© American College of Surgeons 2017. All rights reserved Worldwide.

The National “Stop-The-Bleed” Initiative

© A

mer

ican

Col

lege

of S

urge

ons 2

017.

All

right

s res

erve

d W

orld

wid

e.

Disclosures

Nothing to disclose

© A

mer

ican

Col

lege

of S

urge

ons 2

017.

All

right

s res

erve

d W

orld

wid

e.

Introduction

Uncontrolled hemorrhage remains the single most preventable cause of death after traumatic injury.

Hegvik JR, et al. J Am Coll Surg 2017

© A

mer

ican

Col

lege

of S

urge

ons 2

017.

All

right

s res

erve

d W

orld

wid

e.

Introduction

There is no such thing as a “Golden Hour” for patients with exsanguinating hemorrhage.

“Platinum 15 minutes”

Jacobs LM, et at. JACS 2014

© A

mer

ican

Col

lege

of S

urge

ons 2

017.

All

right

s res

erve

d W

orld

wid

e.

Introduction

The greatest opportunity to save lives after injury is in the prehospital setting.

NASEM Report, 2016

© A

mer

ican

Col

lege

of S

urge

ons 2

017.

All

right

s res

erve

d W

orld

wid

e.

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

© A

mer

ican

Col

lege

of S

urge

ons 2

017.

All

right

s res

erve

d W

orld

wid

e.

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

© A

mer

ican

Col

lege

of S

urge

ons 2

017.

All

right

s res

erve

d W

orld

wid

e.

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

© A

mer

ican

Col

lege

of S

urge

ons 2

017.

All

right

s res

erve

d W

orld

wid

e.

Lessons out of conflict

No preventable loss of limbs due to tourniquets [232 patients, 309 extremities]

Kragh JF, et al. J Trauma, 2008

© A

mer

ican

Col

lege

of S

urge

ons 2

017.

All

right

s res

erve

d W

orld

wid

e.

Lessons out of conflict

The fatal triad of trauma

Kragh JF, et al. Ann Surg 2009

© A

mer

ican

Col

lege

of S

urge

ons 2

017.

All

right

s res

erve

d W

orld

wid

e.

How we got here

Evolving civilian injury

patterns

Lessons learned in war

Hartford Consensus Evolution of B-Con

© A

mer

ican

Col

lege

of S

urge

ons 2

017.

All

right

s res

erve

d W

orld

wid

e.

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

© A

mer

ican

Col

lege

of S

urge

ons 2

017.

All

right

s res

erve

d W

orld

wid

e.

Hartford Consensus II

- Law Enforcement External hemorrhage control is a core law

enforcement skill.

© A

mer

ican

Col

lege

of S

urge

ons 2

017.

All

right

s res

erve

d W

orld

wid

e.

Hartford Consensus II/TECC

- EMS/fire/rescue Response must be more fully integrated and

traditional role limitations revised.

© A

mer

ican

Col

lege

of S

urge

ons 2

017.

All

right

s res

erve

d W

orld

wid

e.

Hartford Consensus II/TECC

- Public Uninjured or minimally injured victims can act as

rescuers.

© A

mer

ican

Col

lege

of S

urge

ons 2

017.

All

right

s res

erve

d W

orld

wid

e.

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

© A

mer

ican

Col

lege

of S

urge

ons 2

017.

All

right

s res

erve

d W

orld

wid

e.

Hartford Consensus III/TECC

Role of “immediate responder”

Building educational capabilities

Expand equipment capabilities

Develop bleeding control programs

© A

mer

ican

Col

lege

of S

urge

ons 2

017.

All

right

s res

erve

d W

orld

wid

e.

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

© A

mer

ican

Col

lege

of S

urge

ons 2

017.

All

right

s res

erve

d W

orld

wid

e.

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.

© A

mer

ican

Col

lege

of S

urge

ons 2

017.

All

right

s res

erve

d W

orld

wid

e.

© A

mer

ican

Col

lege

of S

urge

ons 2

017.

All

right

s res

erve

d W

orld

wid

e.

Current status of B-Con training

As of 3/5/2018

14,300 Instructors trained

• All 50 states

• 42 Countries

>100,000 students trained

© A

mer

ican

Col

lege

of S

urge

ons 2

017.

All

right

s res

erve

d W

orld

wid

e.

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

© A

mer

ican

Col

lege

of S

urge

ons 2

017.

All

right

s res

erve

d W

orld

wid

e.

BLEEDINGCONTROL.ORG

The only thing more tragic than a death… is a death that could have been prevented.