Curso Tactical Emergency Casualty Care

Curso Tactical Emergency Casualty Care
TECC-SEMES Andalucia


jueves, 22 de junio de 2017

Bleeding Control Basic by American College of Surgeons and The Hartford Consensus IV StopTheBleed "Stop the Bleed"

Enlace Director al Programa

Ejemplo de un Sangrado Arterial con potencial de mortalidad y tratable con Torniquete si es en Extremidades y Empaquetamiento en caso de ser en una localizacion en donde no sea posible el torniquete 
Ahora para dar Cursos de Control de Sangrados "BCon" debes de estar registrado en el Coelgio Americano de Cirujanos, por medio de su Comite de Trauma y el programa Stop the Bleed

In September of 2014, NAEMT announced a new education course to teach civilians evidence-based, life-saving bleeding control techniques shown to dramatically increase casualty survival. Called “Bleeding Control for the Injured,” aka “B-Con,” this course was developed in response to the Hartford Consensus led by Dr. Lenworth Jacobs, and at the request of Dr. Norman McSwain, who served as a member of the Hartford Consensus working group.

B-Con teaches participants the basic life-saving medical interventions, including bleeding control with a tourniquet, bleeding control with gauze packs or topical hemostatic agents, and opening an airway to allow a casualty to breathe. The course is designed for NON tactical law enforcement officers, firefighters, security personnel, teachers and other civilians requiring this basic training. B-Con is consistent with the recommendations of the Hartford Consensus on Improving Survival from Active Shooter Events.

NAEMT partners on this and all other trauma initiatives with the American College of Surgeons (ACS). Recently, ACS launched a new website, that includes a new instructor portal for the B-Con course. This new portal houses all of the B-Con course materials, and will allow B-Con courses to be registered so that ACS and NAEMT can track our progress in training the public in basic bleeding control. There is no cost to use this portal, to access the course materials, or to register courses.

Presentacion para Descarga. B-Con es GRATIS y se ha diseñado para que profesionales sanitarios puedan convertirse en multiplicadores, para asi reducir las muertes prevenibles por sangrados producidos por heridas exanguinantes, fue deseo del Dr. Norman McSwain que estos conocimientos quedaran libres, bajo la custudia cientifica del Colegio Americano de Cirujanos y ha sido desarrollado el contenido por el Dr. Peter Pons bajo los Protocolos y Sistemas de Educacion del PHTLS-NAEMT.
Compartimos gratuitamente 


Torniquetes la controversia

En la foto el Dr. Ramon Reyes Diaz y el Mayor Medico Cirujano Toracico y Cardiovascular Георги Кесов 

del Ejercito Bulgaro, Director Medico de las Fuerzas Especiales Bulgaras. Mali-Africa Mayo 2016. 


Guías para el Manejo de Heridos en Incidentes Intencionados con Múltiples Víctimas y Tiradores Activo

Bleeding Control by American College of Surgeons and The Hartford Consensus IV

The American College of Surgeons has a number of resources available on their website to help the public learn more about bleeding control and how to act in a situation that requires immediate responders.

Stop the Bleed Resources

Visit for:

The Hartford Consensus IV: A Call for Increased National Resilience


New Website and Twitter Feed Target Bleeding Control

The American College of Surgeons (ACS) and the Hartford Consensushave launched a new website,, that is designed to assist the public and first responders in the event of a mass casualty or other bleeding control emergency. The site contains easily understood diagrams, videos, and other resources that may be useful in responding quickly to these life-threatening events. As the site evolves, it is anticipated that it also will list bleeding control training courses offered under the auspices of the ACS Committee on Trauma. In addition to the ACS and the Hartford Consensus, the site has a number of notable partners, including the Department of Homeland Security, the Federal Emergency Management Agency, and the Federal Bureau of Investigation. To further the site’s reach, the College also has created a Twitter handle: @bleedingcontrol. Members of the College are urged to visit the new website and follow the Twitter feed to keep apprised of the growth of this initiative.

Compressing the Zones of Care
The Hartford Consensus recommends that an integrated active shooter response should include the critical actions contained in the acronym THREAT:

Threat suppression
Hemorrhage control
Rapid Extrication to safety
Assessment by medical providers
Transport to definitive care
A key component of the Hartford Consensus is this:

In the immediate aftermath of a mass casualty event, some lives may be lost through caution. The standard approach has been to cordon off the zone of casualties, a wide “hot zone,” until it’s been ensured that all threats are suppressed. The Hartford Consensus suggested that the plan be modified to allow earlier access to victims outside the real hot zone, the location of the active shooter, or a possible bomb. Thus, agreement on new systems of integration and coordination between law enforcement and other teams of responders is needed to ensure the mutual understanding and sequencing of roles.*

By compressing the “hot zone” with the two other zones of care, the “warm zone” and the “cold zone,” less time is lost and more time is made available to begin bleeding control techniques so that more lives are saved (see diagram below).

*Source: The Hartford Consensus. Improving Survival Strategies to Enhance Survival in Active Shooter and Intentional Mass Casualty Events:A Compendium. Published by American College of Surgeons, September 2015. Retrieved July 25, 2016.

