University Hospitals (UH), located in Northeast Ohio, serves 20 counties with 10 community hospitals, a Level 1 trauma center and four Level 3 trauma centers. We also operate five freestanding EDs in the community and provide medical direction and oversight of the equipment, education, drugs and protocols for 171 EMS services.
UH is also responsible for disaster preparedness for the health system and the communities it serves. We also provide event medicine services, including at Cleveland Browns football games, marathons, and other events. We manage five American Heart Association training centers and offer five paramedic training programs.
Our system decided early in the development of a national Stop the Bleed initiative that we would implement a comprehensive program for our region. Our program started in our eastern region and quickly snowballed. We believe it’s a program that can be mimicked in schools and businesses across the country.
Innovation Stems from Tragedy
Emergency response programs often start after a tragic event. Ours was no different. Chardon is a quiet rural community in Geauga County, which is about 25 miles from Cleveland. This is in the heart of what’s called the “snow belt”—when other areas get two inches of snow in a day, they get three feet of snow.
On Feb. 27, 2012, students were starting their day at school as usual; there was a group of students in the cafeteria waiting for a bus that would take them to their vocational education program.
A 17-year-old male sitting with the group pulled a gun out of his gym bag and opened fire in the cafeteria, taking the life of three students and injuring two others—one of the injured is now permanently paralyzed.
This was not a community where you would expect this to happen—although I don’t think we expect these events to happen anywhere. It all hit very close to home: our sheriff and deputies had students at that school, as did one of our medical directors.
The event prompted a lot of thought, fear and discussion; what could we do to improve care and ultimately improve outcomes should a horrific event of this nature occur again?
People felt helpless and handcuffed. They didn’t have the equipment they needed; they didn’t know what to do. At this time a lot of the tactical emergency casualty care (TECC) strategies were coming out around the country. Tourniquet use was coming back in vogue, but we didn’t have a formal way of training people to do this.
So, we met with the Geauga County Sheriff, and looked at what UH could do to outfit the police cruisers with bleeding control kits.
Because police cruisers are usually the first responders on scene, we felt they needed to have the equipment to make an impact on saving a life. So, we developed a bleeding control kit. We put a program together specifically for police officers that trained them what to do if they came upon a shooting. We taught them when they might need a chest seal, needle decompression, combat gauze or a tourniquet. These bleeding control kits were placed in each police cruiser.
When our main campus hospital—a Level 1 trauma center—learned of the Stop the Bleed program through the Department of Defense, we filed the proper paperwork and became a Stop the Bleed training center. Our next goal was to begin teaching the program and expanding it throughout the communities we served in Northeast Ohio to enhance community preparedness.
The snowball began to grow. We had expanded from teaching sheriff’s and local police departments to businesses. Then, somebody came up with the idea of schools. If we could train teachers and staff on how to stop bleeding by applying tourniquets, then we could keep blood inside the patient and get them to a trauma center, where they’d have the best chance of survival.
Adopting the ‘Go-Bucket’
Convinced that we could train and prepare teachers to control bleeding in response to an active shooter event, we were in need of a kit that would allow them to have everything they’d need in one place. It wouldn’t only contain items for bleeding control, but also common items they might need if they had to shelter in place during a lockdown that might last several hours.
As we searched for a solution, we learned that an assistant principal at one of the schools had developed a “go-bucket” in case of a radiation emergency—the Perry Nuclear Power Plant was near the school and they had to have a shelter plan.
We took his lead and adopted the bucket concept. After all, a five-gallon bucket is pretty conspicuous—it wouldn’t be as likely to get tucked away like a small first-aid or bleeding control kit. The additional space is important, as each bucket not only contains bleeding control supplies (e.g., tourniquets, combat gauze, bandages, scissors, gloves, marker) but also the supplies needed for a situation where the class would have to shelter in place. This also includes duct tape (in multiple colors for sealing doors, blacking out windows or putting messages on outside windows), door stops, rope, elastic bandages, stretch wrap and, yes, even toilet paper.
Our idea was to put one of these buckets in every classroom in the communities we serve. We started down this road by meeting with the school district superintendents, resource officers and teachers to get buy-in for the program. They gave us valuable input and feedback, even helping us to decide what to put in the buckets.
In addition, we’ve worked with school safety forces and all of our programs involve local first responders, whether they’re EMS, Fire or law enforcement.
When we come in to train, we train all of the teachers as well as the support staff (e.g., administrators, bus drivers, etc.). We can train as many as 150 people in one classroom in about 90 minutes.
To date we have trained over 4,000 teachers and staff in over 100 school districts across the 21 counties we serve. We’ve placed buckets in each of those classrooms, and have deployed over 3,000 Stop the Bleed buckets total.
Bringing Buckets to Your Community
Each of the buckets costs around $70. It’s not a lot, but it adds up, and the total cost of our program is between $300,000 to $400,000. Conversely, if you’re a small health district and you have only one elementary school with 15 classrooms, for example, you’re only looking at about $1,000 to put this together.
Hospitals typically invest back into the communities they serve; and UH has funded our program using community benefit funds. But it doesn’t matter if you’re part of a big hospital system or a single station Fire department in a small rural community, there are many ways you can go into the community and find funds to do something like this in your region.
There are plenty of funds or donations out there. Target local scouting and other civic-oriented groups (e.g., Kiwanis, Eagles) who routinely give money away for programs that benefit the local community. Reach out to big-box retail stores; they may not provide cash, but they may gladly help by donating buckets, rope, duct tape, etc.
Piggy back on work you’ve already done in the community, too. CPR training classes can easily be adapted to also include Stop the Bleed. And you don’t need fancy simulation manikins; we started this program by having students packing “wounds” we had cut into swim noodles. Creativity can sometimes save a lot of money.
Finally, don’t forget to drum up support and find allies—they’re everywhere. Go to the local PTA meetings and explain the importance of bleeding control directly to parents—tell them that their kids can’t just wait for EMTs or paramedics to arrive. Teachers and other community members must be able to apply a tourniquet or pack a wound—it just might save their child’s life.