In era of mass shootings, doctors hope to turn bystanders into first responders - Mass Shooting News

In era of mass shootings, doctors hope to turn bystanders into first responders



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Tylenol. Bandages. Hydrogen peroxide and burn gel. 

These items are ubiquitous in first aid kits in homes and offices across the country. 

But tourniquets and combat-grade clotting agents may be added soon, if American surgeons get their way. 

Kenneth Wright, left, embraces Cara Knoedler on the anniversary of the Oct. 1, 2017 mass shooting on Oct. 1, 2018, in Las Vegas. Behind them is the site of the shooting. (Photo: John Locher, AP)

In the wake of several devastating mass shootings, physicians are working to educate and train the general public in bleeding control, which can buy medical personnel valuable time when responding to violent and unstable scenes. 

Doctors like Baptist Medical Center South’s John Mark Vermillion, the founding surgeon of the hospital’s trauma program, hope to make bleed control training as commonplace as CPR certification in workplaces, concert venues and churches. 

Understanding how quickly a major wound can turn fatal is key: A person can bleed out in as little as five minutes with a major arterial injury.

“The response time for paramedics is often going to be more than that,” Vermillion said. 

In October 2017, when a man opened fire into a crowded, open-air concert venue in Las Vegas, 59 people were killed and more than 500 injured. News reports describe chaos as the shooter fired more than 1,000 rounds in about 11 minutes, according to the Associated Press.

“In an active scene, like the Las Vegas shooting, if gunfire is still going off, paramedics can’t respond. They can’t provide care until the scene is secure,” Vermillion said. “The whole point is to have the training and resources available at a high-risk scene. A lot of people bled to death while waiting for the shooting to be over.”

In the wake of the 2012 Sandy Hook Elementary School shooting, the American College of Surgeons convened a working group to study survivability in mass casualty and active shooting events. The committee, which included national security experts and other emergency medical disciplines, issued four recommendation reports in what is now known as the Hartford Consensus. 

The group’s second report, written by Dr. Lenworth Jacobs, identifies immediate responders — the people already at the scene, sometimes even victims themselves — as the first line of care after tragedy strikes. 

“Obviously, prevention is the way to go,” Jacobs told The New Yorker in April. “But, once something has happened, how can we increase survival?”

At Baptist South, training has been provided for nurses. A full day of teaching is planned for other medical and non-medical staff. Vermillion hopes this will be the start of a ripple effect, as each person can then influence their communities. Anyone can search for Stop the Bleed classes in their area at bleedingcontrol.org, which also contains resources and instructor training.

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Dr. John Mark Vermillion makes rounds with fellow doctors, nurses and medical students at Baptist Medical Center South in Montgomery, Ala., on Wednesday October 24, 2018. (Photo: Mickey Welsh / Advertiser)

“The American College of Surgeons’ goal is anywhere you would have an AED  (defibrillator) you would have a Stop the Bleed bag,” he said. “You have to pre-plan for it because you’ll never know when it’s going to happen.”

Stop the Bleed protocol first teaches people how to identify life-threatening bleeding. Finding the source of the bleed is key and often involves removing clothing. In Stop the Bleed kits, like the kind Vermillion is now stocking in Baptist South, people can use tourniquets to staunch bleeds in arms and legs. If a tourniquet is not available or the wound is in the neck, shoulder or groin, doctors recommend packing the wound with first aid kit gauze and applying steady pressure until medical personnel arrive. 

If a first aid kit is not available, doctors still advise packing the wound with available cloth and applying continuous pressure. Though it seems unsanitary, the goal is to buy the victim enough time to get to a hospital, where trauma professionals can deal with any type of contamination.

The training can be unsettling. Many people aren’t comfortable with blood, even less so with the idea of packing a gaping wound with gauze, at best — at worst, with a T-shirt or sweater. 

Baptist South employees learn emergency bleed prevention in a growing national campaign. (Photo: Baptist South Medical Center)

But Vermillion sees being able and ready to respond as a civic duty.

“No. 1, it may yourself that you’re saving,” he said. “No. 2, it may be your responsibility to save someone else. It may be the only chance they have to survive.”

Contact Montgomery Advertiser reporter Melissa Brown at 334-240-0132 or mabrown@gannett.com.

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