Guest Editorial: Get Involved, Save a Life

Editor's note: In the coming months EMS World will publish brief opinion pieces from our editorial advisory board members on current issues of interest facing the field of EMS. This month Peter Antevy, MD, discusses an initiative in Florida aimed at saving lives.

Over the past decade, Americans have seen a significant increase in mass-casualty and active-shooter incidents across the United States and around the world. These tragedies have forced the lay public to prepare to help their fellow citizens during chaotic and often tragic events. 

This concept isn’t new to the American public. AEDs have become part of the fabric of our country, and expectations around them have progressed such that when a person collapses from a sudden cardiac arrest in public, the AED is retrieved and immediately utilized. We have all become accustomed to seeing these portable devices stored within glass-paned cabinets in public places such as airports, hotels, and casinos. 

AEDs have become a part of our daily lives, and we know that speed matters when using them. There is no faster response than that of private citizens and bystanders within the immediate vicinity of an emergency. In fact, a bystander’s immediate actions can positively impact a victim’s survival.

This same principle applies to other incidents, but perhaps none as important as hemorrhage control. Dating back to the Columbine tragedy in Colorado, and now most recently the Parkland shooting in Florida, we have learned valuable lessons regarding the need for speed in bleeding control. The lives of acutely injured victims depend on the speed to care with use of direct pressure, hemostatic gauze, and tourniquets.

Often, during mass-casualty incidents, professional first responders cannot rapidly reach those in immediate need. For laypeople, the answer is not to simply give up—but to get involved. The general public must step in and become the first responders to help temporize such situations until professional help arrives. With proper training and equipment, the general public can undoubtedly assume this role and in turn improve outcomes. This applies not only to mass-casualty incidents but also to any case of severe bleeding: The bystander must step in and provide immediate care.

The town of Davie, Fla., has successfully engaged its citizens in this initiative by not only changing its community culture but changing local laws as well. The formula has been very successful and has led to enhanced adoption of health-related community initiatives, especially bleeding control.

Where We Began

In 2008, Davie established an aggressive automatic external defibrillator (AED) program. A town ordinance was passed requiring all assembly occupancies (performance halls, restaurants over 100 seats, movie theaters), businesses over 20,000 square feet, mercantile occupancies over 35,000 square feet, and residential occupancies greater than seven stories (hotels, motels, and multistory residential/dormitory buildings) to install and maintain AEDs. The ordinance also required that each of these sites train and maintain staff proficient in using the lifesaving devices. The program was a great success, and the town has celebrated numerous saves since its inception.

In 2014 we recognized the value of the lay public’s assistance during time-sensitive emergencies and together decided to create severe bleeding control kits, which we added to the town’s AEDs. Davie Fire Rescue also rolled out bleeding control education to all 700 town employees as well as to the lay public, incorporating the training into all CPR/AED classes. While the program was moving forward, we encountered some resistance from several community businesses in terms of scaling up to include severe bleeding kits in every AED cabinet.

It was time for more action.

Going Back to the Well

In December 2017, when certain business entities refused to collaborate with the severe bleeding/Stop the Bleed kit (SBK) rollout, we decided to modify the town’s AED ordinance. The language of the ordinance was changed to require Stop the Bleed kits to be placed in every AED cabinet and to mandate hemorrhage control training for employees at each location.   

The ordinance passed. The revision of the ordinance included a requirement for SBKs to be placed in all AEDs that are required by the town. The standard kit includes 2 tourniquets, 2 hemostatic dressings, 2 gauze pads, 2 rolled gauze, a pair of scissors, and gloves. In addition, places of occupancies over 500 people are required to have a large SBK (8 tourniquets, 8 hemostatic dressings, 8 gauze pads, 8 rolled gauze, a pair of scissors, and gloves).

Davie Fire Rescue also received state EMS grant funding to purchase severe bleeding/Stop the Bleed Kits and place the kits with the 400 AEDs that are now located throughout the town of Davie. Davie Fire Rescue is training businesses and the general public. To date, over 500 residents have been trained.

We feel strongly that Stop the Bleed kits including tourniquets can be used safely by the general public after proper training that is given concurrently with basic CPR courses.

The Promise of the Future

Davie Fire Rescue is a perfect example of the success achieved by strong leaders, solid partnerships, and a vision by all involved to mandate programmatic placement of lifesaving equipment combined with training and awareness about emergencies. In fact, fire inspectors check the buildings for the presence of the AED and SBK and will deliver a fine for noncompliance. The proof that this initiative could be replicated followed soon after Davie’s success when Coral Springs-Parkland Fire Department Fire Chief Frank Babinec successfully led the charge to pass a similar ordinance. 

Severe bleeding/Stop the Bleed kits should be disseminated widely to the lay public. Placing these kits alongside public-access defibrillators takes advantage of the public’s familiarity with widely available AEDs. Carrying out the Stop the Bleed initiative across this country has already saved countless lives. Our community knows this to be true. Get involved and save a life!

Visit https://www.dhs.gov/stopthebleed.

ABOUT THE AUTHORS

Peter Antevy, MD, is medical director of Davie (Fla.) Fire Rescue, and a member of the EMS World editorial advisory board. Julie Downey is chief of Davie (Fla.) Fire Rescue.