An Online Wellness Magazine produced by The University of Texas Health Science Center at Houston (UTHealth)

When Seconds Count

Do you know how to stop the bleed?

You stumble upon the scene of an accident. The victim is bleeding profusely. Do you know what to do?

Even if emergency responders are on their way, you need to stop the bleeding — and fast. In a bleeding emergency, every second counts. A person can die from blood loss within five minutes.

Fortunately, caring for a bleeding person isn’t hard. A few simple steps can keep the injured individual alive until help arrives. McGovern Medical School surgeons based at the Red Duke Trauma Institute at Memorial Hermann – Texas Medical Center are participating in the nationwide Stop the Bleed campaign to empower individuals to act quickly and save lives.

“Our first responders in Houston are amazing,” says Sasha Adams, M.D., a trauma critical care surgeon and assistant professor at McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth). “But they’re not the first people on the scene. Those are bystanders without medical training. The whole point of this effort is to teach those bystanders to recognize a person who may be bleeding to death, and give them a chance to intervene.”

Leading cause of preventable death

The Stop the Bleed campaign was launched in 2013 by the Hartford Consensus, a collaborative group of federal law enforcement, trauma surgeons and emergency responders, to improve survival for the victims of gunshots, and mass-casualty events such as the Sandy Hook Elementary shooting or the Boston Marathon bombings. The consensus concluded that the leading cause of preventable death in these incidents was uncontrolled bleeding.

Since then, the group has developed a public campaign to train health professionals and bystanders how to take action in a bleeding emergency, based on advances made by military medicine and research in hemorrhage control during the wars in Afghanistan and Iraq.

After learning about the campaign at a national meeting of trauma surgeons, Adams became a certified Stop the Bleed instructor, and came back to Houston eager to share her knowledge with the medical students she mentors. Adams directs the surgical clerkship for third-year medical students.

“I have a class of 240 medical students, who work, drive, go get groceries, go to sporting events and are involved in the community. I thought, why not teach them? Because that automatically teaches 240 people in the community every year, and then they can carry that knowledge forward with them,” she says. “It was an immediate benefit, not only to them, but to the community.”

Adams teaches students how to identify the source of bleeding, apply pressure to the wound, pack the wound with gauze and apply a tourniquet in under 30 seconds (she times them). Students also receive Stop the Bleed kits to keep in their cars. Each kit contains an instructional booklet on bleeding control, shears to cut away clothing, a tourniquet, bandages and gauze impregnated with clotting factors and protective gloves. Certified Stop the Bleed instructors from Memorial Hermann Life Flight®, led by its medical director and McGovern Medical School assistant professor of surgery, Joseph Love, D.O., also help staff the classes.

While medical school teaches the basics of bleeding control, extra training gives students confidence to use their skills outside of a medical setting.

“Inside a hospital setting, you are surrounded by a big group of people who all work together to provide care,” says Jared Sheppard, M.D., who attended Adams’ training in May. “Outside the hospital, it’s different. You have to provide care on your own. The training helped me think through the steps and learn how to stop the bleeding before the first responders arrive.”

Sheppard recently graduated from McGovern Medical School, and plans to specialize in trauma surgery. He’s also training to become a Stop the Bleed instructor, so that he can share his knowledge with others.

Simple steps to save a life

The training revolves around three simple steps, Adams says. Before offering care, remember to be aware of your surroundings and move yourself and the injured person to safety if necessary. Then, think ABC.

A is for alert. Alert medical personnel to the emergency. Call 9-1-1.

B is for bleeding. Identify the source of bleeding. Cut away clothes to find where the bleeding is coming from, if necessary.

C is for control. Control the bleeding by applying firm, steady pressure to the bleeding site with both hands, if possible. Then apply bandages or clothing to the bleeding site and continue to apply pressure. If the bleeding does not stop, apply a tourniquet 2-3 inches closer to the torso from the bleeding. If the bleeding still doesn’t stop, place a second tourniquet closer to the torso from the first tourniquet.

“You’re not going to hurt anybody”

Don’t be afraid to use a tourniquet to stop severe bleeding, Adams says. Many people are reluctant to use what was once considered an emergency method of last resort, worried it could lead to the loss of the limb. However, growing evidence shows that’s not the case.

“We know from vascular surgery that you usually have up to six hours before there’s irreversible injury,” Adams says. “So we have time. When people lose an extremity, it is due to the original trauma and damage to the muscle that’s unrelated to blood flow. And if someone is bleeding out, they are not getting any blood to the extremity either.”

Adams cautions against using a makeshift tourniquet out of clothing or a belt, or improperly placing a tourniquet, which can worsen the injury. If no tourniquet is available, continue applying hand pressure and pack the wound with gauze to staunch the bleeding until help arrives.

“With the right training, you’re not going to hurt anybody. In fact, you might save a life. The only thing more tragic than a death from bleeding is a death that could have been prevented.”

As common as CPR and AEDs

Adams envisions a future in which everyone learns how to stop bleeding, and bleeding control kits are as common as automated defibrillators (AEDs) in our public spaces.

“If someone collapses, we know to grab an AED, bring it to them, hook them up, and start CPR. Someone with no medical knowledge can save the life of someone having a major cardiac event. Our hope is that we can put Stop the Bleed kits right next to those AEDs, so you could run straight to the box, grab the kit, and be able to do effective bleeding control,” Adams says.

In addition to medical students, Adams, Love and other certified Stop the Bleed instructors from the Department of Surgery at McGovern Medical School, Memorial Hermann Life Flight® and University of Texas Police Department have trained several medical resident cohorts, members of the Harris County Sheriff's Office, Houston Zoo and other community organizations on bleeding control. “We are also in the process of certifying additional instructors so that we can train even more people in the Houston area on how to Stop the Bleed,” Love adds.

This fall, UTHealth also plans to deploy around 150 Stop the Bleed kits at AED stations located across campus, with extra kits going to each school’s administrative offices. “With increased access to these kits, we should see improved outcomes for emergency bleeding situations in and around our campus,” says Robert Emery, Dr.P.H., vice president of Safety, Health, Environment & Risk Management at UTHealth.

It takes just a few minutes to control bleeding. But that short burst of effort buys trauma surgeons like Adams valuable time. When patients lose massive amounts of blood, they go into shock, and are much harder to resuscitate. If their bleeding is controlled, they have a much better chance at survival when they are treated at the hospital.

Knowing what to do in a bleeding emergency becomes second nature with the right training, Adams says. She sees the results in her students. Over the course of the class they transition from feeling hesitant and somewhat unprepared to intervene in a bleeding emergency in the community, to assured they could take action.

“Now they have the knowledge and the confidence, as well as the actual materials at their disposal, to intervene if they were ever to cross paths with a bleeding person.”

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