The Stop the Bleed Coalition points out that the average time for a person to bleed out is between three to five minutes. Jack Sava, MD, director of the Gold Surgery team at MedStar Washington Hospital Center is quoted saying that “An adult can die in less than five minutes from a bleeding wound in a critical area.” With the average time it takes an ambulance to arrive, it is more important than ever for people to know how to uncontrolled bleed (see Fig. 1).
Imagine a family hiking trip in a remote area of the Application Mountains, when one of the children takes a nasty fall down a small ravine, resulting in a compound femur fracture where the bone knicks the femoral artery and causes substantial blood loss. With the remote location and limited phone coverage, first responders would likely take nearly an hour to arrive. The child’s life depends on the family members’ actions.
A 2015 report points out that there are different levels of responders:
Immediate responders – Individuals at the scene who can immediately control bleeding with their hands and available equipment
Professional first responders – Prehospital responders at the scene with the appropriate equipment and training
Trauma professionals – Hospital health care professionals with the equipment and skills to provide definitive care
The immediate responder (e.g., family members on a hiking trip) can provide lifesaving first aid during an emergency, especially when first responders are not nearby or are overwhelmed by multiple casualties. For example, as taught in Texas A&M Engineering Extension Services’ (TEEX) Civilian Response to Active Shooter Events course, it takes an average of three minutes for police to arrive in an active shooter situation. The first arriving officers have the crucial initial priority of neutralizing the shooter (“stop the killing”), and the follow-up officers or Rescue Task Force typically begin first aid (“stop the dying”). Depending on the severity and location of the injury, a person can bleed out in three to five minutes.
Another example would be a motor vehicle incident involving someone severely bleeding. Instead of arriving within a few minutes, Emergency Medical Services (EMS) and other first responders may be significantly delayed due to the traffic caused by the incident. These two examples illustrate the importance of immediate responders’ ability to stop the bleeding until first responders arrive on the scene or until the person arrives at the emergency room.
A person can bleed out in 3-5 minutes. So, immediate responders might be that person’s only chance of survival.
Although the term immediate responders might be new to some, there has been an increase in this type of response. Examples include events/venue staff, coaches, athletic trainers, security officers, and Community Emergency Response Team (CERT) members. Cardiopulmonary resuscitation and automated external defibrillator (CPR/AED), basic first aid, search and rescue, locating lost children, etc. are typical training topics for immediate responders. Added to this list of training opportunities should be administering lifesaving STOP THE BLEED® (STB) measures (direct pressure, wound packing, tourniquet application). In addition to the immediate responders mentioned above, other groups that would benefit from STB training include:
Bus drivers and other transportation officials
Facility workers – plumbers, construction, building services (housekeeping)
Over the road truckers
Martial arts dojo instructors and students
Faith-based staff – ordained, support staff, and volunteers
Special events workers
Building managers/fire wardens/volunteer crisis coordinators
Summer camp counselors
Parking lot attendants
Teaching assistants/lab workers/principal investigators
University students – Such training may also help them in their future careers and add to their resumes. Infusing training topics like STB is also a great addition to students’ academic curriculum, for example:
Criminal Justice majors
Reserve Officers’ Training Corps (ROTC) cadets
This non-exhaustive list provides suggestions to encourage others to think about possible immediate responders within specific organizations. By getting STB training, the people within an organization would be more prepared to respond to an incident immediately.
Some STB classes go beyond the three basic concepts of direct pressure, wound packing, and tourniquets, and include how to use Chest Seals.
Stopping the Bleed
According to the American College of Surgeons STB program, bleeding is “the most common cause of preventable death after injury.” As such, it is important to know how to stop the bleeding and not to rely on first responders who may take too much time to reach critically bleeding victims. Learning to control bleeding is a skill easily learned and should be considered by various people and professions.
Of course, first responders (firefighters, police, and emergency medical technicians [EMTs]) are trained in STB. Although not considered first responders, many emergency managers and public health officials also have completed various first aid classes (Basic Life Support, CPR/AED, STB, etc.). However, do not assume that all clinic staff (nurses, medical assistants, etc.) are specifically trained in STB.
The University of Pittsburg Medical Center’s “Minutes Matter” initiative points out that blood loss is responsible for 35% of prehospital deaths. It also notes that “4 out of 5 victims of a mass casualty are delivered to the hospital by someone other than a trained EMT, first responder, or ambulance.” These statistics highlight the importance of knowing how to control bleeding.
For bleeding control, The Hartford Consensus III: Implementation of Bleeding Control report describes immediate responders as:
Traditionally thought of as “bystanders,” these immediate responders should not be considered passive observers and can provide effective lifesaving first-line treatment. Immediate responders contribute to a victim’s survival by performing critical external hemorrhage control at the point of wounding and prior to the arrival of traditional first responders. Immediate responders contribute to what is the critical step in eliminating preventable prehospital death: the control of external hemorrhage.
University of Georgia’s Emergency Preparedness Office regularly teaches Stop the Bleed to faculty, staff, and students.
Many fire departments and EMS organizations have certified trainers and offers training to the public. In addition, other organizations (emergency management agencies, universities, civic organizations, Citizens Emergency Response Teams, etc.) have STB clubs that regularly offer training, refresher training, and other lifesaving training. The STOP THE BLEED ® Coalition also provides a search feature for trainers and additional information, including upcoming training in specific locations.
The number and type of immediate responders trained in STB are essential for community preparedness. Missionaries, little league coaches, umpires/officials, poll workers, etc. Get creative. The class is also a great way to build collaboration with others. As FEMA illustrates: “Life-threatening emergencies can happen fast, and emergency responders aren’t always nearby. You Are the Help Until Help Arrives.”
Fig. 1. Graphic from the Stop the Bleed Coalition.
Andy Altizer is the Director of Emergency Management at Kennesaw State University, which works closely with Cobb Fire Rescue to provide an active Stop the Bleed training program on campus. He is also a Stop the Bleed Ambassador promoting the program and training to save lives.