Newsletters

POSTED: April 19th, 2018
POSTED IN: EM Pulse - The Official Newsletter of MOCEP, March/April 2018,

Written by Lauren Nystrom, MD, PGY-2, University of Missouri – Columbia

Florida school shooting leaves 17 dead, wounds 17 more. Headlines like this one seem entirely too common, and that’s because they are. Since 2008 the number of active shooting events has tripled from 5 per year (on average) to nearly 16 per year according to the Federal Bureau of Investigation. These horrific acts and the media frenzy surrounding them force us as part of the global medical community, and as part of early response teams, to consider our preparedness for and our response to acts of terrorism and intentional harm. And while active shooters and suicide bombers capture the attention of the media, we in our daily work take care of countless victims of smaller scale traumas forever altering the lives of those involved.

Traumatic injury remains the number one cause of death in Americans from 1-46 years of age, and severe bleeding accounts for over 35% of trauma-related prehospital deaths¹. What if simple prehospital interventions could help empower people outside of healthcare to help with primary hemorrhage control? This question birthed the Stop the Bleeding Coalition during the later years of the Obama administration, which aims to educate civilians on hemorrhage control techniques and create access points for user-friendly hemostasis devices in public areas, much in the same way AEDs have become prevalent in schools, shopping malls, sports arenas, etc. The US military has been practicing bystander hemorrhage control for nearly 2 decades, and outcomes from their Committee on Tactical Combat Casualty Care have proven that addressing immediately correctable causes of death (i.e. hemorrhage control) does indeed save lives.²

The transition of these principles to civilian disaster preparedness has the potential to be bulky and awkward. We need bystander education on what life threatening bleeding looks like and basic first aid techniques for stopping bleeding including tourniquet application and wound packing. This could be accomplished through training in corporate groups, clubs, and community events. We need strategically placed toolkits that include just-in-time educational materials for high occupancy locations as well as difficult to access locations. It would make sense to place hemorrhage control supplies adjacent to AEDs, and to include only the most effective and user-friendly bleeding control devices. The U.S. Department of Defense has provided a robust and publicly available list of such equipment including tourniquets, pressure bandages, dressings, gloves, and scissors.² Finally, we need community support — from our first response teams and hospitals, from our law enforcement, and from our school districts — to put such systems in place on a local level. While legislators and public officials focus on hot-button issues like gun control and background checks, let’s work to improve outcomes in the ways we know best as healthcare professionals. Let’s help stop the bleeding.

References:

1. National Trauma Institute. https://www.nattrauma.org/what-is-trauma/trauma-statistics-facts/
2. NAEMT TCCC-MP Guidelines and Curriculum. http://www.naemt.org/education/naemt-tccc/tccc-mp-guidelines-and-curriculum