The Stop the Bleed program arose as a response to the Sandy Hook Elementary School shooting tragedy that left 20 small children and six adults dead in December of 2012 from an attack by an active shooter. Realizing that victims of violence may die from blood loss within minutes, long before first responders can reach the scene, the Stop the Bleed program seeks to arm survivors and bystanders of violence with the knowledge and skills to act as “immediate responders” who can stop bleeding so that no one needlessly dies.

Ten years after Sandy Hook, violence in our communities has not only continued but increased. Here are a few statistics:

• Each day 12 children die from gun violence, and another 32 are shot and injured in the U.S., according to a study by the New England Journal of Medicine.
• Between 1970 and 2012, there were 1,084 school shootings, an average of 26 per year, in the U.S., according to this map by the Center for Homeland Defense and Security. Tragically, since 2012, the year of the Sandy Hook Shooting, there have been an additional 1,084 school shootings, an average of 108 per year, in the U.S.
• Gun violence is not limited to schools. Indeed, since 2012, gun violence deaths have increased by 44% to 45,000 deaths a year, according to this Washington Post analysis. 
• Guns are the leading cause of death among Americans age 1 to 24, according to a report by the Coalition to Stop Gun Violence and the Educational Fund to Stop Gun Violence.

Considering this extraordinary level of violence, everyone should know how to provide immediate aid that can save a life. Read on to learn more about Stop the Bleed and the importance of training “immediate responders” in today’s world.

The Hartford Consensus and the Origins of a Bleeding Control Initiative

The Stop the Bleed program is a critical component of the Hartford Consensus, which from the initial efforts of Dr. L. M. Jacobs, a Connecticut Trauma surgeon, and Regent of the American College of Surgeons, developed a program to increase survival and enhance citizen resilience to active shooter and mass casualty events. The Hartford Consensus was developed over four meetings taking place between April 2013 and March 2016 and brought together medical and public safety experts from the American College of Surgeons, EMS and Fire leaders, academics, the military, FEMA, and the Department of Homeland Security to develop a program that will prevent anyone from needlessly dying from blood loss. The Hartford Consensus uses a multi-pronged approach to reach this goal. It improves and streamlines coordination between Law Enforcement, EMS, and Trauma Centers, and it provides a framework for training and equipping First Responders, such as police officers, on hemorrhage control. Still, perhaps most importantly, it provides for training people from all walks of life to be “immediate responders.” 

What is an Immediate Responder?

Immediate Responders are those individuals at a scene of a mass shooting or other mass casualty event that can provide lifesaving aid before first responders arrive. Anyone, regardless of background, can undergo a few hours of training to learn techniques that can mean the difference between life and death. Prior training of the public in CPR and the Heimlich Maneuver has saved countless lives over the last few decades. Today with growing violence in schools, places of work, places of worship, and communities of all sizes and locations, the training provided by Stop the Bleed, similarly, is a vital skill set for all.

Stop The Bleed Immediate Responder courses teach actions to ensure personal safety, interactions with law enforcement and EMS, how to identify bleeding as a threat to life, use of hands to apply direct pressure, proper use of safe and effective hemostatic dressings, proper use of tourniquets, and use of improvised tourniquets.

Stop The Bleed teaches that with severe extremity bleeding, hemorrhage control in order to save a life is a priority. Although most extremity injuries do not require a tourniquet, a tourniquet should be applied when bleeding is life-threatening. Situations that require a tourniquet include wounds with pulsatile or steady bleeding, when blood is pooling on the floor, when overlying clothes are soaked with blood, when bandages to cover the wound are ineffective and steadily becoming soaked with blood, and traumatic limb amputations.

What Courses Exist to Train Individuals on Bleeding Control?

Courses to learn the skills of Stop the Bleed are widely available and frequently offered free of charge. An example of this course is the Bleeding Control for the Injured (B-Con) course provided by the National Association of Emergency Medical Technicians (NAEMT).

The NAEMT site has a variety of resources including printable handouts, PowerPoint presentations, and courses providing education regarding Stop the Bleed.

Classes are also available through Hospitals, schools, universities, the Red Cross, and Emergency Care & Safety Institute’s First Aid course offerings.

Although the Stop the Bleed program originated as a response to an active shooter event, it is important to note the skills learned in the B-Con course can be lifesaving in a myriad of traumatic situations such as motor vehicle accidents, industrial accidents, accidents at home, and during natural disaster situations. The skills are easily learned but are perishable. Therefore, to ensure the Immediate Responder is prepared to be clinically effective, they should consider periodic refresher retraining akin to the recertification recommendations for CPR. As a further aid to maintaining and developing skills, the Uniformed Services University has developed a Stop the Bleed App, available from Google and Apple Store, that contains videos, resources, and a step-by-step guide to be used during an actual emergency.

The threat of exsanguination from an active shooter, deliberate act of mass violence, or an accident or natural disaster is real in our society. Stop the Bleed provides education and training so people from all walks of life to be ready to help during these stations and be able to step in and save a life. The Stop the Bleed program builds national resilience and improves our ability to increase survival during these tragic events by empowering people to be able to See Something and then Do Something.

About the Author:

Alfonso Mejia, MD, MPH, FAAOS, is a hand surgeon and the orthopaedic surgery residency program director at the University of Illinois, where he also serves as the vice head of the Department of Orthopaedics. Dr. Mejia is a sworn police officer and has served as a tactical emergency medical support physician on a multi-jurisdictional SWAT (special weapons and tactics) team for the past 22 years. Dr. Mejia also serves as medical editor for several Emergency Care & Safety Institute (ECSI) titles, and both a medical and coeditor on several EMS titles for the Public Safety Group (PSG).