9/24/2018. No financial disclosures to report HOW TO RUN A STOP THE BLEED PROGRAM, PART ONE: DISCLOSURE GOALS

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1 HOW TO RUN A STOP THE BLEED PROGRAM, PART ONE: WHY STOP THE BLEED IS THE PERFECT INJURY PREVENTION PROGRAM Bryce Robinson MD, MS, FACS, FCCM Associate Professor of Surgery Associate Medical Director, Critical Care Harborview Medical Center Department of Surgery University of Washington DISCLOSURE No financial disclosures to report GOALS 1. Provide examples of challenging outreach activities 2. Trace the etiology of Stop the Bleed (STB) 3. Explain why STB is the perfect outreach activity 1

2 CONFESSIONS FROM FAILED INJURY PREVENTION Injury prevention efforts are part of being a good center, its good business, and it can be a lot of fun Injury prevention is mandated for American College of Surgeons verified Level I and II centers. CONFESSIONS FROM FAILED INJURY PREVENTION Committee on Trauma American College of Surgeons, Resources for Optimal Care of the Injured Patient 2007 CONFESSIONS FROM FAILED INJURY PREVENTION So extrapolated from the ACS, the great majority of injury prevention efforts are local and focus on a regional issue, your issues. In Cincinnati in 2006, like many, our issue was gun violence. 2

3 CINCINNATI IN 2006 Cincinnati murder rate greater than: -Chicago -Miami -Phoenix -LA -Boston -Seattle NBC News 12/27/2006 CONFESSIONS FROM FAILED INJURY PREVENTION In typical surgery fashion, we applied the best evidence to date CONFESSIONS FROM FAILED INJURY PREVENTION Hospital-Based Intervention Program requires a significant multi-disciplinary approach Psycho-social follow-up Family or group therapy Assistance with substance abuse treatment Significant funding required Who is going to do all of this at your center, who qualified to do this? 3

4 CONFESSIONS FROM FAILED INJURY PREVENTION 2006, Out of the Crossfire gun violence prevention program University Hospital with the Cincinnati Bar Foundation Full-time coordinator and staff for specific injury prevention 300 victims per year Photo property of the University of Cincinnati CONFESSIONS FROM FAILED INJURY PREVENTION After 4 years, it closed Despite lots of faculty support Difficult to demonstrate benefit It required very specialized personal to be effective and they are expensive Reality of the financial markets Very difficult to demonstrate applicability to donors CONFESSIONS FROM FAILED INJURY PREVENTION Refocus on the largest mechanism of injury for the center Bang for the Buck theory In Cincinnati, its falls - In Ohio, its falls - In Washington, its falls - In the US, its falls 4

5 CONFESSIONS FROM FAILED INJURY PREVENTION Our injury prevention coordinator (n=1) partnered with regional fall prevention efforts Firehouse/EMS education for requested in-house inspections We had a pamphlet for the ACS Low cost, low faculty participation and low expertise in ergonomics, PT-OT efforts, etc. It was there to check the box, nothing really more.. THINGS CHANGE December 14, 2012 Newton, Connecticut Killed 20 children between the ages of 6-7 years old Killed 6 staff members trying to save their lives MEANINGFUL CHANGE? The worst day It felt personal and I couldn t compartmentalize it. Oh, he was drinking and driving Oh, he was selling drugs The need to do something meaningful 5

6 A CALL TO ACTION April 2013: Joint Committee to Create a National Policy to Enhance Survivability from Active Shooter Events and Intentional Mass Casualty By the American College of Surgeons The White House National Security Council US Military FBI Medical communities The recommendations called the Hartford Consensus THE HARTFORD CONCENSUS Among the recommendations: 1. Call for professional first responders to be trained and empowered to stop life-threatening bleeding 2. Call for the training of immediate respondersindividuals who are present at the scene who can immediately control bleeding with their hands and available equipment. STOP THE BLEED October 2015, The White House launches the Stop the Bleed campaign Don t be a bystander. Get informed and be a hero and stop the bleed. 6

7 STOP THE BLEED The American College of Surgeon and the ACS Committee on Trauma took this as a call to action with a goal of: 1. Train every American in basic bleeding control techniques 2. Work to place bleeding control kits in every public venue. STOP THE BLEED Inception of a website: bleedingcontrol.org Paper materials, videos, posters, slide set, app Public service announcements New instructor registration Class locator Store for bleeding control kits Accessed over 700,000 times twitter STOP THE BLEED A public and private partnership 7

8 STOP THE BLEED Who can teach? Physicians Nurses EMTs Paramedics NPs PAs Medical students Nursing students Athletic trainers Other allied medical technicians STOP THE BLEED STOP THE BLEED 8

9 ENTRY INTO POLITICS A wide, national consensus for bleeding control now coming to a statehouse near you. A practical introduction for trauma providers into the legislative process/leaders and for local politicians to the needs of trauma care. Lt. Governor Cyrus Habib and Saman Arbabi MD. January 2018 Why is Stop the Bleed the injury prevention activity for trauma care providers? STB IS THE PERFECT INJURY PREVENTION PROGRAM Its topical, needed, and the training can be applied broadly. 9

