Sadly, the US is experiencing a wave of gun violence. Whether the result of an uptick in shootings in big cities, or high-profile shootings such as those recently in the New York City subway system, Buffalo, NY or Uvalde, TX, all have common denominators: needless loss of life and suffering. This begs the questions: Could steps have been taken to mitigate the loss of life? If so, what are they? Is public access bleeding control the new EMS? A brief historical look-back is in order.

In September 1966, the National Academy of Sciences released a three-year study on the status of initial care and emergency medical services afforded the victims of accidental injury. That study, Accidental Death and Disability: The Neglected Disease of Modern Society, is regarded as the watershed moment in the development and professionalization of emergency medical services in the United States.

Prior to Accidental Death, there was very little standardization of even the most basic aspects of EMS.  Ambulances were inadequate. Crew training was minimal or nonexistent. Witness the sobering observation contained in the study: “Expert consultants returning from both Korea and Vietnam have publicly asserted that, if seriously wounded, their chances of survival would be better in the zone of combat than on the average city street.”

As noted in Accidental Death, accidents were the leading cause of death among persons between the ages of 1 and 37. Fast forward 50 years. In 2020, according to the CDC, accidents and unintentional injuries remain the leading cause of death for those ages 1 to 44. Although not all deaths from accidents and unintentional injuries are the result of uncontrolled bleeding, and not all life-threatening bleeds can be controlled, a significant subset of deaths due to bleeding could be prevented by early intervention of proper bleeding control techniques.

In April of 2013, the American College of Surgeons convened the Joint Committee to Create a National Policy to Enhance Survivability from Intentional Mass Casualty and Active Shooter Events. The impetus for the Joint Committee was the mass shooting that occurred in 2012 at Sandy Hook Elementary School in Newtown, CT. At Sandy Hook, 26 people lost their lives. The Joint Committee’s overall purpose was: “to create a protocol for national policy to enhance survivability from active shooter and intentional mass casualty events.”

The resulting deliberations of the Joint Committee have come to be known as The Hartford Consensus. Hartford Consensus III addressed implementation of bleeding control with one of its stated goals being: “to empower the public to provide emergency care.” In Hartford Consensus III, the Joint Committee concluded that: “the most significant preventable cause of death in the prehospital environment is external hemorrhage.”

The Joint Committee noted those present at an event although “traditionally thought of as “bystanders,” these immediate responders should not be considered passive observers and can provide effective lifesaving first-line treatment.” As stated in Hartford Consensus III “those present at the point of wounding have often proven invaluable in responding to the initial hemorrhage control needs of the wounded.”

Initiatives such as Stop the Bleed, a program of the American College of Surgeons, are an outgrowth of Hartford Consensus III. Stop the Bleed and similar training programs prepare immediate responders to render aid in the all-important first few minutes of an event. They also equip bystanders with the key knowledge to be effective “force multipliers” for first responders.

Is public access bleeding control the new EMS? I believe the answer is a resounding yes. It is imperative that the general public be trained in proper bleeding control techniques. Remember, the life you save may be your own.