Stop the Bleed® remains one of the most active programs for both the Committee on Trauma (COT) and the Division of Advocacy and Health Policy (DAHP). At press time, more than 335,000 people had learned bleeding control techniques through the national Stop the Bleed program (approximately 315,000 in the U.S. and 20,000 in other countries), with more receiving instruction every day. Throughout 2018, the American College of Surgeons (ACS) has worked with Fellows throughout the U.S. and in our nation’s capital to teach Stop the Bleed to legislators and congressional staff. In addition to potentially saving lives, providing Stop the Bleed training for congressional offices and state legislatures has helped to focus the public’s attention on this vital program. The following is a summary of ACS Stop the Bleed advocacy efforts on the state and federal level.
Members of Congress: In-office training
In 2017, the ACS hosted large-scale trainings on Capitol Hill for both members of Congress and congressional staffers. These efforts included a training in October 2017 that featured an appearance from Rep. Steve Scalise (R-LA), House Majority Whip. Representative Scalise sustained a gunshot injury in June 2017, and bleeding control techniques are credited with helping to save his life. Reps. Roger Marshall, MD (R-KS), and Rodney Davis (R-IL) also participated in the October 2017 event. Upon completion of their training, Representatives Marshall and Davis voiced their support for the Stop the Bleed program on the floor of the House of Representatives and urged their colleagues to help raise awareness of the program and to participate in hemorrhage control training.
In 2018, the ACS’ advocacy approach has focused on training individual members of Congress and their staff in their offices in both Washington, DC, and/or in their district. This approach has resulted in a more personal training experience and has allowed Members of Congress and key committee staffers to gain firsthand knowledge about the Stop the Bleed program. At press time, the ACS has hosted Stop the Bleed trainings in 2018 for the following members of Congress and committees/groups:
- Rep. Bill Flores (R-TX)
- Rep. Raul Ruiz, MD (D-CA)
- Sen. Bill Cassidy, MD (R-LA)
- Staff on the Senate Homeland Security and Government Affairs Committee
- Senate Sergeant at Arms
- House Sergeant at Arms
In July, the ACS hosted a Capitol Hill briefing featuring a panel of experts on military surgical care, including John H. Armstrong, MD, FACS; CAPT Eric Elster, MD, FACS, USN; COL Frederick Lough, MD, FACS; and Arthur Kellerman, MD, MPH. The panelists focused on themes from the recent publication Out of the Crucible: How the U.S. Military Transformed Combat Casualty Care in Iraq and Afghanistan and the role military-civilian trauma partnerships play in maintaining trauma care readiness. The panel highlighted how the prolonged conflicts during Operation Iraqi Freedom and Operation Enduring Freedom saw an unprecedented improvement in military combat casualty care and the creation of the Joint Trauma System (JTS), designed to facilitate the development and dissemination of best trauma practices across the Department of Defense. A key lesson learned from military health care has been the positive impact tourniquets can have on injured patients suffering from severe bleeding. Bleeding control techniques are not only saving lives in the military theater, they are also empowering civilians to become immediate responders and to help save lives.
Appropriations report language
The ACS worked with members of the Senate Appropriations Committee to successfully include language illustrating the importance of Stop the Bleed in the Senate Appropriations Legislative Branch Appropriations Committee Report (S. Rept. 115-274) for fiscal year 2019. The language included in the report underscores the importance of Stop the Bleed training and urges the Sergeant at Arms to work with the Office of the Attending Physician to assist in offering Stop the Bleed training to all congressional staff, both in Washington, DC, and in district offices.* Report language is included with Appropriations legislation to guide the administration and departments in support of the Committee’s priorities.
National Stop the Bleed Day
As the College celebrated the first annual National Stop the Bleed Day on March 31, several state legislatures and members of Congress marked the occasion with formal resolutions and congressional statements.
Congressional statements for the record
Sens. Ron Johnson (R-WI), Chairman of the Senate Homeland Security and Governmental Affairs Committee, and Richard Blumenthal (D-CT) issued statements in the Senate for the Congressional Record affirming the importance of bleeding control training for National Stop the Bleed Day, and Reps. Raul Ruiz, MD (D-CA), and Buddy Carter (R-GA) issued statements in the House of Representatives.
At the state level, Alabama, Georgia, Louisiana, New York, Utah, and Wisconsin passed resolutions recognizing the importance of the Stop the Bleed program, and each of these states (with the exception of Louisiana and Georgia) recognized March 31 as their state Stop the Bleed Day to coincide with the national Stop the Bleed Day. The legislatures in Georgia and Louisiana declared their state Stop the Bleed Day to coincide with the ACS State Chapter lobby days taking place in their states.
