It is an uncommon gift to come away from an academic conference motivated to implement a significant change in one’s practice; it is even more rare to be so inspired that you decide to create a whole new program or initiative. Yet such was my reaction upon learning the details of the Stop the Bleed® campaign at the American College of Surgeons (ACS) Clinical Congress 2016 in Washington, DC.
In his presentation, ACS Regent Lenworth M. Jacobs, Jr., MD, MPH, FACS, outlined the rationale, process of development, and plans for a nationwide rollout of the Stop the Bleed campaign. The beauty of the program was immediately apparent. It is simple, concise, easily teachable, and has great potential to save lives that might otherwise be lost. Although the program was created in response to the mass casualty events at Sandy Hook Elementary School, Newtown, CT, in 2012, and the 2013 attack at the Boston Marathon, MA, the skills are transferrable and applicable to the treatment of bleeding from any cause.
As I listened to Dr. Jacobs’ presentation, I kept thinking about my own family and my own community in Rochester, NY. My wife and I are both privileged to serve on the executive boards of the city’s major Jewish agencies, where heated arguments continue about whether armed guards should be hired to protect the Jewish Community Center (JCC) and the Community Day School that our three children attend. My mission became clear—I needed to teach this curriculum to the entire staff of each of these organizations and to install hemorrhage control kits in strategic locations throughout these facilities.
Implementation of the program
Implementing the program was surprisingly simple. Like many other surgeons, I attended a brief training session at Clinical Congress and became certified to teach the curriculum. Over the next few weeks, I met with the leaders of the five largest Jewish organizations in Rochester. As anticipated, they all immediately recognized the importance of this project and were enthusiastic about the opportunity to have their staff members trained—and quickly. At each organization, an hour during the next faculty development or continuing education session was designated for hemorrhage control training.
With some training sessions scheduled, I applied for funding from the Louis S. and Molly B. Wolk Foundation, a local philanthropic organization, which awarded a $10,000 grant to launch the project in February 2017. To facilitate fundraising, I partnered with the Jewish Federation, a 501(c)(3) organization, to create a dedicated account for this project, so that contributions to the project would be tax deductible. Two additional grant applications were under review at press time.
Staff of the Kessler Trauma Center at the University of Rochester embraced the project and volunteered to help run the hands-on portion of the training sessions. They also supplied the training tourniquets and the practice models. As the project gained momentum, the Kessler team trained additional volunteer participants, including residents, advanced practice providers, and faculty from the University of Rochester’s departments of surgery and emergency medicine.
The resources available at bleedingcontrol.org made it easy to run the training sessions. The prepared lecture requires approximately 25 minutes to present and is succinct, practical, and effective. It is followed by a hands-on component during which participants interact directly with trained instructor volunteers to practice applying direct pressure, packing wounds, and using tourniquets.
Attendees were engaged, interested, and made a number of interesting comments, such as, “But I thought that bleeding from an artery cannot be stopped,” and, “If there is a bleeding wound with glass in it, should I try to press around the glass, or remove it first and then press?” Questions like this demonstrate the astounding lack of relevant knowledge among some members of the general public and highlight the importance of this training. Others recalled being warned decades ago, as Cub Scouts, to “never apply a tourniquet” and were particularly happy to learn that today’s tourniquets are safe and can, indeed, save lives.
Warm reception leads to expansion
To date, seven training sessions have been offered in Rochester, with 15 to 110 individuals trained at each session. One to 10 volunteer trainers have assisted with each of these programs, and they all have reported finding the experience to be enjoyable and inspiring and have asked to be included in future training sessions. A total of 12 wall-mounted bleeding control stations, available at bleedingcontrol.org, have been purchased and installed. Additional stations will be purchased as more funding is secured.
As anticipated, the response to the program from participating volunteers and course attendees has been uniformly positive (see sidebar). Numerous teachers expressed heartfelt thanks and admitted that they were previously uninformed or intimidated by the subject of bleeding control but now feel empowered to intervene. Some attendees have requested that we run training sessions with other organizations with which they are affiliated. Perhaps the best example of how the program has been received was its recent selection for the Elmer Louis Award, to be presented by the Rochester Jewish Federation. This award honors superior programming that has left a lasting impact, is of great benefit to the community, and has demonstrated proven achievement.
In addition, the program has been expanded, with plans to run training sessions and to install hemorrhage control kits in all 19 Jewish organizations in the greater Rochester area, including summer camps, synagogues, and day care centers. Moreover, as interest in this topic has grown, additional training sessions, open to the entire Rochester community, are scheduled to take place at the JCC.
Sadly, the launch of this project proved to be all-too timely. January and February 2017 were marked by a flare of anti-Semitic activity, with numerous acts of targeted vandalism and violent crime. In addition, more than 100 bomb threats to JCCs (two to ours, in Rochester) and other Jewish education organizations across the U.S. and Canada had been made as of press time, each resulting in evacuation and a full search of the facilities. Fortunately, no bombs were ever found, and an active Federal Bureau of Investigation review is under way.
Make a difference
As acts of violence become more commonplace and as our nation debates whether this trend is attributable to too many or too few firearms, this program transcends politics and ideology. It is a golden opportunity for surgeons across the country to step up and bring critical, potentially lifesaving knowledge to their communities; to dispel misinformation; and to teach critical skills that hopefully will never require use.
Implementing the Stop the Bleed program is proving to be one of the most satisfying and gratifying endeavors of my career. However, while I have been repeatedly thanked for this work, I truly believe that such thanks are largely undeserved and that my work is simply a fulfillment of a shared obligation that we all have to do our part in improving our communities. The real thanks should go to the College, and to Dr. Jacobs in particular, for creating and promoting such a visionary program that will surely save countless lives.
Finally, of the numerous ACS activities that I have participated in, this program makes me most proud of my Fellowship in the College and of the amazing work that our organization does on behalf of our patients. It is my sincere hope that other surgeons also will be inspired to teach this course in their own communities and that these skills will never be tested.