Hartford Consensus III

ACS Partners with NAEMT in the Development and Release of a

Civilian Training Course on Hemorrhage Control Techniques

Joint effort aims to expand public participation in saving lives in the wake of an active shooter or
other mass casualty event as recommended by the Hartford Consensus

NEWS FROM THE AMERICAN COLLEGE OF SURGEONS | FOR IMMEDIATE

RELEASE

CHICAGO (July 9, 2015): The American College of Surgeons (ACS) has partnered with the
National Association of Emergency Medical Technicians (NAEMT) in the development of a
medical preparedness training course that empowers bystanders to become immediate responders
who treat severely bleeding victims of active shooter or other mass casualty events. The Bleeding
Control for the Injured (B-Con) course was jointly developed by the members of NAEMT’s
Prehospital Trauma Life Support (PHTLS) Committee and the American College of Surgeons
Committee on Trauma (ACS COT) to provide a foundation for first-response care that bystanders
(immediate responders) can administer until professional first responders arrive on the scene (i.e.:
law enforcement, paramedics, firefighters).
The course was developed to expand public education in the area of hemorrhage control so that
bystanders can be empowered to engage in life-saving actions in their own communities. Civilians
are taught the same life-saving bleeding control techniques used by military personnel in Iraq and
Afghanistan that are shown to dramatically increase casualty survival.
“Advocacy and education are two key principles for our Committee on Trauma activities, and the
B-Con course embodies both of them,” said Ronald M. Stewart, MD, FACS, Chair, ACS-COT.
“We were very eager to partner with NAEMT on this important educational project. They
responded quickly to the need for this type of public education program by extracting and
modifying the information contained in their excellent Prehospital Trauma Life Support (PHTLS)
course and adapting it for the lay public.”
The two-and-a-half hour educational course combines didactic lectures with hands-on training
and teaches the initial steps that bystanders should take to care for bleeding victims. Participants
learn why it is important to use a tourniquet to control life-threatening bleeding from an arm or
leg; how to correctly apply a tourniquet to the arm and leg; how to pack a wound and apply
pressure to control bleeding; the importance of identifying injuries to the chest and abdomen; and
the need for victims with these traumatic injuries to be transported immediately to an appropriate
hospital for trauma care.
“Our collaboration with the ACS Committee on Trauma follows a long-standing partnership in
ensuring quality patient care and improving casualty survivability,” said Conrad “Chuck” Kearns,
MBA, Paramedic, A-EMD, President of NAEMT. “B-Con provides bleeding control techniques
that can be performed by any observer of a tragic incident, similar to the way bystanders respond
with CPR.”
The development and release of B-Con training is part of an interdisciplinary public safety
initiative on the part of medical leaders and law enforcement to enhance the resilience of the
general public when confronted with mass-casualty events so that no victims will bleed to death
while awaiting the arrival of first responders on the scene.

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 Hartford Consensus III
The goals of this initiative are part of a larger effort put forth by the Joint Committee to Create a
National Policy to Enhance Survivability from Intentional Mass-Casualty and Active Shooter
Events, which first met in Hartford, Conn. in 2013. Representatives of this collaborative
committee, whose recommendations are called the Hartford Consensus, note that the number one
cause of preventable death in victims of penetrating trauma is hemorrhage, making hemorrhage
control a major priority in improving survivability of victims from active shooter events.
The B-Con course embodies a key principle of the Hartford Consensus III–empowering the public
to provide lifesaving, first-line care,” said Lenworth M. Jacobs, Jr., MD, MPH, FACS, Regent,
American College of Surgeons, and Chairman of the Joint Committee that developed the Hartford
Consensus. “Our ultimate goal is to educate individuals and communities about the use of
effective external hemorrhage control techniques and to ensure access to bleeding control bags in
public places in much the same way that automatic external defibrillators are now accessible to
the public. We also advocate extending Good Samaritan protections to individuals who use
tourniquets and lifesaving devices to control the bleeding of victims at mass-casualty events.”
The Hartford Consensus recommends that an integrated active shooter response should include
the critical actions contained in the acronym THREAT:
· Threat suppression
· Hemorrhage control
· Rapid Extrication to safety
· Assessment by medical providers
· Transport to definitive care
Hemorrhage control is addressed by offering B-Con training for public education and use, and is
part of the third installment of the Committees’ recommendations, known as Hartford Consensus
III. In order to improve survivability, victims with life-threatening external bleeding must be
treated immediately at the point of wounding by trained bystanders who have first determined
that it is safe to act. Further, all bystanders who assume the role of immediate responders must be
trained and have the necessary equipment to provide effective external hemorrhage control until
emergency medical personnel arrive on the scene.
“We view care of the victims as a shared responsibility between law enforcement, fire/rescue, and
EMS,” said Norman McSwain, MD, FACS, from the Joint Committee. “The Bleeding Control
course takes that role a step further by engaging trained bystanders in the process as well. The
course defines their role in this process so that those bystanders can recognize life-threatening
bleeding and learn how to administer the proper medical treatment. We also recommend that law
enforcement and fire and rescue personnel carry tourniquets with them after they’ve completed
the training.”
The Hartford Consensus III report on implementing bleeding control is published in the July
2015 Bulletin of the American College of Surgeons.

