Warner et al 1 describe the use of oral tranexamic acid (TXA) as a novel treatment for remote or mass casualty incident (MCI) trauma. It should save lives with negligible risk of harm while being cheap, readily available and easy to administer. In other words, it could be the disaster equivalent of aspirin for acute coronary syndromes. It represents a realistic treatment anywhere the Gold Standard for haemorrhage (intravenous TXA) is not readily available and as such could be a viable approach to the immense global burdens of trauma2 and pregnancy-related mortality.3 If it has even a moderate impact on those, it has the potential to save the lives of tens of thousands of people per annum. Yet, for UK practitioners, it is the reminder that highly effective alternatives to Gold Standard interventions exist—and may in some circumstances be more appropriate—that is most pertinent right now.

Healthcare professionals often find delivering anything other than the Gold Standard difficult. When extreme events constrain our ability to treat patients within a normal timeframe, we accept the need to triage—but …