Trauma

Connecticut Schoolteachers Learn Hemorrhage Control

Following the 2012 mass shooting at Sandy Hook Elementary School in Newtown, Connecticut, the American College of Surgeons (ACS) convened the Hartford Consensus in Hartford, Connecticut, with the goal of maximizing survival in mass casualty and intentional violence events.

Following recommendations from the Hartford Consensus, many Fire and EMS agencies placed an emphasis on training their providers in hemorrhage control techniques.

The Hartford Consensus also advocated for empowering members of the public to act as immediate responders and initiate the chain of medical care before trained first responders arrive.

The ACS Committee on Trauma (COT) and the National Association of Emergency Medical Technicians (NAEMT) therefore created a public-access hemorrhage-control training program—the Bleeding Control Basic Course (BCON)—as well as the Stop the Bleed campaign to increase public access to hemorrhage control equipment and training.

The BCON course is a one-hour class designed to train community citizens with any level of inexperience to control life-threatening hemorrhage. Nationally, the class has been taught since 2015 to more than 350,000 people by more than 28,500 instructors through Fire and EMS departments, hospitals and other organizations.1

Early evidence shows that Stop the Bleed training builds resilience-associated traits in participants2 and that trauma patients experience enhanced survival with earlier field hemorrhage control.3,4

This article demonstrates a model Stop the Bleed training program for a suburban district’s schoolteachers organized and delivered by a Fire and EMS service.

Improving School Safety

In March 2018, a joint school safety meeting was held in North Haven. The NHFD and the North Haven Police Department presented recommendations to the administration of the North Haven School District for improving the safety of the town schools following the shooting at Marjory Stoneman Douglas High School in Parkland, Florida.

The district superintendent agreed that Stop the Bleed training would be a time- and cost-efficient way to improve the students’ safety and scheduled the training for a professional development day.

Although the session was organized by the NHFD deputy chief, executing the training required coordination from instructors across Connecticut, including representatives from various hospitals, Fire and EMS departments, and commercial EMS services.

The town of North Haven employs 321 teachers at its seven public schools and programs divided among four elementary schools, two middle schools and one high school.5 The school system enrolled 3,162 students in the 2016–2017 academic year.

The goal of the Stop the Bleed campaign is to make communities safer by involving the public in the care immediately following traumatic injury. Trauma is the leading cause of death in individuals aged one to 44, making schools a vulnerable environment with a large number of children concentrated in a space with proximity to windows, vehicles, and playground equipment.6

Fire and EMS departments are uniquely positioned with the expertise, experience and outreach ability necessary to run a successful Stop the Bleed training program. Hemorrhage control classes can provide crucial training for a department’s EMS providers and deliver lifesaving knowledge to members of the community.

Fire and EMS departments are frequently involved in town, city or county government, giving them connections that can be used to advocate trainings for different populations. Fire and EMS departments delivering hemorrhage control training to school staff makes sense for both parties but organizing the training has previously been a difficult task.

Although Stop the Bleed is often interpreted as preparation for mass shooting events, the skills may be utilized in a multitude of community-experienced traumatic events. Though the skills covered in the training may be applied to treat victims of shootings, reducing the application of hemorrhage control skills only to events of gun violence ignores the more common traumatic emergencies of motor vehicle collisions, power tool injuries, playground accidents and kitchen/cooking incidents.

Delivering the Training

The North Haven Fire Department (NHFD) is a combination career and volunteer Fire, Rescue, and EMS department in the suburban town of North Haven, Connecticut. Existing healthcare providers were certified as BCON instructors by the ACS after completion of the BCON course and recruited by the NHFD to instruct the course.

The participants were divided into two sessions, each lasting two hours. Instructor materials and official training equipment are available to instructors at the ACS bleeding control website.7

The didactic component was delivered by a single instructor over one hour, and then each participant was assigned to one of 15 breakout rooms to complete their practical training over the next hour. Each breakout room included two instructors, two training manikins, and multiple tourniquets, gauze packs, and compression bandages.

On Nov. 6, 2018, 34 instructors simultaneously participated in the district-wide training event. Of the school district’s 321 teachers, 278 registered for the training (86.6%). Of these, 100% participation was noted (278 of 278).

Future Training & Recertification

The North Haven School District Superintendent found the training to be extremely valuable and the delivery of this event to be very well thought-out and organized. Through future collaboration between the NHFD and the school district, training will be held for the remaining 43 teachers as well as the support personnel and paraprofessionals. Recertification of trained employees will also be discussed at future meetings.

Stop the Bleed trainings have occurred previously in public schools but a single training event for an entire school district is a unique event.8

And, although all members of the community may benefit from training in hemorrhage control techniques, training the group of individuals responsible for the community’s children should be a top priority.

We hope that this article serves as both a proof of concept and a motivational piece for fire and EMS departments across the country to train their schoolteachers to stop the bleed and save precious lives. ✚

References

1. American College of Surgeons. (2018.) Stop the Bleed: 2018 progress report. Retrieved April 1, 2018, from www.bleedingcontrol.org/~/media/bleedingcontrol/files/2018_stb_progressreport.ashx.

2. Levy-Carrick NC, McCarty JC, Chaudhary MA, et al. Hemorrhage control training promotes resilience-associated traits in medical students. J Surg Educ. 2019;76(1):77–82.

3. Goolsby C, Rouse E, Rojas L, et al. Post-mortem evaluation of potentially survivable hemorrhagic death in a civilian population. J Am Coll Surg. 2018;227(5):502–506.

4. Teixeira PGR, Brown CVR, Emigh B, et al. Civilian prehospital tourniquet use is associated with improved survival in patients with peripheral vascular injury. J Am Coll Surg. 2018;226(5):769–776.e1.

5. Cronin R. (Feb. 27, 2018.) North Haven School District: District Profile and Performance Report for School Year 2016–2017. Connecticut State Department of Education. Retrieved May 20, 2019, from https://edsight.ct.gov/Output/District/HighSchool/1010011_201617.pdf.

6. National Center for Injury Prevention and Control. (May 8, 2017.) Key injury and violence data. Centers for Disease Control and Prevention. Retrieved May 20, 2019, from www.cdc.gov/injury/wisqars/overview/key_data.html.

7. American College of Surgeons Committee on Trauma. (n.d.) BleedingControl.org. Retrieved May 20, 2019, from www.bleedingcontrol.org.

8. Ramly E, Bohnen JD, Fagenholz P, et al. Creation of the first Hartford Consensus compliant elementary school in the USA. Trauma Surg Acute Care Open. 2016;1(1):e000031.