Public Safety & Homeland Security

Tourniquets, Training to Turn Bystanders Into First Responders During Mass Shootings

The idea is to station containers filled with tourniquets, bandages and protective gloves where crowds gather, from airports and malls to schools and concert venues, just in case they’re needed.

by Paul Sisson, The San Diego Union-Tribune / October 4, 2017
With the help of Hans the manikin, students in the Stop the Bleed program learn how to apply tourniquets at Harborview Medical Center. In emergency situations, severe bleeding is a common cause of death for trauma patients. TNS/Alan Berner

(TNS) - With the size and frequency of mass shootings on the rise, a move is underway to make bleeding control kits as common in public places as fire extinguishers and heart defibrillators.

The idea is to station containers filled with tourniquets, bandages and protective gloves where crowds gather, from airports and malls to schools and concert venues, just in case they’re needed.

Many experts are taking the pragmatic but chilling view that mass shootings have now become as unpredictable but inevitable as fires and heart rhythm problems, requiring broad-based changes to the nation’s most basic and ubiquitous safety infrastructure.

“It’s a daunting idea but these kinds of penetrating injuries that occur with firearms, we’re seeing them a lot more than we were 10 years ago,” said Ian Weston, executive director of the American Trauma Society in Washington.

While prevention of mass shooting casualties is at the core of the nation’s long-running debate over gun control, Weston said those responsible for dealing with the consequences of gun violence must assume that it will not end anytime soon.

“Our goal is always to keep people out of trauma centers, but in the case where we can’t do that, we have to make sure we’re as prepared as we can be,” Weston said.

Already, the state of Georgia has funded a program that pays for bleeding control kits to be placed at public schools and a California bill, AB909, was introduced this year in Sacramento that, if it passed, would require bleeding trauma kits to be installed next to all automatic defibrillators in the state.

In 2015, the Obama administration, with the support of the American College of Surgeons and other powerful medical groups, started Stop the Bleed, a national outreach and advocacy program that focuses on educating first responders and the general public on how to stop severe bleeding.

The program has already trained thousands in these techniques which were informed by discussions with the military, which credits increases in battlefield survival in the Afghanistan and Iraq wars to improving the bleeding-control skills of front-line troops who are almost always the first to respond when a comrade in arms suffers a gunshot wound.

As public events, like the mass murder in Las Vegas Sunday, begin to look more and more like battlefields, the medical community has begun to understand that paramedics and emergency medical technicians are not likely to be on hand quickly enough to help patients whose odds of survival improve significantly if their bleeding is stopped within five minutes of sustaining a penetrating injury.

“Essentially, we’re trying to decrease deaths by having citizens play the same role that soldiers do on the battlefield,” said Dr. Jay Doucet, medical director of the Surgical Intensive Care Unit at UC San Diego Medical Center.

UCSD has already worked to train professionals — law enforcement and emergency medical responders — in proper wound-packing techniques and tourniquet application. The university is also offering public courses on the final Thursday of each month.

Discussions are also underway to install bleeding control kits, also called trauma kits, next to defibrillators at San Diego International Airport and UC San Diego Health is in the process of adding the kits in the lobbies of its hospitals in Hillcrest and La Jolla, said Doucet, a trauma surgeon.

The current bleeding control campaign started after 20 children and seven teachers were killed during a shooting rampage at Sandy Hook Elementary School in Newtown, Conn., on Dec. 14, 2012.

A group of medical and law enforcement professionals that calls itself The Hartford Consensus studied the trauma that occurred that day. They concluded that a greater overall awareness of how to stop bleeding, combined with an increase in available supplies such as tourniquets, could save lives in situations where paramedics are unable to get to the scene quickly enough, especially when an active shooter makes immediate access difficult or impossible.

While the focus is on shootings, having more bleeding control kits available in public settings can also help with response to other traumatic events from construction accidents to car crashes, according to Doucet. He said a new study due to be published by a group of researchers in Texas found that equipping emergency technicians with tourniquets had improved survivability by 50 percent.

A recent local incident drives home the point. Doucet said a San Diego County resident recently rolled his vehicle near Barona Casino and was losing blood quickly through severe arm wounds. A passer-by tried to use a dog leash as a tourniquet, but that approach was ineffective. By chance, a local Navy SEAL who happened to have a tourniquet with him was able to use the ratcheting strap to stop the bleeding.

“He ended up losing his arm, but we were able to save his life. He would have died without that tourniquet,” Doucet said.

Some might wonder why tourniquets, if they’re so effective, were not regularly used in trauma situations. The devices fell out of favor because their use was considered harmful in many cases, potentially causing nerve damage, gangrene and other problems.

But more recent studies have shown that the devices, especially professionally designed models that apply even pressure at all points around an injured limb, do offer significant benefit in traumatic injuries where trauma itself was not severe enough to cause death on scene.

Advances have also been made in creating wound dressings with “hemostatic” coatings which can help blood clot more quickly. These types of dressings, which can be backed into a penetrating wound, are also often included in bleeding control kits.

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