The Argument for Public Access Bleeding Kits

In 2014 it became clear that the mechanisms many of our systems had in place to prevent death from exsanguination during mass shootings and other atypical trauma were inappropriate. To our dismay, we noted that during real-life active-assailant scenarios and full-scale drills, victims were not being addressed and treated rapidly. Implementation of the RTF (Rescue Task Force) model was supposed to address this, yet invariably times remained unacceptable. If we were to make a real difference in outcomes, the solution required a different distribution model.

Typically bleeding victims had no choice but to wait for emergency first responders to provide lifesaving hemostasis, yet even reorganization of the response was not able to solve the timeliness issue. By considering other life-threatening conditions such as sudden cardiac arrest, anaphylaxis and overdose, it became clear that the answer for hemostasis required a similar path. AEDs are a staple of most public locations and have been pivotal in saving the lives of many victims of SCA. Epinephrine auto-injectors for anaphylaxis have become ubiquitous and in some states are required in schools. Similarly, naloxone has followed the trend and will likely soon be available at neighborhood pharmacies sans prescription.

In the town of Davie, FL, Assistant Fire Chief Julie Downey and EMS medical director Peter Antevy, MD, reacted to the hemostasis problem first by training the public on bleeding control. Town employees were trained first, followed by incorporation of bleeding control education into standard CPR classes in the community.

They determined that if the public could be trusted with CPR, defibrillation and intramuscular injections, it could be similarly trusted with bleeding control. That decision was the first step toward allowing uninjured victims within hot zones to assist those with life-threatening bleeds. Distribution of bleeding control kits from within was the most obvious way to do this. The town had put in place, years prior, a law that required large public buildings to register their AEDs, and this allowed immediate knowledge of most of the public-access AEDs. Chief Downey then constructed severe-bleeding kits using a pencil case, two tourniquets, gauze rolls and pads, scissors and a pair of gloves, using funding from the town of Davie. By early 2015 the program was fully implemented, and members of Davie Fire Rescue continued to educate the public at health fairs, community gatherings and basic life support classes. The response was always positive, and the required training time was limited. Furthermore, the police were outfitted with a specialized kit that was purposely very thin and vacuum-sealed so it could fit easily along their chest, beneath their vest. This kit used a SWAT-T tourniquet and also added hemostatic gauze and a chest seal.

Stop the Bleed

Antevy presented the innovative concept at the Gathering of Eagles conference in February 2015, and it was well received by those in the EMS community. During this time Rick Hunt, MD, director of medical preparedness at the White House, was working on developing consensus on this same issue by bringing national stakeholders to the table. In October of that year the White House unveiled a new nationwide initiative—Stop the Bleed—which would provide bystanders access to bleeding control equipment, just as they have now with AEDs. The town of Davie was invited to attend the bystander “Stop the Bleed” forum at the White House. Vice Mayor Susan Starkey joined Downey and Antevy at the forum on Tuesday, October 6, 2015. The four-hour event propelled an important concept to the forefront and began to lay the groundwork for local entities to plot a course for the future.

If the general public can be given sanction to take action to stop life-threatening bleeding by providing access to tourniquets and other bleeding-control equipment, many lives can be saved. The town of Davie was recognized as one of the leading municipalities in the country that has already added severe-bleeding kits to community AEDs.

In 2015 Davie already has two critical saves thanks to the public access bleeding kits. In one case a town employee severely injured himself using a power saw, and a colleague rapidly provided hemostasis using techniques he learned in the course. The town’s mayor and commissioners later honored the employee for his heroic actions.