Survey: Civilians support wider access to education on how to help victims of mass casualty events

stop-the-bleedMany civilians have expressed interest in taking a bleeding control training course that would empower them to immediately assist victims of active shooter and other intentional mass casualty events at the point of wounding, according to the results of a national poll published in the Journal of the American College of Surgeons (JACS).* Furthermore, most civilians support training and equipping police officers to perform severe bleeding control on victims as soon as possible, rather than wait for emergency medical services (EMS) personnel to arrive on the scene. Survey respondents also supported the placement of bleeding control kits in public places where large crowds gather, similar to the way that automatic external defibrillators are now found in airports and shopping malls.

Working to save lives

The Joint Committee to Create a National Policy to Enhance Survivability from Intentional Mass Casualty and Active Shooter Events, convened by the American College of Surgeons, recommends careful consideration of these study results. The committee’s deliberations are known as the Hartford Consensus. The Hartford Consensus reports have been published in the Bulletin and JACS since the group’s formation in 2013 and promote the group’s core principle that “no one should die from uncontrolled bleeding.”

To that end, the Hartford Consensus calls for providing law enforcement officers with the training and equipment needed to act before EMS personnel arrive, providing EMS professionals with quicker access to the wounded, and training civilian bystanders to act as immediate responders. This element from the Hartford Consensus is at the heart of the “Stop the Bleed” campaign launched by the U.S. Department of Homeland Security through the National Security Council.

“Stop the Bleed” poster developed for educational purposes by Dr. Jacobs and Ciné-Med

“Stop the Bleed” poster developed for educational purposes by Dr. Jacobs and Ciné-Med

“We know that to save life and limb, you need to stop the bleeding very early—within five to 10 minutes—or victims can lose their lives,” said ACS Regent Lenworth M. Jacobs, Jr., MD, MPH, FACS, Chair of the Hartford Consensus and director of the Trauma Institute at Hartford Hospital, CT. “However, until now, there has been no clear indication of how well trained the general public is in bleeding control and how willing they might be to participate as immediate responders until professionals arrive on the scene.”

Public ready and willing to act

Langer Research Associates, New York, NY, conducted a national telephone survey of the general public, November 6−11, 2015, concluding just two days before the terrorist attacks in Paris. A total of 1,051 telephone interviews were conducted—528 via cellphone and 523 via landline. Respondents were asked whether they had ever participated in first aid training, and, if so, when and whether it included bleeding control instruction. Nearly half of all respondents (47 percent) said that they had received first aid training at some point. Of that number, 13 percent had trained in first aid in the last two years, and 52 percent had first aid trained in the last five years.

Respondents also were asked about their willingness to provide aid to bleeding victims in two different scenarios: a car crash and a mass shooting.

Within the context of the two scenarios, the study authors reported that:

  • Of the 941 respondents able to provide first aid, 98 percent indicated they would be “very likely” or “somewhat likely” to attempt bleeding control on a family member with a leg wound. Within this subgroup, 62 percent indicated they would apply pressure or compression to the wound, 36 percent would apply a tourniquet, 6 percent would cover or wrap the wound in a bandage, and 2 percent would elevate the injured leg.
  • When presented with a scenario of trying to stop severe bleeding in a car crash victim who is unknown to them, 92 percent of a random half sample of respondents indicated they would be very likely (61 percent) or somewhat likely (31 percent) to act.
  • In a mass shooting scenario, 75 percent of the other random half sample responded that they would attempt to give first aid if it seemed safe to act, 16 percent responded that they would wait to see what happens, and 8 percent said they would leave the area. In terms of assisting if the situation seemed safe, 94 percent responded that they would be very likely (62 percent) or somewhat likely (32 percent) to try to help a stranger.

Many respondents reported having major or some concern about several issues related to trying to stop severe bleeding in someone whom they do not know. Specifically, respondents expressed concern about seeing someone bleeding heavily (30 percent), becoming contaminated with a disease (61 percent), endangering personal safety (43 percent), causing a victim additional pain or injury (65 percent), and being responsible for a bad outcome (61 percent). Within the context of rendering assistance in the shooting scenario, 71 percent expressed concern about “putting themselves in physical danger from additional violence.”

Respondents also were asked about their interest in taking a bleeding control class and their support for requiring bleeding control kits in public places. Among the respondents who were physically able to provide first aid, 82 percent said they would be “very interested” or “somewhat interested” in attending a two-hour bleeding control course.

In addition, 93 percent supported the public placement of bleeding control kits (containing gloves, tourniquets, and compression dressings).

The authors also noted strong public approval (91 percent of all surveyed) for training and equipping police officers for severe bleeding control to act as soon as possible before the arrival of EMS personnel, with 65 percent also supporting “faster access of EMS to victims in areas that may not be totally secure.”

“It takes internal fortitude to want to get involved as an immediate responder. We were overwhelmed to learn that the public is prepared to accept this responsibility,” Dr. Jacobs said. “Moving forward, we plan to use these new insights to develop a training program for the public, not just health care professionals, so civilians can learn how to act as immediate responders. We want to steer interested people toward getting the right training and to understand when victims are experiencing the signs of massive bleeding so they can ‘stop the bleed’ and save lives.”


*Jacobs LM, Burns KJ, Langer, G, Kiewiet de Jonge C. The Hartford Consensus: A national survey of the public regarding bleeding control. J Am Coll Surg. 2016;222(5):948-955.

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