Adam Hartswick Double Amputee IED Dustoff Video

Adam wants to make sure this video lives on to inspire and educate. It is the least we can do to host the video of his incident here where it can’t be taken down by subjective community standards. It his his story to tell in order to hral and educate.  You dont like this? Go elsewhere. War is not pretty. This video is testament of that. This is meant to be shared, by the patient, for educational purposes.  This video was initially posted by DJ struntz of North American Rescue who worked with Adam to represent his wounds and recovery in the most respectful way possible. I post this here in respect for his wishes with no financial disclosures. We are still privately funded and maintained by soldiers and law enforcement officers. 

***Be aware that the following footage from the incident is GRAPHIC. If you can’t handle graphic footage, don’t watch this video.***

We would like to offer our profound thanks to Adam Hartswick and the crew of DUSTOFF 68 for sharing their story and hope that it will inspire and educate as many people as possible so that more lives are saved in the future. 
Sgt. Adam Hartswick was deployed to Afghanistan with 3-41 Infantry, Alpha Company, when his life was forcefully altered by a devastating attack on his unit May 14, 2013. 

“I was the company senior medic (68W) responding to an attack on our second platoon,” Adam said, recalling that day. “I wasn’t even supposed to go outside the wire that day. I had guard duty, but when I heard that my guys had been hit – I had to go.” Adam jumped into the back of a responding QRF vehicle and rushed to aid his teammates.

“When I arrived at the scene I immediately discovered that my junior platoon medic, SPC Cody Towse and two other Soldiers were dead.” After the initial explosion, Cody had rushed to aid SPC William Gilbert and SPC Mitch Daehling. William had been killed instantly in the blast, but Mitch was still alive and critically injured. As Cody attempted to treat Mitch, he placed his med ruck on the ground and triggered a second device that killed them both instantly. Cody was posthumously recognized for his heroism and awarded the Bronze Star. 

Arriving on scene with the QRF, Adam worked to set up his CCP and treat the wounded.

Adam suffered minor injuries from another explosion but was able to continue his medic duties.

“I shook that off and went to retrieve him when I was blown up,” he said. “It felt like I got hit by a truck! My body was ringing like a tuning fork, but I was still conscious, so I treated myself. I was able to get one CAT (tourniquet) on good and tight but I was missing an index finger and putting that TQ was the hardest thing I’ve ever done. Thankfully the platoon leader was competent in TCCC and came to me (in spite of the danger of other IEDs) and applied a second CAT on my other leg and reassessed and tightened my initial tourniquet.”  The blast from the IED had critically wounded Adam. “My body was a wreck – I had: bilateral transfemoral amputations, right index finger amputation, partial right thumb amputation, large lacerations on right arm, bilateral perforated eardrums, fractured right hip, mild TBI, various shrapnel wounds, and bruises all over my arms and legs. Somehow I had no torso trauma, no facial trauma.”
In what would later be recognized as the 2013 Dustoff Rescue of the Year, DUSTOFF 68, C/2-3 GSAB, Hunter AAF, GA (CPT Douglas Hill, 1LT Kelly Ward, SGT Robert Silva, SGT Jason Daniels, and SGT David Hixson), plucked Adam and a wounded teammate from the IED strewn battlefield and raced them to Role 3 care. Remarkably, despite having both legs being traumatically amputated, Adam remained conscious without any pain management until he reached the Role 3 OR where he continued to joke with nurses until he was anesthetized.

Six days later, Adam was back in the United States at Walter Reed Medical Center recovering from his injuries. Adam’s father, himself career Army, slept in a chair next to his son’s bed for the weeks that it took Adam to fight his way out of intensive care. 

Today, ever thankful for his second chance, Adam works tirelessly to spread the TCCC gospel through his role as a TCCC instructor with Techline Trauma. As Adam puts it, “Every gunfighter needs to be trained to be a medic and every medic needs to be trained to be a gunfighter.”

Some discussion points to get you thinking:

How do you train for MASCALs and who do you include? Including leadership is important because MASCALs are logistics issues on top of medical issues.

