Dear East Midlands Ambulance Service NHS Trust,
Hello, my name is Martin Antoszczak. I am a student paramedic currently performing a literature review as part of my dissertation on the use of topical TXA for acute epistaxis.

As part of my background information, I want to find the common practice in trusts throughout England.

My questions are:

1) For patients who present with epistaxis which is not responding to direct compression and other first aid measures such as nasal compression devices like the RhinoPinch(R), do you have any alternative treatments that can be facilitated by pre-hospital care providers in the field? (For example, but not limited to, any topical pharmacological agents or providers qualified to perform nasal packing or nasal cautery pre-hospitally).

2) If so, what alternative treatments are available, and what is the necessary training/qualification for the pre-hospital care provider to be able to provide them?

Yours faithfully,

Martin Antoszczak