We used to talk about the Golden Hour in trauma, but in reality, when a person is exsanguinating, every second from time zero counts for something. In cases of penetrating trauma which remains all too prevalent a problem in many urban settings, many lives can be saved with nothing more complex than the application of direct or indirect pressure to stem bleeding, buying time for medical help to arrive.
If a person has a sudden cardiac arrest in a busy train station, airport or shopping mall, you can rest assured that an automatic defibrillator will be within reach. They are simple to use, and members of the public can be talked through the steps by the emergency call handler over the phone.
Taking things a step further, the GoodSam app can be found on the smartphones of many healthcare professionals in the UK. When a cardiac arrest call comes in the emergency call dispatcher can send out an automatic alert to all GoodSam users in the vicinity of the incident enabling them to attend and start lifesaving CPR whilst an ambulance is en-route. I myself have responded to at least 3 such alerts in houses close to where I was. On two such occasions I arrived to find the victims in rigor mortis and a bunch of perplexed relatives wondering who this random guy at their door was claiming to be an off-duty doctor. On one occasion the paramedics had already arrived before I did (the benefits of flashing lights and sirens), meaning my input as a surgical resident who hadn’t run a medical cardiac arrest call in at least 10 years was certainly not required (4H’s and 4T’s right?).
But back to trauma, what if there was a similar EMS-activated first-responder trauma app that not only alerted nearby medics and capable volunteers, but also mapped out the locations of emergency trauma packs? These packs or boxes would be placed in strategic areas of high penetrating trauma prevalence and would contain things like tourniquets and haemostatic dressings. They could also contain a body map highlighting key points at where to apply indirect pressure and maybe even basic i.v. access kits. They could be locked away in a cabinet requiring a code to gain access. This code would be given over the phone by the emergency call handler once the need for such intervention is established. The caller, depending on their clinical experience and confidence could be walked through the process or even have easy-to-follow demo videos sent to their smart device detailing how to apply the dressings or tourniquet as needed. With increasing use of drones there may someday be way of dispatching these trauma first aid packs to the scene of the incident, arriving within minutes. We know that bystander CPR in medical cardiac arrests can triple a person’s chances of surviving to hospital. Bystander haemorrhage control could do similar, if not better. After all, many of the victims of penetrating trauma are otherwise fit and healthy young men with good physiological reserves.
A couple of years back I touched on the Stop The Bleed campaign in the context of US school shootings. The American College of Surgeons campaign has seen over 2.4 million people worldwide trained in the basics of haemorrhage control since it started around 8 years ago. If we are expecting members of the public and non-clinicians to be able to step in a save lives then they need to be given easy access to simple-to-use tools. The effectiveness of programs like Stop The Bleed would be enhanced with the ready availability of haemostatic trauma packs located near schools and in other prominent public spaces (especially in areas with a busy night economy). Particular attention needs to be paid to socially deprived areas and within the communities suffering most from the scourge of knife and gun crime. The emergency services can’t be everywhere all the time, but where there are people willing to help, there is always hope that a life can be saved.
Obi Nnajiuba is a British surgical resident with a specialist interest in trauma, acute care, prehospital care, triage, mass casualty events and trauma systems. His postgraduate qualifications include an MSc in Trauma Sciences and membership of the Royal College of Surgeons of England. He was recently awarded his PhD for his work on optimising the London Trauma System Triage Tool. He is also a registered Motorsport UK physician, providing trackside advanced trauma care to competitors at world famous motor-racing circuits such as Brands Hatch, Goodwood and Silverstone.