About the American College of Surgeons

The American College of Surgeons is a scientific and educational organization of surgeons that
was founded in 1913 to raise the standards of surgical practice and improve the quality of care for
surgical patients. The College is dedicated to the ethical and competent practice of surgery. Its
achievements have significantly influenced the course of scientific surgery in America and have
established it as an important advocate for all surgical patients. The College has more than 80,000
members and is the largest organization of surgeons in the world. For more information,
visit www.facs.org.

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Hartford Consensus III

About the National Association of Emergency Medical Technicians

Formed in 1975 and more than 50,000 members strong, the National Association of Emergency
Medical Technicians (NAEMT) is the only national association representing the professional
interests of all emergency and mobile healthcare practitioners, including emergency medical
technicians, advanced emergency medical technicians, emergency medical responders,
paramedics, advanced practice paramedics, critical care paramedics, flight paramedics,
community paramedics, and mobile integrated healthcare practitioners. NAEMT members work
in all sectors of EMS, including government agencies, fire departments, hospital-based ambulance
services, private companies, industrial and special operations settings, and in the military. For
more information visit: www.naemt.org.
Contact
Dan Hamilton
312-202-5328
or
Sally Garneski
312-202-5409
pressinquiry@facs.org

See more at:

https://www.facs.org/media/pressreleases/2015/naemt0715#sthash.yuZZYbgX.dpuf

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Hartford Consensus III
The Hartford Consensus III: Implementation of Bleeding Control

by LE N W OR TH M . JAC OB S , JR ., M D , M P H , FAC S ; AN D JO I N T C O M M I TTE E TO C R E ATE A N A TI O N AL

P OLIC Y TO E N H AN C E S U R V IVAB ILI T Y FR OM M AS S -C AS U AL TY S H O O TI N G E V E N TS

P U B LIS H E D JU LY 1, 20 1 5

The Hartford Consensus III recognizes the vital role that immediate responders play in responding to
mass-casualty events. They make major contributions to improving survival from these incidents. However,
the Hartford Consensus III does not advocate that members of the public enter areas of direct threat or
imminent danger.

Good Samaritan laws have been effective in empowering the public to become involved in the immediate
response to a victim of cardiac arrest or choking by the initiation of cardiopulmonary resuscitation and the
Heimlich maneuver, respectively. The Hartford Consensus recommends that these legal protections be
extended to include the provision of bleeding control.

Professional first responders

Professional first responders include law enforcement and EMS/fire/rescue. As indicated by THREAT, law
enforcement must suppress the source of wounding if the shooter is still active and then, because they are
usually the initial first responders on the scene, must act to control external hemorrhage. Victims with life-
threatening external bleeding must be treated immediately at the point of wounding. All responders should
be educated and have the necessary equipment to provide effective external hemorrhage control.
Continued emphasis must be on the integration of the immediate responders, law enforcement, and
EMS/fire/rescue to optimize rapid patient assessment, treatment, and transport to definitive care at the
nearest appropriate hospital.

Building educational capabilities

Education in hemorrhage control can take many forms and should be offered using various modalities.
Established 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 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 public and is within
their capabilities.

The public needs to be empowered to engage in lifesaving 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 responders, more advanced courses may offer
additional options to control life-threatening external hemorrhage. All formal training should have specific
objectives and train to competency. For professional responders, the training must be efficient and cost-

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Hartford Consensus III
effective. Ultimately, integrated training exercises must be conducted that include all levels of responders.

April 29, 2015

Roundtable on bystanders: Our nation’s immediate responders

Participants

 Air Medical Physician Association

 American Academy of Physician Assistants

 American Ambulance Association

 American Association of Critical Care Nurses

 American Association for the Surgery of Trauma

 American College of Emergency Physicians

 American College of Surgeons

 American Heart Association

 American Hospital Association

 American Nurses Association

 American Osteopathic Association

 American Physical Therapy Association

 American Public Health Association

 American Trauma Society

 Association of Air Medical Services

 Association of State and Territorial Health Officials

 Eastern Association for the Surgery of Trauma

 Emergency Nurses Association

 Emergency Medical Services Labor Alliance

 International Academies of Emergency Dispatch

 International Association of Chiefs of Police

 International Association of Emergency Managers

 International Association of Emergency Medical Services Chiefs

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Hartford Consensus III
 International Association of Firefighters

 International Association of Fire Chiefs

 Major Cities Chiefs Association

 National Association of Emergency Medical Technicians

 National Association of School Nurses

 National Association of State EMS Officials

 National Athletic Trainers Association

 National Emergency Management Association

 National Volunteer Fire Council

 Society of Emergency Medicine Physician Assistants

 Society of Trauma Nurses

 Trauma Center Association of America

 White House personnel

 Interagency Bystander Workgroup team leaders

 Federal invitees

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Hartford Consensus III
The Hartford Consensus III: Implementation of Bleeding Control
Joint Committee to Create a National Policy to Enhance Survivability
from Intentional Mass-Casualty and Active Shooter Events
Participants

