Public Access Bleeding Kits Can Help Save Lives

Most people have a first aid kit in their medicine cabinets, glove boxes and even desk drawers. Someday, a “severe bleeding kit” might become a permanent fixture as well.

The Town of Davie, in south Florida, recently implemented a program to place severe bleeding kits in all of the town-owned buildings and train everyone to use the tourniquets in the kits. Often, during mass casualty incidents, first responders cannot get to everyone immediately. The citizens become the first responders. With proper training and equipment, the citizens can help improve patient outcomes.

The program is the brainchild of Peter Antevy, MD, a physician at Joe DiMaggio Children’s Hospital and medical director for several fire departments, including the Davie Fire Rescue Department. Antevy, the inventor of the Handtevy Pediatric Box, also serves on the EMS World editorial advisory board.

“We are in an urban environment with a number of active shooters,” Antevy says. “Many times, people bleed out before they can get professional help. We realized that the majority of deaths were treatable.”

Most violent or mass casualty incidents require police officers to secure the scene first.

“In many situations, firefighters and medics have to stay outside until the scene is secure,” Antevy says. “We recommended that a couple of paramedics could go in with the first police officers, but we had a lot of resistance about that in south Florida. So we asked the police to carry a tourniquet kit. They said ‘no,’ even when we suggested it might help save one of their own lives.”

Antevy tried a different approach.

“I went to our EMS chief (Julie Downey) and talked to her about adding kits with tourniquets,” Antevy said. “She thought it was a great idea but we would have to train people to use them first.”

That is exactly what the Davie Fire Rescue Department did.

“We had some resistance at first but then the people who learned discovered that it’s relatively easy,” Antevy says. “We have given the training to people with no medical background and it’s basically a 1-minute instruction on how to use it. I think there is value in it and value in teaching it through the fire department’s CPR classes and public expos. More and more, people are finding themselves in situations with active shooters and we are actively teaching people how to escape and hide. But instead of just hiding, this helps them possibly save a life. Ironically, once the police force heard about how easy it was, they started educating themselves.”

The severe bleeding kits, which Antevy and Downey created, each are contained in basic pencil boxes and include:

• 2 Combat Application Tourniquets (CATs)
• Quick-clot gauze
• 2 5x9 simple gauze pads
• 2 rolls of regular gauze
• 1 set of gloves

“We assembled the kits ourselves,” says Downey, who is the assistant chief, Division of EMS, for the Davie Fire Rescue Department. “It was easy to do. I would encourage anybody to do something like this. It cost the Town of Davie just $2,500 to create these for the entire town.”

The severe bleeding kits were added to the 60 AEDs that the Town of Davie previously mandated for inclusion in all Town-owned facilities. Since the program began six months ago, more than 600 Town of Davie employees and 200 people from the general public have received training.

“We put the equipment in our high-profile areas, outside at the police shooting range, in the fire stations, in the town hall, at the pool, in our parks and in the garage that has a lot of heavy equipment,” Downey says. “It’s really easy to learn how to use each item in the kit. It can be used for any type of mass casualty incident–an airplane crash, a car accident. We provide CPR training to lots of businesses, the Girl Scouts, the Boy Scouts and other groups. Within that, we have severe bleeding training and we are talking to them about how to make makeshift tourniquets or their own kits. We’re hoping nobody ever has to use one, but if they do, the more people who are trained and have access to them, the more the chance someone’s life can be saved.”

Ultimately, Antevy envisions widespread use and need for severe bleeding kits.

“In five years, I think it’s realistic to have severe bleeding kits in every glove box, every teacher’s drawer and every emergency room,” Antevy says. “Every teacher should have and know how to use one. We’ve heard in tragedies such as the Sandy Hook shooting, the man who was shot recently at the Los Angeles airport, even as far back as Columbine, how people bled out because medics and first responders couldn’t get to them in time. But if people on the inside know how to do it, it could save lives. I think the concept will catch on everywhere.”

Davie Police Officers Carry Individual Tourniquet Kits

After training to use the severe bleeding kits, the Davie Police Department also decided they wanted their own kits that each officer could carry at all times. Antevy and Downey agreed to create portable versions for each police officer.

The “Individual Police Officer Kits,” or IPOKs, are similar to the severe bleeding kits that the public now has access to in Davie, with two alterations. The IPOKs have a different kind of tourniquet, a SWAT-T tourniquet.

“The police officers wanted something smaller, something more compact,” Antevy says. “The SWAT-T looks like the inner tube of a bicycle, only it’s flat.”

Additionally, the police officer kit includes a HyFin Chest Seal.

“If someone has an open chest wound, the chest seal can be placed over it,” Antevy says. “It’s like a big square sticker that can cover the hole. The public kit doesn’t have this because if it’s not used correctly, it can cause some problems for the patient. It requires a little bit of professional knowledge because sometimes it requires a ‘burp,’ like burping a baby. You have to lift it up and reapply it to remove the air. The police officers are trained how to do this.”

The IPOKs go under each police officer’s vest.

“The police officers decided they wanted the kit on them at all times,” Downey says. “Their vests are bulky and they have their guns, Tasers and handcuffs, so they wanted something easy to carry. The severe bleeding kits fit right inside their ballistic vests. We also have them in supervisors’ vests for the fire department. The kit is very small and compact, only about a quarter of an inch thick. Every officer has one and it is intended to be used either for that individual officer or a buddy who needs it. But it also can be used for the public if needed.”

An added benefit is that the fire department and police department collaborated on the training and creation of the kits.

“It really brought the police department and fire department together,” Antevy says.