Do you take your aid bag off on the “X” or check where you are placing it?

How can you check your route for secondaries, then check your casualty for secondaries near them?

Adam had to apply a TQ wounded. What drills do you teach/train that can prepare a casualty to apply a TQ to themselves or buddy with an injury? (Taping one hand closed so they cant use fingers, having them relax their injured arm so they cant move it, etc.)

What pain management would you have done for Adam?
For further reading :

https://www.army.mil/article/130158/Bittersweet_reunion_in_the_desert

http://www.centredaily.com/news/article42820236.html

http://www.centredaily.com/news/article42921282.html

http://myfightingseason.vhx.tv/

Wound Packing

What do I do if the tourniquet doesn’t reach up high enough on the limb and there is still heavy bleeding from the arm pit or groin?

Once someone learns about tourniquet use and becomes proficient, the above question is the most obvious and common to be asked.  Anyone who has seen the film, “Blackhawk Down” vividly remembers seeing that ranger laying on the makeshift treatment table, shooting blood across the room, a tourniquet powerless to save his life.  You don’t have to be a surgeon or a Ranger medic to stop bleeding for this injury.  This is where proper and aggressive wound packing comes into the picture.  Packing the wound is not meant to soak up the blood.  It is meant to put firm pressure directly against the injured artery or vein, against the bone if possible, which is causing the bleeding.  The other reason to pack a wound is when a properly trained medical provider is attempting to convert a tourniquet down to a pressure dressing.  We will save that discussion for another day.

Hemostatic Gauze is recommended as packing due to the chemicals added to the gauze.  Quick Clot Combat Gauze DOES NOT PRODUCE HEAT.  It works with the body’s natural clotting abilities and is recommended for use by the Committee on Tactical Combat Casualty Care.  Other hemostatic gauzes such as HemCon Chitogauze, ChitoSam 100 and Celox Gauze have chemicals that work independently of the body’s ability to clot which becomes important if you have a patient taking blood thinners or who has other clotting disorders.  Talk to your medical director to find out what is best for you and the patients you are likely to encounter.

Before you begin, remember that if your casualty is conscious this will be an extremely painful procedure.  Do not hesitate.  Blood is life and your temporary mercy, which is really just you being squeamish, will get your patient killed. Harden your heart and do not stop until the bleeding has. 

The video and step by step instructions below are meant to give you an idea on the basics of properly packing wounds. Reading a blog post and watching a video will not make you an expert in tactical medicine.  You have to seek out reputable training and continuously practice and incorporate any skill into realistic training scenarios. 

  • Once massive bleeding is observed direct pressure in the form of a knee or fist should be placed directly into the wound. I prefer the knee, as it keeps my hands free to prepare my packing material or hemostatic gauze.
  • Tightly wad the end of the material into what we call a power ball. This is what you will use to apply direct pressure to the vessel inside the wound.
  • Quickly remove your knee, identify the source of the gushing blood and jam the power ball directly into the source.
  • Don’t worry about the pooled blood in the wound, as you won’t ever get enough out and it doesn’t make a difference with this strategy anyway.
  • Now that you have effectively controlled the source of bleeding, you can relax a little so that you do the next critical steps properly. Remember the key to this is to maintain continuous, firm pressure so you can’t let that power ball move off of the artery while you pack the rest of the gauze or other material on top and around the power ball.
  • Inch the gauze into the wound replacing one finger with another until the wound is entirely packed and you can’t fit any more. This may require multiple roles of gauze or other material depending on the wound. Don’t be surprised and have a plan for more material.
  • If your packing was not effective you will begin to notice blood soaking through the dressing as you hold pressure. Ready another power ball, remove all of the other packing and start over.
  • If you don’t have 5 minutes due to the developing situation or other patients, be sure to wrap the pressure dressing on top of the packing and secure it before moving on.
  • If it was effective and no blood is noticed during the 5 minutes you are holding pressure you can apply a tightly wrapped and secured pressure dressing.

