In our public spaces we spend thousands of dollars to potentially take care of an individual in cardiac arrest but neglect to prepare to take care of dozens of casualties in the event of a mass shooter, act of terrorism or natural disaster.
According to the American Heart Association there are 320,000 out of hospital deaths from sudden cardiac arrest in the US annually, this is by far the most common cause of death. Over the past several decades the US has rightly made it a priority to train as many individuals to perform CPR and use an AED. In government buildings and public spaces AEDs are in abundance at a minimum of $1,200 each. We know through years of research that time is brain and time is heart muscle, the faster we can perform CPR and use an AED on someone in cardiac arrest the more likely they are to survive. In addition to just surviving if we can initiate good quality CPR fast enough they may even be able to restore total brain function and walk out of the hospital without any long term ailments. This is remarkable and after 15 years in pre-hospital emergency medicine the changes we have seen take place with evidence based research are sure to continue benefiting those we serve. Even with improved research, medicine and community involvement the grim reality of out-of-hospital sudden cardiac arrest is that the large majority of those who go into cardiac arrest never return to normal function or even make it out of the hospital if they get there at all. All of this being said we have another public health emergency that is not being addressed fast enough or serious enough.
According to the American Association for the Surgery of Trauma trauma is the leading cause of death for those under 45 years of age. In the United States there are approximately 150,000 deaths from trauma annually and over 3 million non-fatal injuries from trauma. The vast majority of trauma death is from motor vehicle collisions, followed by homicide and suicide. Multiple studies and anecdotal evidence has shown that the reason many die from trauma in the US has much less to do with the response times / transport times of EMS or door to bed time at the emergency department and far more to do with the leading causes of preventable death not be recognized and treated aggressively and quickly enough. This is to no fault of those providers either in or out of the hospital, they are doing what they know to do. I know this because I was an instructor of civilian EMTs and Paramedics for several years at a local community college, I am familiar with the curriculum, and unfortunately the evidence based research from the military has not crossed into the civilian world.
I get grief from civilian providers for this comment, and I stand behind it; "military medicine is light years ahead of civilian medicine." And it is, the sheer amount and quality of trauma the US Military has seen over the past 16 years in heavy combat has demonstrated what kills people and what keeps them alive. A study released in March of 2015 from the US National Library of Medicine: National Institutes of Health makes the indictment of civilian medicine clear and succinct "An effective, pre-hospital extremity hemorrhage control posture should be translated to all civilian first responders in the United States and should mirror the military's posture toward extremity bleeding control. The pre-hospital response to extremity exsanguination after the Boston Marathon bombing demonstrates that our current practice is an approach, lost in translation, from the battlefield to the homeland." This is terrifying that a city the size of Boston was ill prepared to deal with combat type injuries quickly and effectively, more so it exposed that the public was also unprepared and ill equipped to do so. If a runner had gone into cardiac arrest at the Boston Marathon you could bet there would be 15-20 people who would have immediately initiated CPR or attempted to be involved because they were trained, equipped and confident in their skills; this IS A GOOD THING. However what this terrorist event on the homeland showed us is that even though there were many willing to help the effectiveness of the aid provided was lacking. When we look to more recent events, such as Las Vegas, where 58 died and 527 were injured the need for countless trained, equipped and confident individuals is evident.
Some reasons public access trauma care and campaigns such as Stop the Bleed are so critical for public health are numerous but to list a few:
1) In the event of a cardiac arrest there is only one patient needing care, the chance of someone in a public setting knowing how to treat that individual are high, and it only takes one to effectively treat an individual in cardiac arrest.
2) Mass Casualty, active shooter, terrorist events, natural disasters generally effect dozens of casualties needing immediate trauma care. This calls for multiple trained individuals to even begin to treat the wounded. One trained individual may be effective in the event of a cardiac arrest but in a mass casualty event that trained individual will quickly become overwhelmed and run out of equipment.
3) The dollars behind the cause make it make sense for everyone to be trained. We spend $2000 to place an AED every 300 feet in an airport to take potentially take care of one patient for one specific medical condition. We do this but we wont spend 1/3 of that cost to fully stock and equip a single public access bleeding control kit capable of taking care of 20 casualties in the aforementioned events.
4) If trauma is the leading cause of death for those under 45 years of age, why are we not doing the MOST we can to preserve the lives of those who have so much more time to live.
It is necessary today that we take the lessons learned in combat and apply them to the civilian world, it is necessary that we prepare for the worst. The world is not getting any better unfortunately, the chances of active shooter events and terrorism rises every day. We may not be able to stop every event but we should be prepared as a community to respond take care of our fellow brothers and sisters. It is our moral responsibility to do so.