adapted from the Tactical Combat Casualty Care
(TCCC) course. The TCCC program teaches members of military combat units to manage trauma on the
7 All soldiers who are deployed to an active
theater are educated in bleeding control techniques
and provided with an individual kit, which they are
required to carry on their person. The kit contains personal protective equipment, tourniquets, hemostatic
dressings, and a bandage.
The MCCA has modified and implemented
the TCCC process in its bleeding control training,
which has now been successfully deployed in police
departments across the U.S. More than 300,000 law
enforcement officers have been trained and equipped
with individual bleeding control kits. There have
been numerous reports of patients who have had
life-threatening hemorrhage controlled by law enforcement officers, with successful outcomes.
Engagement of EMS
A second initiative in the national Stop the Bleed
campaign, at the recommendation of the Hartford
Consensus, was to enable EMS personnel to render
care earlier in the medical response process. More specifically, part of the initiative sought to change the
standard procedure of having EMS personnel remain
on the periphery of an event until the scene was clear
of risk and secure before rendering care.
Although this new approach appeared to be a
logical concept, implementation was fraught with challenges. For instance, EMS personnel are not trained or
equipped with gear to protect them from firearms or
explosives, nor are they trained to preserve evidence
at a crime scene. Before this recommendation could
be put in place, it was important that the committee
engage in considerable discussion regarding the risks
and merits of deploying EMS personnel to an unsecured, active crime scene.
The compromise that emerged from this debate was
that bleeding patients would be taken from the Red
Zone—or highly dangerous area—to the Yellow Zone,
which is secure but not totally safe. In the Yellow Zone,
immediate professional medical care would be initiated
by trained and appropriately equipped EMS providers.
This process was facilitated by Richard Serino, former
Deputy Administrator of the Federal Emergency Management Agency (FEMA), and implemented under the
direction of Ernest Mitchell, U.S. Fire Administrator.
Engagement of the public
A third recommendation from the Hartford Consensus centered on public engagement. The primary
directive of the Stop the Bleed campaign was to recognize that for the first few minutes following a major
hemorrhage-producing injury, victims and bystanders can take action to control and limit blood loss.
This concept became known as immediate responder
Support for the public to act as immediate
responders was documented in a national poll of a
representative sample of the general public in the U.S.
In all, 92 percent of the respondents to the Hartford
Consensus survey said they would be very likely or
somewhat likely to try to stop bleeding in someone
they did not know. When asked if they would provide assistance in a mass shooting event, 94 percent
of respondents said they would try to stop bleeding if
it seemed safe to do so. Interest in learning bleeding
control techniques was substantial, with 82 percent
of respondents indicating they would be interested in
attending a local two-hour class on bleeding control and
other first-aid techniques. The survey results indicate
that the public is willing to help bleeding individuals
and is keen on learning how to do so.
10 Strategies are
needed to inform, educate, and empower laypeople to
act as immediate responders for hemorrhage control.