Improvising medical equipment such as tourniquets and packing material should not be your plan A.  Carry a minimal med kit on and off duty and be aware of where bleeding control kits are available in public places.  I routinely carry a tourniquet and flat folded hemostatic gauze everywhere I go, especially if I am carrying a weapon.  Both tourniquets and hemostatic dressings are TSA friendly and can be carried on to an airplane.  If however, you find yourself in a mass casualty situation or another unexpected situation where you need to pack a wound pick the right material with which to improvise.  A ripped up t-shirt makes great wound packing material because you can wad it up tightly into the proper powerball configuration explained above and demonstrated in the video.  What you don’t want is anything fluffy that just soaks up blood without having the ability to apply point pressure.  Tampons make for terrible wound packing when packing a massively bleeding arterial wound.  Do not use a tampon.  Even if you are barricaded in a bathroom with a bleeding casualty pick toilet paper over the basket of tampons.  At least the toilet paper can be waded up and pressed tightly into the wound against the artery.  If your packing has failed and a tourniquet won’t reach your next option will be a junctional tourniquet or even just holding junctional pressure until help arrives.  This will be covered in a future post.

Check out the video below…

https://youtu.be/RwaaGXOrWW8

Get a Tourniquet and Get Started

If you have never been trained to use a tourniquet this is a good starting point in learning what you need to know.  This is written for the complete beginner.  Don’t be ashamed to take responsibility and learn to save a life, even your own.  You should also not be timid about being prepared to save the lives of those you serve with and those you love.  Please post any questions, concerns and comments below.


Human Anatomy Basics You Must First Understand to Stop Bleeding

Tourniquets use mechanical advantage to pinch the arteries against the bones.

Apply high and tight on the injured limb to stop all blood flow to that limb.

The tourniquet can be safely converted or removed later by trained personnel.


When to Use the Tourniquet

Any massive bleeding at all.

Any bright red spurting blood.

Any bleeding you can’t control with direct pressure or any other bandage.

Any bleeding you don’t have time to mess with due to the developing situation.

They can all be safely converted to a regular dressing or removed later.


Parts of a Commercially Available Tourniquet

CAT TQ

The Only 2 CoTCCC Approved Tourniquets: SOFTT-W or the CAT

Click here for the USMCHoss review on both tourniquets

Watch Police Chief Flory explain the application of a SOFTT-W

Manufacturer and Industry Videos

Watch the ITS Tactical SOFTT-W Video

Click here to watch the North American Rescue CAT video


Beware of Counterfeit and Non-Approved or Untested Tourniquets

Tourniquets are medical devices that should go through rigorous testing to ensure that they do what they are supposed to safely.  Knock offs sold by unreliable, no-name online shops have been known to fail at the worst times.  Be sure that you buy from a reputable source.  We can mention some sellers in the comments.


Stowage

If you don’t have it with you it won’t do any good when you need it:

 Ankle holster kit     PR-KydexTQPhoto     1005-Open__44133.1305296922.1280.1280

There are many options available.


Improvising a Tourniquet on the Spot

Improvised tourniquets have failed time and time again.  Your Plan-A should not be to improvise what you may or may not find on the street in an emergency.  If you find yourself in a situation where you must put something together you should remember to secure it tightly and be sure to reassess that it hasn’t stopped working often.  Be sure that it is working in the first place and can apply the amount of force necessary with some kind of mechanical advantage.  The mechanical advantage is one of the main difference between a pressure dressing and a real tourniquet.


Hands-on Familiarization

 You must practice using a tourniquet on yourself.  You have to be able to put one on, under pressure while exhausted and covered in blood, in an uncomfortable position in pitch darkness using your both your dominant and, more importantly, non-dominant hand.  If you cannot you are a liability to yourself and to your partner and community.  You can do this right now.  Stop reading. Go practice.  Then come back and let us know what worked for you.


Get More Training

If learning this basic skill has motivated you to learn more, there are numerous programs available to seek further training.

The Committee on Combat Casualty Care (CoTCCC) has been advocating for tourniquet use by every deployed soldier, not just medics, for years now.

