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ICU Nurse Helps 'Stop the Bleed' by Training the Community


Susan I. Liu, BSN, RN, CCRN, TCRN, is on a mission to save lives in the community. Liu is showing nurses and other healthcare professionals how they can train laypeople in the community to control hemorrhages, which can save lives in emergent situations such as terrorist or mass shooting events.

[caption id="attachment_52296" align="alignleft" width="274"] Susan I. Liu, RN[/caption] A nurse clinician in the surgical/trauma ICU at New York-Presbyterian/Weill Cornell Medical Center, New York City, Liu introduced the Stop the Bleed campaign at her facility. Initially created by the American College of Surgeons she brought the program to her own facility and -- with the help of nursing colleagues -- to different sites in New York City. It has been a labor of love for Liu and she doesn't plan on stopping anytime soon. The national awareness campaign was initially launched by the White House in October 2015 to encourage bystanders to help in a bleeding emergency before professional help arrives. The American College of Surgeons is leading the effort to train civilians to stop uncontrolled bleeding, which is where Liu and her colleagues come in. Liu spoke to about the campaign, the community outreach program she and her colleagues have created, and their own vision of hope.

Explain why the Stop the Bleed campaign was created and the steps taken to start the program in your facility and in the community.

In recent years, terrorist and mass shooting events have become more and more prevalent. Historically, law enforcement officials and medical first responders have had the responsibility of tending to the often critically injured victims of such horrific events. The Stop the Bleed campaign was designed by the American College of Surgeons to teach laypeople the basic principles of hemorrhage control. After taking a Stop the Bleed instructor course, several of my colleagues and I felt our community would benefit from learning these lifesaving skills. A small group of trauma and critical care nurses launched an inaugural training session for the security sergeants and lieutenants in the hospital. We had very positive feedback and wanted to reach larger groups of people. Our vision was to partner with members of our community to collectively make our city safer and to be able to help each other in times of crisis. New York-Presbyterian's department of trauma and critical care surgery supported our vision and assisted us by providing training materials to begin the community outreach program. As we fine-tuned the program, we started offering it at locations in the community, which allowed people to more easily attend the program at their workplaces. Nurses have been an integral part of both the in-hospital and community programs. In fact, we have had nurses present at every one of the 35 Stop the Bleed programs we have held so far, and most have had nurses as lead instructors.

What is the appeal for you in being a part of this movement, and why should other critical care nurses join you?

For me, this program has been a labor of love. People are often hesitant to talk about the increasing threat of terrorists and gun violence, but I have found that learning these skills often empowers people and changes their perspective on events like these. I personally have experienced a lot of emotional distress in the wake of recent events, especially now that I have school-age children. Being out in the community and teaching people skills that could save lives has allowed me to channel that distress and fear into a positive endeavor. It has been extremely rewarding to see how people embrace this education and watch their confidence grow as they realize that even without medical training, they have the power to save lives.

Explain the general principles and other developments of the program.

The Stop the Bleed program is taught in two parts -- a lecture covers identification of life-threatening hemorrhage and the basic hemorrhage techniques, which is followed by hands-on training in which participants practice direct pressure, wound packing and tourniquet application techniques.

Our initial challenge was to create a structure so we could offer the program to all interested members of the community. We organized a table at a local street fair to introduce the campaign and gain community support. We also wanted to build a team of instructors to help expand the program, so we offered courses to nurses and physicians in several departments within the hospital.

Subsequently, we began holding training sessions for members of the community, as well as non-medical hospital employees. Many participants have expressed interest in bringing the program back to their workplaces or schools, which has led to offsite training at universities, law firms and offices.

What are some of the positive results as well as challenges in the process of creating and implementing the program?

The responses have been overwhelmingly positive. We have worked with many people both in and out of the hospital who have been so helpful in organizing groups of participants and spreading the word about the program. Educating groups who truly value the information they are being taught is so rewarding, and each training session fuels our energy and excitement to further develop the program. As with any new initiative, we faced several challenges in structuring and executing the training sessions. These challenges were primarily related to logistics of organizing program times and locations, transportation to offsite locations and availability of volunteer trainers. Most of our trainers are nurses, physicians and medical students who have varied and busy schedules that make it difficult to plan sessions in advance. Even with these challenges, we have developed a wonderful core group of trainers who have been invaluable in making the Stop the Bleed program a success.

What are your hopes for the future of this program?

We would like the Stop the Bleed program to become as widespread as basic CPR training, and have trauma first-aid kits mounted in public places next to AEDs. The techniques taught in the program are relatively simple, yet so critical. We hope to continue to increase the number of instructors as well as the number and size of classes offered. We are in the process of collaborating with other hospitals in the New York-Presbyterian system to reach out to all areas of New York City.

Courses related to 'trauma and blood loss'

60081: Critical Blood Loss Demands Fluid Resuscitation to Fight Hypovolemic Shock (1 contact hr) Hypovolemia occurs for a variety of reasons. Nausea, vomiting or diarrhea can deplete intravascular volumes. Excessive diuresis from diabetes insipidus or diabetic ketoacidosis can also reduce intravascular volumes. When caring for trauma patients, hypovolemic shock is due to blood loss from sustained injuries. A blood loss of 20% of total blood volume is considered hypovolemic shock. Hypovolemia is not always that obvious. Patients with abdominal or chest injuries or fractures may bleed internally. Hypovolemic shock can be life-threatening in most trauma situations. Undetected or undertreated compensatory hypovolemic shock can progress to decompensated shock. The entire trauma team must remain alert for the signs of hypovolemic shock. 60050: Facing Limb Loss, Part 1 (1 contact hr) About 2 million Americans already have some form of limb loss, and more than 185,000 new amputations are done each year. The primary causes of acquired limb loss are diabetes, peripheral vascular disease, trauma, infection and cancer. About 90% of amputations done in the United States are lower extremity amputations. Part 1 of this series outlines causes of limb loss, amputation procedures, postoperative care and rehabilitation, including the role healthcare providers as a team play in helping patients regain function and prevent further amputation. People who experience limb loss may interact with healthcare providers in multiple settings, so healthcare providers across disciplines need to be well informed about it.