School district staff learns bleeding control techniques

Uncontrolled bleeding is responsible for 35 percent of pre-hospital trauma deaths and 40 percent of deaths within the first 24 hours. The Stop the Bleed campaign was launched in 2015 as part of a nationwide effort to reduce these numbers. Stop the Bleed aims to teach civilians simple techniques to slow or stop life-threatening bleeding, believing that people already at the scene can help save lives before first responders arrive.

The campaign also supports training for law enforcement and other nonmedical first responders and recommends easy access to bleeding control kits containing tourniquets, gloves and hemostatic gauze. Ideally, the kits would be located in malls, airports, schools and sports centers — the same public spaces where automated external defibrillators are found now.

As part of the national Stop the Bleed campaign, the Southern Minnesota Regional Trauma Advisory Committee (SMRTAC) began training law enforcement in 2015 using the Bleeding Control for the Injured (B-Con) course. The training lasts about 90 minutes and includes a presentation with videos as well as hands-on practice applying a tourniquet and packing gauze in a simulated wound.

"We explain where the tourniquet should be placed on the limb and how to route it through and tighten it. Then participants practice on each other or on themselves," explains Todd M. Emanuel, R.N., trauma performance improvement coordinator at Mayo Clinic's campus in Rochester, Minnesota. "We also demonstrate how to use gauze to stop bleeding in areas where you can't use a tourniquet, such as the groin, armpit, and external chest or abdomen and how to maintain the airway in patients with neck wounds."

The course also addresses a common question — whether improvised tourniquets can be used instead of manufactured ones. "We tell people to do what they can to slow the bleeding, even if it's with a belt or T-shirt, as long as the improvised tourniquet is replaced with an appropriate one as soon as possible. Otherwise, there's a risk of serious limb injury or loss," Emanuel explains.

He says demand for the B-Con course has grown exponentially. "After one of our trainings, county officers used what they'd learned to stop severe bleeding in a car crash victim. That prompted another county sheriff to schedule a training."

Within a year, SMRTAC volunteers had trained close to 400 people. Emanuel says the next step was to take the course to the general public.

"There was a lot of discussion about where to start," he says. "We talked about past school shootings — especially the Sandy Hook tragedy, which was the impetus for the Stop the Bleed campaign — and decided to focus on schools. We realized that the risk of an active shooter or other mass casualty event at a school is relatively low, so we thought it was important to also concentrate on areas that have increased potential for significant injury every day, such as industrial arts classes, maintenance and grounds crew operations, and sporting events."

Stewartville: Training the entire staff

The Stewartville school district was chosen because of its reputation for innovation and because Emanuel is on the school board there. The school superintendent, principals and curriculum development staff attended the first training in August 2016. The next sessions, in September, included grounds and maintenance staff, nurses, paraprofessional staff, and special education teachers. Emanuel says the district's goal is to train all remaining teachers and coaches, making it the first school district in the state to train its entire staff in hemorrhage control.

After the course, the school district purchased bleeding control kits for the main school office in each of the four district buildings, health offices, three industrial arts class areas, the football field and every school vehicle.

"We don't suggest what kits to buy; the school systems are always strapped, and there are so many other things the budget can go to. We do try to make sure they buy the correct type of tourniquet. There are several tourniquets on the market but only a few are similar in design and function to the widely used combat application tourniquet (CAT), which can be purchased for about $26 on Amazon. With the addition of a regular roll of gauze, a full kit can be put together for as little as or $29," Emanuel says.

The hope is that school districts will talk to each other and promote the importance of having at least a few bleeding control kits on hand. "The schools may never have to use them — and we hope they don't — but they have the potential to save a life by having these tools available, and someone with no medical training can do it easily," Emanuel says.

One concern is that SMRTAC volunteers — most of them physicians, nurses, EMTs and first responders — won't be able to keep up with the demand for trainings. But Emanuel says they plan to have more train the trainer courses in southern Minnesota, so the work can be spread around as more requests come in.

"It's a matter of 'see one, do one, teach one,' " he says."I expect the promotion of tourniquet use and training will start to snowball throughout the country. Schools, sports teams, businesses, farming operations, factories — the sky's the limit. But it's important for individuals to know how to use a tourniquet and have access to one, too. I have a bleeding control kit in each of my vehicles. It's such a simple tool at relatively low cost with huge life-saving potential."