•The overlying clothes are soaked in blood.
•Bandages or makeshift bandages used to cover the
wound are ineffective and steadily become soaked
•An arm or leg is traumatically amputated.
• The patient was bleeding and is now in shock (
unconscious, confused, pale).
Immediate responders should attempt to stop
or slow massive hemorrhaging initially by using
their hands (gloved whenever possible) to initiate
primary compression. This compression should
be applied directly or just proximal to the site of
hemorrhage and with the use of sustained, direct
pressure. Performing this task may be difficult for
someone without any first aid training, but it will
significantly enhance the survival of the actively
hemorrhaging injured victim.
Once the professional responder arrives at the
scene, care should be transferred to this individual because he or she will be equipped with and
trained in the use of more sophisticated hemorrhage
control methods, such as hemostatic dressings and
In a manner similar to the presentation of CPR
training, hemorrhage control training programs
should be available to the public and offered by
employers, civic and religious groups, schools, and
the health care community at large.
As an increasing number of public and private
locations implement plans to preplace hemorrhage
control equipment or co-locate this equipment with
automatic external defibrillators, clear messaging
and signage should be posted so people can easily
and rapidly access this equipment.
The primary components of enhancing citizen resilience must focus on training considerations including:
• Determination of terminal learning objectives for bleeding control courses
•Establishment of standard curriculum for bleeding
Ȗ Education of the public in bleeding control using
multiple teaching methods, including:
Ƒ Didactic education programs
Ƒ Online modules
Ƒ Smartphone applications
• Tiered bleeding control education for the following:
Ȗ Immediate responders with no equipment other than
Ȗ Immediate responders with bleeding control kits (he-
mostatic dressings and tourniquets)
Ȗ Professional first responders with bleeding control kits
•Creation of public awareness through “Bleeding Safe”
communities similar to the “Heart Safe” communities
that were designed to promote survival from sudden
out-of-hospital cardiac arrest
Specifically, the Hartford Consensus recommends
developing a curriculum for the immediate responder.
The curriculum would feature a tiered approach
that uses the hands of the immediate responder fol-
lowed by hemostatic dressings and tourniquets when
these lifesaving interventions become available. This
HARTFORD CONSENSUS IV
FIGURE 1. EXCERPT FROM “STOP THE BLEED” POSTER DEVELOPED
TO EDUCATE THE PUBLIC ON BLEEDING CONTROL