Training civilians to use military hemorrhage control techniques

May 06, 2016

A few months after the Sandy Hook Elementary School shooting in 2012, a group of government and health care leaders met in Hartford, Connecticut, to discuss ways to save more lives in tragedies like Sandy Hook, in which 20 children and six adults died. The result was what came to be known as the Hartford Consensus — a series of recommendations designed to prevent deaths from uncontrolled bleeding after intended mass casualty attacks.

Before Hartford, the main priority in mass shootings was to stop the killing. Rescue came later — sometimes too late for the wounded, who bled to death before medical workers were allowed to enter the scene. Some victims of the Columbine High School shootings waited hours for medical care, finally dying while the building was still in lockdown.

The new paradigm was to establish safe corridors so firefighters and Emergency Medical Services (EMS) could rapidly enter, assess, stabilize and evacuate people with survivable injuries, even if the scene wasn't completely secure. The Hartford Consensus also sparked a nationwide effort to provide first responders — police, fire and EMS — with hemorrhage control kits containing tourniquets and hemostatic gauze and the training to use them.

Getting the public involved

The third Hartford Consensus meeting took place in April 2015. This meeting focused on strategies for preparing the public to serve as immediate responders after mass casualty events.

"The idea is that people already at the scene can make the biggest difference in saving lives by performing critical hemorrhage control before first responders arrive," explains David S. Morris, M.D., a trauma surgeon at Mayo Clinic's campus in Rochester, Minnesota. He points out that in the aftermath of the Boston Marathon bombings, civilian bystanders worked alongside first responders to triage the critically injured and facilitate their transport to area hospitals. Every one of those patients survived.

Hartford Consensus III calls for a similarly seamless response after other mass casualty attacks. In a perfect scenario, immediate responders, first responders and trauma professionals would function as an integrated team using the THREAT system, which includes:

  • Threat suppression
  • Hemorrhage control
  • Rapid Extraction to safety
  • Assessment by medical providers
  • Transport to definitive care

Hartford Consensus III also recommends that immediate responders have the training needed to stop life-threatening bleeding and access to hemorrhage control kits containing tourniquets 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.

Stop the Bleed

Logotipo de la campaña Stop the Bleed

Stop the Bleed (Detener el sangrado) es una campaña nacional para brindar a los civiles el conocimiento y las herramientas para salvar vidas.

In October 2015, the White House officially launched Stop the Bleed — a nationwide campaign to provide civilians with the tools and knowledge to save lives, based on Hartford Consensus III recommendations. The goal of the initiative is "to build national resilience by empowering the general public to be aware of the simple steps that can be taken to stop or slow life-threatening bleeding."

"Stop the Bleed elevates hemorrhage control to the level of public health, and it's now seen in the same light as CPR," Dr. Morris says. "We have done a very good job of familiarizing the public with CPR and basic life support; we think we can use that same model by partnering with the American Heart Association, which already has the infrastructure in place. There are CPR classes in every community, and it would be easy enough for the CPR instructor to spend 20 minutes on hemorrhage control."

He says the Southern Minnesota Regional Trauma Advisory Committee (SMRTAC) has already provided medical preparedness classes for first responders and will be offering the same free course to educators as well as to mall and venue security officers.

"SMRTAC wants to offer training in as many places as possible, and the hope is it will take off. As a parent, I would be reassured knowing that my children's teachers know how to control bleeding and have access to tourniquets in their school," Dr. Morris says.

SMRTAC developed its medical preparedness course in 2013 in response to requests from police and fire officials. Around the same time, the American College of Surgeons partnered with the National Association of Emergency Medical Technicians to develop a similar training course aimed at turning lay people into immediate responders. The Bleeding Control for the Injured (B-Con) course teaches military bleeding control techniques that have been shown to dramatically increase casualty survival.

"B-Con doesn't require a lot of resources. One instructor can teach it in two or three hours," Dr. Morris explains. "It has the added advantage of having dedicated time when students can practice these techniques and become familiar with them."

He points out that even though the emphasis of the training courses is on preparing for a mass casualty event, it's unlikely most people will be involved in one.

"Most of us probably won't need to respond to a mass shooting, but we might be the first on the scene of a car crash or workplace or farm accident. And there may be one person there who needs hemorrhage control," he says.