On the night a gunman using high-powered firearms shot and killed 58 people attending an outdoor concert in Las Vegas, an attack that injured more than 800 other people, Sunrise Hospital and Medical Center treated 215 victims. About 70 percent of the wounded and injured drove themselves to the hospital or got a ride from a friend or a bystander, as opposed to being brought in by emergency first responders. Roughly a dozen of these victims walked into the hospital with makeshift tourniquets, fashioned from scarfs, bandannas or belts, says Dr. Scott Scherr, regional medical director for TeamHealth, Emergency Medicine West Group and chairman of emergency services for the facility. Concert bystanders, not professional first responders, had applied the tourniquets.
“They were pretty well done,” Scherr says. “A few of the patients had obvious arterial wounds. The tourniquets slowed the bleeding enough to further (the victims’) care in the hospital.” Given the number of victims who needed medical attention that night in October 2017, the makeshift tourniquets may have saved some victims from grievous injury and maybe even death, he says. There was no way first responders could tend to everyone who needed help. “Even though there were multiple fire department, law enforcement and EMS personnel who responded, with more than 800 injured, they were vastly outnumbered,” Scherr says. “An adult body can lose its entire blood supply in less than three minutes. Someone can bleed to death in less than three minutes. Time is crucial when you have a situation like this.”
The bloody episode dramatically showed how members of the general public can help victims and emergency personnel during a medical emergency, Scherr says. That assistance, in turn, allowed emergency first responders to render medical aid to other victims. “Every year, thousands of people experience serious health emergencies such as heart attacks, seizures and breathing difficulties at sports events, at home or while at work,” says Dr. Evelyn Balogun, medical director of urgent care, occupational medicine and employee health at Inspira Health Network in Vineland, New Jersey. “Oftentimes, the first and fastest response in these everyday situations is provided by friends and co-workers.”
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Civilian assistance can mean the difference between life and death for some people who suddenly need emergency medical assistance. That’s because emergency responders typically won’t arrive for several minutes and perhaps longer, research suggests. Emergency medical units, on average, arrive seven minutes after a 911 call, according to a research letter published in the journal JAMA Surgery in October 2017. The response time more than doubles to more than 14 minutes in rural areas (where emergency responders are more spread out than in large cities). In rural areas, it took almost 30 minutes for emergency workers to arrive in nearly 10 percent of the cases studied. “In some, albeit rare (emergency) conditions, even modest delays can be life-threatening,” the research paper states.
Those potentially life-threatening conditions include cardiopulmonary arrest, severe bleeding and airway occlusion. The need for civilian assistance is particularly acute in mass casualty incidents, like the Las Vegas shooting and countless other violent attacks, says Dr. Stephanie Davis, a board member with the American College of Osteopathic Emergency Physicians. Research suggests 30 to 40 percent of fatalities in mass shootings involve victims bleeding to death (as opposed to dying quickly from the trauma of the gunshot), Davis says. “That’s a high percentage, and assistance from bystanders can make a difference,” she says.
You don’t need any previous medical training to learn how to provide emergency first aid, says Michelle Rud, trauma educator/outreach and injury prevention coordinator at Osceola Regional Medical Center in Kissimmee, Florida. Since August 2017, Rud has helped train 5,000 people to help people who are bleeding. Her efforts are part of the “Stop the Bleed” campaign, a national education effort launched in 2015 by the Obama White House in collaboration with several federal agencies and organizations like the American College of Surgeons. Officials launched the initiative in response to a series of reports, published by the American College of Surgeons, recommending various responses following the attack in December 2012 at Sandy Hook Elementary School in Newtown, Connecticut, where a gunman fatally shot 20 schoolkids and six adults staff members. The reports were published between 2013 and 2016.
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During a course that lasts about an hour, Rud, a registered nurse, teaches civilians (and sometimes law enforcement officers) how to apply pressure to a bleeding wound, how to pack a wound with gauze or ripped pieces of most types of clothing or paper towels and how to apply a tourniquet. She advises students that if they don’t have medical gauze, almost any kind of material (other than denim, which isn’t effective) — even oily rags — can be used to pack a wound. There’s no need to fear infection, because medical professionals will address that issue when they provide treatment. Rud shows photos of real traumatic injuries, including a nearly-severed foot, demonstrates techniques to stop bleeding and has students try these methods themselves on mannequins or on a training partner. “I’ve taught people as young as 6 and as old as 98.” When she asked the 6-year-old, a girl, to demonstrate how to pack a wound and apply a tourniquet, she did both just the way Rud had taught. “If a 6-year-old can understand it, anyone can,” Rud says. “Most people learn by hearing, seeing or touching. This program covers all three.”
If you want to learn how to help someone who’s suffering from a medical injury, explore these three strategies.
Take a course that teaches how to stop bleeding. There are plenty of resources available to find Stop the Bleed training, offered at no charge. You can visit bleedingcontrol.org, which provides an online tool that lets you find a course in your geographic area. Checking with major hospitals in your area is also a good idea, since many of them participate in the campaign, says Dr. Jack Sava, director of trauma at MedStar Washington Hospital Center in the District of Columbia. Throughout the U.S. 15,332 instructors have trained 124,350 people since the program began, according to bleedingcontrol.org’s 2018 progress report.
Learn how to do CPR. The American Red Cross offers a variety of online and in-person first aid and CPR classes, plus options that blend the two formats. The organization also provides training in CPR and in how to use an automated external defibrillator, a device that can potentially provide a shock to someone suffering cardiac arrest that resumes the heart’s normal rhythm. The Red Cross website, redcross.org, has an online tool that allows you to find the class nearest to you. In the District of Columbia, a course in adult and pediatric CPR/AED training starts at $60. Some adult and pediatric first and CPR/AED training cost $99 and others are more expensive, depending on the skills that are being taught. The list of classes and prices is available online. The American Heart Association also offers training in how to use an AED and how to do CPR. While learning how to compress a wound and apply a tourniquet can save lives, “the average person is still far more likely to have an opportunity to use CPR or an AED than to use a tourniquet,” says Dr. Dustin Calhoun, medical director for emergency management at the University of Cincinnati Medical Center.
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Read up on how to identify and help someone suffering from a heat stroke. Helping someone suffering from heat stroke isn’t complicated, says Dr. Nicholas Kman, a clinical professor of emergency medicine at the Ohio State Wexner Medical Center. In hot weather, dizziness, a rapid heartbeat, muscle weakness and cramps and a failure to sweat can indicate heat stroke. You can cool someone by putting him or her in shade, in an ice bath or a tub of cool water, providing a spray or mist or water and applying ice packs to the neck or groin area, where there are large blood vessels than can help cool the body. “If you think about heat stroke, essentially the body is cooking,” Kman says. “The body temperature is usually 104 degrees or higher. We tell civilians you can’t wait for first responders; you should try to help the person cool down.” You can learn more on how to treat heat illness at cdc.gov.
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