Every year, more than 9 million people travel through Cleveland Hopkins International Airport (CLE) in Cleveland, Ohio. With the possibility of severe hemorrhage from a multitude of sources, including escalators, machinery, active shooter events or other terrorism events, the Stop the Bleed program felt like a perfect fit for an airport.
The CLE Fire Department started research of the Stop the Bleed program several months ago, and wanted to make sure the program was a perfect fit for both CLE and nearby Burke Lakefront Airport (BKL)—a public airport on the shore of Lake Erie, in the northeast part of downtown Cleveland. CLE is the eighth airport in the nation to implement the Stop the Bleed program on the airport property, and first in the city of Cleveland to implement the program on a city property.
With over 50 automated external defibrillators (AED) on the airport property, we identified those locations as buddy locations to co-locate the Stop the Bleed kits. Other kits were added at areas where injuries could occur, such as the base of six escalators, as well as ticketing and baggage locations. In addition, kits were added to each building on the airport property, including those where many airplane mechanics, baggage handlers and other support personnel work each day. This brought the number of kits to 95 at CLE and five at BKL.
Acquiring Stop the Bleed Kits
One component in the Stop the Bleed kit, the tourniquet, was identified as a potential issue. The standard put forth by the national Stop the Bleed program is the CAT tourniquet; however we proposed to have Stop the Bleed kits with the SWAT-T tourniquets. As a department, we decided the benefit of including the SWAT-T tourniquet outweighed the cost. With the many different types of tourniquets available, performance, cost and successful application were all factors in our decision.
In a conversation with Eric Goralnick, MD, MS, medical director of emergency preparedness for Brigham and Women’s Hospital in Boston and assistant professor of emergency medicine at Harvard Medical School, he stated the overall success of bleeding control training with application of the CAT tourniquet was 88%.1
With the higher percentage of successful placement of the CAT tourniquets versus other commercial tourniquets including the SWAT-T, this will decrease that amount of time needed to apply a tourniquet and decrease the amount of time a patient would have a life threatening bleed. The CAT tourniquets also will provide an easier, less extensive method to apply for a lay person.
The CLE Airport Fire Department approached our medical direction and EMS partner, Southwest General Health Center, to help us to acquire commercially produced Stop the Bleed kits. As an airport fire department not affiliated with a larger city fire department, our opportunity to receive grants and other funding options are limited. Southwest General EMS Coordinator Jackie Haumschild and Medical Director Susan Tout, MD, assisted in having the Southwest General Foundation purchase 100 Stop the Bleed kits to outfit both CLE and BKL airports.
Areas for the kits were identified and labeled with the CLE Airport Fire Department logo and the national Stop the Bleed logo. These labels identify kit locations to those traveling through the airport that may have received training in other locations. The decision was made to place the kits prior to training airport employees because of the necessity of public access and prior knowledge.
Another layer to our public knowledge of Stop the Bleed locations and accessibility is the integration of the PulsePoint application. CLE is the first location in Northeast Ohio to integrate the locations of the Stop the Bleed kits into PulsePoint, which denotes the locations of AEDs within public spaces to assist laypersons in assisting with CPR or bleeding control. Clearly identifying these kits ensures the public can locate them to reduce the amount of time a person is bleeding and decrease the time of life-threating bleeding.
Training Airport Employees
Training over 2,000 airport employees is a large undertaking. Identifying groups of employees who may serve as potential responders in a situation is different than a general bleeding control training of public persons. Having over 50 paramedics within the fire department who can act as instructors for the Stop the Bleed program, and share valuable knowledge of the pathophysiology and reasons behind bleeding control, has been beneficial in training airport employees.
We first identified different areas we felt may be more likely to potentially be involved in an active shooter situation or a situation where hemorrhage control is necessary. This led us to select Transportation Security Administration (TSA) agents and airline ticket agents as likely lay person “first responders” in situations where immediate bleeding control might likely be necessary. We identified multiple dates and times to set up training for different shifts of airport employees, and have identified different locations that benefit the employees in ease of training.
The CLE Airport Fire Department has started training the management team of CLE on bleeding control. Having champions of the Stop the Bleed program from the management team was key in ensuring the success of the CLE program. It’s noted in one study on appropriate tourniquet application that after 3–9 months, the appropriate application of tourniquets falls to 54.5%.1 Therefore we have instituted a yearly review of the Stop the Bleed training, and will ensure that those trained in basic bleeding control are proficient in the basic bleeding control procedures on an annual basis.
The Stop the Bleed training of airport employees also fell in line with our recent training in Rescue Task Force. Recently, CLE Fire Department completed Rescue Task Force training in the active shooter scenario. The training took place in a concourse that’s currently vacant and allowed the department to train in real-life simulations. This training was key to illustrate to the first arriving fire and police department units how successful the Rescue Task Force is in active shooter situations. The Stop the Bleed program complements the Rescue Task Force to ensure that the potential for loss of life secondary to hemorrhage is minimal.
The Stop the Bleed program’s website states, “Uncontrolled bleeding is the number one cause of preventable death from trauma. The greater the number of people who know how to control bleeding in an injured patient, the greater the chances a victim has of surviving that injury.”2 Having readily available Stop the Bleed kits and airport employees who are trained in basic bleeding control will be of great assistance to the CLE Fire Department, as well as the trauma centers where we deliver these patients, likely ensuring a higher success rates of recovery for patients suffering traumatic bleeding events.
1. Goralnick E, Chaudhary MA, McCarty JC, et al. Effectiveness of instructional interventions for hemorrhage control readiness for laypersons in the public access and tourniquet training study (PATTS): A randomized clinical trial. JAMA Surg. 2018;153(9):791–799. doi:10.1001/jamasurg.2018.1099
2. Pons PT, Jacobs L. (2017.) What everyone should know to stop bleeding after an injury. BleedingControl.org. Retrieved Feb. 13, 2019, from www.bleedingcontrol.org/~/media/bleedingcontrol/files/stop%20the%20bleed%20booklet.ashx.