Tick tock

There was Fort Hood in 2009, where 13 people were killed in a shooting spree. Then there was the rampage at Sandy Hook Elementary in 2012, where 27, mostly children, died. Recently, a lone gunman at an Orlando nightclub killed 49 people. The list goes on and on.

Over the last decade alone, 538 people have been killed in mass shootings in the U.S. That doesn’t include the multitude of victims of other mass violent, deadly crimes.

Then there are everyday injuries that cause trauma and death: the preschooler playing with a knife that accidentally nicks an artery. The carpenter working with a power saw that slips.

Trauma is the leading cause of death of children, and bleeding is a major preventable cause. It can take as little as five minutes for a person to bleed to death. But simple steps can save lives, and these steps are being taught to emergency personnel and medical professionals so that they can, in turn, empower bystanders to become lifesavers.

It’s like modern-day CPR training, said Kaori Tanaka, D.O., M.S.P.H., assistant professor of emergency medicine. Fear of the unknown prevents many people from being proactive in a bleeding control situation, just as years ago, before widespread CPR training, people didn’t know how to respond to a person in cardiac arrest.

“Once people are trained, they know what to do and have a higher likelihood of being able to act,” Dr. Tanaka said.

Following the Sandy Hook tragedy, the American College of Surgeons in 2013 gathered a panel of physicians, law enforcement and military personnel, and federal agency leaders. They determined that modern American life features a new reality—one where active shooter/mass casualty events happen often enough that people should be better prepared.

“As our experience with these events has accumulated,” the report stated, “it has become clear that longstanding practices of law enforcement, fire/rescue and EMS responses are not optimally aligned to maximize victim survival.”

Ways to improve survival already exist, but they are underutilized, the report found. “While efforts to isolate or stop the active shooter remain paramount, early hemorrhage control is critical to improving survival.”

Dubbed the Hartford Consensus, the group met four more times and developed policies and procedures to improve the care of trauma patients based on lessons learned in the wars in Iraq and Afghanistan. Then, in 2015, the White House launched the “Stop the Bleed” campaign to better prepare the public to save lives by raising awareness of basic ways to stop life-threatening bleeding following everyday emergencies, and man-made and natural disasters.

“The world has experienced its share of natural disasters and high-casualty incidents,” said Ronald Stewart, M.D., professor and chair of the Department of Surgery and chair of the American College of Surgeons’ Committee on Trauma.

“Under these circumstances, emergency services are often spread thin, with multiple individuals with injuries requiring treatment immediately.”

The National Association of Emergency Medical Technicians and the trauma committee joined forces to establish the B-Con Course, short for bleeding control, which trains people on managing bleeding under time-sensitive circumstances before trained responders can arrive. The curriculum has been taught multiple times at the university and across South Texas by UT Health San Antonio and University Health System instructors. It is overseen by the Committee on Trauma.

Bringing the training to campus was about creating momentum for this initiative based on unique challenges that are faced in the 27,000-square-mile South Texas region, Dr. Stewart said. Given its size and geography, it may take longer for emergency responders to arrive to outlying areas.

“In almost any community, it is likely to take more than five minutes to arrive on the scene before someone with trauma can be treated, and in that five minutes, the person can die,” he said. “That is where a trained bystander can really make a difference.”

Currently, the course is offered to the public through instructors in the Division of Trauma & Emergency Surgery, and emergency medicine and emergency health sciences departments. The curriculum, running about an hour long, is focused on the recognition of life-threatening bleeding and appropriate medical treatment. Participants learn how to control bleeding with direct pressure and when and how to apply a tourniquet. They learn how to pack the wound and how to identify injuries to the chest or abdomen, and understand why these victims need immediate hospital transport.

The goal is to create as many instructors as possible so that they can, in turn, teach others and spread knowledge of life-saving techniques in an emergency.

San Antonio is a perfect place to roll out the program, Dr. Stewart said. The city has local expertise in trauma and bleeding control, and “there is the largest military medical presence anywhere in the world,” he said. “It is also surrounded by ranches and large spaces, where hunting and work-related injuries often occur.”

An added bonus, he said, is the community’s willingness to help others.

“The more we can spread this knowledge, the more potential we have for saving lives,” he said.