Editor’s note: The Joint Committee to Create a National Policy to Enhance Survivability from Intentional Mass Casualty and Active Shooter Events developed the following call to action at its January 7–8 meeting in Dallas, TX. This committee meeting, chaired by American College of Surgeons (ACS) Regent Lenworth M. Jacobs, Jr., MD, MPH, FACS, focused on the implementation of strategies to empower bystanders to help victims of mass casualty events. The following is the Hartford Consensus IV, edited to conform with Bulletin style.

Despite advances in the response to active shooter and intentional mass casualty events, a gap remains in our national preparedness and resilience. Drawing from experiences at myriad mass casualty events, the immediate responder (volunteer responder) represents an underutilized resource, yet one capable of dramatically increasing our all-hazards (injuries from all natural and man-made causes) national resilience. The overarching principle of the Hartford Consensus, outlined in previous reports, is that no one should die from uncontrolled bleeding. We have championed the following acronym to summarize what we have determined are appropriate steps to ensure that the maximum number of victims of these tragic events can be saved:


  • Threat suppression
  • Hemorrhage control
  • Rapid Extrication to safety
  • Assessment by medical providers
  • Transport to definitive care

Status update

Continuing in our efforts to improve survival from these events and the more common traumatic injuries that occur daily in the U.S., the Hartford Consensus met for the fourth time in January. The discussion at this meeting was focused on the role of individuals in immediate proximity to victims of injury, whatever the etiology.

Based on foundational work by the U.S. Department of Defense and the Committee on Tactical Combat Casualty Care (CoTCCC), previous Hartford Consensus reports have centered on improvements in the professional responder’s role in providing care to individuals wounded in active shooter and intentional mass casualty events. We submit that harnessing the power of immediate responders is not a new concept, as the public has been used to successfully initiate cardiopulmonary resuscitation (CPR) in the event of an out-of-hospital cardiac arrest. Furthermore, seminal work describing the lifesaving benefit of TCCC training in maximizing casualty survival among our troops wounded in combat in Iraq and Afghanistan has uniformly emphasized the importance of all personnel in dangerous environments, not just medics, being trained and equipped to control external hemorrhage when their unit members are injured (also known as Buddy Care). Because the public, by and large, has the will to help in these situations, this report seeks to outline the next steps necessary to continue to fortify our national resilience for a public response to hemorrhage control.

To date, the professional first responder community, including emergency medical services (EMS), law enforcement officers, fire and rescue personnel, and public safety officials, have widely accepted the Hartford Consensus’ principles. For example, the concept of immediateThreat suppression, which maximizes survival from life-threatening injuries, has been embraced and implemented on a national level.

External Hemorrhage control is the intervention that has proven most effective in the prehospital setting. The victim, an immediate responder, or a professional first responder should use this technique as quickly as possible once the immediate threat of further injury has been mitigated.

The concept of Rapid Extrication of casualties from areas of direct threat (hot zones) to less dangerous but not completely secure areas (warm zones) or secure areas (cold zones) expedites Assessment andTransport to definitive care. Furthermore, casualties no longer are expected to remain untreated for significant periods of time until the area is completely secure.

It is clear that the immediate responder has a role to play in rendering aid between the time of injury and the arrival of the professional first responder. The immediate responder can and should be actively involved in hemorrhage control until care is transferred to the professional first responder. Hemorrhage control kits, much like automatic external defibrillators, should be widely available in public places for immediate responder use. The professional first responder will have medical training and be equipped with bleeding control kits containing hemostatic dressings and tourniquets.

Prehospital and hospital emergency medical services have made substantial improvements in their ability to respond to mass casualty events by taking part in multi-agency drills and training scenarios, which allow hospitals to immediately assemble appropriate teams to receive and manage trauma patients. Sophisticated triage networks must be exercised to evenly distribute the injured so that individual hospitals are not overwhelmed. Hospitals located further from the incident should be seamlessly involved in the preparation and management of significant numbers of severely injured patients.

Current national opinion

The Hartford Consensus III focused on empowering the public to provide care. In intentional mass casualty events, those individuals present at the point of wounding have proven invaluable in responding to the initial hemorrhage control needs of the injured. While traditionally described as “bystanders,” these immediate responders need not be passive observers and can provide effective lifesaving first-line treatment. Examples of the effectiveness of such actions by immediate responders have been observed not only in the aftermath of the Boston Marathon bombings, multiple active shooter events, and the recent attacks in Paris, France, but also in the wake of hurricanes, tornadoes, industrial accidents, and everyday incidents, such as motor vehicle collisions. The Hartford Consensus IV meeting focused on building national resilience by outlining strategies to educate the public to become immediate responders.

