Above photo by Gregory Guevara
Article by Jeremy Fridling
What Is Stop The Bleed?
2012年，在康涅狄格州纽敦的桑迪胡克小学26人被杀四个月后，美国外科医生学院召集了医学，执法，紧急医疗服务，消防救援局和The Medicine，Griveconce of Medicine，Grivecore，急诊医疗服务和哈特福德的军事。该组织被称为联合委员会，以制定一项国家政策，以提高故意群众和积极的射手事件的生存能力，该组织的任务是制定政策，以改善未来创伤事件的受害者生存能力。这次会议和随后的三场会议导致了哈特福德共识论文的创建。这些论文提出了有关政策，程序和教育变化的建议，目的是最大程度地减少大规模伤亡事件中的生命损失。
一项这样的建议，即在哈特福德共识III中：实施出血控制，呼吁授权公众参与救生行动。传统上，既定的紧急医疗服务和医院护理系统已经提供了创伤护理。但是，在最近的许多大规模伤亡事件中，可预防死亡的主要原因是激怒，许多患者在院前护理人员到达之前已流血致死。委员会呼吁建立“直接响应者”，将轻伤或未受伤的旁观者转变为演员，并授权他们提供救生的出血控制。该委员会还主张增加对专业响应者的出血控制教育，并扩大公众对出血控制设备的访问。
While Tactical Combat Casualty Care (TCCC) has been taught in the military and law enforcement worlds for several years and Tactical Emergency Casualty Care (TECC) has become popular with fire-rescue and EMS in recent times, no course existed to teach laypeople the way CPR is taught. The American College of Surgeons worked with the National Association of Emergency Medical Technicians to create the Bleeding Control Basic class, a one-hour long course based on TCCC and TECC principles designed to provide people of all levels of medical training with the knowledge, skills, and motivation to save lives by treating life-threatening hemorrhage. Specifically, the class teaches how to control bleeding using direct pressure, wound packing, and tourniquet application. Since 2015, the bleeding control course has been delivered to more than 100,000 people in every state in America and in multiple countries worldwide. More than 10,000 instructors have been certified.
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The Stop The Bleed Campaign came out of President Obama’s Presidential Policy Directive 8 for National Preparedness and is endorsed by the Department of Homeland Security. A new campaign, National Stop The Bleed Day, aims to organize a bleeding control course in every state on the same day—March 31英石, 2018—and increase the number of bleeding control trainees to one million people.
Why Does It Matter?
The most common cause of preventable death in mass casualty events like the shooting at Sandy Hook and theshooting at Pulse Nightclubis exsanguination. The Bleeding Control Basic course was developed because many victims died from blood loss before contact with first responders or before making it to a hospital in these and similar incidents. To maximize the chances of victim survival, first responders and members of the public—who are already on scene when the incident takes place—must be educated in the management of traumatic hemorrhage so that patient care can be immediately implemented and maintained all the way through transfer of care to hospital personnel.
In 2015, the Hartford Consensus conducted a telephone survey and found that 82% of able respondents would be interested in attending a two-hour bleeding control course. Although no study to-date has examined the application of treatments by course participants, saves were made at the Boston Marathon Bombing and Route 91 Harvest Festival shooting by members of the public already on scene using the techniques taught by the bleeding control course. Multiple studies have found increased survival rate from bystander cardiopulmonary resuscitation (CPR) attempts in out-of-hospital cardiac arrest, and I believe that studies—when they are conducted—will demonstrate a similar increase in survival from traumatic hemorrhage when bystander treatments are administered.
What Can You Do to Help?
You can teach the class. You can teach members of your department or office, you can teach members of your family, and you can teach members of the public. You can share this lifesaving information and empower people to save themselves and save others. Hosting and teaching a bleeding control class is a great way to perform local outreach and get involved in your community. More and more people are looking to take the class and learn the skills, and the demand for instructors has never been greater. The Hartford Consensus is looking to have trauma first aid kits installed next to AEDs in public facilities, but the equipment does no good unless members of the public are instructed in its use.
