Page 151 - Journal of Special Operations Medicine - Winter 2015

The Hartford Consensus III recognizes the vital role that training must be efficient and cost-effective. Ultimately,
immediate responders play in responding to mass-casu- integrated training exercises must be conducted that in-
THE HARTFORD CONSENSUS III: IMPLEMENTATION OF BLEEDING CONTROL alty events. They make major contributions to improv- clude all levels of responders.
ing survival from these incidents. However, the Hartford
Consensus III does not advocate that members of the Specific educational content for immediate responders
public enter areas of direct threat or imminent danger. should include:

Good Samaritan laws have been effective in empower- • Actions to ensure personal safety
ing the public to become involved in the immediate re- • Appropriate interactions with law enforcement, EMS/
sponse to a victim of cardiac arrest or choking by the fire/rescue, and medical personnel
initiation of cardiopulmonary resuscitation and the • How to identify bleeding as a threat to life
Heimlich maneuver, respectively. The Hartford Consen- • Use of hands to apply direct pressure
sus recommends that these legal protections be extended • Proper use of safe and effective hemostatic dressings
to include the provision of bleeding control. • Proper use of effective tourniquets
• Use of improvised tourniquets as a last resort
Professional first responders
Professional first responders include law enforcement For professional first responders, educational content
and EMS/fire/rescue. As indicated by THREAT, law en- should include:
forcement must suppress the source of wounding if the
shooter is still active and then, because they are usually • Actions to ensure personal safety
the initial first responders on the scene, must act to con- • Coordination and integration of all responders
trol external hemorrhage. Victims with life-threatening • Communication among all responders
external bleeding must be treated immediately at the • Appropriate interactions with immediate responders
point of wounding. All responders should be educated • Application of THREAT principles
and have the necessary equipment to provide effective • Proper use of direct pressure
external hemorrhage control. Continued emphasis must • Proper use of safe and effective hemostatic dressings
be on the integration of the immediate responders, law • Proper use of effective tourniquets
enforcement, and EMS/ fire/rescue to optimize rapid pa-
tient assessment, treatment, and transport to definitive It is appropriate to use existing national organizations
care at the nearest appropriate hospital. to widely disseminate the principles embodied in these
education initiatives.
Building Educational Capabilities
Education in hemorrhage control can take many forms
and should be offered using various modalities. Estab-
lished education programs for individuals, communities,
and professional responders can be modified to include
effective external hemorrhage control techniques. The
Bleeding Control for the Injured (B-Con) course offered
by the National Association of Emergency Medical
Technicians is an example of a newly created program
that is appropriate for training individuals who have JAMES BROOKS HART, CMI
little or no medical background. Other methods such
as public service announcements, slogans, advertising,
and entertainment media should be used to convey the
message that bleeding control is a responsibility of the One-handed tourniquet application
public and is within their capabilities.

The public needs to be empowered to engage in lifesav-
ing actions. This training should be included as part
of preparing for situations involving other potential
hazards, including everyday events that may produce
trauma and hemorrhage. For professional first respond-
ers, more advanced courses may offer additional op-
tions to control life-threatening external hemorrhage. JAMES BROOKS HART, CMI
All formal training should have specific objectives and
train to competency. For professional responders, the

The Hartford Consensus 139