curriculum and practicum for combat casualty survival
training and skills. The education includes tourniquet
training and the correct placement and use of hemostatic dressings.
The Connecticut Fire Academy also has implemented emergency medical services programs. These
programs include the Train the Trainer Program.
The academy has purchased a number of hemorrhage
control training kits, and the training simulates the
management of wounds and severe hemorrhage. The
academy also has implemented bleeding control and
trauma bags, which are used at the Connecticut Fire
Academy and other locations. Similar training programs also have been incorporated into emergency
medical responder and emergency medical technician
training refresher programs.
Hartford Hospital, one of two Level I trauma centers
in the state, took a leadership role in implementing the call to action of the Hartford Consensus. It
became clear that the immediate response, prehospital
management, communication, and transportation of
victims had to be integrally linked to the in-hospital
response of the trauma center. To ensure an effective
response 24 hours a day, seven days a week, specific
training had to be implemented throughout the entire
In the spring of 2014, various groups throughout
Hartford Hospital were offered tourniquet-appli-
cation training on a voluntary basis. These groups
included the board of directors; executive manage-
ment team members consisting of vice-president–level
staff; the LIFESTAR air medical crew; and manage-
ment forum representatives consisting of managers,
physicians, registered nurses, public safety officers,
and other available staff. The public safety officers
were especially targeted for training to comply with
the Hartford Consensus recommendation that law
enforcement accept bleeding control as one of its core
responsibilities. The strategy of engaging the clini-
cal and administrative leadership of the hospital in
understanding the real risks and the need to be pre-
pared in the event of a mass casualty event was critical
to gaining the endorsement for widespread training
of all levels of hospital personnel.
The training consisted of either a live demonstra-
tion of the application of a combat-style tourniquet
and return demonstration by the learners or a video
demonstration and return demonstration. Initially,
the live demonstrations were used for small groups
of approximately 15 to 20 individuals. A three-minute
video was created to teach larger groups and on a more
frequent basis. Both the live and video formats involved
a presentation by a trauma surgeon who explained and
demonstrated the correct steps to apply a combat-style
tourniquet after first advising that personal safety
should always be a priority. The demonstration, time
for questions and answers, and return demonstration—
the entire training—took approximately 15 minutes.
The Women’s Auxiliary Organization of the hospi-
tal was instrumental in providing voluntary funding
for the tourniquets, hemostatic dressings, and gloves.
They also funded the purchase of bleeding control bags,
which were strategically placed within the hospital next
to automatic external defibrillators.
Hartford Hospital is the major teaching hospital for
the University of Connecticut. It has implemented a
large, modern simulation center designed to develop
hands-on competence in skills that include appropriate methods to control hemorrhage. Mannequins and
simulated environments are used to replicate mass
casualty disasters in the field and allow students to
practice immediate management of hemorrhage.
The simulation center also represents the emergency
department and teaches the assessment and treatment
of hemorrhage, including decision making for surgical
or radiologic intervention.
The simulation center allows trainees who have
demonstrated competence in the individual skills to
practice their specific roles in real time as part of a
team. This training allows prehospital personnel such
as emergency medical technicians and paramedics to
fully integrate with immediate responders at the scene,
as well as with law enforcement officers and fire personnel. These exercises include comprehensive assessment
This flexibility is critical in a response to episodic activities such
as terrorist events, which can generate widespread casualties,
fear, confusion, and disruption within the state.