Major Incidents, Trauma

What the White House’s Stop the Bleed Campaign Means for EMS

Issue 40 and Volume 41.

In October 2015, the White House launched its Stop the Bleed campaign—a special national initiative designed to provide bystanders with the tools and knowledge to stop life-threatening bleeding. This effort to save lives and build resilience has broad private sector support, but, although this is an initiative to engage the general public, EMS is critical to its success.

Working with the private sector and nonprofit organizations, the Stop the Bleed campaign is putting knowledge gained by first responders and the military into the hands of the public to save lives.

Uncontrolled bleeding can result from manmade and natural disasters (e.g., active shooters, bombings, train crashes, tornadoes) and from everyday occurring emergencies (e.g., vehicle crashes, plate glass window accidents, farming accidents). Severe bleeding can kill within minutes before EMS or other public safety providers arrive. Thus, the person closest to you may be the only one who can “stop the bleed” fast enough.

STOP THE BLEED: A CHECKLIST FOR EMS

✔ Acquire a free licensing agreement from the Department of Defense for use of the Stop the Bleed logo. Email your request for a licensing agreement to Ramin Khalili ([email protected]).

✔ Once you’ve got the logo, use it and distribute it widely.

✔ Engage your communities to encourage the general public to Stop the Bleed.

✔ Adopt a local high school or community organization in which to teach simple ideals around the importance of bystanders and how they can save lives and build resilience, and specifically how to stop life-threatening bleeding.

✔ Initiate peer-to-peer education for public health and primary care healthcare workers in their communities.

✔ Teach Stop the Bleed instructions in your already established outreach programs.

✔ Share the Stop the Bleed info graphic from the DHS website with your family, friends and community.

✔ Proactively initiate, support and provide EMS medical oversight for placing public access bleeding control kits next to AEDs in your communities.

✔ When a bystander takes action, thank that person.

GENESIS OF STOP THE BLEED

Stop the Bleed guidelines

This national preparedness initiative is the shared responsibility of all levels of government, the private and nonprofit sectors, and individual citizens. Similar to the use of CPR or automatic external defibrillators (AEDs), the goal 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, and to promote the general public’s access to bleeding control kits in public spaces.

The Stop the Bleed initiative was the product of a federal interagency workgroup. Prior to its launch, officials received input and broad support from representatives of federal departments and agencies, and from participants of roundtables representing large segments of the population, physicians’ and other healthcare organizations, emergency management, 9-1-1, EMS, the fire service, law enforcement and the corporate sector.

VISION FOR STOP THE BLEED

1. The general public will know the phrase and its logo: The phrase “Stop the Bleed” anchors the initiative. It will be broadly disseminated and its associated logo will become part of the public’s consciousness much like “stop, drop and roll” is today. As a central part of the logo, the figure of the hand is a simple reminder that most bleeding can be stopped by direct hand pressure. The Department of Defense created and owns the Stop the Bleed service mark, and it’s available for use free of charge. (See sidebar, “Stop the Bleed: A Checklist for EMS,” above.)

2. The general public will know how to stop life-threatening bleeding: The logo is a prompt for the general public to act to stop life-threatening bleeding—they don’t have to wait for EMS to arrive. The Department of Homeland Security Stop the Bleed website has a shareable infographic describing steps used to stop life-threatening bleeding, and bleeding control educational resources. On Oct. 16, 2015, the American Heart Association and American Red Cross jointly announced updated first aid guidelines with new bleeding control updates that align with the White House Stop the Bleed initiative.

3. The general public will have access to effective personal bleeding control kits: EMS providers are familiar with individual first aid kits designed for public safety personnel, but now the corporate sector is marketing and developing personal bleeding control kits for use by the general public. Minimum potential items for personal bleeding control kits listed by the federal interagency workgroup include:

  • An effective tourniquet;
  • Compressive dressing (6-inch);
  • S-rolled gauze;
  • Trauma shears;
  • Nitrile gloves (large); and
  • A bag or container to hold the equipment.

4. The general public will have access to effective public access bleeding control kits: Bleeding control kits should be co-located with AEDs to increase visibility. The public access kits will have multiple quantities of the personal kits. Those who have their own personal access bleeding control kit will already be familiar with the contents of the public kit.

The corporate sector is already producing these kits, and public access bleeding control kits have been installed adjacent to AEDs in public locations such as Charlotte Douglas International Airport (Charlotte, NC.), Hartford (Conn.) Hospital and Connet quot School District in Islip, N.Y.

5. Every bleeding control kit will provide “just in time” audio and visual training: Experience has taught us that no matter how good our outreach and education programs, we can’t be sure a bystander will have taken a course or have a mobile app that can teach in a moment’s notice how to stop life-threatening bleeding. We should learn from the success of AEDs.

Audio built into an AED can teach someone with no prior training “just in time” how to provide an electrical shock to save a life. The Stop the Bleeding initiative believes that same voice inside a bleeding control kit can teach someone with no training how to apply direct pressure and use a tourniquet to save a life.

Stop the Bleed campaign

Displaying visual instructions on the outside of kits has an additional benefit—their presence in public places will provide a long-term opportunity for the public to know how to stop bleeding.

The Uniformed Services University of Health Sciences has already published research demonstrating “just in time” instructions increase laypeople’s successful application of Combat Application Tourniquets.1

The corporate sector has embraced the concept of “just in time” training for bleeding control kits.

CONCLUSION

So, if this is a public campaign, what does it have to do with EMS? We’re all in this together.

Don’t assume everyone knows what you know. Family members of EMS providers and others in your community may not know how to stop life-threatening bleeding, and sharing what you know may turn out to be the difference between life and death. And since there will be a handoff of the patient from the bystander who has stopped the bleed to EMS providers, by default, there’s an important partnership between EMS and the general public.

And this goes beyond saving lives. Quoting Herman B. “Dutch” Leonard, MD, lead author of Why Was Boston Strong? Lessons from the Boston Marathon Bombing: “Our challenge and opportunity isn’t just about saving lives from immediate life threats. It isn’t just about cost-benefit analysis. It also goes far beyond increasing survival from daily occurring and catastrophic tragedies. It’s about building resilience of people through increasing personal and community efficacy and effectiveness. It’s about building on a foundation of the public’s propensity to act and a willingness to intervene. And it’s about building a community narrative, speaking to the notion of a nation of people who are self-propelled and who have a spirit of taking care of each other, especially in their most desperate moments of need. This is who we are as a nation.”

EMS must be leaders in the campaign to Stop the Bleed. This is an outward facing initiative for the general public that will happen with or without EMS, but our engagement will accelerate its implementation. JEMS

REFERENCE

1. Goolsby C, Branting A, Chen E, et al. Just-in-time to save lives: A pilot study of layperson tourniquet application. Acad Emerg Med. 2015;22(9):1113–1117.

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