Sandy West | Kaiser Health News
December 11, 2019
When a student recently opened fire at a California high school, staff members did what they were trained to do. They shepherded students to safe spaces, barricaded doors, pulled shades — and, when gunfire struck, used techniques adapted from the battlefield to save lives.
The staffers used two bleeding-control kits in the Nov. 14 shooting in Santa Clarita, in which two students were killed and three injured before the gunman fatally shot himself, said Dave Caldwell, spokesman for the William S. Hart Union High School District. The kits, a recent addition to the district northwest of Los Angeles, are equipped with tourniquets, compression bandages and blood-clotting hemostatic gauze to prevent excessive blood loss.
Such kits have been pushed in school districts across the country. Georgia pioneered a statewide initiative to equip schools with Stop the Bleed Kits, for the 2017-18 academic year. This year, Texas, Arkansas and Indiana passed legislation to put them into schools. The Arkansas law requires public school students to be trained on the kits as part of the health curriculum to graduate.
Some gun control advocates say the efforts sap the political energy needed to reduce the actual violence. Most of the policies on bleeding-control kits have occurred in Republican-led states, where gun control may be especially unlikely to pass. Still, Democrat-controlled Illinois is among those to have picked up the campaign, with the Illinois Terrorism Task Force announcing in September plans to distribute 7,000 of the kits to the state’s public schools.
There is no statewide mandate for the kits in California. Rather, two students in the William S. Hart Union High School District took the initiative there.
Sisters Cambria, 15, and Maci Lawrence, 13, were worried about school shootings and natural disasters. They said they wanted to help keep students safe. After sharing their worries with their father, Dr. Tracy “Bud” Lawrence, who directs the emergency department of the Henry Mayo Newhall Hospital in Santa Clarita, the sisters raised $100,000 through the “Keep the Pressure” nonprofit they established to get bleeding-control kits into every classroom in the district.
“We just wanted to get them into as many hands as possible,” Bud Lawrence said.
Stop the Bleed kits were developed following the 2012 mass shooting at Sandy Hook Elementary School in Newtown, Conn., in which 20 children and six adults were killed. Dr. Lenworth Jacobs, who was a surgeon at the trauma center closest to Sandy Hook, said he and his staff prepared for an influx of patients from the attack, but none came to the hospital. They had not survived.
Jacobs, through a coalition known as the Hartford Consensus, led military leaders, law enforcement, trauma surgeons and emergency responders to develop recommendations on how to improve the survival rate in mass casualty events. Among the recommendations was the development of a Stop the Bleed campaign.
The American College of Surgeons, a member of the Hartford Consensus, launched the Stop the Bleed campaign to distribute the kits and to promote training so that more people understand how to stop bleeding if responding to an emergency. Jacobs said the effort has reached 100 countries and trained 1.5 million people.
Advocates for the campaign stress that the kits can help any type of significant traumatic injury.
Most fatal injuries, in fact, aren’t caused by gunfire, said Billy Kunkle, deputy director for the Georgia Trauma Commission. Kunkle said the No. 1 cause of such deaths is falls, followed by car crashes.
In 2018, for example, a fourth-grade student in Georgia was playing with friends on the playground when she fell and a friend fell on top of her. According to news reports, the girl broke her arm and severed her artery. The school’s nurse, using the Stop the Bleed kit her school had received less than 24-hours earlier, applied a tourniquet that the surgeons who treated Lopez credited with saving her life.
Kunkle said the kits should be viewed as an extension of a first aid kit. He likened them to other lifesaving tools, such as defibrillators, that have been installed throughout public spaces.
“We know it works. We know it saves lives,” said Republican Indiana state Rep. Randy Frye, a retired firefighter who authored legislation to put the kits in the state’s public schools. “You can’t wait for 911, even in the best system.”
Still, gun control advocates say bleeding-control kit efforts allow lawmakers to avoid dealing with the cause of school shootings.
“On the one hand, anything we do to save lives is good. But, on the other hand, fundamentally, it is allowing lawmakers and officials to ignore the root cause of gun violence,” said Kyleanne Hunter, vice president of programs for Brady, formerly known as the Brady Campaign to Prevent Gun Violence.
“Yes, we need to deal with mental health. Yes, we need to deal with first aid and medical care. And we need to address how easy it is to get guns,” Hunter said. “We don’t believe it should be an either-or.”
Legislators have ignored numerous proposals aimed at reducing gun violence, including Brady’s “End Family Fire,” she said. According to a Wall Street Journal analysis, 75% of school shootings involved guns that shooters found unsecured in their homes. End Family Fire encourages the safe storage of weapons to make it more difficult for children to access unsecured guns.
“I am sure that a lot of school safety legislation allows some legislators to say, ‘We are doing something,’ and that allows a release valve for them to not focus on gun control,” said Democratic Texas state Rep. Diego Bernal, who was a co-sponsor on the Stop the Bleed legislation in his state.
Still, he added, “I suspect, even if there was gun control legislation, we would pursue this bill. I don’t think this is an either-or proposition.”
Among the advantages of having the kits in schools and more people trained on methods to stop bleeding, Jacobs said, is that a lockdown often follows a shooting. That prevents emergency responders from getting in or the injured from getting out. In every kind of trauma, he said, minutes count.
“If, God forbid, something happens, you really want to know there is someone right there beside you who can do something,” said Jacobs. “If you can keep the blood inside the body until you reach the hospital, you have a phenomenal chance for survival.”
In Georgia, the governor allocated $1 million from fees generated by the state’s Super Speeder traffic safety law to pay for the kits. To date, Kunkle said, the kits are in about 2,100 of the state’s 2,300 schools, and have been used seven times.
In Arkansas and Indiana, the cost of supplying kits to schools was covered largely by private donations.
Dr. Marlon Doucet, a Little Rock, Ark., trauma surgeon, is leading efforts to expand access and training on Stop the Bleed kits in schools and elsewhere in his state. He believes strongly that training more people — including cops, teachers and students — will save lives.
Twenty-five people were shot in the July 2017 Little Rock Power Ultra Lounge shooting, and all survived, Doucet said.
“No one died because law enforcement officers were using tourniquets and packing wounds,” he said. “This just makes sense.”
Kaiser Health News is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.