The Committee for Tactical Emergency Casualty Care (CTECC) now published guidelines specific to law law enforcement and tactical medical providers domestically. Check them out at: http://www.c-tecc.org/

First Care Provider is making tourniquet training available to civilians.

Tactical medical training for Law enforcement is becoming more and more widely available, if you are interested in a good program in your area post a question below and you will get some great advice and direction.


Get Equipped. Get Educated. Get Trained.  Save Lives.

“IF YOU SEE SOMETHING, DO SOMETHING!”

“The most significant preventable cause of death in the prehospital environment is external hemorrhage.” 

The following article was reprinted here with permission from the Chairman of The Hartford Consensus, Lenworth M. Jacobs, MD, MPH, Dsc(Hon), FWACS(Hon), FACS

Click the link to download the full PDF:

TCCC Jacobs HCS III ACS Bulletin 2015

Or read below: 

 

The Hartford Consensus III: Implementation of Bleeding Control
by Lenworth M. Jacobs, Jr., MD, MPH, FACS, and the Joint Committee to Create a National Policy to Enhance Survivability from Intentional Mass-Casualty and Active Shooter Events
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Editor’s note: The Joint Committee to Create a National Policy to Enhance Survivability from Intentional Mass-Casualty and Active Shooter Events developed the following call to action at its April 14 meeting in Hartford, CT. This committee meeting, chaired by American College of Surgeons (ACS) Regent Lenworth M. Jacobs, Jr., MD, MPH, FACS, focused on implementation of strategies for effective hemorrhage control. The deliberations of the group yielded the Hartford Consensus III document. This report was presented at a White House roundtable forum on April 29, which included representatives from 35 medical and surgical, nursing, law enforcement, fire, emergency medical services (EMS), and other stakeholder organizations (see pages 22 and 24 for lists of participating organizations and agencies). The participants unanimously endorsed the principles set forth in the Hartford Consensus III. The following is the Hartford Consensus III, edited to conform with Bulletin style. Our nation’s threat from intentional mass-casualty events remains elevated. Enhancing public resilience to all such potential hazards has been identified as a priority for domestic preparedness. Recent events have shown that, despite the lessons learned from more than 6,800 U.S. combat fatalities over the last 13 years, opportunities exist to improve the control of external hemorrhage in the civilian sector.* These opportunities exist in the form of interventions that should be performed by bystanders known as immediate responders and professional first responders, such as law enforcement officers, emergency medical technicians (EMTs), paramedics, and firefighters (EMS/ fire/rescue), at the scene of the incident. The Joint Committee to Create a National Policy to Enhance Survivability from Intentional Mass-Casualty and Active Shooter Events was founded by the ACS. The committee met twice in 2013, making specific recommendations and issuing a call to action. The deliberations of the committee have become known as the Hartford Consensus. A third meeting was convened on April 14. This Hartford Consensus III meeting
focused on implementation strategies for effective hemorrhage control. The overarching principle of the Hartford Consensus is that in intentional mass-casualty and active shooter events, no one should die from uncontrolled bleeding. An acronym to summarize the necessary response is THREAT:
• Threat suppression 