2018 Stop the Bleed state activities
In 2018, 17 ACS chapters included Stop the Bleed trainings as part of their state chapter lobby days—Alabama, Arkansas, California, Connecticut, Florida, Georgia, Kansas, Louisiana, Massachusetts, Michigan, North Carolina, Oregon, Tennessee, North and South Texas, Virginia, and Washington. By organizing a Stop the Bleed training program, chapters can educate legislators and staff on how to respond to a severe bleeding injury and build relationships with elected officials in order to discuss other important health care public policy issues. The Georgia, Kansas, Louisiana, and Tennessee Chapters donated bleeding control kits to be installed in their respective state capitols. Georgia, Kansas, and Louisiana donated two wall-mounted bleeding control stations for the House and Senate chambers in their respective states, while Tennessee donated eight individual kits to be added to the capitol’s existing AED (automated external defibrillator) stations.
Before the start of the 2018 state legislative sessions, the College released a bleeding control state legislative tool kit that can be found on the State Advocacy Resources page of the College’s website intended for use by state legislators. This tool kit provides resources including model legislation, sample talking points, sample letters to legislators, sample action alerts, and samples of documents used by other chapters to assist Fellows in advocating for legislation that would lead to the installation of bleeding control kits in public places. Efforts by ACS Fellows resulted in the introduction of such legislation in Massachusetts, Missouri, and North Carolina, while a bill in California was carried over from 2017 to 2018.
The Massachusetts bill, the Trauma Response Preparedness Act, H.D. 4327, received strong support from the state ACS chapter. Working with Rep. Shawn Dooley (R), the chapter helped advocate for passage of the legislation and initiated an Action Alert when Representative Dooley attempted to add the legislation as an amendment to the state’s budget bill. Unfortunately, the budget amendment ultimately failed. However, on August 9, 2018, Representative Dooley and ACS Fellow Lisa Ferzoco, MD, FACS, met with Jim Peyser, Massachusetts Secretary of Education, to discuss potential funding for bleeding control kits in the state’s public schools using surplus budget funding earmarked for school safety.
In North Carolina, the legislature approved public funding for a pilot program for Transylvania County to install bleeding control kits in county schools and to train school personnel. The North Carolina pilot program, launched August 15, included training teachers in the techniques to properly use the bleeding control kits. The sponsor of the pilot, Rep. Cody Hensen (R), has indicated plans to support legislation to expand the program statewide.
Legislation in California was introduced in 2017 and subsequently carried over to 2018, which mandates the installation of bleeding control kits in public places. The California bill did not pass by the end of legislative session. A similar bill in Missouri also failed to pass prior to adjournment of the legislature. And in South Carolina, a bill requiring bleeding control kits in public schools was introduced shortly after the shooting in Parkland, FL, but unfortunately did not pass before the end of session.
At this time, several ACS chapters are taking steps to support the introduction of new legislation requiring that bleeding control kits be installed in public places or schools. Specifically, legislators in Louisiana, Oklahoma, Tennessee, and Texas plan to introduce bills during the 2019 session.
The importance of advocacy
On a daily basis, Congress, policymakers, and state legislatures make decisions that have the potential to affect the surgical profession. To have a robust, effective advocacy program, it is essential that all surgeons and Fellows of the ACS join together with a united voice to engage congressional leaders and public officials in support of patients and surgical priorities.
As the Stop the Bleed program continues to grow, ACS members will play an important role in helping to disseminate the program into their local communities and engaging with their state/federal officials about Stop the Bleed events and activities. If you would like to participate in Stop the Bleed advocacy efforts, contact DAHP staff at firstname.lastname@example.org or 202-337-2701.
The ACS DAHP suggests the following activities to support the Stop the Bleed program:
- Attend the Leadership & Advocacy Summit, March 30–April 2, 2019, in Washington, DC
- Learn more, take action, and explore tools and resources available to surgeon-advocates online at facs.org/surgeonsvoice, in addition to engaging via social media (@SurgeonsVoice)
- Host your federal/state legislators at your facility/practice and engage in the following:
- Site visits
- Facility tours
- Stop the Bleed training courses
- Meet with members of Congress in your home district or in Washington, DC
The DAHP is available to assist with these efforts and can help prepare you for a successful meeting, event, or facility tour.
The authors would like to recognize Jon Sutton, ACS Manager of State Affairs, Division of Advocacy and Health Policy, and Christian Johnson, ACS State Affairs Associate, Division of Advocacy and Health Policy, for their contributions to this article.
*Library of Congress. Title I legislative branch appropriations. Report 115-274. 115th Congress. Second session. June 14, 2018. Available at: www.congress.gov/115/crpt/srpt274/CRPT-115srpt274.pdf. Accessed September 10, 2018.