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4A after access: a new mnemonic to aid timely administration of IV/IO treatment in trauma patients
  1. Kieran Campbell1,
  2. E Scanlon1,
  3. K Bhanot2,
  4. F Harper1 and
  5. D N Naumann2
  1. 1 Academic Department of General Practice, Royal Centre for Defence Medicine, Birmingham, UK
  2. 2 Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK
  1. Correspondence to Maj Kieran Campbell, Academic Department of General Practice, Royal Centre for Defence Medicine, Birmingham B15 2WB, UK; kieran.campbell{at}


Administration of medication is a well-established part of prehospital trauma care. Guidance varies on the types of recommended medications and when they should be administered. Mnemonics have become commonplace in prehospital medicine to facilitate recall and retention. However, there is no comprehensive aid for the administration of medication in trauma patients. We propose a new mnemonic for the delivery of relevant intravenous or intraosseous medications in trauma patients. A ‘4A after Access’ approach should enhance memory recall for the efficient provision of patient care. These 4As are: antifibrinolysis, analgesia, antiemesis and antibiotics. This mnemonic is designed to be used as an optional aide memoire in conjunction with existing treatment algorithms in the military prehospital setting.


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  • Correction notice This article has been corrected since it first published. The authorship order has been amended.

  • Contributors KC and ES were involved in the planning and design of this paper. KC, FH, ES, DNN and KB were all involved in data interpretation and subsequent write-up of this paper. KC is responsible for the overall content and is the guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Disclaimer Any opinions expressed within this manuscript are the authors’ own, and do not necessarily represent those of the UK Defence Medical Services.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.