Jeff Clawson, M.D.

Jeff Clawson, M.D.

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From: Hunt, Richard Sent: Tuesday, September 08, 2015 1:23 PM To: 'Jeff Clawson, MD' <

Subject: Request for exemplary leaders in Bystander Stop the Bleed initiative to participate in White House event

This email is in follow-up to the April 29, 2015 Roundtable on “Bystanders: Our Nation’s Immediate Responders” convened here at the White House.

Attached please find a Request for Exemplary Leaders in Supporting the Bystander “Stop the Bleed” Initiative to Participate in White House Event and objectives for the initiative.

The White House plans to convene a signature event on October 6, 2015 that will include the celebration of actions by federal and private sector partners to create meaningful and lasting impact in support of bystanders as immediate responders in stopping life threatening bleeding.

Our national preparedness is the shared responsibility of all levels of government, the private and non-profit sectors, and individual citizens. The goal of this initiative is to build national resilience by empowering the general public to take action to stop life threatening bleeding. As we have seen in such tragic incidents such as the Boston Marathon bombings and the train crash in Philadelphia, anyone can contribute to safeguarding the nation from harm.

We are requesting information on efforts that are already in place or are planned that support the following objectives:

• The general public will know the phrase and associated logo: “Stop the Bleed”

• The general public will have access to effective personal bleeding control kits

• The general public will have access to effective public bleeding control kits

• Every bleeding control kit will provide “just in time” audio and visual training

As a stakeholder, you are invited to submit a description of:

1) our organization’s efforts to actively promote and implement the objectives for this

initiative, and

2) the specific actions your organization has taken or plans to take to advance

one or more of the objectives.

Further details are in the attachment.

Based on submissions a limited number of exemplary partners will be highlighted in this signature White House event on October 6, 2015.

Submissions are due by COB September 22, 2015 and should be sent via email.


Richard C. Hunt, MD, FACEP Director for Medical and Public Health Systems Preparedness and Response National Security Council Staff The White House

September 22, 2015

Richard C. Hunt, MD

National Security Staff

White House

Washington, D.C. 20504

RE: Request for Exemplary Leaders in Supporting the Bystander “Stop the Bleed” Initiative.

Dear Rick,

Obvious Critical Injuries with Uncontrollable Bleeding – The Coming Lay Use of Tourniquets & the Dispatcher’s Involvement in the “Stop the Bleed” White House Initiative

Early battlefield use of tourniquets took place before the development of modern medicine, in past conflicts like the Crimean Wars, the American Civil War, and World War I and II. In those times, tourniquets were often used in severe situations common to war—amputations, bayonet wounds, bombs, and land mines. The long times to get these tourniqueted patients to definitive medical and surgical care (if that was even remotely available at the time), often resulted in loss of circulation and enervation, and death of limb tissue—giving these devices a bad name, which significantly restricted their use in early EMS in the mid-20th century.

In more recent times, the use of specially constructed tourniquets in the modern military has taken hold, been studied, and has saved many lives, with lessened expected side effects. In the US and many other parts of the world, domestic and militant terrorists’ use of mass shootings, bombs, axes, machetes, and other very dangerous weapons has created a more significant type and frequency of critical arterial bleeding encountered in civilian settings.

Better designed hemorrhage control devices, quicker and directed delivery to trauma centers, and the increased exposure of civilians willing to be advised by EMDs to perform “just-in-time” treatments, has changed the playing field for improving this type of care.

The IAED has been invited to work with the President’s Task Force for “Bystanders: Our Nation’s Immediate Responders,” facilitated by the National Security Council, to advise and aid in the “Stop the Bleed” initiative. We believe this will involve development within the Advanced Medical Priority Dispatch System (AMPDS) of special pre-arrival instruction protocols directing or assisting the application of tourniquets in critical, life-threatening bleeding situations. For the Academy’s needs, this will also involve vetting bystanders who are openly asking to apply an improvised tourniquet when possible and appropriate. In addition, when prepackaged, stationed, tourniquets are made available, advise bystanders where they are located and, when asked, to correctly assist callers in applying them—“Just-in-time training, for just-in-time situations.”

