Page 97 - JSOM Winter 2019

The Rise of the Stop the Bleed Campaign in Italy

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Daniele Valsecchi, OF-1, MD *; G. Sassi, OF-1, MD ; L. Tiraboschi, OR-1, RN ;
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M. Bonetti, OR-5 ; E. Lagazzi, OR-1 ; A. M. Michelon, OR-2, RN ;
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T. Nicolussi, OR-3, RN ; A. Stevan, OR-1, RN ; N. M. Bonasera-Vincenti, OR-1, RN ;
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R. Guelfi-Pulvano, OF-1, RN ; R. Tripodi, OF-5, MD 1,2
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ABSTRACT
Background: The B-Con Basic 1.0 protocol is a medical train- context, to 15 minutes or longer for extraurban contexts.
ing designed to teach how to control massive external hae- These parameters increase drastically if you find yourself in
morrhages in emergency conditions. Spread throughout the situations of a “maxi-emergency” or in unsafe scenarios, such
United States since 2013, thanks to the Stop the Bleed cam- as a terrorist attack, where the rescuers are unable to access
paign, it has seen a progressive international spread during the critical area until it has been secured. However, to be ef-
2016–2018. We report here data from the first 18 months of fective in the treatment of massive external hemorrhage, you
our training in Italy. Methods: Since January 2017, military must intervene in a period ranging from 3 to 8 minutes from
Operators enlisted to the Volunteer Military Corps of the Ital- the beginning of the bleeding, according to the site of wound.
ian Red Cross and registered to the ACS B-Con instructor da-
tabase have provided B-Con courses. These instructors have We can therefore understand how the greatest difference can
provided extensive training, involving learners among military be made by those who are directly on the scene, whether they
and civilian populations, especially health professionals and are the “bystanders,” the civilians on the scene, or the “first
students. Further, they have obtained a formal adhesion to the responders,” any rescue figure who first comes to the place.
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National Stop the Bleed Day 2018. Results: Through August However, they may undertake immediate effective treatment
2018, we trained 1186 learners in Italy on the B-Con protocol. only if they have the necessary knowledge. 6
The learners were mainly military personnel and law enforce-
ment agents (620 [52%]) but also students and civilian health In 2013, a group of physicians, rescuers, and military took
personnel (566 [48%]). Conclusion: The B-Con protocol has part in the Joint Committee to Create a National Policy to
been very well received in Italy by military and police per- Enhance Survivability from Mass Casualty Shooting Events,
sonnel. Good results have been assessed among civilian health signing what was then called the Hartford Consensus (cur-
professionals and medical students, especially by those opera- rently in its fourth revision). In the context of this document,
tors involved in the field of emergency medicine. the training protocol called B-Con (Bleeding Control Basic
1.0) was outlined, with the specific aim of training a wide
Keywords: B-Con; bystanders; first responders; Hartford; spectrum of men and women, like law enforcement (LE), fire-
resilience fighters, and emergency medical technicians (EMTs) but also
civilians without medical or tactical skills, about the specific
rescue skills needed to provide immediate care to a wounded
person with massive external hemorrage. A landmark of this
Introduction
program is the training in rapid use of arterial tourniquets,
The emergency treatment of posttraumatic massive external among those approved by the Committee on Tactical Combat
hemorrhage has been a widely debated topic, especially in the Casualty Care, Israeli compression bandages, and hemostatic
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United States, for more than a decade. However, only recently gauze, both for self-medication and for an injured person. 7
the need for a specific program on the subject has been un-
derstood, in the aim to raise awareness and to transfer the Since 2016, this training protocol has been part of a world-
experience accumulated in the new millennium war contexts wide campaign, sponsored directly by the White House, called
into civil theaters. 2 Stop the Bleed—Save a Life; since 2017, the entire training
program and the scientific updates of the B-Con protocol are
The idea was born in the United States in 2012, following the also directly supervised by the American College of Surgeons.
tragic shooting at the Sandy Hook school. It has been seen on
that occasion, and in subsequent events such as the terrorist The Rise of the Stop the Bleed Campaign in Italy
attack during the Boston Marathon in 2013, that the conven-
tional response of the rescue chain was not functional to in- In Italy, although the basics of bleeding control were already
crease the survival of the wounded. The average time to be in the specific training for combat medics and in emergency
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rescued by an ambulance varies from 8 minutes, in an urban first aid courses delivered by private companies, the B-Con
The data reported in this study were partially presented, as preliminary data, at the Special Operations Medical Association Scientific Assembly
(SOMSA) in Charlotte, May 2018, as a poster.
*Correspondence to daniele.valsecchi.85@gmail.com
1 All authors are affiliated with the Coordination Group for the B-Con–Bleeding Control Program, Italian Red Cross Volunteer Military Corps.

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2 Dr Tripodi is also affiliated with the National Inspectorate of the Italian Red Cross Volunteer Military Corps, Rome, Italy. Mr Bonetti and Mr
Lagazzi are also affiliated with the University of Genova, Faculty of Medicine and Surgery, Genova, Italy.
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