by Ramin A. Khalili
For Col. Michael Davis, the problem isn't the bloodas a reconstructive surgeon by trade, it's never been about the bloodrather it's the way Hollywood always make the blood look so bloody.
"It's not like a horror movie," said Davis, director of the U.S. Army Medical Research and Materiel Command's Combat Casualty Care Research Program (CCCRP), talking about the mechanics of traumatic bleeding and perception versus reality. "You're never going to see projectile bleeding from a patient like you do on the screen, but people always think they will."
Said Davis, "And that's a barrier, I think a problem."
It's a problem for the military, certainlyas hemorrhage remains the No. 1 killer on the battlefield, and thus a chief concern for Davis and his teambut it's also a growing problem for American citizens on the home front. According to the Centers for Disease Control and Prevention, trauma is the No. 1 cause of death in the United States for people under 46, accounting for nearly 50 percent of those fatalities. But dive deeper into those numbers and you find the remnants of a slew of recent mass trauma events, like the 2012 school shooting in Newtown, Connecticut; the 2013 Boston Marathon bombing; and the 2015 Amtrak train derailment in Philadelphia. The message, then, has become overwhelmingly and tragically clear: Preparedness and vigilance are now requirements as injuries formerly confined to faraway combat zones now occur randomly and unpredictably on American street corners.
Enter the "Stop the Bleed" campaign.
A HOMEGROWN EFFORT
Launched at the White House in late 2015 via presidential proclamation, "Stop the Bleed" is a federal outreach program designed to save lives by teaching American citizens the simple basics of military-tested bleeding control: steps like using tourniquets to stanch blood flow and packing open wounds with clean gauze. These same steps have contributed to a 67 percent decrease in fatalities caused by extremity bleeding during recent U.S. conflicts in Iraq and Afghanistan, as compared with previous U.S. involvement in Vietnam.
Based on that success rate and CCCRP's overall expertise, the National Security Council asked the program to develop the campaign in direct reaction to the aforementioned domestic incidents, with the goal of fostering a new brand of national resilience at the grassroots level.
Indeed, "Stop the Bleed" is the reason Davis now straddles foreign combat zones and the U.S. home front as part of his daily duties. For him, the connectionand cooperationbetween the two worlds has never been more clear. The campaign, which operates as an unfunded mandate and thus without any spending authority, has grown dramatically via a grassroots marketing effort grounded primarily in simple, word-of-mouth outreach. For extra heft, CCCRP has begun working with a variety of stakeholders to develop a codified set of bleeding control training techniques and education guidelines.
The goal: Combine resources across the federal and private sectors to bring the campaign to the general public, where individuals can learn lifesaving skills from registered trainers across the country. "Saving a life is something everybody can do," said Davis. "We just have to find a way to teach that, to translate those basics of military medicine to a larger audience."
That larger audience has certainly materializedand quicklyas the analog-style outreach effort has led to successful licensing of the "Stop the Bleed" logo to more than 300 corporations, universities, government agencies and nonprofit entities worldwide as of early 2019. The licensing process, which is free to those using the logo for educational purposes, gives CCCRP, as the copyright owner, oversight as to who exactly is promoting the campaign and how that promotion is taking place.
Notable U.S. licensees include The Walt Disney Co., the American Red Cross and the Boy Scouts of America, along with hundreds of police and fire departments across the country, all of whom pledge to promote the proper tenets and techniques of the campaign. As a testament to the desire for such simple yet valuable information, the "Stop the Bleed" campaign so far has processed licensing requests from Italy, Canada, the United Kingdom and Belgium.
"When we go out to schools and teach these bleeding control courses, we don't even have to ask kids to put down their phones," said Dena Abston, executive director of the Georgia Trauma Commission in Rossville, Georgia. "That's how engaged they arethat's how much they want to learn these skills."
Georgia state lawmakers are equally enamored, pouring hundreds of thousands of dollars in grant money into a new effort that would install one dozen bleeding control kits inside each of the state's more than 2,300 schoolsmore than 27,000 kits in all. In addition, efforts are underway to train at least 10 administrators in each of those schools in bleeding control techniques.
Said Abston of the campaign's popularity, "I've never seen anything like it."
THE IMPACT OF LIFESAVING ACTION
But when it comes to saving a life, to physically inserting oneself into a mass trauma scene and becoming an active bystander, there are still barriers to overcome, that "gore factor" being chief among them.
"Hollywood movies always show blood squirting everywhere," said Gregory Tony, newly installed sheriff of Broward County, Florida, and owner of the active shooter response training company Blue Spear Solutions LLC. "But the reality can be much less dramatic from a visual standpoint."
Said Tony, "I can recall arriving at a shooting scene one time where the victima female shot in the upper neck and backwas lucid and providing detailed information about the shootings."
It's that kind of firsthand experience that has driven Tony, an early "Stop the Bleed" licensee and adopter, to push the campaign into his immediate community and beyond. By speaking directly and specifically to key local stakeholders as part of a coordinated action plan, he said, he's been able to allay those fears, break down the barriers and convey the importance of immediate action and its overall impact.
