Aug. 25—Less than two months before he succumbed to cancer, paramedic Richard Knowlton traveled to the Outer Cape to help train Truro Fire Department staff and lifeguards on how to stop people with traumatic injuries from bleeding to death.
Knowlton, the Cape and Islands Emergency Medical Services System co-director, used the Father's Day training to demonstrate the uses of tourniquets that cut off blood spurts and state-of-the-art dressings that encourage blood to clot.
"He said, 'This is important,'" said Donna Rex, Knowlton's co-worker and current co-director of the system.
"You can bleed to death very quickly, within minutes," she said.
Little did Truro rescuers know that the Stop-the-Bleed training they received in June would be needed six weeks later after a shark bit a man Aug. 15 off Long Nook Beach.
"It made a difference," Truro Fire Chief Timothy Collins said of the national training program that stemmed from the Sandy Hook Elementary School shootings in 2012.
The first line of defense for 61-year-old shark bite victim William Lytton came from beachgoers on a remote beach south of Long Nook who improvised with towels to stop the bleeding of a puncture on his left leg and hip.
Truro Fire Department rescuers took over as Lytton, a neurologist and medical school professor, was whisked by ambulance to a medical helicopter 12 miles south.
Among calls heard on the police scanner as the ambulance began its trip from the beach to the helicopter landing area was a Truro rescuer asking for more of a blood coagulation product known as QuikClot.
Twice, a rescuer asked for more QuikClot—first as the ambulance headed to meet rescuers, then as it passed through Wellfleet to the landing area.
QuikClot is one of several hemostatic dressings developed to treat severe hemorrhaging in soldiers in Iraq and Afghanistan, said Dr. David Farcy, of Miami Beach, president of the American Academy of Emergency Medicine.
The gauze-type dressing is applied to wounds with severe bleeding on the torso, abdomen and buttocks -- areas of the body where arterial flow cannot be cut off with a tourniquet, Farcy said.
In QuikClot, kaolin is the natural agent that accelerates the clotting process, Farcy said.
Hemostatic dressings are "10 times more effective than regular gauze," said Dr. Lenworth Jacobs, a professor of surgery at the University of Connecticut Health Center in Farmington.
"The name of the game is to keep the blood inside the body," he said. "You can bleed to death in five to 10 minutes."
Jacobs started the nationwide Stop-the-Bleed program after the Sandy Hook school shootings Dec. 14, 2012, in Newtown, Connecticut, that killed 20 children ages 6 or 7 and six adult women who worked at the school.
"You can't live through that and keep on going" without taking some kind of action, Jacobs said.
Surveys of the public showed that people want to do something to help in an emergency where someone is bleeding, Jacobs said.
The Stop-the-Bleed program, in which participants learn how to apply pressure, tourniquets and hemostatic dressing, provides the necessary training, Jacobs said.
"You don't want to just shout and scream and call 911," Jacobs said. "Ultimately, the goal is to train everyone."
As part of the national program, the town of Truro has purchased a half-dozen stop-the-bleed kits, one for each primary town building, to be placed near the automated external defibrillators, Collins said.
Each kit contains a tourniquet, pressure dressing, hemostatic dressing and gloves. Collins said he has taken the "train the trainer" class and intends to offer training in Town Hall within the next few months, based on what town leaders decide.
Chatham Fire Department emergency medical services coordinator Mark Heller said the department has carried hemostatic dressing for two to three years.
"There's a certain amount we carry," estimating that two packs are needed per hemorrhaging patient, Heller said.
"Everybody's using it now," said Shane Clark, emergency medical services officer for the Cotuit Fire Department.
Collins said he could not comment on the methods used to control Lytton's medical condition because of privacy constraints.
He also said he did not want to endorse a particular product but did say the town rescuers carry hemostatic dressings among their medical tools.
Wellfleet Fire Lt. Shawn Clark said the Z-folded and treated gauze of Quikclot is what that town's firefighters have chosen for several years to keep in their trauma bags on ambulances.
Clark pulled out a "QuikClot Combat Gauze" package that held one sterile strip that was 3 inches by 4 yards. The product costs about $48 through an online supply store.
"It's for uncontrollable bleeding," Clark said. "Like an arterial bleed."
Stop-the-Bleed training on the Cape already has extended beyond firefighters and emergency services personnel.
Almost 100 teachers and staff members at Dennis-Yarmouth Regional High School took part in the training April 11, said Yarmouth Fire Department Lt. James Roberts.
Nineteen instructors from several Cape fire departments and emergency services agencies led school staff through the once-maligned art of applying tourniquets and the new techniques involved with hemostatic dressings, Roberts said.
"You're supposed to find the point of bleeding," Roberts said. "If you don't stop the bleeding, people die."
"In the beginning, I think they were very leery," Roberts said about school staff. But after practice sessions on mannequins and "extremity props," "we had a lot of positive feedback," Roberts said.
"Training like that, especially in the times we live in, is invaluable," said Dennis-Yarmouth Principal Anthony Morrison, who was first trained in bleeding cessation programs in the military.
It's not just worst-case scenarios such as shootings that can cause traumatic bleeding, Morrison said. "Broken bones can also cause major bleeds."
Roberts said the school now has tourniquets on hand but not hemostatic dressing yet.
Tourniquets fell out of favor at one point because of outdated beliefs they would cause the limbs they were used on to be amputated, emergency responders said.
But that is not the case, and emergency responders in Yarmouth have been carrying arterial tourniquets for several years, Roberts said.
Lytton, who was reported to be in good condition at Tufts Medical Center in Boston this week, was the second person to be bitten by a shark off Truro beaches in the last six years.
A man from Denver survived an attack by a great white off Ballston Beach in 2012.
"We talked specifically about shark bites" in the Father's Day training in Truro, Rex said.
She said she was impressed with the department's response to the latest shark bite victim's injuries, and is sure Knowlton—who died at age 59 on Aug. 4—would be, too.
"They did everything right," Rex said. "I'm so happy. Rick would be so happy."