When the Hartford Consensus called for the public to assume the role of immediate responder, it was uncertain how capable the average person would be at carrying out this charge. To determine the public’s ability and willingness to serve as immediate responders, a nationally representative survey was conducted to assess public opinion regarding the following:

  • Current level of training in first aid, including bleeding control
  • Willingness to render first aid for severe bleeding
  • Potential impediments to willingness to act
  • Support for changes in first responder policy to allow police and emergency medical services to render aid more quickly
  • Willingness to be trained in bleeding control
  • Support for the distribution of bleeding control kits in public places

The survey was conducted by a professional survey firm using established and validated sampling techniques. The questionnaire was administered via landline and cellular telephone interviews to a random sample of 1,051 adults in all 50 states on November 6–11, 2015. The survey findings are as follows:*

  • There is broad support for initiatives to train and equip first responders and for the public to render first aid for bleeding control in mass casualty incidents.
  • Large majorities of able-bodied Americans report that they are willing to offer such aid, especially if training and supplies are made available.
  • Training, including instruction in bleeding control, is strongly associated with the following:
    • Greater willingness to give aid
    • Fewer concerns about reasons not to give aid
    • Interest in receiving further, updated training
  • Concerns to be addressed include:
    • Getting injured during an active shooter event
    • Causing greater pain or injury
    • Bearing responsibility for bad outcomes
    • Contracting disease
  • Support for policies and procedures to make hemorrhage control training and equipment widely available is overwhelming. Specific examples include the following:
    • Near unanimous support for deployment of kits into public spaces (93 percent)
    • Strong support for training police to provide bleeding control as a part of their duties (91 percent)
    • Substantial support for faster access to active shooter and intentional mass casualty events (65 percent)

Current state of readiness and national resilience

The Hartford Consensus intends to create a vision for best-practice hemorrhage control for increasing survival after all-hazards injuries including active shooter and intentional mass casualty events. The goal is to inform and inspire decision makers around the country to effect this vision by establishing appropriate metrics, applying these metrics, and using this information to motivate decision makers.

Metrics for readiness

Metrics to assess readiness include course completion records for TCCC-based medical training. Examples of these training programs include the following:

  • Tactical Emergency Casualty Care
  • Bleeding Control for the Injured (B-Con)
    • Available through the ACS and the National Association of Emergency Medical Technicians (NAEMT)
  • Law Enforcement and First Response Tactical Casualty Care
    • Available through the ACS and NAEMT
  • Specialized Tactics for Operational Rescue and Medicine (STORM)
    • Available through Georgia Regents University, Augusta
  • Advanced Law Enforcement Rapid Response Training (ALERRT)
    • Available through Texas State University, San Marcos

Metrics for resilience

Metrics to assess resilience include the following:

  • Registry data for all wounded law enforcement officers and all casualties from active shooter and intentional mass casualty events
  • Case series reports describing injuries, treatments, and outcomes for all casualties, including reports on wounded law enforcement officers and all victims wounded in mass casualty events
  • Preventable death analyses for law enforcement officers killed in the line of duty and victims of active shooter and intentional mass casualty events

Many trauma deaths result from injuries that are intrinsically non-survivable, whereas others occur from injuries that were potentially survivable had optimal care been rendered. Obtaining a clear understanding of the proximate cause of all law enforcement officer deaths that result from trauma as well as all fatalities in active shooter or intentional mass casualty events will identify opportunities to improve care for officers wounded in the line of duty.

Enhancing citizen resilience

All potential responders to victims of a trauma event should be able to recognize the signs that indicate that bleeding is life-threatening, including the following:

  • Pulsatile or steady bleeding is coming from the wound.
  • Blood is pooling on the ground.
  • The overlying clothes are soaked in blood.
  • Bandages or makeshift bandages used to cover the wound are ineffective and steadily become soaked with blood.
  • An arm or leg is traumatically amputated.
  • The patient was bleeding and is now in shock (unconscious, confused, pale).

Immediate responders should attempt to stop or slow massive hemorrhaging initially by using their hands (gloved whenever possible) to initiate primary compression. This compression should be applied directly or just proximal to the site of hemorrhage and with the use of sustained, direct pressure. Performing this task may be difficult for someone without any first aid training, but it will significantly enhance the survival of the actively hemorrhaging injured victim.

Once the professional responder arrives at the scene, care should be transferred to this individual because he or she will be equipped with and trained in the use of more sophisticated hemorrhage control methods, such as hemostatic dressings and tourniquets.

In a manner similar to the presentation of CPR training, hemorrhage control training programs should be available to the public and offered by employers, civic and religious groups, schools, and the health care community at large.

As an increasing number of public and private locations implement plans to preplace hemorrhage control equipment or co-locate this equipment with automatic external defibrillators, clear messaging and signage should be posted so people can easily and rapidly access this equipment.

