On June 14,2014, a law was passed in Texas that requires every high school student to take a CPR course prior to graduation. A distinct challenge to this mandate was—and remains—funding.

Like other states, Texas schools struggle financially to provide students with their core educational requirements. So, how do financially challenged school districts find the resources to meet the reality of training for a catastrophic medical event?

Here’s what the Centre For Emergency Health Sciences did in South Central Texas to address what could only be described as an emergent need.

Making It Happen

To avoid confusion in what we were proposing to teach, we made sure everyone knew that we would be providing affordable, simple, fun and lifesaving education for anyone willing to be trained. The Stop the Bleed, Start the Heart program targeted specific actions needed to immediately save a life:

  • Tourniquet application;
  • Choking relief;
  • AED usage; and
  • Compression-only CPR.

As an engaged, informed and fun-loving community partner, the Centre for Emergency Health Sciences (CEHS) joined with our colleagues at the Comal Independent School District (CISD)—key allies in our 2016 Stop the Bleed efforts—along with our corporate partner North American Rescue, to train 5,642 middle school students at each of the CISD’s seven middle schools in the rural Texas Hill Country.

Our alliance assured each participant received state of the science training taught by professional, engaged—and entertaining—educators from CEHS. Our educators were supported by CISD faculty, who were all well-trained in hemorrhage control and CPR by CEHS staff.

Fishing in a Well-Stocked Pond

In January and February, with help from the school’s health services and athletics coordinators, we identified the sixth, seventh and eighth grade physical education period as an ideal time slot to provide the lifesaving education.

This decision meant that some students would miss a day of athletics or dance class. Crushing as that might first appear, everyone realized that the physicality involved with each effort would likely align with the day’s usual activity level.

Given that we were all foundational friends in the national Stop the Bleed initiative, our staff as well as school district staff knew from past experience that we could teach “kids” to “see something and do something,” (i.e., stop the bleed), but we also believed that with the right nudge, these young people would be able to “see something and do a lot.”

One Plus One Equals Something Entirely New

“On the surface, Stop the Bleed is a national program intended to cultivate grassroots efforts that encourage bystanders to become trained, equipped and empowered to stop life-threatening bleeding before help arrives,” says Ashley Hoppe, BBA, NREMT, business director at CEHS, as well as the program’s energizing facilitator. “We simply sat down as a team to chat about what was working in our community and then we watched it logically morph into our Stop the Bleed and Start the Heart program. It was as if someone finally put the keys to the front door right in our hands.”

“The overarching goal of our program is to empower each student to immediately act upon identifying massive bleeding, choking or cardiac arrest,” says Hoppe. “We emphasize each portion of the program to remove the shock factor from an emergency while simultaneously giving them the power of hands-on training and knowledge.”

Middle school students are the ideal age group to participate in this type of training because they are genuinely engaged and eager, and they nearly always pass the information on to other family members and friends. “Through wee [i.e., small of stature] force multiplication, our community network of immediate responders, who can act quickly and appropriately, exponentially grew and became stronger.”

Bringing it Together

The combination of CEHS educators and well-trained CISD faculty, in concert with the right supplies (CPR and choking manikins, AED trainers and CAT tourniquets) in the right place, allowed multiple things to happen. CEHS brought fun, science and additional expertise, North American Rescue helped with resources, and together with the school faculty, we provided guiding hands to teach our lifesaving message.

The CPR and AED lesson was divided into three simple steps that facilitated easy recall and immediate action:

Step 1: “Hey, hey, are you OK?

Students were taught to verify whether or not the person who is ill needs CPR or some other kind of medical assistance.

Step 2: Dial 9-1-1.

Students were taught the importance of the 9-1-1 system and how it works for everyone.

Step 3: Push hard. Push fast.

Students were taught compression-only CPR where they learned that high-quality, minimally interrupted chest compressions are easy, yet crucial, to survival. With this step, students were also shown how to apply and use an AED with continued emphasis on minimally-interrupted compressions.

After briefly discussing these three steps, each student individually practiced chest compressions on a manikin. This was actively accomplished with faculty and peers on the gymnasium floor.

For the Stop the Bleed component, students were taught an expedited approach to tourniquet application, along with easy-to-remember tips, including, “If it won’t quit, tourniquet,” and “high or die.”

“The simple act of knowing how to use a tourniquet can have an instant and profound effect on both the patient and our immediate responders,” Hoppe says, “especially since our students [both rural- and urban-oriented] can encounter emergencies in their everyday lives, from ordinary household and recreational accidents to unthinkable catastrophes.”

Commitment to Our Future

“Our Stop the Bleed project at Comal Independent School District began four years ago in response to the increase in school shootings nationwide,” says CISD’s health services coordinator Courtney Nesloney, RN, BSN. “At that time, tourniquets and Stop the Bleed stations were purchased, with help from North American Rescue, and placed in all Comal Independent School District campuses.”

In addition to teaching our middle school students lifesaving skills, our ninth-grade students receive didactic instruction in their biology classes, and compression-only CPR training is a requisite for high school graduation. By combining these initiatives early, we know that as the students grow, the lessons will get easier to teach, skills retention will increase, and lives will undoubtedly be saved.

CISD staff members are trained annually by campus nurses on bleeding control and tourniquet usage. In addition, school nurses attend several enhanced training sessions on casualty and trauma care—utilizing human cadavers—to maximize their preparation for incidents that may occur on campus or in the community. This enhanced training is part of CISD and CEHS commitment to “connecting experience with the future.”

Imagine’—Not Just Lyrics to a Song

“The final note in this successful melody was the overwhelming desire to put pressure where it was needed, and compress lifesaving skills into a fun and memorable event,” says Hoppe. “Our team imagined and then created an example of community, corporate and school district leadership, in a village that needed more than just talking points.”

Acknowledgements: The authors would like to acknowledge the U.S. Army Institute of Surgical Research, the Committee on Tactical Combat Causality Care, and all of who have bravely served others in their time of need. Your work beyond walls and borders remains an inspiration and guiding light to us all. Directly as a result of your service, stewardship and sacrifice, lives have been—and will continue to be—saved. A special thanks to the Comal Independent School District Board of Trustees and School Administrators for believing in their students, faculty, community and our team.