Lenworth M. Jacobs, Jr., MD, MPH, FACS

Chairman, Hartford Consensus
Vice-President, Academic Affairs
Hartford Hospital
Board of Regents,
American College of Surgeons

Richard Carmona, MD, MPH, FACS

17th U.S. Surgeon General

Norman McSwain, MD, FACS

Medical Director, Prehospital Trauma Life Support
Tulane University

Frank Butler, MD, FAAO, FUHM

Chairman, Committee on Tactical Combat Casualty Care
Department of Defense Joint Trauma Systems

Doug Elliot
President, The Hartford
Chair, Board of Directors
Hartford Hospital

Andrew L. Warshaw, MD, FACS, FRCSEd(Hon)

President, American College of Surgeons
Massachusetts General Hospital, Boston

Jonathan Woodson, MD, FACS

Assistant Secretary of Defense for Health Affairs, Department of Defense

Richard C. Hunt, MD, FACEP

Director for Medical Preparedness Policy,
National Security Council Staff
The White House

Ernest Mitchell
Administrator, U.S. Fire Administration
Federal Emergency Management Agency
Department of Homeland Security

Alexander Eastman, MD, MPH, FACS

Major Cities Police Chiefs Association

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Hartford Consensus III
Chief of Trauma, Parkland Memorial Hospital
University of Texas Southwestern Medical Center

Kathryn Brinsfield, MD, MPH, FACEP

Assistant Secretary, Health Affairs
Chief Medical Officer,
Department of Homeland Security

Colonel Kevin O’Connor, DO, FAAFP

Physician to the Vice-President
The White House

William Fabbri, MD, FACEP

Director, Emergency Medical Services
Federal Bureau of Investigation

Richard Serino
Distinguished Visiting Fellow,
Harvard University, School of Public Health
8th Deputy Administrator,
Federal Emergency Management Agency

Alasdair Conn, MD
Chief Emeritus, Emergency Medicine
Massachusetts General Hospital

Karyl Burns, PhD

Research Scientist, Hartford Hospital

Matthew Levy, DO, MSc, FACEP

Johns Hopkins University
Senior Medical Officer,
Johns Hopkins Center for Law Enforcement Medicine

Leonard Weireter, MD, FACS

Vice-Chair, Committee on Trauma
American College of Surgeons
Eastern Virginia Medical School

John Holcomb, MD, FACS

Chief, Division of Acute Care Surgery
University of Texas Health Science Center

Peter Rhee, MD, MPH, FACS

Department of Surgery
University of Arizona

Ronald Stewart, MD, FACS

Chair, Committee on Trauma

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Hartford Consensus III
American College of Surgeons
The University of Texas Health Science Center at San Antonio

Robert Anderson, CDR, MSC, USN

Military Assistant to the Assistant Secretary of Defense for Health Affairs
Department of Defense

Thomas M. Scalea, MD, FACS

Physician-in-Chief,
R Adams Cowley Shock Trauma Center
University of Maryland School of Medicine

Donald Jenkins, MD, FACS

Medical Director, Trauma Center
Mayo Clinic

David R. King, MD, FACS

Trauma, Emergency Surgery and Surgical Critical Care
Department of Surgery
Massachusetts General Hospital

The Bleeding Control for the Injured (B-Con) course was developed by NAEMT's PHTLS
Committee with leadership provided by Dr. Peter Pons and Dr. Norman McSwain.

The course was developed in response to efforts by the U.S. Departments of Homeland
Security and Health and Human Services to increase collaboration between law enforcement,
the fire service and EMS in responding to active shooter/IED/mass casualty events. B-Con is
consistent with the recommendations of the Hartford Consensus on Improving Survival from
Active Shooter Events. The Hartford Consensus recommends that an integrated active shooter
response should include the critical actions contained in the acronym THREAT:
1.Threat
2.Hemorrhage control
3.Rapid Extrication to safety
4.Assessment by medical providers
5.Transport to definitive care

The Hartford Consensus Group recommends that the response to a traumatic incident, whether
involving an active shooter or some other cause of injury, in fact begins with bystander
response. It is with this in mind that the B-Con course was developed and is now being offered.
This new 2 ½ hour course teaches participants the basic life-saving medical interventions,
including bleeding control with a tourniquet, bleeding control with gauze packs or topical
hemostatic agents, and opening an airway to allow a casualty to breathe. The course is
designed for NON tactical law enforcement officers, firefighters, security personnel, teachers
and other civilians requiring this basic training. Course materials include a PowerPoint
presentation and instructor notes, instructor’s guide, and skill station guide.

A separate, additional PowerPoint module is included in the course materials specifically for law
enforcement participants. This module provides an orientation to the content of the Hartford
Consensus and the changing approach to active shooter and other complex
and hazardous responses.

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Hartford Consensus III

At the completion of the course, participants will be able to:

•Explain the rationale for early use of a tourniquet for life-threatening extremity bleeding.
•Demonstrate the appropriate application of a tourniquet to the arm and leg.
•Describe the progressive strategy for controlling hemorrhage.
•Describe appropriate airway control techniques and devices. •Demonstrate the correct
application of a topical hemostatic dressing (combat gauze).

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