Training considerations

The primary components of enhancing citizen resilience must focus on training considerations including:

  • Determination of terminal learning objectives for bleeding control courses
  • Establishment of standard curriculum for bleeding control
    • Education of the public in bleeding control using multiple teaching methods, including:
      • Didactic education programs
      • Online modules
      • Smartphone applications
  • Tiered bleeding control education for the following:
    • Immediate responders with no equipment other than their hands
    • Immediate responders with bleeding control kits (hemostatic dressings and tourniquets)
    • Professional first responders with bleeding control kits
  • Creation of public awareness through “Bleeding Safe” communities similar to the “Heart Safe” communities that were designed to promote survival from sudden out-of-hospital cardiac arrest

Specifically, the Hartford Consensus recommends developing a curriculum for the immediate responder. The curriculum would feature a tiered approach that uses the hands of the immediate responder followed by hemostatic dressings and tourniquets when these lifesaving interventions become available. This curriculum should also outline the specific anatomic locations for effective compression of large vessels to stop massive life-threatening hemorrhage. In most cases, control of external hemorrhage can be accomplished by applying direct pressure on the bleeding vessel—even major vessels such as the carotid or femoral arteries. However, victims with life-threatening hemorrhage often bleed to death when direct pressure is the only treatment available to achieve hemostasis. For direct pressure to be effective, it must be applied with both hands using significant sustained and direct force. The patient should be stationary on a surface firm enough to provide effective counter pressure. Frequently, direct pressure cannot be effectively applied while the patient is being moved. Discontinuation of pressure to check the status of the bleeding site during transport must be avoided to ensure bleeding control.

In addition, immediate responders should be taught how to apply hemostatic dressings. For life-threatening hemorrhage from an extremity, immediate responders should be taught to apply a tourniquet. Application of direct pressure, a hemostatic dressing, or a tourniquet must be maintained without interruption until the patient reaches a location where the damaged vessel can be repaired surgically. Wounds with minimal external bleeding, suggesting no major blood vessels have been injured, may be dressed with gauze or a hemostatic dressing until the patient arrives at definitive care.

The curriculum also should include techniques to open and maintain an airway, especially in cases of massive oral hemorrhage. If the victim is conscious, this technique is usually best accomplished by having the victim sit up and lean forward to allow gravity or coughing to clear the blood from the upper airway.

The successful completion of this curriculum should result in the receipt of merit-type badges for scouts and explorer posts and certification in bleeding control.

Dissemination and implementation of a national resilience plan

A critical first step to achieving national resilience is training and equipping immediate responders and professional first responders to control external hemorrhage, along with the strategic positioning of bleeding control kits in locations where active shooter or intentional mass casualty incidents have been observed to occur.

The next step is a campaign to inspire the public to obtain bleeding control training and sustain that training. This should be actively promoted through the following:

  • Emotional appeals such as, “When you stop the bleed, you save a life”
  • Simple, consistent messaging
  • Messages that can be delivered across diverse platforms

To achieve sustainable changes in behavior aimed at immediate control of life-threatening external hemorrhage, the implementation plan should take into account the following considerations:

  • The content of the plan should include:
    • The immediate responder concept
    • An all-hazards approach
    • A standard curriculum
    • Funding for implementation and sustainability
  • The audience for bleeding control courses are:
    • Immediate first responders (public)
    • Professional first responders
    • Law enforcement officers
    • Firefighters
    • EMS personnel
  • Potential content distribution networks include:
    • The Medical Response Corps
    • The Red Cross
    • The National Disaster Medical System
    • The National Guard
    • Boy and Girl Scouts
    • Professional medical societies and organizations
    • Federal, regional, and local health departments
    • Emergency service agencies
  • Strategies to promote these concepts include:
    • Work with other groups concerned with safety
    • Gather stakeholder input and explain the value of prospective buy-in by all
    • Develop a strategic communications plan that drives demand and builds community acceptance
    • Deliver a message of health literacy and cultural competence that informs but does not inflame
    • Explain the political barriers and facilitators of implementation
    • Establish a liaison with state legal authorities to guarantee the validity of Good Samaritan protections as applied to immediate responders and first responders to encourage their participation in bleeding control.


National implementation of the Hartford Consensus is a meticulous and incremental process. It consists of many elements that require collaboration and strategic leadership to achieve an efficient, effective, knowledgeable, resilient, and prepared citizenry.
We strongly believe the public can and should act as immediate responders to stop bleeding from all hazards, including active shooter and intentional mass casualty events. The ACS has a long history of setting standards and educating responders through its Committee on Trauma and its programs. The ACS is therefore well-positioned to use its national and international networks to implement bleeding control education to improve survival and enhance resilience.

Author’s note:

All text and images in this article are copyright of the Hartford Consensus. For permission to reprint or for more information, contact Dr. Jacobs
The “Stop the Bleed” poster show above was developed for public education purposes and will be available for wide distribution. To obtain copies, contact Dr. Jacobs.

The Hartford Consensus IV: A Call for Increased National Resilience

Joint Committee to Create a National Policy to Enhance Survivability from Intentional Mass Casualty and Active Shooter Events


Lenworth M. Jacobs, Jr., MD, MPH, FACS

Chairman, Hartford Consensus

Vice-President, Academic Affairs

Hartford Hospital

Board of Regents,

American College of Surgeons (ACS)

Richard Carmona, MD, MPH, FACS

17th U.S. Surgeon General

Frank Butler, MD, FAAO, FUHM

Chairman, Committee on Tactical Combat Casualty Care

Department of Defense Joint Trauma System

Andrew L. Warshaw, MD, FACS, FRCSEd(Hon)

