Stop the Bleed

State: NY Type: Model Practice Year: 2019

The Florida Department of Health in Nassau County, serves a population of 82,721 according to the 2017 Census. The population of Nassau County under the age of 18 is 20.1%, between 18 and 64 is 59.2%, and 65+ is 20.7%. Nassau County is the northeastern-most county in Florida and its elevation runs from one foot to 200 feet above sea level. It is bordered to the north and west by the State of Georgia, to the southwest by Baker County, to the south by Duval County (Jacksonville), Florida, and to the east by the Atlantic Ocean. Nassau County is rural in nature, with a population density of 113 persons per square mile, with 41% of the county's population living on a coastal barrier island. Intentional and non-intentional injury remains a significant cause of premature mortality. Emergency Medical Services and Fire Rescue are required to serve large areas of Nassau County including rural areas. Other Nassau factors that increase EMS response time to injury include rail traffic and recent road construction that may disrupt egress & ingress. Finally with recent Active Shooter Hostile Events, large and even smaller community gatherings present multi-trauma mass care challenges in smaller counties. This project focuses on promoting community resiliency through first responder and citizen training on hemorrhage control. Following the recommendation of the Hartford Consensus IV, this project promotes community training and placement of kits for hemorrhage control as a key pre-hospital strategy to reduce mortality. The goal is to make "Stop the Bleed" training as widespread as basic life support I.e. Cardio-Pulmonary Resuscitation (CPR) and to preposition hemorrhage control kits alongside Automatic External Defibrillators (AEDs) to facilitate use and early response. This strategy is especially important in a large semi-rural community with a limited number of EMS and law enforcement first responder units. According to the National Trauma Institute. A traumatic injury with a major loss of blood is responsible for over 35 percent of prehospital deaths and is also responsible for over 40 percent of deaths that occur with the first 24 hours of hospital admission. This program is aimed at providing the general public with the knowledge and eventually the tools to address hemorrhage situations, this training with a kit will greatly affect the morbidity rate of bleeding related deaths. This project was purposed in August 2016, with a grant award date of November 9, 2016. Materials were ordered February 2017, and received in April 2017. We began training School Board Personnel in May and finished the required 2 personnel per school quota training in June 2017. We began deploying the kits to all Nassau County School Building at the start of the new school year in August 2017 at a rate of One Hemorrhage control kit per school, in April 2018 we received another shipment of 97 kits which were deployed at a rate of four additional kits per school. Currently there are five kits in every school in Nassau County. The success of this program is currently based on the wave of support generated by individuals and institutions looking for ways to address mass casualty incidents. Once the program of instruction is complete trained individuals identify situations where this program could be applied. When we began in 2017 it was hard to obtain the minimum two individuals per school, our latest class we conducted in October 2018 had 19 people at one school. We actually had to cutoff enrollment to this class due to class sizes be limited to 20 people. Because the program is so easy it can be taught to people of all levels of training from novice to experienced personnel there is something for everyone.
This program began with the CHD Director going to a symposium where Dr. Brad Elias described the potential benefits of a hemorrhage control program. FDOH Nassau recognized that Life Threatening bleeding can occur from emergency situations in our communities every day. From vehicle crashes and incidents involving farming equipment or public transportation to accidental injuries from natural disasters like tornadoes or inflicted injuries from intentional acts of violence like shootings and bombings, uncontrolled arterial bleeding can result in death within three minutes – even before emergency medical services or other emergency responders can arrive. These first minutes following a traumatic injury are crucial in saving a life. FDOH realized that help offered by bystanders can often make the difference between life and death. Our agency already pushes for public knowledge of CPR and how to use AED Machines, however serious bleeding from an extremity is the most frequent cause of preventable death from injury. The FDOH-Nassau program began as a pilot program through a grant from the Northeast Florida Healthcare Coalition. Within a year of this program being implemented the Nassau model” had been used by every county in Florida's RDSTF Region 3. Phase 1 of the implementation has focused on Schools, County Buildings, and Faith-based Organizations. Phase 2 will focus on Public transportation, and other public partners. Phase 3 is a partnership to provide resources and training to private agencies and partners. The Stop the Bleed” Program is backed by evidence based practices provided by the American College of Surgeons, The Committee on Trauma, and the National Association of Emergency Medical Technicians below is a link to the Hartford Consensus.
Enter the LHD and Community Collaboration related to your practice Our initial deployment phase was required to have two people from every school trained before a kit could be deployed. These people selected for training were usually the school nurse and an administrator. Once these two people were trained a kit was deployed, as more individuals received training we deployed more kits, currently we are at a 5 kit capacity at every school. This 5 kit per school actually exceeds our initial project goal of making kits as common as AED's since there are only 2 AED's per school. During the planning phase we involved the Nassau County School Board, Nassau County Emergency Management, Nassau County Fire and Rescue, and the Nassau County Sheriff's Office. These partners have been long standing partners for preparedness and response to events, these stakeholders had just taken part in an Active Shooter Exercise which had heightened the awareness to the need for bleeding control kits. The kits were provided by a grant from the Northeast Florida Healthcare Coalition in the amount of 20K, currently there are no sustainment costs and training is conducted by public agencies for no charge.
Evaluations were conducted following the training phase. Most students surveyed were 32.14% Nassau County School Board, 64.29% FDOH- Nassau, and 3.57% Local governmental entity. Question 1 The degree to which this program will enhance my professional skills and knowledge. 32.14% said 4/5 67.86 said 5/5 Question 2 - The degree to which the content met the stated objectives. 21.43% said 4/5 78.57% said 5/5 Question 3 - The degree to which the content was accurate and current. 23.08% said 4/5 76.92% said 5/5 Question 4 - The degree to which the instructor(s) was effective in conveying information. 3.7% said 3/5 14.81% said 4/5 81.48% said 5/5 Question 5 - The degree to which resource information provided was adequate and useful. 3.7% said 3/5 22.22% said 4/5 74.07% said 5/5 Question 6 - The degree to which the entire program was meaningful and appropriate. 22.22% said 4/5 77.78% said 5/5 Question 7 - The degree to which the time allocated was adequate for the material presented 10.71% said 3/5 28.57% said 4/5 60.71% said 5/5 Question 8 - The degree to which the environment was conducive to learning. 3.57% said 2/5 3.57% said 3/5 32.14% said 4/5 60.71% said 5/5
Currently the sustainability for the full program is 5 years with the initial grant, after the 5 year period the sustainability is 80%. This is due to the first phase of the program using a hemostatic agent in the Hemorrhage control kits, the second deployment used a sealed kit with no hemostatic agent which gave it an unlimited service life. If kits are used local shareholders have agreed to replace them as needed.
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