Military Trauma Care Techniques Could Enhance Civilian Hemorrhage Control Efforts

The advancements in trauma care learned from military conflicts have now been incorporated into civilian trauma centers, highlighting the importance of rapid hemorrhage control in saving lives during mass casualty events.

Lessons learned from Operation Enduring Freedom and Operation Iraqi Freedom have transformed modern trauma care by incorporating damage control resuscitation, advances in transfusion medicine, and the use of tourniquets. Severe bleeding remains a significant cause of death in traumatic injuries outside of military conflict, highlighting the importance of early hemorrhage control. 

In 2013, the Hartford Consensus emphasized the need for all responders, including bystanders, to have the knowledge and equipment to stop severe bleeding immediately in mass casualty events, just like the widespread dissemination of CPR and automated external defibrillators (AED) training. The White House's "Bystander Stop the Bleed Forum" in 2015 led to the US government's "Stop the Bleed" (STB) initiative, promoting bleeding control kits and training in schools, airports, and communities nationwide to enhance public access and response to traumatic injuries. Military implementation of STB programs set a template for in-garrison hemorrhage control preparedness in both military and civilian settings to enhance response to mass casualty events and save lives.

Widespread use of AEDs has saved lives and shown effectiveness by the layperson, like the advantages offered by Bleeding Control basic (B-con) kits. These kits may even be easier to use due to the simplicity of tourniquet application. Young, healthy individuals are typically saved from traumatic hemorrhages, compared to the typical AED patient. The location and maintenance of bleeding control kits will vary depending on each installation and the specific contents of the kit.

Training in hemorrhage control can be obtained from Tactical Combat Casualty Care (TCCC), which has been linked to saving lives on the battlefield. The American College of Surgeons has tailored TCCC training to focus on hemorrhage control for the STB campaign with the B-Con course. Challenges include retention of knowledge and skills over time, requiring strategies for ongoing training and retraining. Point-of-care instructions, like AEDs, have been trialed to accompany bleeding control kits, showing potential in increasing correct application rates. The availability of medical personnel as instructors is a barrier to widespread training, but courses like Self-Aid Buddy Care (SABC) provide alternatives to reach more individuals. By addressing challenges such as retention, utilizing point-of-care instructions, and overcoming instructor limitations, the goal of reducing preventable deaths through hemorrhage control can be achieved.

After contacting the defense logistics agency, researchers procured custom STB kits developed by private vendors to address the needs of first responders at Joint Base Andrews (JBA). These kits focus primarily on tourniquets and standard gauze, departing from standard commercially available products due to cost and maintenance considerations. The custom kits include essential items such as CAT tourniquets, trauma shears, and six-inch trauma dressings, tailored to the needs of their first responders. They positioned these kits strategically across the base alongside AEDs, with plans for ongoing maintenance and training initiatives involving active-duty members, civilians, and specific population groups like retirees and schools.

“The STB initiative has the opportunity to save lives, not only in the public arena but on military installations worldwide. It is critical we educate, train, and prepare for mass casualty events to save lives in our current environment. We have launched our STB initiative here at JBA and hope our program serves as a potential model for other installations to proceed with developing their own in-garrison hemorrhage control program,” shared the researchers. 

The researchers emphasized that minor modifications may be needed for implementation at other military installations based on individual needs and resources, but affordable and customizable hemorrhage control kits can easily meet these needs. 

Reference
Chambers JA, Seastedt K, Caterson E, et al. “Stop the Bleed”: a US military installation’s model for implementation of a rapid hemorrhage control program. Military Medicine. 2018;184(3-4):67-71. doi:10.1093/milmed/usy185