Immediate Past-President,


Massachusetts General Hospital, Boston

David B. Hoyt, MD, FACS

Executive Director,


Margaret Knudson, MD, FACS

Medical Director, Military Health System Strategic Partnership ACS

San Francisco General Hospital and Trauma Center

Jonathan Woodson, MD, FACS

Assistant Secretary of Defense for Health Affairs, Department of Defense

Alexander Eastman, MD, MPH, FACS

Major Cities Police Chiefs Association

chief of trauma,

Parkland Memorial Hospital

University of Texas Southwestern Medical Center

Kathryn Brinsfield, MD, MPH, FACEP

Assistant Secretary, Health Affairs

Chief Medical Officer,

Department of Homeland Security

William Fabbri, MD, FACEP

Director, Emergency Medical Services

Federal Bureau of Investigation

Karyl Burns, PhD

Research scientist, Hartford Hospital

Matthew Levy, DO, MSc, FACEP

Senior medical officer,

Johns Hopkins Center for Law Enforcement Medicine,

Johns Hopkins University

John Holcomb, MD, FACS

Chief, Division of Acute Care Surgery

University of Texas Health Science Center

Ronald Stewart, MD, FACS

Chair, Committee on Trauma

American College of Surgeons

The University of Texas Health Science Center at San Antonio

Peter Pons, MD, FACEP

Associate Medical Director,

Prehospital Trauma Life Support, International

National Association of EMTs

CDR Todd Lewis, MSC, USN

Military Assistant to the Assistant Secretary of Defense for Health Affairs

Ray Mollers

Workforce Health and Medical

Support Division

Office of Health Affairs

Department of Homeland Security

Michael Marquis

General manager,

Johnson & Johnson Consumer Products, Inc.

Stephen Fanning

President and chief executive officer,


Gary Langer


Langer Research Associates, LLC
*Note: A full report on the survey will be published in an upcoming issue of the Journal of the American College of Surgeons.
Link to FACS

American College of Surgeons Releases Hartford Consensus Compendium

The September 2015 American College of Surgeons Bulletin is devoted to active shooter and intentional MCI preparedness and response. Entitled  “Strategies to Enhance Survival in Active Shooter and Intentional Mass Casualty Events: A Compendium,” this 92-page document should be downloaded, distributed and read by all EMS managers, supervisors, manufacturers and providers because it illustrates best practices, equipment needs and benefits, and tactical approaches that EMS, fire and law enforcement agencies need to focus on.

Blood gushes from virtual leg injury to help train combat medics

Fittingly, the American College of Surgeons, through an introduction by Hartford Consensus Chairman Lenworth M. Jacobs, Jr., MD, MPH, FACS, dedicated this epic document to Norman McSwain, MD, who recently passed away. I paraphrase Dr. Jacobs dedication message here:

Immediately following the active shooter disaster at the Sandy Hook Elementary School in Newtown, CT, Dr. Norman McSwain agreed to be a founding member of the Joint Committee to Develop a National Policy to Increase Survival from Active Shooter and Intentional Mass Casualty Events. Dr. McSwain brought the dedication, passion, and intellect for which he was famous to the Hartford Consensus deliberations.

He fiercely advocated for an organized coordinated prehospital response that incorporated hemorrhage control by immediate bystander responders, a change in focus of the mission of law enforcement to include immediate stopping of life-threatening hemorrhage of victims, and an urgent response by emergency medical personnel to treat and transport trauma patients to the appropriate trauma hospitals. He recognized that time was a critical factor for patients who had massive bleeding.

Dr. McSwain has had a lifelong commitment to improving the care of trauma patients. He personally cared for thousands of trauma patients irrespective of who they were and what their station in life was. His dedication and commitment to the education of prehospital personnel was exemplified by the creation of the Prehospital Trauma Life Support course which has been taught to more than a million students in more than 60 countries. These principles have also been embraced by the military in the Tactical Combat Casualty Care courses.

Through this work, his commitment to excellent prehospital care has been given to millions of trauma patients worldwide. Throughout his career Dr. McSwain was been honored by the American College of Surgeons Committee on Trauma and numerous other professional organizations. However, it was his personal commitment to excellent individual care of the patient, his personal example of the compassionate trauma surgeon, and his kind, caring desire to help people from all walks of life that will always be remembered.

He was a good friend, an excellent person, and an example for all of us that will be forever captured by his greeting to everyone: “What have you done for the good of mankind today?”  May he rest in peace.

Please DOWNLOAD and distribute this important document to your friends and colleagues. 

