Penetrating Abdominal Injury in Prehospital Care Expectations and Limitations Related to Current Treatment Guidelines in Polish Emergency Medical Services System Presented as a Case Report
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Abstract
Introduction: Among multiple organ trauma, abdominal injuries occupy a special place, as they are associated with a high risk of severe complications and frequently require careful prehospital treatment and urgent surgical intervention. This type of injury carries a high risk of damage to the organs located not only in the abdominal cavity but also in the chest – depending on the angle of penetration. This increases the risk of complications during treatment. One of the modern methods used in the prehospital care to control bleeding is tranexamic acid, which has been used for years in other clinical settings. Taking into account the variety of treatment protocols, the indications for its use deserve a broader perspective in prehospital care.
Methods: We performed detailed description of a case study of a 60-year-old woman with a penetrating abdominal injury resulting from a self-inflicted stab wound with suicidal intent. We also describe the treatment implemented in prehospital care with tranexamic acid administration and the use of a non-obvious method of immobilization of a foreign body in an existing wound.
Aim of our study was to evaluate the prehospital management of a woman with a penetrating abdominal injury, with particular attention to the administration of tranexamic acid and improvised method of foreign body immobilization.
Findings: The prehospital treatment described in this paper enabled the inhibition of the progression of hypovolemic shock, securing the foreign body in the wound and safe transport of the patient to the trauma center, where she was admitted in a stable condition.
Conclusion: Efficient teamwork, proper immobilization of the foreign body and appropriate, targeted medication administration enabled the patient's safe transport to the hospital. In this particular case, prehospital administration of tranexamic acid and restrictive fluid resuscitation did not worsen the patient's condition.
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References
Ali, A., Gruen, R. L., Bernard, S. A., Burns, B., Forbes, A. B., Gantner, D. C., McArthur, C. J., Maegele, M., & Mitra, B. (2026). Tranexamic acid timing and mortality impact after trauma. Annals of Emergency Medicine, 87(1), 83–89. https://doi.org/10.1016/j.annemergmed.2025.06.609
Barrett, W. J., Kaucher, K. A., Orpet, R. E., Campion, E. M., Goodloe, J. M., Fischer, P. E., Colwell, C. B., & Lyng, J. W. (2025). Prehospital trauma compendium: Tranexamic acid in trauma—A joint position statement and resource document of NAEMSP, ACEP, and ACS-COT. Prehospital Emergency Care, 20, 1–8. https://doi.org/10.1080/10903127.2025.2497056
Brongel, L. (2003). Guidelines for severe multiple and multiorgan traumatic injuries. Przegląd Lekarski, 60, 56–62. https://pubmed.ncbi.nlm.nih.gov/14679695
Campbell, J. E., & Alson, R. L. (2020). International trauma life support for emergency care providers (9th ed.). Pearson.
Committee on Tactical Combat Casualty Care. (2024). Tactical combat casualty care (TCCC) guidelines 2024: Current as of 25 January 2024. Joint Trauma System, Defense Health Agency, United States Department of Defense. https://tccc.org.ua/en/collection/recommendations
Dick, W. F. (2003). Anglo-American vs. Franco-German emergency medical services system. Prehospital and Disaster Medicine, 18(1), 29–35. https://doi.org/10.1017/S1049023X00000650
Fouche, P. F., Stein, C., Nichols, M., Meadley, B., Bendall, J. C., Smith, K., Anderson, D., & Doi, S., A. (2024). Tranexamic acid for traumatic injury in the emergency setting: A systematic review and bias-adjusted meta-analysis of randomized controlled trials. Annals of Emergency Medicine, 83(5), 435–445. https://doi.org/10.1016/j.annemergmed.2023.10.004
Gendler, S., Gelikas, S., Talmy, T., Lipsky, A. M., Avital, G., Nadler, R., Radomislensky, I., Ahimor, A., Glassberg, E., Mozer Glassberg, Y., Almog, O., Yazer, M. H., Benov, A. (2023). Prehospital tranexamic acid administration in pediatric trauma patients: A propensity-matched analysis of the Israeli Defense Forces registry. Pediatric Critical Care Medicine, 24(5), e236–e243. https://doi.org/10.1097/PCC.0000000000003202
Kasperczak, M., Zaręba, A., Pawłowska-Kasperczak, K., Kasperczak, F., Zaręba, M., & Antczak, A. (2025). Renal trauma: A 4-year retrospective review of injury severity, treatment approaches, and outcomes from a Polish trauma center. Clinics and Practice, 15(4), 67. https://doi.org/10.3390/clinpract15040067
