 University of Maryland School of Medicine and Director of Wound, Healing and Metabolism at the R. Adams Cowley Shock Trauma Center. Doctor, thank you for your time. Thank you for having me. Tell me about Stop the Bleed. Where did this program come from? So Stop the Bleed was a really a joint effort of multiple organizations in the federal government. And it really was one of the first programs that really sought to involve the public in trying to improve survival from injury. And it developed some really simple techniques that we can train the public to use when there is life-threatening bleeding that can improve survival of patients to get to the hospital where they can get expert care. What's the response from the public been like? I mean, people, you know, everybody's learned the Heimlich maneuver and CPR, and hopefully they've learned how to work a defibrillator. Why is this an important part for regular civilians to know? So as you heard in the segment before, bleeding is still the leading cause of death after injury. So if we want to impact that number and save more lives, the sooner we control bleeding, the better chance we have of saving a patient. So when there is that life-saving hemorrhage, we rely on our professional emergency response people. And as we heard, we have a wonderful sort of elegant system in the state of Maryland that really goes out and gets you when they know you're injured, but they have to know you're injured and they have to get to you. So there's often a lag between the time of injury and the time that help arrives. And if a bystander who is there at the moment of injury or close thereafter can do some simple techniques that will lessen the amount of blood loss, then that gives a patient a much better shot at survival. I think if somebody was in the scouts or took a life-saving course, they probably learned about tourniquets. Did we learn it right? I've heard that maybe there was some, I don't want to say bad info, but the techniques have improved. Well, one of the things that has improved is we have great, better tourniquets that are available commercially. They are not super expensive so that you can have your own little Stop the Bleed kit for about $40, where you'll have gloves and gauze and a tourniquet and the things that you might need to help stop the bleed. So these manufactured tourniquets are our best bet. Now you see on TV a lot of times people taking the belt off or taking a scarf and wrapping it around the arm as a method to control hemorrhage. And that looks great on TV, but we know from testing that it doesn't actually stop the bleed well and in certain circumstances can actually increase the amount of bleeding because think about it, when you get your blood drawn, what do we do? We put a tourniquet on your arm to plump up your blood vessels and then we stick a needle in and the blood comes back more freely. So a Venus tourniquet is what that is so it's not as tight as the one that we're gonna teach you to put on to stop arterial bleeding. So when those are put on, there's no blood below the area where the tourniquet is placed. Oh, do you wanna try it? Not on me, maybe on this thing, which... So I wanna start with the first... You wanna start with the punctures? Yeah, I wanna start with the first step because your first step is not necessarily to put a tourniquet on, it's really to do some more simple measures and that more simple measure is just applying pressure. So that's really the first step to the actual process of stopping the bleed and it can't be just, oh, I'm putting my, I'm applying pressure. No, I'm not. You have to really apply pressure. So you're leaning into it, you're putting your body weight. You are exhausted after you finished because you're holding pressure. Remember, you have to stop that artery. You're trying to block an artery and you're trying to prevent the blood from coming out. So applying pressure is the first step. The second step, excuse me, if you have a wound that is deep as these on these models are, sometimes putting pressure isn't enough and you literally have to pack the wound with gauze or if you don't have gauze, this, a shirt, any piece of cloth, a scarf, whatever you might have at hand could be used to pack a wound. Because we're not worried at this point that it's a sterile dressing. It's not worried about it being sterile because if you don't survive to get to the hospital, you don't survive to get an infection. So this is really about saving a life. And all you wanna do is put that gauze in to the bottom of the wound and fill it up completely. So you can use gauze, you can use the scarf or a shirt, as I mentioned, or you can use a regular bandage, whatever you have can be utilized. This is not for the faint of heart. I mean, in real life, you know, this person's bleeding badly, somebody may be concerned about blood-borne illness, but there's a life to be saved. Yes, and you know, again, most of us don't walk around the streets with our gloves in our pockets. So when it comes to that, you may not have a pair of gloves to put on. One of the things I tell classes that I teach that you could use, if you keep them in your bag, you know those terrible plastic bags that the state of Maryland wants us not to use anymore. Those T-shirt bags, if you save them like I do and have them in your car, you can stick your hand in that and have that act as a barrier between you and the blood if you should find yourself in this kind of circumstance. Okay, we'll get back to the demo. Good email question from Robert. What should be in trauma kits, first aid kits at public places, schools, workplaces and so forth? That's a wonderful question, Robert. I think the things that are necessary are gloves, so having gloves so that we can protect ourselves as we try to help patients. We need some gauze, so it doesn't have to be fancy gauze. Now this is what I call fancy gauze. This has hemostatic agents in it, so it helps the blood to clot faster, but this planal gauze will work as well, so gauze or one of these hemostatic gauze, you'll need some scissors, you will need a marking pen because it's very important to write on the tourniquet the time, if you're gonna put a tourniquet on, we wanna know what time that tourniquet was placed because there is a limit to the amount of time we wanna leave a tourniquet in place before we take it down so that that limb won't necessarily require amputation. Do you wanna demo the tourniquet on our friend here? You sure you don't want me to do it on you? Yes, I'm quite sure. I don't even like the blood pressure. So usually we leave the loop in. This tourniquet could be used on an arm or a leg, so it's big enough that it can go on either. So usually you just simply slip the loop through the extremity. You wanna assure you place the tourniquet between the heart and the wound. So if my injury is here, my heart's here, I want the tourniquet up here, right? So you want it away from the wound, but not below it. It has to go on tight. And if your patient is conscious, they're not going to like it. They're gonna say it hurts, they may even scream and holler, but you have to assure them that what you're doing is meant to help. So you wanna make it tight, and you know it's tight because you don't wanna be able to get your finger between the tourniquet and the skin. So I've secured it, I've fastened the Velcro down, amend this windlass, which is a key part of the tourniquet that allows you to tighten it even further. And if you look closely, you can see it dimpling in, and usually it takes about two turns of the windlass, and then you're gonna lock it there, and then you're gonna bring your Velcro strap over, and then strap this. And this is where you need your marking pen, where you're gonna note the time so that when the patient arrives at the hospital, the hospital personnel will know how long the tourniquet has been in place. Oh, please. And you're gonna know, how do you know you've done a good job? You won't see bleeding, right? So if the bleeding stops, you've done a good job. How do you know this is the right treatment? That it's a situation, instead of the pressure you demoed that that's not working, we need the tourniquet. So if you're applying pressure and you still see blood dripping under your hand, then it's time to try something else. Sometimes you will need your hands. Maybe if you're by yourself, you will need your hands free so that you can go for help, or you can do some other maneuver that you may need. So putting a tourniquet allows your hands to be free in some way, so it has that advantage. But usually you know you need to move on to the next step because this is ineffective, or maybe you're even getting tired, because as I said, you're using energy when you're applying pressure and you do this for 10 minutes, it may get tiresome. I have about half a minute. You and your colleagues have been taking our friend out here in the community and training groups. How long does that take? So the training is about an hour. It's not a super long. There's a small sort of slideshow that we give where we teach some background about what does life-threatening hemorrhage look like because people often don't know what that looks like. And so we have to sort of, if you see blood soaking through clothing, if you see it puddling up around a wound, those things are signs that there may be life-threatening hemorrhage. It's a great pleasure talking with you. Your health segments are a co-production of Maryland Public Television and the University of Maryland Medical System.