American College of Surgeons  "Hartford Consensus Compendium" Logo

One-handed tourniquet application and immediate responder hemorrhage control
PHTLS B-Con Bleeding Control  for the Injured Course
Hartford Consensus III
Download the  B-Con presentation y PDF (English)

Curso Control de Sangrados en el Herido de PHTLS y NAEMT
Bleedin Control Course B-Con PHTLS  and NAEMT

Hartford Consensus III

ACS Partners with NAEMT in the Development and Release of a Civilian Training Course on Hemorrhage Control Techniques
Joint effort aims to expand public participation in saving lives in the wake of an active shooter or other mass casualty event as recommended by the Hartford Consensus

CHICAGO (July 9, 2015): The American College of Surgeons (ACS) has partnered with the National Association of Emergency Medical Technicians (NAEMT) in the development of a medical preparedness training course that empowers bystanders to become immediate responders who treat severely bleeding victims of active shooter or other mass casualty events. The Bleeding Control for the Injured (B-Con) course was jointly developed by the members of NAEMT’s Prehospital Trauma Life Support (PHTLS) Committee and the American College of Surgeons Committee on Trauma (ACS COT) to provide a foundation for first-response care that bystanders (immediate responders) can administer until professional first responders arrive on the scene (i.e.: law enforcement, paramedics, firefighters).
The course was developed to expand public education in the area of hemorrhage control so that bystanders can be empowered to engage in life-saving actions in their own communities. Civilians are taught the same life-saving bleeding control techniques used by military personnel in Iraq and Afghanistan that are shown to dramatically increase casualty survival.
“Advocacy and education are two key principles for our Committee on Trauma activities, and the B-Con course embodies both of them,” said Ronald M. Stewart, MD, FACS, Chair, ACS-COT. “We were very eager to partner with NAEMT on this important educational project. They responded quickly to the need for this type of public education program by extracting and modifying the information contained in their excellent Prehospital Trauma Life Support (PHTLS) course and adapting it for the lay public.” 
The two-and-a-half hour educational course combines didactic lectures with hands-on training and teaches the initial steps that bystanders should take to care for bleeding victims. Participants learn why it is important to use a tourniquet to control life-threatening bleeding from an arm or leg; how to correctly apply a tourniquet to the arm and leg; how to pack a wound and apply pressure to control bleeding; the importance of identifying injuries to the chest and abdomen; and the need for victims with these traumatic injuries to be transported immediately to an appropriate hospital for trauma care.
“Our collaboration with the ACS Committee on Trauma follows a long-standing partnership in ensuring quality patient care and improving casualty survivability,” said Conrad “Chuck” Kearns, MBA, Paramedic, A-EMD, President of NAEMT. “B-Con provides bleeding control techniques that can be performed by any observer of a tragic incident, similar to the way bystanders respond with CPR.” 
The development and release of B-Con training is part of an interdisciplinary public safety initiative on the part of medical leaders and law enforcement to enhance the resilience of the general public when confronted with mass-casualty events so that no victims will bleed to death while awaiting the arrival of first responders on the scene.
The goals of this initiative are part of a larger effort put forth by the Joint Committee to Create a National Policy to Enhance Survivability from Intentional Mass-Casualty and Active Shooter Events, which first met in Hartford, Conn. in 2013. Representatives of this collaborative committee, whose recommendations are called the Hartford Consensus, note that the number one cause of preventable death in victims of penetrating trauma is hemorrhage, making hemorrhage control a major priority in improving survivability of victims from active shooter events.
The B-Con course embodies a key principle of the Hartford Consensus III–empowering the public to provide lifesaving, first-line care,” said Lenworth M. Jacobs, Jr., MD, MPH, FACS, Regent, American College of Surgeons, and Chairman of the Joint Committee that developed the Hartford Consensus. “Our ultimate goal is to educate individuals and communities about the use of effective external hemorrhage control techniques and to ensure access to bleeding control bags in public places in much the same way that automatic external defibrillators are now accessible to the public. We also advocate extending Good Samaritan protections to individuals who use tourniquets and lifesaving devices to control the bleeding of victims at mass-casualty events.” 
The Hartford Consensus recommends that an integrated active shooter response should include the critical actions contained in the acronym THREAT:
·     Threat suppression
·     Hemorrhage control
·     Rapid Extrication to safety
·     Assessment by medical providers
·     Transport to definitive care
Hemorrhage control is addressed by offering B-Con training for public education and use, and is part of the third installment of the Committees’ recommendations, known as Hartford Consensus III.  In order to improve survivability, victims with life-threatening external bleeding must be treated immediately at the point of wounding by trained bystanders who have first determined that it is safe to act. Further, all bystanders who assume the role of immediate responders must be trained and have the necessary equipment to provide effective external hemorrhage control until emergency medical personnel arrive on the scene.  
“We view care of the victims as a shared responsibility between law enforcement, fire/rescue, and EMS,” said Norman McSwain, MD, FACS, from the Joint Committee. “The Bleeding Control course takes that role a step further by engaging trained bystanders in the process as well. The course defines their role in this process so that those bystanders can recognize life-threatening bleeding and learn how to administer the proper medical treatment. We also recommend that law enforcement and fire and rescue personnel carry tourniquets with them after they’ve completed the training.” 
The Hartford Consensus III report on implementing bleeding control is published in the July 2015 Bulletin of the American College of Surgeons.
# # #
About the American College of Surgeons
The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for surgical patients. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 80,000 members and is the largest organization of surgeons in the world. For more information, visit
About the National Association of Emergency Medical Technicians
Formed in 1975 and more than 50,000 members strong, the National Association of Emergency Medical Technicians (NAEMT) is the only national association representing the professional interests of all emergency and mobile healthcare practitioners, including emergency medical technicians, advanced emergency medical technicians, emergency medical responders, paramedics, advanced practice paramedics, critical care paramedics, flight paramedics, community paramedics, and mobile integrated healthcare practitioners.  NAEMT members work in all sectors of EMS, including government agencies, fire departments, hospital-based ambulance services, private companies, industrial and special operations settings, and in the military.  For more information visit:

