Laura Auel winced as Clif Castleman tightened a bright orange training tourniquet around her upper arm. “There we go,” Castleman said as he constricted the veins and arteries in the 21-year-old college student’s right arm.
“In some cases, and in some I’ve done in real life, people have said the tourniquet hurts more than the wound itself,” Castleman explained to nearly 50 residents of Poolesville, Md., gathered in an elementary school cafeteria.
“It definitely did hurt, my hand started to go a little numb,” said Auel, who attended the course in December with her mother. “I think in light of recent events in the news, we all felt strongly about being prepared.”
Once reserved for the battlefield, military medical techniques such as tourniquet application are becoming more widely taught to civilians. Castleman is a volunteer instructor for the Stop the Bleed campaign, which trains the public in simple hemorrhage-control techniques that could save lives in an accident, mass shooting or terrorist attack.
“It’s a fun, easy, free training,” Castleman said. “The person whose life you may save could be your friend, a complete stranger or a family member.”
Following the 2012 massacre at Sandy Hook Elementary School in Newtown, Conn., President Barack Obama called for an effort to enhance public resilience to mass casualty events. The American College of Surgeons responded with the Hartford Consensus, in 2013, which called for training the public in bleeding-control techniques.
“The most common cause of preventable death following injury is hemorrhage,” said Babak Sarani, a trauma surgeon at George Washington University Hospital. “The longer someone bleeds, the higher the chance that they are going to die. … The first person who can help that victim, inevitably, is another civilian.”
Surgeons developed a training course for people with no medical background, and the course was offered by volunteer instructors. The American College of Surgeons estimates that 120,000 people have taken a Stop the Bleed course, but one group of military veterans thought more people should be trained.
Andrew Fisher made eight combat deployments as a physician assistant with the Army’s 75th Ranger Regiment. He recognized the benefits of the program, but saw that it was not well known.
“I don’t know if we’re reaching out and getting publicity, interaction and involvement with the civilian community,” said Fisher, who is in medical school at Texas A&M College of Medicine.
Fisher knew a handful of other veterans interested in trauma medicine though a Facebook group called Next Generation Combat Medic. The group focuses on teaching the finer points of combat medicine.
“It’s kind a niche topic, military medicine,” said Max Dodge, a former Army flight medic and Next Generation Combat Medic administrator. Dodge and other members of his group noticed that even civilian health-care providers were not aware of the Stop the Bleed program.
“We realized that this program was important, it has the potential to save more lives than CPR,” Dodge said. He describes National Stop the Bleed Day as a “grass-roots awareness campaign” to promote the program. In September 2017, the group decided to create the National Stop the Bleed Day.
The group picked the date, March 31, 2018, coordinated with the American College of Surgeons and began the awareness campaign. The group is encouraging people to sign up for free Stop the Bleed courses at bleedingcontrol.org.
As planning for the campaign progressed, several mass shootings unfolded: Las Vegas, Sutherland Springs, Tex., and most recently at Marjory Stoneman Douglas High School in Parkland, Fla. Although these incidents may increase interest in bleeding-control classes, the organizers of National Stop the Bleed Day are quick to point out that trauma happens every day.
“You may see these horrible, tragic incidents that occur, and I want everyone to be prepared for that, but overall, you’re more likely to find someone on the side of the road in a car accident,” Fisher said.
National Stop the Bleed Day falls between Good Friday and Easter, so the campaign coordinators are encouraging people to look for courses before or after if the date conflicts with their holiday plans.
“There might be a course in your neighborhood on the 31st, but there might be one on the 28th or the 2nd,” said Mark Gestring, a trauma surgeon who has been involved in Stop the Bleed for two years. He expects more courses to be scheduled in the next few weeks.
Gestring points out that training is only part of the program. Making bleeding-control supplies available in the public domain is just as important, he said.
“What’s the point of me teaching you to use a tourniquet if you’re never going to see a tourniquet?” Gestring said.
At the University of Rochester, where Gestring works, bleeding-control kits are being added to nearly 150 automated external defibrillator cabinets across the campus. Gestring says the university is planning a week of education and training on the kits leading up to National Stop the Bleed Day.
Bleeding-control kits contain supplies such as gauze and tourniquets. The gauze can be used to pack wounds and apply pressure to stop bleeding. Tourniquets are used to control heavy bleeding from an arm or leg, which is also known as extremity hemorrhage.
“In the year 2018, there’s no excuse for somebody to die from extremity hemorrhage — absolutely none,” Gestring said.