Which route is specified for tranexamic acid administration in ALS standing orders?

• A. IV/IO over 10 minutes
• B. IM
• C. PO
• D. Subcutaneous

Answer: (A)

The route specified for tranexamic acid in ALS standing orders is intravenous or intraosseous infusion over about 10 minutes. This route is chosen because it provides rapid, predictable systemic levels needed to help limit bleeding from traumatic injuries. In the prehospital setting, IV/IO access allows a controlled, timely delivery that aligns with the urgency of hemorrhage control.

Other routes are not used in these standing orders because they have slower or unreliable absorption and are impractical in an emergency. Intramuscular administration would slow onset and vary with tissue perfusion; subcutaneous delivery also has slower or unpredictable absorption; oral dosing is unsuitable due to vomiting, aspiration risk, and unpredictable gastric absorption in acutely injured patients.