Dan Hamilton
Sally Garneski

Hyper-Realistic simulation doing a Combat Medic/EMT-B course at PPA-International Medical

See more at:

Hartford Consensus III participants. Seated, left to right: Drs. McSwain, Warshaw, Jacobs, Woodson, Brinsfield, and Levy; and Mr. Elliott. Standing left to right: Dr. Rhee, Mr. Mitchell, Drs. Eastman, Conn, O’Connor, Stewart, Butler, Burns, Weireter, Hunt, Holcomb, and Fabbri; and Commander Anderson.

The Hartford Consensus III: Implementation of Bleeding Control

The Hartford Consensus III recognizes the vital role that immediate responders play in responding to mass-casualty events. They make major contributions to improving survival from these incidents. However, the Hartford Consensus III does not advocate that members of the public enter areas of direct threat or imminent danger.
Good Samaritan laws have been effective in empowering the public to become involved in the immediate response to a victim of cardiac arrest or choking by the initiation of cardiopulmonary resuscitation and the Heimlich maneuver, respectively. The Hartford Consensus recommends that these legal protections be extended to include the provision of bleeding control.

Professional first responders

Professional first responders include law enforcement and EMS/fire/rescue. As indicated by THREAT, law enforcement must suppress the source of wounding if the shooter is still active and then, because they are usually the initial first responders on the scene, must act to control external hemorrhage. Victims with life-threatening external bleeding must be treated immediately at the point of wounding. All responders should be educated and have the necessary equipment to provide effective external hemorrhage control. Continued emphasis must be on the integration of the immediate responders, law enforcement, and EMS/fire/rescue to optimize rapid patient assessment, treatment, and transport to definitive care at the nearest appropriate hospital.

Building educational capabilities

Education in hemorrhage control can take many forms and should be offered using various modalities. Established education programs for individuals, communities, and professional responders can be modified to include effective external hemorrhage control techniques. The Bleeding Control for the Injured (B-Con) course offered by the National Association of Emergency Medical Technicians is an example of a newly created program that is appropriate for training individuals who have little or no medical background. Other methods such as public service announcements, slogans, advertising, and entertainment media should be used to convey the message that bleeding control is a responsibility of the public and is within their capabilities.
The public needs to be empowered to engage in lifesaving actions. This training should be included as part of preparing for situations involving other potential hazards, including everyday events that may produce trauma and hemorrhage. For professional first responders, more advanced courses may offer additional options to control life-threatening external hemorrhage. All formal training should have specific objectives and train to competency. For professional responders, the training must be efficient and cost-effective. Ultimately, integrated training exercises must be conducted that include all levels of responders.

April 29, 2015

Roundtable on bystanders: Our nation’s immediate responders

  • Air Medical Physician Association
  • American Academy of Physician Assistants
  • American Ambulance Association
  • American Association of Critical Care Nurses
  • American Association for the Surgery of Trauma
  • American College of Emergency Physicians
  • American College of Surgeons
  • American Heart Association
  • American Hospital Association
  • American Nurses Association
  • American Osteopathic Association
  • American Physical Therapy Association
  • American Public Health Association
  • American Trauma Society
  • Association of Air Medical Services
  • Association of State and Territorial Health Officials
  • Eastern Association for the Surgery of Trauma
  • Emergency Nurses Association
  • Emergency Medical Services Labor Alliance
  • International Academies of Emergency Dispatch
  • International Association of Chiefs of Police
  • International Association of Emergency Managers
  • International Association of Emergency Medical Services Chiefs
  • International Association of Firefighters
  • International Association of Fire Chiefs
  • Major Cities Chiefs Association
  • National Association of Emergency Medical Technicians
  • National Association of School Nurses
  • National Association of State EMS Officials
  • National Athletic Trainers Association
  • National Emergency Management Association
  • National Volunteer Fire Council
  • Society of Emergency Medicine Physician Assistants
  • Society of Trauma Nurses
  • Trauma Center Association of America
  • White House personnel
  • Interagency Bystander Workgroup team leaders
  • Federal invitees

The Hartford Consensus III: Implementation of Bleeding Control

Joint Committee to Create a National Policy to Enhance Survivability from Intentional Mass-Casualty and Active Shooter Events

