BWHers Study How to Best ‘Stop the Bleed’

Pablo Uribe Lietz (center) demonstrates for Harvard Medical School students how to properly apply a tourniquet.

Even if you have no medical training, you might be able to save the life of someone experiencing a heart attack if there’s an automated external defibrillator (AED) nearby. Designed to be used by those with minimal or even no training, these devices automatically detect an abnormal heart rhythm and administer an electrical shock after sensors are applied.

Now, a group of BWHers plans to develop a similar kit for treating uncontrolled bleeding that anyone can use during an emergency before medical personnel arrive. The project is part of Stop the Bleed, a national awareness campaign about how to stop life-threatening bleeding.

In this Q&A, Eric Goralnick, MD, medical director of Emergency Preparedness, discusses the innovative ways BWH is contributing to Stop the Bleed in partnership with The Gillian Reny Stepping Strong Center for Trauma Innovation, Gillette Stadium and several local partners.

What gave rise to this initiative?

EG: Stop the Bleed was started in the wake of the Sandy Hook shootings by a group of clinicians, the Hartford Consensus, whose goal was to find what we can do as a society to minimize preventable deaths after mass shootings or other mass-casualty events.

To do that, they looked at the success the military has had in preventing deaths from extremity injuries by training many ground forces in trauma combat casualty care. The focus is on teaching lay individuals to recognize life-threatening bleeding and intervene – either applying pressure to a wound, packing a wound and then applying pressure or, if it’s an extremity, applying tourniquets. From this, the Hartford Consensus recognized the need to empower laypersons to intervene.

How is the Brigham contributing to the campaign?

EG: Where we think Brigham can particularly add value is in innovation, education and operationalizing the concepts of Stop the Bleed.

We’re working to identify the equivalent of the defibrillator for hemorrhage control, starting with trials of a few commercial “just-in-time training” kits for bleeding control. Potentially, we may design our own.

We’re also developing training programs. When we look at these horrible events, they have traditionally occurred in places like stadiums, public transportation hubs, schools and shopping malls. We want to work with these organizations to train their staff in bleeding control.

This program’s success is possible thanks to our collaboration with the Department of Emergency Medicine and Trauma Service at BWH and Massachusetts General Hospital, the Center for Surgery and Public Health, Fallon Ambulance, South Shore Hospital and Boston MedFlight.

Tell us more about the research and training.

EG: At our first event, we trained more than 50 health care professionals, followed by a series of similar events in the community.

We also launched a randomized study at Gillette Stadium, where we’ve enrolled more than 560 staff, including security officers, vending station operators, parking attendants and others. Each staff member was randomly assigned to one of four groups comparing the effectiveness of tourniquet application after receiving traditional training, “just-in-time training” kits with audio or diagrams or no advance training.

Through focus groups, we’re learning how to design a more intuitive kit. Roughly 90 percent of the people got it right after in-person training, and we think we can develop a kit that’s equivalent.

In addition, Stepping Strong and Gillette purchased 525 first-aid kits that will be worn by personnel who have been trained. They’ve also purchased public-access tourniquet kits that are hung next to AEDs.

Next, we will retest and reevaluate these individuals to gauge how often they should be retrained. Finally, we’ll describe best practices for training a stadium’s workforce, as this is the first Stop the Bleed program in a professional sports stadium that we’re aware of.

This is an opportunity for science to guide us, and the science we have is from the battlefield – and the many soldiers, sailors, airmen and Marines whose lives have been saved because of tourniquets.

‘Stop the Bleed’ at HUBweek

BWH is participating in HUBweek, a weeklong festival celebrating innovation in Boston. On Wednesday, Oct. 11, 3-5 p.m., explore innovation at Brigham Health through an interactive scavenger hunt, which includes a training session with BWH’s Stop the Bleed project. The event is free to attend and open to all staff. Register and learn more here.

Brigham Health’s Strategy in Action: Scalable Innovation
Learn more about our strategic priorities at BWHPikeNotes.org.

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