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Blood loss, or hemorrhage, is the most common cause of preventable death, except for injury. In many cases, medical personnel are not on the scene of an accident or injury at work quickly enough to control bleeding. That leaves it to average folks to step in and help out. That’s why trauma surgeons from around the country created a campaign called Stop The Bleed
Stop the Bleed has already trained 100,000 people in the US. The trauma team at the UVM Medical Center wants to add to that number. It will soon offer free public courses. Dr. Tim Lee, an acute care surgeon at the UVM Medical Center, shares information about the program.
Listen to the interview at the link below, or read the transcript that follows.
Let’s think about that scenario: somebody comes across a scene where there’s bleeding, and they’re not medically trained. What’s the worst case scenario that they could encounter?
Well, the worst case scenario I think is, number one, that that type of situation’s happening. It’s terrifying. Your life is in danger. You’re seeing acts of violence around you. I think it’s hard for people in any circumstance to think clearly initially and to know how to respond. Unfortunately, these events, as we know through national news, are occurring in United States frequently. Particularly noteworthy, in the last few months, there’ve been several large scale active shooting incidents.
The worst case scenario in these is that you have an active assailant. You have victims who are unable to be reached by rescue efforts and law enforcement, because there’s an active shooter. These victims are on their own as far as trying to tend their own wounds or having someone help them. The immediate responder is, in fact, civilians who are trapped along with the victims. Having a fundamental knowledge base and skillset to identify uncontrolled bleeding and treat it can be definitely lifesaving.
Stop the Bleed started after the Sandy Hook tragedy. It’s an unfortunate set of circumstances, as you were saying, first responders can’t get in, because once that starts happening the procedure usually is to lock down the building. There are victims in there that can’t be reached, maybe for hours, while they’re having blood loss issues, so it compounds the problem.
Correct. Victims can’t get out and rescue personnel can’t get in. Again, yes, the Stop The Bleed campaign, initially, was started by the Hartford Consensus. That was a direct response after the horrible events that occurred at Sandy Hook Elementary School in 2012. The American College of Surgeons established a taskforce led by senior surgeons combined with EMS leadership and law enforcement leadership. What they put together was a policy and guidelines to deal with these mass casualty active shooter scenarios.
Unfortunately, as these scenarios continue to occur, this policy evolved and in 2015 the Stop The Bleed campaign was initiated. This was designed to directly target lay people, the public at large, and to try and spread the skills and knowledge in how to address serious bleeding wounds in this unthinkable situation.
How did you develop the tools and techniques to train an average person?
Hemorrhage control or control of life threatening bleeding is fairly straightforward, but it can be very daunting and intimidating to people who are not used to seeing it and dealing with it. The fundamentals are very basic and anybody can do this. These kits are designed to be easy to use. Our goal is to have them accessible. Just as you would find an defibrillator in a public space, you would have a Stop The Bleed kit available that’s equipped with tourniquets, with gauze that is coated with materials to help blood coagulate , and also other components in there to try and let whatever civilian bystander, who becomes an immediate responder, be equipped to help address injured individuals.
What’s the process with tourniquets?
Tourniquets are essentially a circumferential type of dressing that you tighten until all bleeding stops. In the past there was some concern that in civilian settings, leaving tourniquets on too long could cause nerve loss, muscle loss, and limb loss. That has turned out to be not true whether in civilian or military settings. . In military situations, There have been no significant, or meaningful studies that show there is limb loss associated with tourniquet use. On the other hand, it is very effective at stopping life threatening bleeding. I think it should be a standard of care when you identify bleeding in an extremity.
It’s very straightforward, very intuitive, but you just have to know that the resource is there and know some simple techniques on how to apply it and how to use it.
You see people using a belt or a tie on TV and in movies. Is that okay?
Yes. Our goal, again, is to try and get these kits into very visible and accessible in public areas. But certainly, we can’t have these kits everywhere. Any improvised strap that you can tie above an extremity wound and tighten down sufficiently will work.
What are hemostatic dressings?
In some circumstances you may be faced with either multiple people who are injured, and this could be, use as an example, an active shooter where many people injured, or it could be a severe accident of some sort where many people have injuries. If you don’t have enough tourniquets, or the wound is a little to proximal or too close to the junction, say your chest and your arm, and there’s a gaping wound, sometimes a tourniquet can’t be easy applied. The next best thing is to apply direct pressure. With large deep wounds, direct pressure, directly over it, is helpful, but what you want to do is get packing into the wound. The packing material has coagulative properties to it to help the blood coagulate quicker.
If you’re in a situation where there’s extremity bleeding and, say, your torso, which do you do first?
In the class, this is all reviewed. It’s a very good question. For extremity bleeds, if it’s controllable by pressure and there is not multiple injuries or multiple people that need be addressed, immediate responder could just hold pressure until EMS arrives. If there’s multiple people that need to be address, then one person’s not sufficient, so a tourniquet, in that scenario, would help treat one person while the immediate responder goes and address another one. If direct pressure it not enough, and if there continues to be bleeding, then a tourniquet should be applied.
Do you think the average person can learn how to do this?
I think so. I think people have an amazing capability to adapt and respond. Sometimes, you just need a little fundamental baseline knowledge that you can tap into. At some point, during stressful situations, I think everybody has the capacity to do something and do something good.
What is the training like?
Our Stop the Bleed session usually run between, I’d say, 30 to 45 minutes. It includes a lecture, going over some fundamental principles and some images of what an uncontrolled bleeding situation would look like. Once we cover that, then we actually have models and several stations where students can practice applying tourniquets, applying hemostatic dressings, or gauze, and learn these potentially lifesaving skills.
It’s a very straightforward course. Our aim is to make it readily and easily accessible to the public.
If you want more information, you can send an email to BleedingControl@UVMhealth.org.
What’s the process for distributing the Stop the Bleed kits and what is the cost?
These kits, they do cost money. We do like to purchase them. We’re, right now, doing some community outreach to gauge the interest and trying to reach out to public forums, public schools, gathering places, venues, things like that. We’ll try and get financial and public support to try and distribute these kits so that every place that has a potential public gathering space will have one of these.
What are the capabilities and resources, we have at the UVM Medical Center to help people?
Well, University of Vermont Medical Center is a level 1 trauma center, and we have all the necessary resources to deal with any high level trauma. We have excellent first responders. EMS response is excellent in the State of Vermont, made up of volunteers and non-volunteer EMS units.
We do have a large area that is rural in nature, Vermont as well as upstate New York, that we take patients from. There are a number of times, as you mentioned, the use of these kits is not just relegated to acts of violence or shootings. We see oftentimes there’s civilian accidents where a patient can suffer a dismemberment or a limb. They come in with a tourniquet in place, and it’s due to the EMS providers and local immediate responders that apply it. Those are lifesaving.
We have a dedicated operating room that we can activate at any time when a high level trauma comes in that requires operative intervention. There is also have what’s called a hybrid suite, where we can do operative intervention along with our interventional and vascular surgery colleagues in case there’s a severe blood vessel injury that needs attention as well. We have the capabilities to allow us to treat all traumatic injuries.