"Most people have a fear of working with or touching blood, but we figured out how to get more supporters and participants," said Tony. "Our greatest success comes when we talk with people like school officials, local legislators, church pastors and business owners about the severity of excessive bleeding, and paint a full picture of the community impact of learning bleeding control techniques."
To that end, Tony has teamed with those same types of entities in Florida and North Carolina to teach bleeding control fundamentals to both children and adults, including work with the students and families at Marjory Stoneman Douglas High School in Parkland, Florida, the site of a horrific school shooting in February 2018 that left 17 people dead and another 17 people injured.
"Unfortunately our first responders are now the everyday civilians," said Max Schachter, whose 14-year-old son, Alex, was one of the victims in that shooting. "We know this is going to happen again, and so we need to solicit all Americans to learn how to Stop the Bleed.' "
Lori Alhadeff, whose 14-year-old daughter, Alyssa, also died in the Parkland shooting, talks about the campaign in the same manner; to her, it's a clear imperative. "Bleeding control training and equipment should now be mandatory for every school, teacher [and] student," she said.
As a result of Tony's work in the wake of the Parkland shooting, Florida state senators are drafting legislation mandating implementation of the "Stop the Bleed" campaign in every school in the state, a clear nod to the importance of young children and teens in this equation.
"Youth is the key ingredient to success here," said Tony. "Kids have the greatest opportunity for impact, for immediate response and for the long-term continuity of this national campaign."
CONFIDENCE, COMPETENCE, RESULTS
Back in his office at Fort Detrick, Maryland, Davis pulls a bright orange tourniquet from his desk drawer and spins the plastic windlass around with his fingers, tightening the cordage for a brief second before releasing the tension. He does this once, twice, three times. He understands the apprehension in the face of traumatic bleeding, he said, but he also knows that empowerment is the best tool to fight those fears.
"Nobody's mentally prepared for a trauma scene," he said. "Everybody always thinks, this is overwhelming,' and this is above my capacity' but I can assure you it is not."
Granted, while the steps for aiding a trauma victim are (ideally, at least) relatively basic, there's a clear and dramatic difference between dealing with massive bleeding cases in a clinical versus a real-world environment. Even Davis admits, "Trauma is just a totally different animal in the field."
Still, the tenets of the "Stop the Bleed" campaign are designed to simplify the process and mitigate the knowledge gap between medical professionals and those active bystanders willing to save a life. That process begins with locating the site of bleeding on the victim, then applying immediate and firm pressure before applying a tourniquet about two to three inches above the wound to help stop the bleedingmaking sure to then twist the tourniquet rod tightly before securing it with both the built-in clip and the Velcro safety strap (depending on your tourniquet model). Finally, if the wound is still bleeding, pack it with gauze. "Use more than you think you need," said Davis. This last part is of special importance; emergency room doctors note that while it's best to use clean gauze to pack a wound, anything absorbent will work, even if it's dirty. As the saying goes in the ER, "We can treat a live patient with an infection, but we can't treat a dead one."
Indeed, it's the simplicity of that message that has resonated so deeply. Stories of real people using those techniques to save lives are submitted to CCCRP weekly from across the country. The campaign even took center stage recently through a series of public service announcements featuring the cast of the CBS television network's medical drama "Code Black." Campaign partner the American College of Surgeons engineered appearances from actors Rob Lowe and Marcia Gay Harden as a part of that effort. Abston, with offices based out of tiny Rossville, Georgia, was interviewed by NBC "Nightly News" late last year about her work with the campaign.
"They sent a camera crew all the way up here from Atlanta because they were so interested," she said.
For Davis, this is the way it was always supposed to go: a simple, lifesaving message backed by science, results and military mighta message easy enough to teach quickly yet powerful enough to save lives. It recognizes that, whatever the statistical likelihood of mass violence may be, bleeding control skills increasingly are used in daily, around-the-house types of situations andas the campaign likes to notein more rural areas of the country, with the states of Iowa and Montana becoming "Stop the Bleed" license holders expressly to combat farming injuries.
As someone who previously served as chief of reconstructive surgery at Bagram Air Base, Afghanistan, during deployment in Operation Enduring Freedom and then as deputy commander of the U.S. Army Institute of Surgical Research in San Antonio, Texas, Davis can attest to the power of "Stop the Bleed" because he's seen it in action.
"This is the tool that's going to save lives," said Davis, still fiddling with the tourniquet in his hand, still watching it tighten and release. "Mass trauma is easily the biggest health crisis of this generation, and so we've got to be prepared we've got to spread the word."
For more information, go to https://www.nytimes.com/2017/10/05/well/live/bleeding-first-aid.html.
RAMIN A. KHALILI is a communications manager with PotomacWave Consulting, providing contract support as the knowledge manager for CCCRP, a position that includes an administrative role for the "Stop the Bleed" campaign. Before assuming his current role, he spent more than a decade as a broadcast journalist, working in a number of cities in the U.S. During that time, he earned an Associated Press Award for his work in Phoenix, before securing a position as chief NASA correspondent for CBS in Orlando, Florida. He holds a B.A. in communications from Penn State University.
This article is published in the Spring issue of Army AL&T.