May 21--Mass casualty events -- ranging from the slaughter of 26 innocents at Sandy Hook Elementary School in 2012 to the bombs that killed three and injured more than 250 at the Boston Marathon in 2013 -- have highlighted the need for a well-trained citizenry, according to a doctor promoting bleeding control techniques.
After chronicling several other mass casualty attacks in the United States and Europe, Dr. Lenworth Jacobs said, "It's a big problem, and it's getting worse."
Jacobs, speaking to roughly 250 people at a trauma care symposium that Gundersen Health System sponsored Friday at Western Technical College in La Crosse, noted the attacks at schools besides Sandy Hook, including Columbine and several colleges and universities.
"You don't go to get an education to be shot," said Jacobs, director of the Trauma Institute at Hartford (Conn.) Hospital as well as emergency medical services for the city of Boston.
Citing homemade pressure cooker bombs that killed three people and maimed or otherwise injured more than 250 near the Boston Marathon as an example, Jacobs said, "Terroristic attacks are not designed to kill you" but rather, to instill fear not only at the scene but also in the general population in the aftermath.
"They put the bombs low to take out legs" and injure as many people as possible as the shrapnel -- small nails, plastic, pellets and wood -- was propelled throughout the large crowd near the finish line, he said.
Similarly, several coordinated terrorist attacks in Paris in November 2015 killed 130 people, although the assaults near the Stade de France in Saint-Denis as part of that wave killed just three, while instilling widespread terror.
"If you blow up a stadium, you will not create a lot of damage, but it will create panic, and people will be injured in the panic," he said.
The scope of attacks has become widespread, Jacobs said, adding, "It's a ubiquitous problem."
The onslaught also envelopes secondary targets, he said, noting threats against shopping malls between Thanksgiving Day and Christmas -- the retail industry's most lucrative time of the year.
Targeting the commercial sector "is totally unrelated to survival, values and health," he said, but it underscores terrorist goals of disrupting as many people and institutions as possible in a small amount of time.
The pervasive nature of the attacks have made it clear that survival for many will pivot on the ability of trained civilians to tend to people's wounds while first responders are en route instead of waiting for medical personnel to arrive, Jacobs said.
Jacobs' world-acclaimed expertise in the issue stems from his leadership in several trauma initiatives and chairmanship of the Hartford Consensus, which the American College of Surgeons created as the Joint Committee to Increase Survival from Active Shooter and Intentional Mass Casualty Events.
The Hartford Consensus generates strategies to respond to such attacks, detailing the roles of law enforcement, first responders, medical personnel, hospitals and bystanders.
Arriving at recommendations required the planners to "check their ego at the door to make positive changes," he said.
Among the mantras emerging from the Hartford Consensus, two follow-ups and recommendations from the Obama administration and the federal Homeland Security Department is the slogan, "Nobody should die from uncontrolled bleeding."
Similarly, the initiative has adapted the post-9/11 rallying cry of, "If you see something, say something" to make it, "If you see something, do something," Jacobs said.
Action is particularly important within the first few minutes of an incident because deaths from bleeding and other severe injuries are concentrated in that time span, he said.
"Civilians have to make life-or-death decisions," he said. "We've got to get to the time of civilians to be more involved."
Training -- especially in bleeding control -- will be paramount, he said, noting that such education is as important as longtime efforts to teach people how to use automated external defibrillator.
To illustrate his point, Jacobs showed slides in the pandemonium after the marathon bombing in which civilians jumped into the breach to apply pressure, tourniquets -- some using their own belts and/or shirts or other articles of clothing -- and other techniques to stop the bleeding of victims.
To highlight the fact that a bystander easily can use a shirt as a pressure pack to top bleeding, shirts sold in some stores have tags suggesting just that use, with the notation that "This shirt can save a life," he said.
Jacobs cited statistics indicating that the military suffered a 7.4 percent rate of preventable combat deaths from bleeding in 1970 because knowledge of how to stop bleeding was concentrated in the medical corps.
By contrast, that rate dropped to 2.3 percent in 2012 because all soldiers now carry tourniquets, and that saves hundreds, perhaps thousands, of lives, he said.
The fact that other soldiers carry tourniquet kits also frees up medics to treat the more severely injured, he said.
Another advantage to the expanded training is "they can put a tourniquet on and move on to the next person," instead of having to remain with an injured colleague to apply pressure.
"It frees up two people," Jacobs said.
The Stop the Bleed Campaign, in part, applies the lessons learned in combat to training for civilians, which Jacobs said should include a certification certificate like CPR training does.
The Stop the Bleed campaign also advocates putting "bleed bags," with supplies such as protective gloves, scissors, tourniquets, blood-stopping bandages and other first-aid supplies next to AED machines, as well as private citizens' carrying smaller versions in their cars.
President Barack Obama lent his cloud to the endeavor, Jacobs said, "to build national resilience in stopping life-threatening bleeding.
"Become a change agent to increase survival," Jacobs concluded.
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