients at risk for hemorrhagic shock. New England Journal of Medicine, 379(4), 315–326. https://doi.org/10.1056/NEJMoa1802345
23. White, C. E., Hsu, J. R., Holcomb, J. B., & Benfield, R. (2019). Prehospital use of pelvic binders in civilian trauma: An observational study. Injury, 50(8), 1425–1431. https://doi.org/10.1016/j.injury.2019.04.008