• Hemorrhage control 

• Rapid Extrication to safety 

• Assessment by medical providers 

• Transport to definitive care

The Hartford Consensus calls for a seamless, integrated response system that includes the public, law enforcement, EMS/fire/rescue, and definitive care to employ the THREAT response in a comprehensive and expeditious manner.
Three levels of responders There are different levels of responders in an intentional mass-casualty or active shooter event:
• Immediate responders: The individuals who are present at the scene who can immediately control bleeding with their hands and equipment that may be available
• Professional first responders: Prehospital responders at the scene who have the appropriate equipment and training
• Trauma professionals: Health care professionals in hospitals with all of the necessary equipment and skill to provide definitive care
Immediate responders One goal of the Hartford Consensus III is to empower the public to provide emergency care. During intentional mass-casualty events, those present at the point *Holcomb JB, Hoyt DB. Comprehensive injury research. JAMA. 2015; 313(14):1463-1464.
Recent events have shown that, despite the lessons learned from more than 6,800 U.S. combat fatalities over the last 13 years, opportunities exist to improve the control of external hemorrhage in the civilian sector.
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continued on page 23
Lenworth M. Jacobs, Jr., MD, MPH, FACS Chairman, Hartford Consensus Vice-President, Academic Affairs Hartford Hospital Board of Regents, American College of Surgeons
Richard Carmona, MD, MPH, FACS 17th U.S. Surgeon General
Norman McSwain, MD, FACS Medical Director, Prehospital Trauma Life Support Tulane University
Frank Butler, MD, FAAO, FUHM Chairman, Committee on Tactical Combat Casualty Care Department of Defense Joint Trauma Systems
Doug Elliot President, The Hartford Chair, Board of Directors Hartford Hospital
Andrew L. Warshaw, MD, FACS, FRCSEd(Hon) President, American College of Surgeons Massachusetts General Hospital, Boston
Jonathan Woodson, MD, FACS Assistant Secretary of Defense for Health Affairs, Department of Defense
Richard C. Hunt, MD, FACEP Director for Medical Preparedness Policy, National Security Council Staff The White House
Ernest Mitchell Administrator, U.S. Fire Administration Federal Emergency Management Agency Department of Homeland Security
Alexander Eastman, MD, MPH, FACS Major Cities Police Chiefs Association Chief of Trauma, Parkland Memorial Hospital University of Texas Southwestern Medical Center
Kathryn Brinsfield, MD, MPH, FACEP Assistant Secretary, Health Affairs Chief Medical Officer, Department of Homeland Security
Colonel Kevin O’Connor, DO, FAAFP Physician to the Vice-President The White House
William Fabbri, MD, FACEP Director, Emergency Medical Services Federal Bureau of Investigation
Richard Serino Distinguished Visiting Fellow, Harvard University, School of Public Health 8th Deputy Administrator, Federal Emergency Management Agency
Alasdair Conn, MD Chief Emeritus, Emergency Medicine Massachusetts General Hospital
Karyl Burns, PhD Research Scientist, Hartford Hospital
Matthew Levy, DO, MSc, FACEP Johns Hopkins University Senior Medical Officer, Johns Hopkins Center for Law Enforcement Medicine
Leonard Weireter, MD, FACS Vice-Chair, Committee on Trauma American College of Surgeons Eastern Virginia Medical School
John Holcomb, MD, FACS Chief, Division of Acute Care Surgery University of Texas Health Science Center
Peter Rhee, MD, MPH, FACS Department of Surgery University of Arizona
Ronald Stewart, MD, FACS Chair, Committee on Trauma American College of Surgeons The University of Texas Health Science Center at San Antonio
Robert Anderson, CDR, MSC, USN Military Assistant to the Assistant Secretary of Defense for Health Affairs Department of Defense
Thomas M. Scalea, MD, FACS Physician-in-Chief, R Adams Cowley Shock Trauma Center University of Maryland School of Medicine
Donald Jenkins, MD, FACS Medical Director, Trauma Center Mayo Clinic
David R. King, MD, FACS Trauma, Emergency Surgery and Surgical Critical Care Department of Surgery Massachusetts General Hospital
V100 No 7 BULLETIN American College of Surgeons
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THE HARTFORD CONSENSUS III: IMPLEMENTATION OF BLEEDING CONTROL
JOINT COMMITTEE TO CREATE A NATIONAL POLICY TO ENHANCE SURVIVABILITY FROM INTENTIONAL MASS-CASUALTY AND ACTIVE SHOOTER EVENTS
PARTICIPANTS
of wounding have often proven invaluable in responding to the initial hemorrhage control needs of the wounded. Traditionally thought of as “bystanders,” these immediate responders should not be considered passive observers and can provide effective lifesaving first-line treatment. Immediate responders contribute to a victim’s survival by performing critical external hemorrhage control at the point of wounding and prior to the arrival of traditional first responders. Immediate responders contribute to what is the critical step in eliminating preventable prehospital death: the control of external hemorrhage. The Hartford Consensus III recognizes the vital role that immediate responders play in responding to mass-casualty events. They make major contributions to improving survival from these incidents. However, the Hartford Consensus III does not advocate that members of the public enter areas of direct threat or imminent danger. Good Samaritan laws have been effective in empowering the public to become involved in the immediate response to a victim of cardiac arrest or choking by the initiation of cardiopulmonary resuscitation and the Heimlich maneuver, respectively. The Hartford Consensus recommends that these legal protections be extended to include the provision of bleeding control.
