Learn To Stop The Bleed
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Empowering Bystanders: How to Save Lives During “Trauma Season” and Beyond
In the critical minutes following a traumatic accident, the actions of a single bystander can mean the difference between life and death. While many people are familiar with CPR for cardiac emergencies, fewer know how to address the number one cause of preventable death after an injury: severe bleeding [1]. During the summer months—often referred to by medical professionals as “trauma season”—outdoor activities spike, leading to a significant rise in emergency room visits.To combat this public health challenge, the American College of Surgeons Committee on Trauma administers the premier bleeding control training program known as Stop the Bleed [2]. In an educational interview on Midday Maryland, host Jonathan Marx sat down with David S. Shapiro, MD, a surgeon, trauma provider, critical care physician, and the Chair of the American College of Surgeons Committee on Trauma’s Stop the Bleed Program [3]. Together, they discussed the vital importance of emergency preparedness, how to identify a bleeding emergency, and the exact steps required to control bleeding before professional help arrives.
The Critical Gap: Why Immediate Response Matters
When a medical emergency involving severe trauma occurs, a person can bleed to death in as little as three to five minutes [1]. Even in areas with rapid emergency response, it often takes several minutes for an emergency medical technician (EMT) or paramedic to arrive on the scene. This delay creates a critical time gap where bystanders must act as immediate responders.
The Stop the Bleed campaign was originally initiated by a federal interagency workgroup convened by the National Security Council Staff at the White House [4]. This collaborative effort was led by the American College of Surgeons to bring the lifesaving lessons of military medicine back to the civilian homeland [4]. During the conflicts in Iraq and Afghanistan, advances in hemorrhage control and military trauma care demonstrated that early tourniquet application and wound packing significantly increased survival rates [5]. Today, the campaign translates these military breakthroughs into public knowledge, establishing national resilience and promoting injury prevention [4].
Recognizing a True Bleeding Emergency
Not all cuts and scrapes require advanced intervention. However, it is crucial to recognize when an injury has crossed the line into a life-threatening situation. Dr. David S. Shapiro, MD outlines the key visual indicators of a severe bleeding emergency during his interview [3]:
•Spurting Blood: Blood that is actively pulsing or spraying from a wound indicates an arterial breach, which requires immediate intervention.
•Pooling Blood: A large puddle of blood forming rapidly on the ground or around the victim.
•Saturated Clothing: Blood that is quickly soaking through clothes, bandages, or wraps.
•Loss of Extremity: Any traumatic amputation of an arm or leg automatically constitutes a bleeding emergency.
•Unresponsiveness: A victim who is confused, pale, or has lost consciousness due to blood loss.
The Three Core Actions to Stop Bleeding
The core curriculum of the Stop the Bleed program focuses on three simple, rapid techniques that anyone can perform with minimal training [6]. These actions are designed to be easy to remember under pressure, much like the steps of CPR.
| Action Step | Technique | Primary Purpose | Best Used For |
| 1. Direct Pressure | Use two hands to push down firmly and continuously on the wound using a clean cloth or gauze. | Compresses the ruptured blood vessels against the bone to stop the flow of blood. | Shallow wounds, cuts, or initial treatment for any bleeding wound. |
| 2. Wound Packing | Stuff sterile gauze or clean cloth deep into a gaping wound, then apply firm, continuous pressure with both hands. | Fills the void in deep tissue to apply direct pressure to the source of internal bleeding. | Deep, gaping wounds on the neck, shoulder, groin, or torso where tourniquets cannot be applied. |
| 3. Tourniquet Application | Wrap a dedicated tourniquet high and tight on an injured limb, pull the strap tight, and twist the windlass until bleeding stops. | Completely occludes arterial blood flow to an injured extremity. | Severe, life-threatening bleeding on arms or legs. |
How to Use a Tourniquet: A Step-by-Step Guide
Understanding how to use a tourniquet is one of the most powerful skills in first aid and disaster preparedness. Despite historical misconceptions, modern clinical data proves that a tourniquet is a safe and highly effective tool for temporary hemorrhage control [5].Here is the correct procedure for how to use tourniquet devices (specifically the Combat Application Tourniquet, or C-A-T, which is featured in official kits) [3] [6]:
- Place the Tourniquet: Position the tourniquet around the bleeding limb, approximately 2 to 3 inches above the wound. Do not place it directly over a joint (such as the knee or elbow); if the wound is near a joint, place the tourniquet above the joint. If the exact source of the bleed is unclear, apply it “high and tight” on the limb.
- Pull the Strap: Pull the self-adhering band as tight as possible through the buckle and secure it back on itself.
- Twist the Windlass: Twist the windlass rod until the bleeding stops and the distal pulse is no longer felt. Note that tourniquet application can be highly painful for the victim, but it is necessary to save their life.
- Lock the Rod: Secure the windlass rod inside the clip to keep it from untwisting.
- Record the Time: Write the exact time of application on the tourniquet’s time strap using a permanent marker. This is vital information for the emergency medical technician and trauma surgeons who will treat the patient later.
What is Inside a Trauma Kit?
For comprehensive emergency preparedness, keeping a dedicated trauma kit in your home, car, and backpack is highly recommended. During his appearance on Midday Maryland, Dr. David S. Shapiro, MD unboxed a standard bleeding control kit and demonstrated its contents [3].
Unlike a standard first aid kit that contains adhesive bandages and antiseptic wipes, a specialized bleeding control kit contains medical-grade supplies specifically curated to stop bleeding from severe trauma [3]:
- Cohesive/Protective Gloves: To protect the responder from bloodborne pathogens.
- Compressed Gauze: Highly absorbent sterile gauze used for wound packing and applying direct pressure.
- Trauma Shears: Heavy-duty scissors capable of cutting through thick clothing, leather, or seatbelts to expose the wound.
- Permanent Marker: Used to write the time of tourniquet application.
- C-A-T® Tourniquet: A military-grade windlass tourniquet approved by the Committee on Tactical Combat Casualty Care.
- Instruction Manual: A quick-reference guide detailing the core steps of the program.
Get Trained and Join the Movement
The American College of Surgeons Stop the Bleed program is a grassroots effort that has already trained over 5 million people worldwide [2]. Health and safety are shared community responsibilities, and getting trained is both free and highly accessible.
You can visit stopthebleed.org (specifically stopthebleed.org/summer) to access free resources [7]. The lecture portion of the course is available as an online interactive module, allowing you to learn the theory of bleeding control from the comfort of home [6]. To receive your official certification, you can use the “Find a Course” tool on the website to locate an in-person skills session near you, where a certified instructor will guide you through hands-on practice for wound packing and tourniquet use [6].
By integrating these lifesaving skills into your personal emergency preparedness plans, you become a vital link in the chain of survival, ready to protect your family, friends, and community when seconds count.
References
1.American College of Surgeons. Why is Stop the Bleed important? Stop the Bleed FAQ.
2.American College of Surgeons. About ACS Stop the Bleed. About Stop the Bleed.
3.GoToHealth Media. Stop the Bleed Interview with Dr. David S. Shapiro. YouTube Video.
4.American College of Surgeons. Our History and the Hartford Consensus. Stop the Bleed History.
5.Butler, F. K., Jr., MD. Lessons Learned from Military Hemorrhage Control. Stop the Bleed History.
6.American College of Surgeons. What You’ll Learn & How We Teach. Get Trained.
7.American College of Surgeons. National STOP THE BLEED® Month. Stop the Bleed Summer Campaign.
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