Shuffling into health class Tuesday morning at River Hill High School, ninth-graders were asked a question that left many at a standstill: What would you do if you saw someone in need who was severely bleeding?
Some students remained silent, while others suggested calling 911 to get the wounded to the nearest hospital for treatment.
“If someone is bleeding significantly, they can die before the EMS or any other medical person arrives,” responded Col. Kyle Remick, an active Army trauma surgeon with the Walter Reed National Military Medical Center who was a guest in the classroom. “It’s that window of several minutes that you have as a bystander where you can stop bleeding and save a life before EMS arrives.”
A Clarksville resident and parent of a River Hill sophomore, Remick came to the school Dec. 12 to train ninth-graders in life fitness and health classes how to recognize and treat people suffering from severe bleeding. Training is promoted through the Stop the Bleed national awareness campaign.
Remick, a trauma surgeon with the federal government’s Uniformed Services University of the Health Sciences, taught the classes in collaboration with the school system, county fire department, University of Maryland Shock Trauma Center, Johns Hopkins Trauma Center and Maryland Committee on Trauma.
The Stop the Bleed initiative – launched by the White House in October 2015 – stemmed from the Sandy Hook Elementary School shooting in Newtown, Conn., in 2012 and the Boston Marathon bombing in 2013, said Paul Brooks, of the U.S. Department of Homeland Security’s Office of Health Affairs.
The campaign was designed to educate, empower and equip civilians in a bleeding emergency before help arrives. Brooks said it also calls for the general public to have access to bleeding control equipment, including first-aid kits and tourniquets.
“Much like you might encounter an automatic defibrillator in a school, library, mall or airport, we envision bleeding control kits co-located with those AEDs,” said Brooks. “Tourniquets are being applied to folks with bleeding emergencies on a regular basis with positive outcomes and no untoward effects.”
Law enforcement, fire and education departments can purchase equipment through grants, such as the Department of Justice’s COPS grant, FEMA grant programs or the Safe Schools grant program. If agencies are not covered under grants, Brooks said charitable organizations, endowments and foundations nationwide sponsor training and kit placement in their buildings.
So far in 2017, Brooks said at least 100,000 people across the country have been trained in Stop the Bleed.
“We’re thrilled to hear Howard County is pursuing this and we appreciate the visibility because we want to raise awareness,” Brooks said. “It’s an unfortunate need, but it’s neighbors helping neighbors and a great way for a community to become stronger.”
Stop the Bleed in Howard County
Matthew Levy, medical director for the county’s fire department, said Howard County was one of the first counties in the U.S. to go live with the Stop the Bleed program. Since launching the program in 2016, Howard’s fire department has provided free training in bleeding control, also known as BCon, to more than 2,600 people at minimal cost to the department.
The fire department also provides free hands-on CPR classes, Levy said, with more than 50,000 people trained, including students in the school system.
“We recognize that we can have the most well-optimized emergency care system with police and fire responders rapidly dispatched,” Levy said. “When we want to get information out to the masses, one of the best places to do that is through the school system. This is hopefully going to be the preamble for a relationship where we can pilot this with the school system on a larger level.”
On Tuesday, about 285 students were trained throughout the school day.
During fourth period, about 120 students carefully listened to Remick’s opening remarks, which he began by sharing that a person can die from severe blood loss within five minutes. Eyes widened as Remick showed animated illustrations on the process.
Afterward, students huddled around eight tables with health officials and used a mannequin limb to put their knowledge to the test. The limb had gash, stab and gunshot wounds for three different scenarios. Students were given bleeding control kits equipped with medical gloves, QuikClot combat gauze, dressings and small blue tourniquets.
Stop the Bleed is generally taught in a two-part, 50-minute course, he said, with a 30-minute presentation and a 20-minute hands-on demonstration.
After calling 911, Remick said bystanders must apply firm and steady pressure to the person’s wound, using both hands, if possible. Bystanders should then maintain pressure with bandages or clothing to try to slow the bleeding. Hemostatic gauze, commonly found in a bleeding control kit, must be pushed into the wound as much as possible before wrapping.
If that doesn’t slow the bleeding, a tourniquet should be applied.
“Tourniquets were a huge evolution in the past decade on the battlefield and have saved many soldiers’ lives,” said Remick, who returned from his fourth deployment to Iraq in August. He’s spend his latest six-month deployment providing medical care to wounded soldiers and partnering forces.
Tourniquets should be placed two to three inches from the bleed toward the torso and can be applied over clothing, he said. Once bystanders pull the devices strap through the buckle, they must tightly twist, clip and secure the rod with the tourniquet’s clasp or Velcro strap.
If necessary, a second tourniquet can be used to slow bleeding by placing it between the first tourniquet and the torso.
“These simple maneuvers that occur on the battlefield can be translated to really any type of injury,” he said. “This should really be an all hazard-type response not just for events of active shooters but also under events like a car accident, where somebody has a bad leg injury, or a natural disaster, where someone is injured and bleeding.”
Remick said he’s operated on wounded service members who have returned to the states from overseas. The military joint trauma system of care transports the wounded from anywhere in the world to trauma and surgical teams in Landstuhl, Germany and later to Walter Reed. The Bethesda campus has a robust physical therapy, medicine and rehabilitation amenities, he said.
About a year ago, Remick reached out to Levy to collaborate on training for students.
“The effort is to teach citizens across the board in the U.S. and a great place to start is with high schoolers,” he said. “In a couple of years, they’ll be adults and on their own and that’s a worthy skill.”
Health teacher Sybil Modispacher said she and her colleagues participated in Stop the Bleed during a professional development seminar last year. The initiative goes hand-in-hand with CPR training, she said, so school system health supervisor Linda Rangos and instructional facilitator Tempe Beall are working with the fire department to develop a Stop the Bleed lesson plan for future curriculum.
“We live in a world that was a little different than when I was growing up,” Modispacher said. “There are situations, like school shootings. We have the wildfires in L.A. that are catastrophic. Having skills like this that are fairly easy to teach and for people to retain are important for kids to know.”
Jatin Suri, 14, said he found the training “very surprising.”
“I never knew that you were supposed to pack the gauze inside the wound,” Suri said. “Of course, [the limb] was not the real thing, but it helped me see how it would be in real life. When you put on the strap, it decreased in size, so it was realistic.”
Classmate Mick Dannelly, 15, said he also didn’t know the gauze must be packed into the wound, but the demonstration was “fun and realistic.”
“It was very interesting,” Dannelly said. “I learned a lot about stopping the bleeding and information I can use.”
Learning ways to slow or stop severe bleeding felt “empowering,” Modispacher said.
“Not everybody has that call to want to help,” she said, “but I’m the person who, if you’re pulled over on the side of the road, I’m probably going to pull over to check and make sure you’re OK.”