Training Bystanders to Become Immediate Responders to Assist in Mass Casualty Incidents
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.
More than 10 years after Sandy Hook, violence in our communities has not only continued but increased. Here are a few statistics:
- In the U.S., gun death rates among children aged 1-17 have increased by 106% since 2013 and have been the leading cause of death among this age group since 2020, according to the Johns Hopkins Center for Gun Violence Solutions.
- Since the shooting at Columbine High School in 1999, more than 390,000 students in the U.S. have experienced gun violence at school, according to the Sandy Hook Promise.
- 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.
- 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.
- Mass shootings have been increasing in frequency over time. From 1966-1975, there were 12 mass shootings in the United States. From 2013-2022, there were 170, according to the Rockefeller Institute of Government.
Considering this extraordinary level of violence, everyone should know how to provide immediate aid that can save a life.
The Hartford Consensus and the Origins of Stop the Bleed
The Stop the Bleed program is a critical outcome 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 make recommendations to improve survival from intentional mass casualty incidents.
“This was just a remarkable example of the civilian sector taking concepts pioneered by tactical combat and casualty care and transitioning those to the civilian sector,” said Navy Captain (Ret.) Dr. Frank Butler. Dr. Butler is a Navy SEAL who was the architect of Tactical Combat Casualty Care (TC3) and who recently received the Presidential Citizens Medal for his role in TC3.
The Hartford Consensus uses a multi-pronged approach. 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. Perhaps most importantly, it also provides ways to train people from all walks of life to be “immediate responders.”
What is an Immediate Responder?
Immediate Responders are individuals, typically bystanders, 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.
The results have had a lifesaving effect, similar to how 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. Since its inception, Stop the Bleed has trained nearly 4 million people worldwide.
Stop The Bleed Immediate Responder courses teach attendees how to identify life-threatening bleeding, 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 is a priority. Someone who is severely bleeding can bleed to death in as little as 3-5 minutes, which is often before EMS can arrive on scene. Although most extremity injuries do not require a tourniquet, a tourniquet should be applied when bleeding is life-threatening.
Dr. Butler credits Stop the Bleed with giving everyday individuals the knowledge they need to make a difference, even in everyday accidents where an injury was not caused by violence.
“When I go out on my bike rides, my emergency kit is a tourniquet and a cell phone. I’m prepared to stop any hemorrhage that I might have from a bicycle accident, and I’m also prepared to save somebody else,” he said. “If I come across somebody that’s been in an automobile accident, I can apply a tourniquet and save that person’s life. Think of hunters. Think of scuba divers. Anytime there’s a potential for significant trauma, there’s a potential need for a tourniquet. And if you have a tourniquet, you need to have somebody who’s trained to use it. And that’s why Stop the Bleed has been such a powerful program. It has trained Americans across the country, not just doctors, not just medics, but everybody to use tourniquets when it’s appropriate.”
What Bleeding Control Courses are Available?
In addition to Stop the Bleed classes, courses to learn these skills 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.
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.
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).