With Active-Shooter Events on the Rise, Advocates Say Everyone Should Know How to Stop Bleeding

Trauma surgeon Lenworth Jacobs can't shake the helplessness he felt on the day a 20-year-old entered Sandy Hook Elementary School and began shooting first graders. "We were told to prepare for casualties," he says. "They never came."

Jacobs, director of Hartford Hospital's Trauma Institute, says the level-1 trauma center, minutes away by helicopter, would have been an ideal setting to care for survivors – had there been any. Twenty children, ages 6 and 7, and six adults died at the Newtown, Connecticut, school that day, Dec. 14, 2012, many from uncontrolled bleeding.

The tragedy led to Jacobs to what he describes as an epiphany. With massacres like Sandy Hook, San Bernadino, California, and now Orlando on the rise and the death toll growing, the time has come to teach bystanders how to stop bleeding and save lives. Just as many have been trained to perform CPR, bystanders can also be taught to stop, or at least slow, the bleeding.

If the wound is to an arm or a leg, a tourniquet can save a limb or a life. Anywhere else, apply pressure with a hand or a wadded up shirt. "You can bleed to death in 10 or 15 minutes," Jacobs says. "The only person who can help you is you, yourself, or Joe Citizen."

The realization that many people are dying who might be saved prompted Jacobs, a leader of the American College of Surgeons, to propose that the world's largest surgeons' organization take action. The group formed a committee made up of representatives of government, law enforcement, defense and medical officials to develop a national policy designed to increase survival from active shooter and mass casualty events.

"This is now taken seriously everywhere," says Dr. Corey Slovis, director of emergency medicine at Vanderbilt Medical Center. "We've gone from 'This can never happen' to 'I hope it never happens here.' We all hope and pray it will never happen again, and we all fear that it will."

With backing from the White House, the group drew up what is now known as the Hartford Consensus. The goal is to extend lessons learned from roughly 7,000 combat fatalities over the last decade to mass casualty events on the home front. To achieve it, they launched a national campaign called the Stop the Bleeding Coalition, made up of organizations as diverse as the American Academy of Pediatrics and the U.S. Department of Homeland Security, many dedicated to public safety.

"Obviously some of the lessons we've learned from the battlefield are very salient to why people die before they make it to the hospital," says Dr. Brian Eastridge, trauma medical director at University Hospital in San Antonio, a colonel in the U.S. Army Reserve and one of the developers of the military trauma system. "The large majority of people who die do not reach definitive care. On the battlefield, the number was substantial – almost 90 percent."

Today, Jacobs says, every soldier that goes into the field gets a bleeding control kit, which includes tourniquets and other dressings designed to stop bleeding. "If a soldier gets shot in a firefight, his buddy stops his bleeding with a tourniquet, and then goes on."

"In the military," Eastridge says, "we're extremely successful at fielding a tourniquet. That has saved countless lives."

Coalition members are attempting to do on the streets of U.S. cities what military medical personnel have done on battlefronts worldwide. "We have embarked on training the citizens of the United States to become first responders," Jacobs says.

The group envisions three levels of responders:

· Immediate responders: Anyone present at the scene who can immediately control bleeding with their hands or any equipment that may be available.

· Professional first responders: Emergency medical personnel at the scene who have appropriate equipment and training.

· Trauma professionals in hospitals.

The strategy has taken root among emergency medical service and law enforcement organizations. Over a quarter of a million police and other personnel, Jacobs says, have now been trained and equipped to stop and help the wounded, even in risky situations. In addition, organizations in most communities with populations greater than 500,000 have also begun training programs.

"In our hospital, we have trained over 300 people and given them bleeding control kits," Jacobs says. "We've placed them beside every [automatic external defibrillator] in the hospital." As for the 18,000 people working in the five-hospital Hartford Healthcare System, he says, "we're training all of them."

"We want to train people for all hazards, not just the bad stuff in Orlando or Boston," Jacobs adds, whether it's a massive laceration from a child's fall or a scary wound from a power tool. "You should know what to do," he says. "You can stop that bleeding."