As Mass Shootings Become More Common, A Push To Make Tourniquets Routine First Aid

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BRAINTREE, Mass. CPR and the Heimlich maneuver are routine first aid. Look around schools, libraries, concert halls and many gyms and you’ll see a heart defibrillator ready for action.
Now, as we face more mass shootings and other disasters, should tourniquets, used to stop severe bleeding, be just as common?
The White House says yes; it’s rolling out a national campaign called “Stop the Bleed.” Last week, the American Red Cross and American Heart Association updated first aid guidelines to include bleeding control and the use of tourniquets. And the Red Cross expects to add bleeding control to its online and in-person trainings in the coming months.

But one Boston surgeon isn’t waiting.

‘It’s The Reality In Which We Live’

“Step one, you apply direct pressure,” Dr. David King tells a dozen nurses from Catholic schools in the Boston Archdiocese, gripping his right forearm to demonstrate. The nurses, all women, have gathered at the church headquarters in Braintree to learn what they can do to stop severe bleeding. King, a trauma surgeon at Massachusetts General Hospital, moves quickly to step two.
If pressure doesn’t stop the flow of blood, pack the wound tight. Use specially treated blood clotting gauze if you have it, King says. If not, a T-shirt will do.
“You’ll see in 10 seconds whether that’s worked or not. If it doesn’t, what’s the next step and the final step?” King asks, looking from one face to the next. “It’s to put a tourniquet on, right?”
King grabs a handful of black plastic straps with Velcro on one side, a double buckle at one end and a small black stick the nurses would twist on the tourniquet to clamp blood vessels shut, if needed. King would like to see a tourniquet in every classroom, mall, train station — in any public place. His conviction is rooted in 14 years as an Army combat surgeon, and the 2013 Boston Marathon, which he ran. He finished before the blasts and was at MGH to meet the flood of wounded patients who came pouring in.
“After the Boston Marathon bombing, my military experience just started making me think that this is an exportable skill that we can teach anybody,” King said of applying pressure, packing wounds and using tourniquets. “It’s unfortunate that we have to be teaching teachers how to do this, but it’s the reality in which we live.”

Finding Extra Minutes

King is part of a national advisory group that recommends all Americans be prepared to act as immediate responders. Two weeks ago, the White House and the Department of Homeland Security embraced that idea with the “Stop the Bleed” campaign.
“Five minutes can make the difference between life and death,” Deputy Homeland Security Adviser Amy Pope said at the campaign launch, about how quickly someone injured in a shooting, bomb blast, tornado or train accident can bleed to death.
“We want to make sure more people can survive a severe injury,” Pope continued, “that more people will have more than five minutes, more time to be treated and seen by a professional, more time to live.”
The campaign plans public education announcements and widespread access to bleeding control kits with tourniquets.
The Red Cross’s decision to update its first aid update guidelines is in response to the national campaign.
“The Red Cross feels that every American needs to know how to care for someone who has massive, life threatening bleeding,” said Jonathan Epstein, senior director of science and content for the American Red Cross. “Recent incidents at schools and malls, the Boston Marathon, are all situations that have pushed health care and emergency medicine to make sure that citizens can respond in an emergency.”
Dr. King wrote his own script and is scheduling his own trainings.

Empowered To Save A Life

The Catholic school nurses gathered for the training break into small groups and practice threading and tightening a tourniquet on themselves. Then, with King watching, they test the tourniquet on a tube-shaped pillow that King has wrapped in black duct tape. It’s about the size and density of someone’s thigh.
“Wait a minute, I’m stuck,” says Elizabeth Paquette, the nurse at Malden Catholic High School, looking perplexed.
Threading the buckle twice for maximum tension, and then pulling the strap hard enough to close off bleeding completely, is hard. King has some tips.
“I put my hand on the leg,” he says, demonstrating, “I push [the leg] away from me, while I pull the free end [of the tourniquet] towards me.”
Theresa Hartel, the nurse at Boston College High School, takes a turn. She leans into the dummy thigh and then yanks back with a mighty pull.
“Oh, go Theresa,” her fellow nurses yell, “that’s what we were missing.”
Hartel twists the little black bar or windlass on the tourniquet to increase the tension.
“Wow, Theresa,” says Bridget Jaklitsch, the nurse at St. Francis Xavier in South Weymouth.
“He’s not bleeding anymore,” Paquette announces.
Jaklitsch says she is disturbed to think school nurses need this training, but she wants to be prepared.
“As nurses we are first responders, whether it be at school or a marathon. I was there the day of the Boston Marathon,” Jaklitsch says. “Anytime there’s an emergency, we react. To have the knowledge about how to put on a tourniquet, I’m thrilled that Dr. King was here today to teach us that.”
King grins watching nurses master this new first aid skill, even if it is in response to a grim reality.
“You can talk about preventing these incidents and that’s a move for the legislature and us as voters,” King says, “but that may take months or years or may never happen. I’m going to leave this teaching session today with a group of empowered nurses who now know what to do tomorrow. It doesn’t take an act of Congress. It took us 30 minutes on a Wednesday afternoon and they’re empowered to save a life now.”
Empowered with a skill these women hope they’ll never need to use.

