About Mike Verkest
My name is Mike Verkest and I am currently an education consultant for FlightBridgeEd team and the EMS training officer for AMR Multnomah County (Portland), Oregon. My EMS career started as a volunteer in rural Southern Oregon where I practiced as an EMT, EMT-I and Paramedic. I moved to Portland in 2004 as an operations supervisor. In 2008, I took over the clinical side of the house. Multnomah County is a fantasist place to practice prehospital medicine.
We have some of the most progressive protocols in the country, we have great relationships with our fire partners and we take excellent care of our patients. We have a very involved medical director who always hand his fingers on the pulse of the next big thing. Oregon Health Sciences University (OHSU) sits on Marquam Hill overlooking the city of Portland. OHSU is one of the two Level 1 trauma facilities in the state and as a top research institution, is also always on the leading edge of discovery. OHSU researchers as part of the resuscitation outcomes consortium (ROC) and paramedics from AMR in Multnomah and Clackamas counties will soon begin a new research project.
TXA in Traumatic Brain Injury.
Most providers know that TXA is not new and in fact, is widely used in EMS and in ED’s across the country. The benefits of TXA have been proven in patients who are bleeding and require massive transfusion. The studies (CRASH-2 and MATTERS) have clearly shown that TXA administration within 3 hours is the key…in fact, the sooner the better.
There are, within those studies a group of patients that had TBI. A small study out of Thailand (n=243) showed that patients with TBI (as diagnosed by CT) that were given TXA had a 7-10% reduction in mortality, hemorrhage progression was reduced and overall survival was better.
This study is exciting for a number of reasons:
1. Once the primary injury has occurred, there isn’t typically much EMS can do. We can make sure the patient gets to the right facility, does not get hypoxic and control seizures. Clearly, the hospital has its work cut out for them as these patients usually require an all hands on deck approach to the resuscitation.
2. As the previous studies showed within 3 hours showed a benefit, it also showed that within an hour was even better. Our aim will be to administer the study medication within minutes of the injury.
Lets talk about our study:
The ROC TXA in TBI randomized placebo controlled trail that has 3 treatment arms.
1gm of TXA prehospital, followed by 1gm over 8 hrs
2gm of TXA prehospital, followed by 2gm over 8 hrs
Placebo prehospital , followed by Placebo over 8 hrs
Blunt of penetrating TBI
All SBP 90 or better prior to enrollment
GCS 12 or less (prior to RSI or sedation)
Successful IV (cannot give via I/O)
15 years old or > 50kg
Transport destination is OHSU (we have another L1trauma center in our area, but the are unable to participate)
Prisoner, pediatric or pregnancy
Patient having acute MI or CVA
Active seizure or hx of seizure (if known)
GCS 3 with no reactive pupils > 20 BSA Burns
The study is looking to enroll 1,002 patients from the U.S and Canadian ROC sites. you can find out more information about the ROC TXA in TBI study by visiting
More information is available at website: www.ClinicalTrials.gov
Enter study ID: NCT01990768
ROC specific information can be found here https://roc.uwctc.org/tiki/tiki-index.php?page=roc-public
Thanks for taking some time to read about this exciting research opportunity! I look forward to more blog posts soon! You can email any questions to email@example.com
Roberts. The CRASH-2 trial: a randomised controlled trial and economic evaluation of the effects of tranexamic acid on death, vascular occlusive events and transfusion requirement in bleeding trauma patients. Health Technol Assess 2013;17(10):1-79
Morrison. Military Application of Tranexamic Acid in Trauma Emergency Resuscitation (MATTERs) Study. Arch Surg 2012;147(2):113-119