Professional first responders Professional first responders include law enforcement and EMS/fire/rescue. As indicated by THREAT, law enforcement must suppress the source of wounding if the shooter is still active and then, because they are
usually the initial first responders on the scene, must act to control external hemorrhage. Victims with life-threatening external bleeding must be treated immediately at the point of wounding. All responders should be educated and have the necessary equipment to provide effective external hemorrhage control. Continued emphasis must be on the integration of the immediate responders, law enforcement, and EMS/ fire/rescue to optimize rapid patient assessment, treatment, and transport to definitive care at the nearest appropriate hospital.
Building educational capabilities Education in hemorrhage control can take many forms and should be offered using various modalities. Established education programs for individuals, communities, and professional responders can be modified to include effective external hemorrhage control techniques. The Bleeding Control for the Injured (B-Con) course offered by the National Association of Emergency Medical Technicians is an example of a newly created program that is appropriate for training individuals who have little or no medical background. Other methods such as public service announcements, slogans, advertising, and entertainment media should be used to convey the message that bleeding control is a responsibility of the public and is within their capabilities. The public needs to be empowered to engage in lifesaving actions. This training should be included as part of preparing for situations involving other
Hartford Consensus III participants. Seated, left to right: Drs. McSwain, Warshaw, Jacobs, Woodson, Brinsfield, and Levy; and Mr. Elliott. Standing left to right: Dr. Rhee, Mr. Mitchell, Drs. Eastman, Conn, O’Connor, Stewart, Butler, Burns, Weireter, Hunt, Holcomb, and Fabbri; and Commander Anderson.
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HARTFORD CONSENSUS III
potential hazards, including everyday events that may produce trauma and hemorrhage. For professional first responders, more advanced courses may offer additional options to control life-threatening external hemorrhage. All formal training should have specific objectives and train to competency. For professional responders, the training must be efficient and costeffective. Ultimately, integrated training exercises must be conducted that include all levels of responders. Specific educational content for immediate responders should include:
• Actions to ensure personal safety
• Appropriate interactions with law enforcement, EMS/ fire/rescue, and medical personnel
• How to identify bleeding as a threat to life
• Use of hands to apply direct pressure
• Proper use of safe and effective hemostatic dressings
• Proper use of effective tourniquets
• Use of improvised tourniquets as a last resort
For professional first responders, educational content should include:
• Actions to ensure personal safety
• Coordination and integration of all responders
• Communication among all responders
• Appropriate interactions with immediate responders
• Application of THREAT principles
• Proper use of direct pressure
• Proper use of safe and effective hemostatic dressings
• Proper use of effective tourniquets
It is appropriate to use existing national organizations to widely disseminate the principles embodied in these education initiatives.
• Air Medical Physician Association • American Academy of Physician Assistants • American Ambulance Association • American Association of Critical Care Nurses • American Association for the Surgery of Trauma • American College of Emergency Physicians • American College of Surgeons • American Heart Association • American Hospital Association • American Nurses Association • American Osteopathic Association • American Physical Therapy Association • American Public Health Association • American Trauma Society
• Association of Air Medical Services • Association of State and Territorial Health Officials • Eastern Association for the Surgery of Trauma • Emergency Nurses Association • Emergency Medical Services Labor Alliance • International Academies of Emergency Dispatch • International Association of Chiefs of Police • International Association of Emergency Managers • International Association of Emergency Medical Services Chiefs • International Association of Firefighters • International Association of Fire Chiefs