How to Apply a Tourniquet

9 months after discharge, relapsed UK Ebola patient ‘critically ill’

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(CNN) About nine months ago, Pauline Cafferkey was discharged from a London hospital — seemingly signaling her victory in beating Ebola.

Now, not only is Cafferkey back in the hospital with a rare relapse of the deadly virus, but she’s gotten worse.

London’s Royal Free Hospital announced Wednesday afternoon that “Cafferkey’s condition has deteriorated and she is now critically ill.”

The hospital didn’t elaborate on the news about the Scottish nurse, who last year became the first person diagnosed with Ebola in the United Kingdom. But it’s not a good sign, coming five days after the same medical facility confirmed Cafferkey had been transferred there from Queen Elizabeth University Hospital in Glasgow “due to an unusual late complication of her previous infection by the Ebola virus.”

That day, the Royal Free Hospital indicated that Cafferkey was in “serious condition” and being treated in a “high-level isolation unit.”

Since her January discharge, Cafferkey has been out and about, including receiving a Pride of Britain award late last month and paying a visit to 10 Downing Street, where pictures showed her with the prime minister’s wife, Samantha Cameron.

Last week Dr. Emilia Crighton, director of public health for the National Health Service for Greater Glasgow and Clyde, insisted that the risk of the 39-year-old Cafferkey inadvertently passing on Ebola to anyone else was “very low.”

“In line with normal procedures in cases such as this, we have identified a small number of close contacts of Pauline’s that we will be following up as a precaution,” Crighton said.

Went to Sierra Leone during Ebola outbreak

Like many other volunteers, Cafferkey had gone to West Africa knowing the dangers there. The Ebola virus had spread like wildfire, ultimately killing more than 11,000 people and infecting some 28,000, according to the World Health Organization.

Yet that harsh reality didn’t stop the public health nurse in Scotland’s South Lanarkshire area from being part of a 30-person team deployed by the UK government to work in Sierra Leone with Save the Children.

She and other health care workers would later be credited with playing a significant part in corralling and ultimately ending the devastating outbreak.

But, as Cafferkey learned, it came at a cost.

She fell ill shortly after touching back down on UK soil. Her Ebola diagnosis came next, followed by intensive treatment at the Royal Free Hospital. That facility has an isolation unit tended by specially trained medical staff and a tent with controlled ventilation set up over the patient’s bed.

Her road to recovery wasn’t always smooth. The Royal Free Hospital at one point noted that her condition had “gradually deteriorated over … two days” and that she was then critical.
Cafferkey, though, managed to rebound and weeks later was allowed to go home.

Agency: 58 had contact with symptomatic nurse

She had good reason to celebrate September 28. That night she was honored at the Pride of Britain awards, a star-studded event (with this year’s celebrities including soccer star David Beckham and Rupert Grint of “Harry Potter” fame) honoring good deeds around the country, spokeswoman Elizabeth Holloway told CNN.

The next day, Cafferkey joined other honorees at the Prime Minister’s residence.

Less than a week later, on October 5, she went to a doctor in Glasgow because she felt sick, said a spokesperson for NHS Greater Glasgow and Clyde, who was not named per policy. Cafferkey was sent home, only to be admitted the next day to Queen Elizabeth University Hospital in the Scottish city.

Holloway said no one associated with the Pride of Britain awards is being monitored for possible Ebola, because Cafferkey wasn’t showing any signs of illness at the time. Ebola only spreads when there’s direct contact with the bodily fluids of an infected person who is displaying symptoms of the disease.

In a statement, NHS Greater Glasgow and Clyde said that health authorities have identified 58 people who had been in close contact with Cafferkey since she became symptomatic. Forty of those who’d had direct contact with her bodily fluids were offered an Ebola vaccine; 25 of them accepted while 15 declined, according to the health agency.

And yes, tests earlier this year indicated the nurse wasn’t showing signs of Ebola. But that doesn’t mean that traces of the virus can’t linger — if not in the blood, then perhaps elsewhere in the body.

Her relapse is also proof that the Ebola fight isn’t totally over, one week after WHO reported the first week since March 2014 with no new cases.