War abroad and carnage at home since 9/11 have taught Americans much about saving lives after violent tragedies. Whether they were hurt in mass shootings or gruesome car accidents, it’s not uncommon for victims to bleed to death on the scene because trained assistance didn’t arrive in time to help them.
But one of the most powerful initiatives in trauma care in the past 15 years might make a difference.
Across the country, a public safety campaign is underway to teach both first responders, such as police officers, and average citizens how to stop trauma victims from bleeding to death. United under the banner of a White House-led public safety campaign called “Stop The Bleed,” federal agencies, major health care and law enforcement trade associations, local governments and some companies are backing the effort.
The national push for broader training is “a direct descendant of the 9/11 experience,” said Oscar Guillamondegui, medical director of the trauma intensive care unit at the Vanderbilt University Medical Center.
Better medical supplies and devices — perfected under combat conditions by the military since 2001 — combined with a first-aid technique once done only in hospitals are playing leading roles in helping grievously wounded people when time matters most.
Here are three 21st century advances that are making U.S. trauma care better:
Training
Groups such as the National Association of Emergency Medical Technicians and the American College of Surgeons make instructional materials available for free online so qualified instructors can train police officers and the public in bleeding control. Trauma departments across the country are offering similar programs.
In Boston, trauma surgeons are instructing teachers at schools run by the Archdiocese of Boston on how to stop bleeding. Cities also are teaching police officers how to apply tourniquets and arming them with bleeding-control kits — more than 36,000 officers from Phoenix to Philadelphia had taken such training by 2014, according to the American College of Surgeons.
In Denver, at least six citizens and five police officers have been saved over the past five years because officers at the scene were trained in bleeding control, said Dr. Peter Pons, an emergency physician who created that city’s program. He is also professor emeritus at the School of Medicine at the University of Colorado.
Tourniquets
Tourniquets were rarely used in civilian accident scenes even 10 years ago because it was assumed that applying one would lead to amputation of the injured arm or leg.
When a tourniquet did need to be applied, paramedics and emergency medical technicians often created their own, using triangular fabric bandages and other materials carried in their vehicles.
While tourniquets could not have helped the many 9/11 victims who died when hijacked airplanes crashed into the twin towers and the Pentagon, their usefulness has been proven in other circumstances.
Today, commercially designed tourniquets, called combat tourniquets, can be found in nearly every ambulance and emergency response unit in the country, and that’s due in part to years of successful military use in Iraq and Afghanistan.
“At the start of the war, [tourniquets] had a bad name; by the end of the war, it was recognized as absolutely lifesaving,” said Dr. John Holcomb, a trauma surgeon at the University of Texas Health Science Center at Houston. Houston police alone were issued 10,000 tourniquets in 2014.
Holcomb is a member of the Hartford Consensus, a joint committee drawn from the medical community and government that recommends ways to improve survivability from intentional mass casualties and active shootings. The Hartford Consensus has recommended that all first responders carry tourniquets since its formation in 2013 after the Sandy Hook Elementary School shooting in Newtown, Conn., the previous year.
Each state sets its own standards for what ambulances must carry, but EMS Resource Advisors’ Scott Moore, a consultant to the American Ambulance Association, said nearly every ambulance service in the country has trained employees in applying combat tourniquets.
Wound-Packing
When a tourniquet can’t be applied to stanch profuse bleeding — such as gunshot wounds in shoulders or chests — another technique comes into play. It’s called wound-packing — literally, stuffing a wound with gauze and applying pressure to keep blood in the victim’s body. Traditionally, only physicians were taught this technique, according to Denver’s Pons.
Now, ambulance personnel all over the U.S. are using wound-packing, aided by special gauze treated with chemicals that make blood clot faster. These “hemostatic dressings,” with names like QuikClot Combat Gauze, were developed and originally used by the military.