Kopta, A., Sulej-Niemiec, M., Sumera, K., Webster, C., Polak, M., Kukla, P., & Szura, M. (2026). Characteristics of patients with abdominal and/or pelvic injuries presenting to emergency departments. Polski Przegląd Chirurgiczny, 98(1), 1–8. https://doi.org/10.5604/01.3001.0055.4693
Kudo, D., Yoshida, Y., & Kushimoto, S. (2017). Permissive hypotension/hypotensive resuscitation and restricted/controlled resuscitation in patients with severe trauma. Journal of Intensive Care, 5, 11–17. https://doi.org/10.1186/s40560-016-0202-z
Kuliś, M., Brongel, L., Budzyński, P., Hladki, W., Lorkowski, J., Nazimek, R., Jarzynowski, W., & Magiera, J. (2007). Selected aspects in abdominal trauma management. Polski Przegląd Chirurgiczny, 79(5), 353–361. https://doi.org/10.2478/v10035-007-0055-1
Mazzei, M., Donohue, J. K., Schreiber, M., Rowell, S., Guyette, F. X., Cotton, B., Eastridge, B. J., Nirula, R., Vercruysse, G. A., O’Keefe, T., Joseph, B., Brown, J. B., Neal, M. D., & Sperry, J. L. (2024). Prehospital tranexamic acid is associated with a survival benefit without an increase in complications: Results of two harmonized randomized clinical trials. Journal of Trauma and Acute Care Surgery, 97(5), 697–702. https://doi.org/10.1097/TA.0000000000004315
Mitura, K. M., Celiński, D., Miłowski, T., Leszczyński, P. K., Snarska, J., Gałazkowski, R., & Szajda, S. D. (2026). Out-of-hospital emergency medical services in Poland: Organization, challenges, and modern solutions. Frontiers in Public Health, 14, Article 1743569. https://doi.org/10.3389/fpubh.2026.1743569
National Association of Emergency Medical Technicians. (2023). PHTLS: Prehospital trauma life support (10th ed.). Jones & Bartlett Learning.
National Institute for Health and Care Excellence. (2023). Evidence reviews for tranexamic acid. https://www.nice.org.uk/guidance/ng232/documents/evidence-review-9
Neeki, M. M., Dong, F., Toy, J., Vara, R., Jabourian, N., Jabourian, A., Wong, D., Vaezazizi, R., Seiler, K., Pennington, T. W., Powell, J., Yoshida-McMath, C., Kissel, S., Schulz-Costello, K., Mistry, J., Surrusco, M. S., O’Bosky, K. R., Van Stralen, D., Ludi, D., … Culhane, J. T. (2017). Efficacy and safety of tranexamic acid in prehospital traumatic hemorrhagic shock: Outcomes of the Cal-PAT study. Western Journal of Emergency Medicine, 18(4), 673–683. https://doi.org/10.5811/westjem.2017.2.32044
Poland Law Department. (2006). Act of 8 September 2006 on state emergency medical services (Journal of Laws 2006, Item 1410, as amended). https://isap.sejm.gov.pl/isap.nsf/download.xsp/WDU20061911410/U/D20061410Lj.pdf
Ramesh, G. H., Uma, J. C., & Farhath, S. (2019). Fluid resuscitation in trauma: What are the best strategies and fluids? International Journal of Emergency Medicine, 12, 38–47. https://doi.org/10.1186/s12245-019-0253-8
Sanak, T., Nożewski, J., Putowski, M., Załustowicz, A., Burakowski, A., Józefowicz, K., & Kosiński, S. (2025). Adult trauma centers in Poland: Where do we stand? International Journal of Emergency Medicine, 18, 214–228. https://doi.org/10.1186/s12245-025-00984-3
Shakur, H., Roberts, I., Bautista, R., Caballero, J., Coats, T., Dewan, Y., El-Sayed, H., Gogichaishvili, T., Gupta, S., Herrera, J., Hunt, B., Iribhogbe, P., Izurieta, M., Khamis, H., Komolafe, E., Marrero, M., Mejía-Mantilla, J., Miranda, J., Morales, C., … Yutthakasemsunt, S. (2010). Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): A randomised, placebo-controlled trial. The Lancet, 376, 23–32. https://doi.org/10.1016/S0140-6736(10)60835-5
Soar, J., Böttiger, B. W., Carli, P., Couper, K., Deakin, C. D., Djärv, T., Lott, C., Olasveengen, T., Paal, P., Pellis, T., Perkins, G. D., Sandroni, C., & Nolan, J. P. (2021). European Resuscitation Council guidelines 2021: Adult advanced life support. Resuscitation, 161, 115–151. https://doi.org/10.1016/j.resuscitation.2021.02.010
Statistics Poland. (2026). Pomoc doraźna i ratownictwo medyczne w 2025 r. https://stat.gov.pl/obszary-tematyczne/zdrowie/zdrowie/pomoc-dorazna-i-ratownictwo-medyczne-w-2025-r-,14,10.html
Sulej-Niemiec, M., Kopta, A., Żurowska-Wolak, M., Bogacki, P., & Szura, M. (2024). Trauma centre admission criteria for elderly patients. Polski Przegląd Chirurgiczny, 97(2), 56–64. https://doi.org/10.5604/01.3001.0054.7271
World Health Organization. (2024, June 19). Injuries and violence. https://www.who.int/news-room/fact-sheets/detail/injuries-and-violence