Community preparedness: M a r k G e s t r i n g, M D F A C S C h a i r, E M S C o m m i t t e e
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1 Community preparedness: M a r k G e s t r i n g, M D F A C S C h a i r, E M S C o m m i t t e e
2 Disclosures None
3 Introduction Uncontrolled hemorrhage remains the single most preventable cause of death after traumatic injuries. Hegvik JR, et al. J Am Coll Surg 2017
4 Introduction There is no such thing as a Golden Hour for patients with exsanguinating hemorrhage. Jacobs LM, et at. JACS 2014
5 Introduction The greatest opportunity to save lives after injury is in the prehospital setting. NASEM Report, 2016
6 The trauma care chain of survival A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve ZERO preventable deaths after injury. NASEM June 2016
7 The trauma care chain of survival A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve ZERO preventable deaths after injury. NASEM June 2016
8 How we got here Evolving civilian injury patterns
9 How we got here Evolving civilian injury patterns Virginia Tech, April 2007 Binghamton, April 2009 Fort Hood, November 2009 Sandy Hook, December 2012 Boston Marathon, April 2013 Charleston, June 2015 Paris, November 2015 San Bernardino, December 2015 Brussels, March 2016 Orlando, June 2016 Dallas, July 2016 Nice, July 2016 London, March 2017
10 How we got here Evolving civilian injury patterns Military style injuries Multiple casualties Complicated scenes
11 How we got here Lessons learned in war Combat Medic Memorial Statue, Fort Sam Houston, TX
12 Lessons out of conflict The military s experience with rapid bleeding control is not only relevant but also timely. Rasmussen TE, et al. J Trauma 2015
13 Lessons out of conflict Review of 4,596 US combat fatalities, Incidence of preventable death from extremity hemorrhage dropped (7.8% 2.6%) - 67% decrease Decrease coincided with widespread fielding of tourniquets to US forces Eastridge BJ, et al. J Trauma 2012
14 Lessons out of conflict The number of US lives saved through the use of tourniquets alone is estimated to be between 1,000 and 2,000. Anderson R, et al. J Am Acad Orthop Surg, 2012
15 How we got here Lessons learned in war Importance of rapid hemorrhage control
16 Bleeding control in the civilian setting Prehospital Emergency Care, 2014
17 Recommendations - Tourniquets 1) Recommend use of tourniquet in prehospital setting for control of significant extremity hemorrhage if direct pressure is ineffective or impractical. 2) Suggest using commercially produced windlass, pneumatic or ratcheting devices that have been demonstrated to occlude arterial flow. 3) Suggest against the use of narrow, elastic or bungee-type devices. 4) Suggest that improvised tourniquets be applied only if no commercial device is available. 5) Suggest against releasing a tourniquet that has been properly applied in the prehospital setting until the patient has reached definitive care. Prehospital Emergency Care, 2014
18 Recommendations Hemostatics 1) Suggest the use of topical hemostatic agents, in combination with direct pressure, for control of significant bleeding in the prehospital setting in anatomic areas where tourniquets cannot be applied and where sustained direct pressure alone is ineffective or impractical. 2) Suggest that topical hemostatic agents be delivered in a gauze format that supports wound packing. 3) Only products determined effective and safe in a standardized laboratory injury model should be used. Prehospital Emergency Care, 2014
19 Prehospital Emergency Care, 2014 American College of Surgeons All rights reserved Worldwide.
20 How we got here Evolving civilian injury patterns Lessons learned in war Hartford Consensus Military experience Evidence-based guidelines
21 How we got here Evolving civilian injury patterns Lessons learned in war Importance of rapid hemorrhage control + Immediate responder
22 How we got here Evolving civilian injury patterns Lessons learned in war
23 Operationalizing B-con education Stress importance of preparedness Focus on all hazards Stress relevance of skill set Key Concepts Empower civilians as immediate responders Early (immediate) bleeding control Public awareness is critical
24 The immediate responder As demonstrated after the Boston Marathon bombing, the public can and will act as first responders. Walls RM, et al. JAMA 2013
25 B-Con Course is designed to educate and empower the public to recognize and stop severe bleeding before the arrival of medically trained first responders.
26 B-Con Course is designed to educate and empower the public to recognize and stop severe bleeding before the arrival of medically trained first responders.
27
28 B-Con Ensure your own safety The ABCs of bleeding A - Alert - Call 911 B - Bleeding Find the bleeding injury C - Compress Apply pressure/pack/tourniquet
29 B-Con Ensure your own safety The ABCs of bleeding A - Alert - Call 911 B - Bleeding Find the bleeding injury C - Compress Apply pressure/pack/tourniquet NOT just a tourniquet course
30 B-Con Who can teach ATLS instructor or provider ATCN/TNCC instructor or provider Any EMR, EMT, Paramedic, RN, PA or MD
31 B-Con Who can teach ATLS instructor or provider ATCN/TNCC instructor or provider Any EMR, EMT, Paramedic, RN, PA or MD After completion of a provider course
32 National Stop the Bleed initiative B-Con 2,055 instructors as of 4/ courses completed 152 courses scheduled All 50 states
33 National Stop the Bleed initiative National effort Awareness Advocacy Equipment Sustainability
34
35 National Stop the Bleed initiative American College of Surgeons All rights reserved Worldwide.
36 National Stop the Bleed initiative American College of Surgeons All rights reserved Worldwide.
37 National Stop the Bleed initiative American College of Surgeons All rights reserved Worldwide.
38 National Stop the Bleed initiative American College of Surgeons All rights reserved Worldwide.
39 National Stop the Bleed initiative Equipment/Sustainability Requires action at the federal, state and local level Private sector Multiple potential funding sources
40 National Stop the Bleed initiative What can you do? Teach B-Con Help make the course available Be an advocate
41 The only thing more tragic than a death is a death that could have been prevented. BLEEDINGCONTROL.ORG
42
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