Participants at a Stop the Bleed course, which teaches first responders how to deal with uncontrolled bleeding in trauma victims.
Photography by Kevin Van Paassen
Nancy McClure, a customer care co-ordinator with Metrolinx, is tightening a tourniquet around the white-shirted arm of her colleague Gobi Ravinthiran, who holds the same position with the Greater Toronto Area/Hamilton public-transit agency. Amid laughter, she asks him three times if it hurts – it does, as it’s supposed to – and then tries to distract him by saying, “Look at your bicep!”
Nancy is practising a technique she has just learned in Stop the Bleed, a two-hour course offered at Sunnybrook to teach first responders and people who work in large public spaces, as well as the general public, to deal with uncontrolled bleeding, which is one of the most preventable causes of death from trauma outside the hospital setting.
She was among 100 Metrolinx employees taking the morning session; another 60 attended in the afternoon. “We see all kinds of things at Union Station,” says Nancy, 30, of the workplace she and Gobi share. “It makes a big difference if you’ve been prepared and you know what to do.”
Stop the Bleed started in the U.S. in the wake of the shooting in 2012 at the Sandy Hook Elementary School in Newtown, Conn., when 20 students, aged 6 and 7, and six adult staff were killed. That tragedy led to the Hartford Consensus, a strategy created by health-care and government leaders who met in Newtown and which recommended, among other things, that more people should learn how to treat uncontrolled bleeding.
When Dr. Avery Nathens, Sunnybrook’s surgeon-in-chief, heard about Stop the Bleed, he committed himself to bringing it to Canada. He found a ready partner in Sharon Ramagnano, manager of trauma services at Sunnybrook. In May, the two travelled to Chicago to learn more about the program from the American College of Surgeons, for which Dr. Nathens is the director of the Trauma Quality Improvement Program (TQIP).
Soon after, they taught 12 Sunnybrook staff members to be Stop the Bleed instructors; there are now 26 instructors among Sunnybrook staff. So far, besides Metrolinx, the course has been presented to about a dozen City of Toronto events staff in the lead-up to Nuit Blanche, the city’s annual arts celebration in the fall.
“I thought ultimately this was a necessary thing to bring to Canadians,” says Dr. Nathens, who is also a senior scientist of Sunnybrook Research Institute’s evaluative clinical sciences platform and its Trauma, Emergency & Critical Care (TECC) research program. “We’ve been relatively immune thus far from mass shooting events, but likely this is going to come to us at some point. And the skills that can be acquired through the bleeding control course are not necessarily just specific to gunshot wounds. It might be a motor-vehicle crash, it might be a bike accident.” Dr. Nathens also points out that without proper intervention, people can “bleed out in minutes,” dying well before the arrival of Emergency Medical Services (EMS).
There are similarities between the program and CPR training, according to Dr. Nathens and Sharon. “Our thought was, [controlling bleeding] is just as simple; however, it’s not recognized as the first thing for people to do,” says Sharon. The course teaches participants how, after calling 911, they can stop uncontrolled bleeding – in a limb by using a tourniquet, and in a limb or the trunk of the body by packing wounds with gauze or another material and then applying pressure until help arrives. One hour of the Stop the Bleed program is devoted to hands-on practice involving a partner and then a fake limb.
Trainees are taught not to focus on possibly introducing bacteria into someone’s wound when applying pressure or packing. Instead the focus should be on the life-saving technique they are doing to help them make it to a trauma centre where the medical professionals can fix their injuries and any complications.
When Toronto hosted the Trauma Association of Canada’s annual meeting in February this year, Sunnybrook taught health-care practitioners from across the country how to be instructors for Stop the Bleed. Sharon also coordinated efforts for training to be offered in the GTA by contacting malls and other public places where masses of people typically gather.
Upon learning about Stop the Bleed, Steve Harvey – manager of operational support for Metrolinx’s safety and security division – quickly arranged for Metrolinx employees to attend the program. “Things can happen that create trauma for people, and it doesn’t necessarily have to be a terrorist act,” says Steve. “It could simply be a massive motor-vehicle collision. And don’t forget that downtown, there’s a significant amount of construction going on. If we have people available on the ground who have skills to help people survive, to me that’s a win.”
Sharon Ramagnano, manager of trauma services at Sunnybrook, and Dr. Avery Nathens, surgeon-in-chief, train hospital staff to become Stop the Bleed instructors for the larger community.