  1. Organization: International Academies of Emergency Dispatch (IAED)

  2. # of Members: 56,000

  3. # of Communication Centers using the AMPDS: 3,005

  4. Scope of use: 44 countries – 16 languages and dialects

  5. IAED Mission: To advance and support the public safety, emergency telecommunications professional and ensure that citizens in need of emergency, health, and social services are matched safely, quickly, and effectively with the most appropriate care and resource. And to conduct an on-going review of the current standards of care and practice in EMD, Fire, Police, Nurse Triage, and other areas of public safety telecommunications and continually evaluate the tools and mechanisms used to meet or exceed those standards."

  6. Role of the IAED in “Stop the Bleed”: As the first contact from the scene, and often the involved bystanders, 9-1-1 Emergency Dispatchers must be able to understand, almost better than anyone, the real-time aspects of the Critical Bleeding Control process. Emergency dispatchers will deal directly with these patients and their citizen rescuers, so the Academy will create and/or modify the following for this “just-in-time” process to be safe and successful:

  7. What IAED can and is committed to do:

  1. Create scripted support protocols for citizen direction and assistance in directly applying a tourniquet (these are similar in nature to our EpiPen, Aspirin, and Narcan Administration Assistance Instructions).

  2. Modify current training for all Emergency Dispatchers in applying these instructions.

  3. Establish an ongoing method of ensuring all newly trained Emergency Dispatchers are updated with the necessary improvements as the evolution of this important process unfolds.

  4. Modify the Principles of Emergency Medical Dispatch – 6th Edition textbook to outline and emphasize these important changes in pre-arrival scene care.

  5. Create computer-based training “Special Procedures Briefing” CD for training all emergency dispatchers in these new processes.

The IAED will also assist the White House/National Security Council directly by creating and nearly instantly disseminating these dispatch assistance protocols and their associated, succinct computer-based training program nationwide (and internationally), which will then directly impact the dispatcher’s guidance of these “newly armed” citizen rescuers anytime the application of a tourniquet or included treatments are needed.

  1. What IAED has done and is currently doing: The Advanced Medical Priority Dispatch System Protocols have detailed pre-arrival instructions regarding bleeding control, that emphasize direct pressure and provide some advice as to lay rescuers not applying a tourniquet, but also advising not removing it if already applied by bystanders. These instructions have been modified within the last week in time for the release of version 13.0 on October 1st. The modifications include the following:
  1. Removed the instruction “Do not use a tourniquet” in Control Bleeding Panel X-5.

  2. Modified the Critical EMD Information (CEI) to: “If a tourniquet has already been applied, do not advise removing it. If asked about applying one, tell them to do what they think is best.”

  3. Revised practice scenarios in EMD Course Manuals to remove any reference to the former instruction “Do not use a tourniquet.”

  4. Began the Council of Standards process to create the scripted telephone instructions necessary to aid a lay rescuer in applying a tourniquet to an extremity when bleeding is clearly dangerous, or can’t be stopped by direct pressure instructions.

  5. Update and quickly disseminate these changes and new instructions, constructed and approved by the Council of Standards, in the manual card system, the Quality Assurance Guide, and the automated ProQA logic engine system.

  6. Add the capability to the automated ProQA system to cross link the Bleeding Control Kits to the locations of AEDs within various registries that are polled directly by ProQA.

The Academy welcomes the opportunity to aid you and the exceptional people at the NSC and White House in this most important and timely initiative. Keep up the great work!


Jeff Clawson, M.D.

Chair, Rules Committee

Medical Council of Standards

Division of Research, Standards, & Academics

International Academies of Emergency Dispatch

cc: Scott Freitag, President

Jerry Overton, Board of Trustees

Pam Stewart, Chair, Board of Certification

Brett Patterson, Chair, Medical Council of Standards

Vicki Maguire, Chair, Curriculum

Note: Shortly thereafter, IAED was recognized as an Exemplary Leader in this Initiative and

Dr. Clawson attended the special celebratory event at the White House on October 6th.