To be certified as an instructor by the American College of Surgeons Committee on Trauma, an EMR, EMT, paramedic, RN, PA, or MD only needs to complete the Bleeding Control Basic course and register atwww.bleedingcontrol.org。PHTLS讲师，TECC/TCCC提供者或讲师，以及ATLS提供者或讲师根据其先前的教育资格，只需要注册即可。完成该课程的医学，护理或EMS培训计划的学生可以注册为副讲师，并协助完整的讲师教授课程。
在Frank H. Netter MD医学院，我正在与其他医学生和Quinnipiac大学护理学院的学生合作进行课程，目的是教1,000多人。自2018年1月以来，我们使用社交媒体和口口相传的大约200人教了大约200个人。我们的参与者年龄从17岁到71岁；他们的医学教育水平从没有到医生。他们的职业从学生到退休人员再到急救人员到零售工人再到老师。来自学校和社区中心的管理人员已经接受了主持课程的想法，参与者很高兴能参加和赞赏材料的重要性。
3月31日国家停止流血日英石is approaching, and now is a great time to get involved. Classes are being offered across the country, and many are still open to new students or in need of additional instructors. You, too, can get involved with the Stop The Bleed movement. Find a class near you atwww.bleedingcontrol.org，注册为讲师，并参与您的社区。
References:
1.“ ACS与NAEMT合作，在开发和发布有关出血控制技术的平民培训课程中。”Facs.org，2015年7月9日，www.facs.org/media/press-releases/2015/naemt0715。
2. American College of Surgeons. Bleeding Control Basic (BCon) Course v. 1.0 Instructor Information. Bleeding Control Basic (BCon) Course v. 1.0 Instructor Information, 2017.
3. Gallagher, E. J., et al. “Effectiveness of Bystander Cardiopulmonary Resuscitation and Survival Following out-of-Hospital Cardiac Arrest.”JAMA: The Journal of the American Medical Association，卷。274, no. 24, 1995, pp. 1922–1925., doi:10.1001/jama.274.24.1922.
4. Goolsby, C., Jacobs, L., Hunt, R. C., Goralnick, E., Singletary, E. M., Levy, M. J., … Kirsch, T. D. (2018). Stop the Bleed Education Consortium: Education program content and delivery recommendations.创伤和急性护理手术杂志，84（1），205-210。doi：10.1097/ta.0000000000001732。
5. Herlitz，Johan等。“旁观者CPR的功效：外行人和医疗保健专业人员的干预。”复苏，卷。66, no. 3, 2005, pp. 291–295., doi:10.1016/j.resuscitation.2005.04.003.
6. Jacobs, Lenworth M. “Joint Committee to Create a National Policy to Enhance Survivability from Mass Casualty Shooting Events: Hartford Consensus II.”美国外科医生学院杂志，卷。218, no. 3, 2014, doi:10.1016/j.jamcollsurg.2013.11.004.
7. Jacobs，Lenworth M.等。“改善主动射击事件的生存。”创伤和急性护理手术杂志，卷。74, no. 6, 2013, pp. 1399–1400., doi:10.1097/ta.0b013e318296b237.
8. Jacobs, Lenworth M., et al. “The Hartford Consensus: A National Survey of the Public Regarding Bleeding Control.”美国外科医生学院杂志，卷。222，不。5，2016，第948–955页，doi：10.1016/j.jamcollsurg.2016.02.013。
9. Jacobs，Lenworth M.，联合委员会制定一项国家政策，以提高故意群众和积极的射手活动的生存能力。Hartford共识III：出血控制的实施：如果您看到某事会做些事情。Bull Am Coll Surg。2015; 100：40–46。
10. United States, Congress, Department of Homeland Security. “National Preparedness Goal.” National Preparedness Goal, 1st ed., 2011.
Jeremy Fridling,BA, NRP, TC-P is a medical student at the Frank H. Netter MD School of Medicine at Quinnipiac University interested in Acute Care Surgery. Jeremy is a volunteer firefighter-paramedic at the Cabin John Park Volunteer Fire Department in Montgomery County, Maryland and the West Lanham Hills Volunteer Fire Department in Prince George’s County, Maryland. Prior to attending medical school, Jeremy worked as a firefighter-paramedic at the Westminster Fire Department in Carroll County, Maryland. Jeremy is a TCCC provider and a Bleeding Control instructor. Jeremy has been involved in the fire service since 2010. Photo by Rachel Bojarski.
