the national “stop -the -bleed” initiative · 2018. 4. 24. · © american college of surgeons...
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© American College of Surgeons 2017. All rights reserved Worldwide.
The National “Stop-The-Bleed” Initiative
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Disclosures
Nothing to disclose
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Introduction
Uncontrolled hemorrhage remains the single most preventable cause of death after traumatic injury.
Hegvik JR, et al. J Am Coll Surg 2017
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Introduction
There is no such thing as a “Golden Hour” for patients with exsanguinating hemorrhage.
“Platinum 15 minutes”
Jacobs LM, et at. JACS 2014
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Introduction
The greatest opportunity to save lives after injury is in the prehospital setting.
NASEM Report, 2016
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The trauma care chain of survival
A National Trauma Care System: Integrating Military and
Civilian Trauma Systems to Achieve ZERO preventable
deaths after injury.
NASEM June 2016
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Lessons out of conflict
“The military’s experience with rapid bleeding control is not only relevant but also timely”.
Rasmussen TE, et al. J Trauma 2015
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Lessons out of conflict
Review of 4,596 US combat fatalities, 2001-2011
Incidence of preventable death from extremity hemorrhage dropped (7.8% → 2.6%)
- 67% decrease
Decrease coincided with widespread fielding of tourniquets to US forces
Eastridge BJ, et al. J Trauma 2012
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Lessons out of conflict
No preventable loss of limbs due to tourniquets [232 patients, 309 extremities]
Kragh JF, et al. J Trauma, 2008
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Lessons out of conflict
The fatal triad of trauma
Kragh JF, et al. Ann Surg 2009
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How we got here
Evolving civilian injury
patterns
Lessons learned in war
Hartford Consensus Evolution of B-Con
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Evolution of B-con
HC, June 2013
HC II, Septem
ber 2013
Sandy Hook, December 2012
No one should die from uncontrolled bleeding A national call to action – ANSWERED BY THE AMERICAN COLLEGE OF SURGEONS
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Hartford Consensus II
- Law Enforcement External hemorrhage control is a core law
enforcement skill.
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Hartford Consensus II/TECC
- EMS/fire/rescue Response must be more fully integrated and
traditional role limitations revised.
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Hartford Consensus II/TECC
- Public Uninjured or minimally injured victims can act as
rescuers.
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Evolution of B-con
HC, June 2013
HC II, Septem
ber 2013
B-Con developed, Jan 2014
Sandy Hook, December 2012
Stress importance of early hemorrhage control Empower immediate responders Integrate lessons learned from military
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Hartford Consensus III/TECC
Role of “immediate responder”
Building educational capabilities
Expand equipment capabilities
Develop bleeding control programs
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Operationalizing B-con education
Stress importance of “preparedness”
Focus on “all hazards” Relevance of skill set
Key Concepts Empower civilians as “immediate responders”
Early (immediate) bleeding control
Public awareness is critical
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B-Con
Course is designed to educate and empower the public to recognize and stop severe bleeding before the arrival of medically trained first responders.
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Current status of B-Con training
As of 3/5/2018
14,300 Instructors trained
• All 50 states
• 42 Countries
>100,000 students trained
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EMS Scope of Practice
Change notice submitted.
▫ Review by expert panel
▫ Recommendation that wound packing and tourniquet use be included in scope of practice at all responder levels
February 2007
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BLEEDINGCONTROL.ORG
The only thing more tragic than a death… is a death that could have been prevented.