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A safer way to live with guns

Yale Medicine Magazine, 2018 - Spring


A tourniquet could save someone who has been shot from bleeding to death. That and other similar skills were taught in a “Stop the Bleed” class at Yale School of Medicine, one small part of a national effort on Sept. 17 by health care providers on the impact of gun violence.

“Scrubs Addressing the Firearms Epidemic” (or, SAFE) coordinated events at medical schools across the country on Sept. 17, said Victoria Bartlett, a second-year medical student. She is a member of the SAFE chapter at Yale, and helped organize the New Haven event. About 45 people attended, mostly medical students.

SAFE is a national group of doctors, nurses, medical students, and other healthcare providers that was started to get medical professionals involved ending gun violence. There are 41 SAFE chapters in the United States. All of them held events on Sept. 17, according to Sarabeth Spitzer, a spokeswoman for the group and a member of the chapter at Stanford Medical School. Those included rallies, faculty lecture panels, lunchtime talks, and Stop the Bleed classes, Spitzer said.

Bartlett said she wanted to give people tools they can use if they are ever bystanders at a shooting.

“I feel I have no idea how to address the problem as a future health care provider,” Bartlett said.

The Stop the Bleed class was developed by the American College of Surgeons in response to the incidence of gun violence and have been offered nationwide for the past 18 months, said Kimberly A. Davis, MD, MBA ’12, professor of surgery and vice chair of clinical affairs for the Department of Surgery. The class on Sept. 17 was the first time it was held at Yale.

Much of the focus was on gunshot wounds and organizers cited the incidence of gun violence around the country in comments at the start of the class. But organizers said their goal was simply to educate people and not get involved in the discussion about gun control.

“The point of this is not to take political sides but I think everyone can agree that we want to reduce the number of people who are dying from gun violence,” Bartlett said. She said she would like to see more training on treating severe bleeding in the field in the medical school’s curriculum.

Davis asked for students’ help in lobbying medical school leaders to put bleeding control kits where there are already automatic external defibrillators, which are devices used to help heart attack victims. She said bleeding control kits include a tourniquet, gauze pads designed to stop profuse bleeding and nitrile gloves and could be lifesaving in the event of a shooting.

Students were taught lifesaving skills

A wound that provokes a shocked response from an onlooker, which instructor Jeremy Fridling called the “Oh Wow” rule, likely means it is life-threatening and needs immediate attention. Fridling is a paramedic and second-year medical student at the Frank H. Netter School of Medicine at Quinnipiac University.

Fridling reviewed how to apply a tourniquet for a wound to an arm or leg, compression applied to a wound using hands and any cloth or gauze that may be available, and packing a wound to stop the bleeding.

Helping a gunshot victim can be simple but not easy. The wounds are often difficult to look at and the victim will likely be in tremendous pain and frightened, Fridling said. Using a tourniquet may save someone but will not make them feel better. Fridling said it is crucial to focus on stopping the bleeding rather than signs of discomfort from the patient.

Using medical gauze is best but many other materials that can absorb blood without disintegrating can be used, even a sweaty shirt that was worn to the gym, Fridling said.

Another key point Fridling and other speakers made is to start treatment immediately and not worry about making a victim’s situation worse since a gunshot wound has already done a lot of damage.

According to the American College of Surgeons’ Stop the Bleed website more than 124,000 people have participated in the class across the country. That includes as many as 850 in Connecticut through a free outreach program the medical school and Yale New Haven Health run. People who would like to present a class can contact Pina Violano, manager of injury prevention and community outreach at Yale New Haven Health.