• Major Cities Chiefs Association • National Association of Emergency Medical Technicians • National Association of School Nurses • National Association of State EMS Officials • National Athletic Trainers Association • National Emergency Management Association • National Volunteer Fire Council • Society of Emergency Medicine Physician Assistants • Society of Trauma Nurses • Trauma Center Association of America • White House personnel • Interagency Bystander Workgroup team leaders • Federal invitees
APRIL 29, 2015
ROUNDTABLE ON BYSTANDERS: OUR NATION’S IMMEDIATE RESPONDERS
PARTICIPANTS
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JAMES BROOKS HART, CMI
JAMES BROOKS HART, CMI
Building equipment capabilities Immediate responders need to recognize that applying pressure to a bleeding vessel is the appropriate first action to take and that their hands are a first-line resource. In most cases, control of external hemorrhage can be accomplished by applying direct pressure on the bleeding vessel. Hemostatic dressings and tourniquets may be needed to effectively stop bleeding. For this reason, the Hartford Consensus recommends that all police officers and any concerned citizens carry a hemostatic dressing, a tourniquet, and gloves. This guideline should also apply to all EMS/fire/rescue personnel. Ground and air medical transport vehicles should carry multiple dressings and tourniquets based upon local need. In addition, bleeding control bags should be accessible in public places as determined by a local needs assessment. Potential sites for bleeding control bags include shopping malls, museums, hospitals, schools, theaters, sports venues, transportation centers (such as airports, bus depots, and train stations), and facilities with limited or delayed access. All hemostatic dressings and tourniquets must be clinically effective as documented by valid scientific data. The Tactical Combat Casualty Care guidelines for the U.S. military contain objective evidence to support the safety and efficacy of the various options for tourniquets and hemostatic dressings. Contents of the bleeding control bags should include the following:
• Pressure bandages • Safe and effective hemostatic dressings • Effective tourniquets • Personal protective gloves
Placement of bleeding control bags should be as follows:
• Next to all automatic external defibrillators based on local need
• Immediately recognizable visually or via a Web application
• Secure but accessible locations
• Able to be used within three minutes
Building resources for bleeding control programs Procurement of equipment and training for bleeding control requires action at the federal, state, and local levels, as well as in the private sector. Tourniquet and hemostatic dressing procurement should reflect either the evidence and experience that the U.S. military has gained in the last 13 years of war or scientific evidence that becomes available. Federal agencies should make elimination of preventable death from hemorrhage a priority issue that will influence funding. At the
One-handed tourniquet application
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HARTFORD CONSENSUS III
Immediate responder hemorrhage control
state and local levels, government should interact with the private sector to identify potential risks at public venues and workplaces. It is also important to note that municipalities can engage in fundraising activities at the local level to procure equipment. Professional organizations should set standards that encourage education, equipment, and training for immediate responders, which should be offered as a measure of public safety. Volunteers can be a resource to provide the training. Considerations for the development and sustainability of bleeding control programs include the following:
• Using clear and concise messaging that bleeding control is an issue for public and private sectors
• Engaging the private sector, including businesses and trade associations
• Appealing to philanthropic organizations
• Applying for grant funding from government and private agencies
• Involving professional, community, social, and faithbased organizations
Conclusion The most significant preventable cause of death in the prehospital environment is external hemorrhage. As demonstrated by guidelines enacted by the military, widespread bleeding control is critical to saving lives. Our nation has a history of learning hard lessons from wartime experiences; the case for hemorrhage control is no different. The Hartford Consensus directs that all responders have the education and necessary equipment for hemorrhage control and strongly endorses civilian bystanders to act as immediate responders. Immediate responders represent a foundational element of the ability of the U.S. to respond to these events and are a critical component of our ability to build national resilience. Immediate responders must be empowered to act, to intervene, and to assist. We are a nation of people who respond to others in need. It is no longer sufficient to “see something, say something.” Immediate responders must now “see something, do something.” ♦
Author’s note All text and images in this article © the Hartford Consensus. Permission to reprint granted by Dr. Jacobs. For permission to reprint or for more information, contact Dr. Jacobs at lenworth.jacobs@hhchealth.org.
JAMES BROOKS HART, CMI
JAMES BROOKS HART, CMI
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