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'Stop the Bleed' campaign aims to educate, empower bystanders at mass casualty events

When the first alert page sounded at Hartford (Connecticut) Hospital the morning of Dec. 14, 2012, nobody in the trauma ward thought much of it.

“They were putting us on standby, as there had been a school shooting in Sandy Hook,” said Lenworth M. Jacobs, MD, MPH, FACS, who was on call that day as director of the Trauma Institute at Hartford Hospital, the only Level I trauma center in the region. “We didn’t pay much attention initially. We thought it was just one shot into the roof. Very quickly, it became very clear that that was not the case.”

Within minutes, Dr. Jacobs and the trauma staff learned the nightmarish truth. Twenty children and six staff members at Sandy Hook Elementary School lay dead or dying after a shooter rampaged through the building.

“The president was talking about it,” Jacobs recalled. “In an hour, it was world news.”

There was little Jacobs and the world-renowned staff at Hartford could do. Days later, Jacobs studied some of the postmortem examinations.

“It was a very powerful, very compelling experience to review these autopsies,” he said. “It really changes you. You don’t go back to work the same way after that.”

Jacobs shared this story June 15, as the keynote speaker at Creighton University’s Trauma Symposium, speaking to an audience of fellow trauma surgeons, surgeons, residents, medical students and more than 250 nurses, first responders and other emergency medicine practitioners.

In the aftermath of Sandy Hook, and with the Boston Marathon bombing just four months later, Jacobs was one of several physicians and first responders summoned to the White House to speak with President Obama about the distressingly high number of what seemed to be preventable deaths at the scene of mass-casualty events.

“The president looked at us and said, ‘You guys gotta do something about this,’” Jacobs recalled.

What was borne out of that directive and collaborations with the National Security Agency (NSA), the FBI, the military and national groups of fire and police chiefs was the Stop the Bleed campaign, an initiative encouraging bystanders to become active in stopping life-threatening bleeding and moving Americans to get the know-how to do just that.

“What we came to discover is that these events are often over in less than five minutes,” Jacobs said. “Most are over in two minutes. If you can stay alive for 10 to 15 minutes, you can make it. What that meant was the person who is going to help you is sitting right beside you.”

Jacobs cited the usual statistics surrounding mass-casualty events, but with a different twist. He showed that during the Columbine High School shooting of 1998, it was 40 minutes before emergency medical personnel were given the all-clear to enter the school. Much the same thing happened at Sandy Hook.

But at the 2013 Boston Marathon, a scene that was a maelstrom of blood and smoke, while more than 250 people were injured, many losing limbs, just three people were killed. The reason, Jacobs opined, is that more average citizens threw themselves into the fray to stop victims’ bleeding.

Jacobs showed several photographs from the scene of people putting pressure above wounds, creating makeshift tourniquets out of sweatshirts to stanch the flow of blood. The group directed by President Obama to find a solution saw that if those efforts could be more finely honed and spread across a wider population, there was a better chance of seeing survival numbers go up in mass-casualty events.

“You don’t need to be a rocket scientist to know if you’re bleeding out mass quantities, you don’t have much time,” he said. “The attitude in Boston became, ‘I didn’t come here to save lives, but I’m going to try anyway.’ We saw that many people were altruistic, that these messages were ingrained in us, we just needed to speed that message and training further along.”

The Stop the Bleed campaign aims to arm everyday citizens with the skills and equipment needed to save lives at large-scale events where bleeding is a very preventable cause of death.

“It has advanced the concept evident in World War II, Korea and most importantly Vietnam. Conflicts. ‘Citizen Soldiers,’ helping one another” said Juan Asensio, MD, FACS, FCCM, FRCS (England), Trauma Symposium co-director and Creighton School of Medicine Professor and Vice-chairman Department of Surgery and Director of the Trauma Center at the Creighton University Medical Center and Adjunct Professor of Surgery, Uniformed Services University of the Health Sciences. “It’s an experience that can be translated into the civilian arena. It’s something all citizens can take part in and save a life.”

As a presidential directive, Stop the Bleed has become highly visible through public service announcements on television and at sporting events. Bleeding control kits have started to pop up at public places around the nation and the world, coming with state-of-the-art tourniquets and compression bandages. And training has reached hundreds of thousands of people in the United States.

“We want the public to be immediate responders,” Jacobs said. “We want them informed, educated and empowered to serve, to stop bleeding. We’ve all heard, ‘If you see something, say something.’ Well, we’re trauma guys. We say, ‘If you see something, do something.’ It’s action that saves lives. No one should die from uncontrolled bleeding.”

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