Life-saving STB and B-Con techniques need to become as familiar as CPR

Apr 11 2018

Nearly 60,000 people die from bleeding each year, and though injuries that result in extreme blood loss have long been a sight all too common in areas like West Philadelphia, the national spotlight has certainly shone upon the issue of late. These days it seems everyone has a dog in the fight; as politicos battle over gun control legislation, teens march in the streets advocating for improved school safety measures, and debates wear on across the dinner table, trauma experts at the national, state, and local levels are taking cues from decades-long CPR awareness campaigns to improve public education and training in life-saving bleeding control (B-Con) techniques.

Trauma surgeons at Penn Medicine care for several hundred gunshot victims per year. While any one of them would agree that proper CPR training to save the lives of the more than 350,000 people in the United States who suffer out-of-hospital cardiac arrests each year is crucial, the fact of the matter is, they also know that proper application of tourniquets and wound packing is the only way to stem blood loss.

"Medical students and residents new to our trauma rotation are frequently shocked when the first maneuver in the trauma bay is to stop chest compressions on patients who are bleeding profusely," said Brian Smith, MD, an assistant professor of Trauma, Critical Care, and Emergency Surgery at Penn Medicine, adding that not only does CPR result in significantly lower blood pressure, but it is also associated with higher rates of organ damage and death. "Thankfully, bleeding control techniques may be one of the easiest lessons to teach. As the saying goes, 'the engine is just fine, the problem is no gas.'"

CPR training programs have been around since the technique was first developed in 1960. That same year, the American Heart Association (AHA) started a program to train physicians with close-chest cardiac resuscitation. A decade later, the first mass citizen training event was held and in just two years, more than 100,000 people had learned the life-saving technique.

Of course, none of this is meant to suggest that CPR has cracked any sort of code on public awareness of the issue – today, fewer than 1 in 5 adults in the United States have received proper training and according to the AHA, only 46 percent of people who experience a cardiac arrest outside the hospital get the help they need before emergency responders arrive. There's no doubt that there's a long way to go, but with the benefit of nearly 60 years of efforts, advocates have certainly come a long way. For example, all fifty states now have laws and/or regulations requiring that public gathering places have AEDs available, and CPR training courses are widely available online and in-person at training centers or in group settings at libraries, community centers, and other public spaces. And to make training even more accessible, programs like the Mobile CPR Project, led by Benjamin Abella, MD, MPhil, a professor of Emergency Medicine, and a team from Penn's Center for Resuscitation Science, are taking to the streets to bring CPR training directly to communities.

In some regards, Smith says, bleeding control training is even easier than CPR. Just look to a popular t-shirt for the answer: "This shirt can save a life." It references how even a t-shirt can be used to pack a wound and provide pressure to control bleeding; buying the precious minutes needed to get patients to the hospital. This is just one part of the Stop the Bleed Campaign, a simple and effective collection of techniques aimed at reducing blood loss from traumatic injuries.

The Stop the Bleed Campaign was launched by the White House and National Security Council in 2015 in response to the Hartford Consensus conferences after the shooting at Sandy Hook Elementary School. The American College of Surgeons has since operationalized the program and supported the efforts of countless doctors, nurses, paramedics, and other professionals to teach bleeding control skills to the public.

It is estimated that more than 150,000 people have learned the basic steps of direct pressure, wound packing, and tourniquet application instructed during 11,000 course offerings since January of 2017. The campaign marks a significant transition from traditional trauma courses which have focused on in-hospital care, to classrooms outside of our hospital walls.

And while B-Con kits are becoming increasingly visible in the public arena, they are conspicuously absent relative to their better-known AED counterparts so often seen in malls, churches, airports, and classrooms. Funding for such kits remains desperately needed.

"We can offer training with tourniquets, but at the end of the day, if there's nothing to leave behind that people can use in the case of an actual emergency or traumatic injury, witnesses of are left to devise their own methods of bleeding control instead of being able to step in and use the most effective tools available," said John Gallagher, DNP, RN, CCNS, trauma program manager, who is leading bleeding control outreach efforts at Penn Medicine.

Announced earlier this month, Gallagher and other Penn trauma experts are joining forces with the Pennsylvania Trauma Systems Foundation and the Pennsylvania State Police to provide STB tourniquet and wound packing training to all Pennsylvania State Troopers. After completing the 90-minute training course, each officer will receive a combat application tourniquet to carry with them while on duty. The tourniquets are provided through a grant funded by the University of Pittsburgh Medical Center.

Since the start of the STB campaign, B-Con courses have been taught in countless statehouses and have even reached Capitol Hill, with an estimated 20 members of Congress successfully trained. The pool of instructors also continues to grow as doctors, nurses, medics and other healthcare professionals strive to meet the demands of our communities. However, clearly work remains to advocate for this curriculum and the needs of bleeding patients everywhere.

"The sad truth is that in today's climate, life-saving techniques must go beyond basic CPR training," Smith said. "To save a life, we must consider the times, the injuries, and react with appropriate training for all bystanders. Let's use this moment to make STB and B-Con as familiar as CPR."