Do YOU Know How to Stop a “Big Bleed?”

This article first appeared in The Havok Journal on December 17, 2018.

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Current survival rates for out of hospital cardiac arrest ranges from 6-10%. However, we continuously pour efforts and money into this training. Items such as Automated External Defibrillators (AEDs) have been available for public use for several years. Furthermore, Cardiopulmonary Resuscitation (CPR) has been around for decades.

An area where a bystander could make a difference is extremity hemorrhage control. However, it is almost non-existent. It’s only recently that it has become a topic of interest.

The national campaign Stop The Bleed and local efforts like Denver Health’s Bleeding Control course are only two of a few options for hemorrhage control. Similar to the military (1-4), hemorrhage is a major cause of preventable death in the civilian population. (5,6)

Even with training, the military maintains about a 25% preventable death rate, mostly due to extremity hemorrhage. While the injury patterns seen in the civilian system are different, hemorrhage still accounts as a significant portion of preventable death.

The military relies on the Committee on Tactical Combat Casualty Care (CoTCCC) to provide up to date trauma care guidelines. The CoTCCC consists of a group of military and civilian subject matter experts in trauma and prehospital care. It is required that all service members are given instruction prior to their deployment on how to identify and treat the three causes of preventable death on the battlefield-life-threatening extremity hemorrhage, tension pneumothorax, and airway obstruction.

Not far behind the CoTCCC, the civilian equivalent is the Committee for Tactical Emergency Casualty Care (C-TECC).  They provide similar guidelines for tactical paramedics and police officers, in an effort to save the lives of SWAT, tactical officers, and bystanders during active shooter situations.

However, that is not enough. Members of the military and civilian sectors have called for a civilian model similar to the military to eliminate civilian preventable death. (7,8) Bystander hemorrhage control is essential to saving more lives in active shooter situations and in everyday accidents.

So can you prevent a death in an active shooter situation? Or even a family member in the event of an accident?

Recent events in Tampa, Dallas, Baton Rouge, and Nice have shown that a mass casualty event could happen anywhere and you may be the closest responder.

Learn how to stop massive hemorrhage and save a life. Go to Stop the Bleed for more information.

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1. Bellamy RF. The causes of death in conventional land warfare: implications for combat casualty care research. Mil Med. 1984;149(2):55-62.
2. Eastridge BJ, Mabry RL, Seguin P, et al. Death on the battlefield (2001-2011): Implications for the future of combat casualty care. J Trauma. 2012;73(6, Supplement 5):S431-S437.
3. Holcomb JB, McMullin NR, Pearse L, et al. Causes of death in U.S. Special Operations Forces in the global war on terrorism: 2001-2004. Ann Surg. 2007;245(6):986-991.
4. Kelly JF, Ritenour AE, McLaughlin DF, et al. Injury severity and causes of death from Operation Iraqi Freedom and Operation Enduring Freedom: 2003-2004 versus 2006. J Trauma. 2008;64(2 Suppl):S21-26; discussion S26-27.
5. Tien HC, Spencer F, Tremblay LN, Rizoli SB, Brenneman FD. Preventable deaths from hemorrhage at a level I Canadian trauma center. J Trauma. 2007;62(1):142-146.
6. Teixeira PG, Inaba K, Hadjizacharia P, et al. Preventable or potentially preventable mortality at a mature trauma center. J Trauma. 2007;63(6):1338-1346; discussion 1346-1337.
7. Fisher AD, Callaway DW, Robertson JN, Hardwick SA, Bobko JP, Kotwal RS. The Ranger First Responder Program and Tactical Emergency Casualty Care Implementation: A Whole Community Approach to Reducing Mortality From Active Violent Incidents. J Spec Ops Med. 2015;15(3):46-53.
8. Jacobs LM, Rotondo M, McSwain N, et al. The Hartford Consensus III: Implementation of Bleeding Control. 2015; http://bulletin.facs.org/2015/07/the-hartford-consensus-iii-implementation-of-bleeding-control/. Accessed July 15, 2016.

Andrew D. Fisher is now a medical student at Texas A&M College of Medicine after serving many years as a physician assistant with the U.S. Army. He joined the Army in 1993 as a Light Infantryman and spent three years at 1st Battalion, 75th Ranger Regiment before leaving the Army to pursue a college education. He is a 2006 graduate of the Interservice Physician Assistant Program. His previous assignments as a PA include UNCSB-JSA (Republic of Korea) and 1st Battalion, 75th Ranger Regiment. He has deployed seven times in support of the Global War on Terror/OCO. Andrew has taken care of more patients in the 75th Ranger Regiment than any other person since October 2001 and is the 2010 Army PA of the Year. Known as Old Man River, he is always angry, irritable, and cynical; at least it appears that way. He considers himself to be the least talented writer for the Havok Journal, but is very appreciative to have the opportunity. In his spare time he enjoys… who are we kidding, he has no spare time.