Letters to the Editor

Editor’s note: The following comments were received regarding recent articles published in the Bulletin.

Letters should be sent with the writer’s name, address, e-mail address, and daytime telephone number via e-mail to dschneidman@facs.org, or via mail to Diane Schneidman, Editor-in-Chief, Bulletin, American College of Surgeons, 633 N. Saint Clair St., Chicago, IL 60611.

Letters may be edited for length or clarity. Permission to publish letters is assumed unless the author indicates otherwise.

Hemorrhage control training should be mandatory for health care professionals

After every terrible tragedy, we see bystanders, news outlets, and social media forums discussing the importance of hemorrhage control. However, interest in these lifesaving skills waxes and wanes with active shooter or terrorist incidents. In 2016, the National Academies of Science, Engineering, and Medicine published the report, A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths After Injury, which stated that approximately 30,000 potentially survivable deaths occur in the U.S. each year.*

The Hartford Consensus gave us a foundation to eliminate preventable death. The collaboration between the American College of Surgeons and the Department of Homeland Security has helped develop programs like Stop the Bleed® and bleedingcontrol.org to address potentially survivable deaths. The goal: teach bystanders to identify and treat life-threatening bleeding with direct pressure, tourniquets, and pressure dressings.

We expect and encourage the bystander to seek these training opportunities and become certified in bleeding control; however, there is little expectation that medical professionals learn these skills. Bleeding control is not mandatory training in the majority of medical schools, although it’s not uncommon for students to undergo cardiopulmonary resuscitation (CPR) training before matriculation. Nor is bleeding control training offered in many medical schools. Hospitals do not require bleeding control training but often require CPR certification for physicians applying for privileges.

A Stop the Bleed course can be completed in as little as two hours. Many injuries that cause life-threatening bleeding are immediately treatable, and this care will saves lives. Compare this with the results from administering CPR for cardiac arrest, where underlying disease is common—even with the best prehospital treatment and return of spontaneous circulation, outcomes are poor.

Why does the health care system expect bystanders to take bleeding control courses, yet have no expectations of the people who comprise the same health care system? For society to understand the importance of hemorrhage control, all health care professionals should be certified in a bleeding control course. A health care professional is anyone who participates directly in patient care.

The solution starts by mandating bleeding control training for employment as a health care professional at a hospital or clinic. Physician credentialing should require mandatory training that allows the physician to identify and treat life-threatening hemorrhage. Additional courses or instruction are available to identify and treat the other two leading causes of preventable death—tension pneumothorax and airway obstruction.

The next logical step is the requirement that bleeding control be taught early in medical school education—possibly the first week of medical school and with the assistance of emergency medical services and other emergency health care professionals.

These efforts will give medical students a real-life skill and help them understand the importance of preventable death from bleeding. These opportunities can also bring forward students who can eventually become instructors and teach hemorrhage control to the community. In turn, we will help create community outreach projects that will benefit bystanders and medical leaders alike.

We, as health care professionals, cannot expect bystanders to understand the importance of bleeding control and trauma care if health care professionals continue to ignore the importance of these skills. To truly address the impact of trauma and accidents on our population, we must start with health care professionals.

Andrew D. Fisher, MPAS, PA-C, MS-2
Texas A&M College of Medicine
Temple, TX


*National Academies of Sciences, Engineering, and Medicine. A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths After Injury. Washington, DC: The National Academies Press; 2016.

Jacobs LM. Out of unspeakable tragedy comes progress in bleeding control. Bull Am Coll Surg. 2017;102(6):11-16.

Institute of Medicine. Strategies to Improve Cardiac Arrest Survival: A Time to Act. Washington, DC: The National Academies Press; 2015.

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