10 STB IS THE PERFECT INJURY PREVENTION PROGRAM The cost of the program is low. People volunteer their time. You need space, tourniquets and manikins (and a sense of humor). STB IS THE PERFECT INJURY PREVENTION PROGRAM People actually really want to teach the class and help. STB IS THE PERFECT INJURY PREVENTION PROGRAM The material isn t complicated 10

11 STB IS THE PERFECT INJURY PREVENTION PROGRAM You don t need specialized people to teach. Those that take the class can then teach it, on and on and on. STB IS THE PERFECT INJURY PREVENTION PROGRAM The partnerships defined by the ACS can host and likely teach the class! That s called a win-win STB IS THE PERFECT INJURY PREVENTION PROGRAM You can easily measure the effect of your efforts For poster session at the 2018 Society of Trauma Nurses meeting 11

12 STB IS THE PERFECT INJURY PREVENTION PROGRAM Its injury prevention that can serve as public relations for trauma care. STB IS THE PERFECT INJURY PREVENTION PROGRAM Don t you want to be a hero? GOALS 1. Provide examples of challenging outreach activities 2. Trace the etiology of Stop the Bleed (STB) 3. Explain why STB is the perfect outreach activity 12

13 HOW TO RUN A STOP THE BLEED PROGRAM, PART TWO: WHAT EXACTLY IS INVOLVED IN STARTING (AND MAINTAINING) A STOP THE BLEED PROGRAM Maria Paulsen, RN, BSN Trauma Outreach Education Coordinator Stop the Bleed Program Manager Harborview Medical Center University of Washington mruoff@uw.edu DISCLOSURE No financial disclosures to report GOALS 1. Implement the basic steps to start a program. 2. Create/acquire the materials needed to run a program. 3. Establish a program. 4. Report your progress. 13

14 9/24/2018 HISTORY October 2015 National Campaign launched by the White House March 2016 Harborview Medical Center: Stop the Bleed Campaign Work Plan drafted June 2016 Pilot program for schools begun August 2016 Stop the Bleed classes begun for UW employees October 2016 HMC STB Program for the community begun Harborview Medical Center Stop the Bleed Program August 6, 2016 AM August 6, 2016 PM August 13, 2016 AM August 13, 2016 PM August 24, 2016 October 8, AM October 8, PM October 29, AM October 29, PM November 12, AM November 12, PM December 5, 2016 December 10, AM December 10, PM January 28, AM January 28, PM January 30, FCC February 13, 2017 February 18, AM February 18, PM March 18, AM March 18, PM April 29, AM April 29, PM May 18, Zoo May 20, AM May 20, AM ATTENDED ATTEND ED In House UW class 29 In House UW class 26 In House UW class 38 In House UW class 26 High School Pilot Program Safeco Field Fauntleroy Community Center 16 Disaster Committee Meeting Woodland Park Zoo TOTAL 1224 September 9, AM September 9, PM 32 September 25, 2018 UW EMS & Trauma Confrerence 188 October 7, AM October 7, PM 15 November 11, AM 76 November 11, PM 53 December 2, AM 58 December 2, PM December 5, ZOO January 10, 2018 State Capitol January 25, Laurelhurst Woodland Park Zoo STB Legislative Day in Olympia 350 Laurelhurst Community Club 25 January 27, AM 45 January 27, 2018 PM 40 February 24, 2018 AM 50 February 24, 2018 PM 52 March 17, AM 32 March 17, 2018 PM March 28, 2018 Seattle Public Schools 35 Seattle School Nurses 80 March 31, NSTBD April 23, Spokane April 25, 2018 West Seattle Inland Trauma Conference Fauntleroy Community Center April 28, AM 37 April 28, PM 35 May 19, AM 47 May 19, PM TOTAL TOTAL TRAINED TO DATE: 2850 STEP ONE Become an Instructor Attend an official class. Sign up at to become an official instructor. Familiarize yourself with the state website Consult others in the state that are already running programs. 14

15 STEP TWO Organizational Support Meet with your organizational leaders to make sure they are aware of what STB is and why it is important. Identify who will be in charge and how you will go about structuring your program. You will need to tackle both getting classes up and running, as well as, getting equipment placed in public areas. STB EQUIPMENT PLACEMENT STB equipment should be accessible in all public areas. Consider placing on all patient floors as well as offices and departments. This may be something your disaster team can spearhead. STEP THREE Venue, Content and Faculty You will need to have a site that has AV capability so that you can show the slides. Design your added content, if any. Train and register enough instructors to support the class size you wish to accommodate. 15

16 9/24/2018 STEP FOUR Equipment Tourniquets: SOFT-T, CAT, others Packing material: kerlix, hemostatics, compression dressings Tourniquet models: manikins, fake legs, PVC pipes Wound packing models: professional, homemade. Paperwork/Handouts Powerpoints IT TAKES A VILLAGE Know what your resources are! If you are small, look to some bigger sites to see about sharing materials. We can all work together to make each other stronger. STEP FIVE Have a Class! List your classes on the state website ( Complete all the paperwork and submit to 16

17 9/24/2018 YOU NEED HELP I am here for you! mruoff@uw.edu GOALS Implement the basic steps to start program Create/acquire the materials needed to run a program Establish a program Report progress QUESTIONS 17

18 THANK YOU 18

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