Lenworth M. Jacobs, Jr., MD, MPH, FACS
Chairman, Hartford Consensus
Vice-President, Academic Affairs
Hartford Hospital
Board of Regents,
American College of Surgeons
Richard Carmona, MD, MPH, FACS
17th U.S. Surgeon General
Norman McSwain, MD, FACS
Medical Director, Prehospital Trauma Life Support
Tulane University
Frank Butler, MD, FAAO, FUHM
Chairman, Committee on Tactical Combat Casualty Care
Department of Defense Joint Trauma Systems
Doug Elliot
President, The Hartford
Chair, Board of Directors
Hartford Hospital
Andrew L. Warshaw, MD, FACS, FRCSEd(Hon)
President, American College of Surgeons
Massachusetts General Hospital, Boston
Jonathan Woodson, MD, FACS
Assistant Secretary of Defense for Health Affairs, Department of Defense
Richard C. Hunt, MD, FACEP
Director for Medical Preparedness Policy,
National Security Council Staff
The White House
Ernest Mitchell
Administrator, U.S. Fire Administration
Federal Emergency Management Agency
Department of Homeland Security
Alexander Eastman, MD, MPH, FACS
Major Cities Police Chiefs Association
Chief of Trauma, Parkland Memorial Hospital
University of Texas Southwestern Medical Center
Kathryn Brinsfield, MD, MPH, FACEP
Assistant Secretary, Health Affairs
Chief Medical Officer,
Department of Homeland Security
Colonel Kevin O’Connor, DO, FAAFP
Physician to the Vice-President
The White House
William Fabbri, MD, FACEP
Director, Emergency Medical Services
Federal Bureau of Investigation
Richard Serino
Distinguished Visiting Fellow,
Harvard University, School of Public Health
8th Deputy Administrator,
Federal Emergency Management Agency
Alasdair Conn, MD
Chief Emeritus, Emergency Medicine
Massachusetts General Hospital
Karyl Burns, PhD
Research Scientist, Hartford Hospital
Matthew Levy, DO, MSc, FACEP
Johns Hopkins University
Senior Medical Officer,
Johns Hopkins Center for Law Enforcement Medicine
Leonard Weireter, MD, FACS
Vice-Chair, Committee on Trauma
American College of Surgeons
Eastern Virginia Medical School
John Holcomb, MD, FACS
Chief, Division of Acute Care Surgery
University of Texas Health Science Center
Peter Rhee, MD, MPH, FACS
Department of Surgery
University of Arizona
Ronald Stewart, MD, FACS
Chair, Committee on Trauma
American College of Surgeons
The University of Texas Health Science Center at San Antonio
Robert Anderson, CDR, MSC, USN
Military Assistant to the Assistant Secretary of Defense for Health Affairs
Department of Defense
Thomas M. Scalea, MD, FACS
R Adams Cowley Shock Trauma Center
University of Maryland School of Medicine
Donald Jenkins, MD, FACS
Medical Director, Trauma Center
Mayo Clinic
David R. King, MD, FACS
Trauma, Emergency Surgery and Surgical Critical Care
Department of Surgery
Massachusetts General Hospital

The Bleeding Control for the Injured (B-Con) course was developed by NAEMT's PHTLS Committee with leadership provided by Dr. Peter Pons and Dr. Norman McSwain.

The course was developed in response to efforts by the U.S. Departments of Homeland Security and Health and Human Services to increase collaboration between law enforcement, the fire service and EMS in responding to active shooter/IED/mass casualty events. B-Con is consistent with the recommendations of the Hartford Consensus on Improving Survival from Active Shooter Events. The Hartford Consensus recommends that an integrated active shooter response should include the critical actions contained in the acronym THREAT: 1.Threat 
2.Hemorrhage control 
3.Rapid Extrication to safety 
4.Assessment by medical providers 
5.Transport to definitive care

The Hartford Consensus Group recommends that the response to a traumatic incident, whether involving an active shooter or some other cause of injury, in fact begins with bystander response. It is with this in mind that the B-Con course was developed and is now being offered.
This new 2 ½ hour course teaches participants the basic life-saving medical interventions, including bleeding control with a tourniquet, bleeding control with gauze packs or topical hemostatic agents, and opening an airway to allow a casualty to breathe. The course is designed for NON tactical law enforcement officers, firefighters, security personnel, teachers and other civilians requiring this basic training. Course materials include a PowerPoint presentation and instructor notes, instructor’s guide, and skill station guide. 

A separate, additional PowerPoint module is included in the course materials specifically for law enforcement participants. This module provides an orientation to the content of the Hartford Consensus and the changing approach to active shooter and other complex and hazardous responses. 

At the completion of the course, participants will be able to:

•Explain the rationale for early use of a tourniquet for life-threatening extremity bleeding.
•Demonstrate the appropriate application of a tourniquet to the arm and leg. 
•Describe the progressive strategy for controlling hemorrhage. 
•Describe appropriate airway control techniques and devices. •Demonstrate the correct application of a topical hemostatic dressing (combat gauze). 

"Stop The Bleed" 
The Obama Administration launched the "Stop The Bleed" campaign Wednesday, October 6, 2015 to provide people with the tools to stop life threatening bleeding in the event of an emergency, saying:
"Severe bleeding can lead to death in five minutes or less. A victim can bleed to death much faster than trained public safety personnel can arrive. The person standing or sitting next to that individual may be the ONLY one who can make the difference between life and death." 

No matter how rapid the arrival of professional emergency responders, bystanders will always be first on the scene.  A person who is bleeding can die from blood loss within five minutes, therefore it is important to quickly stop the blood loss.
"Stop the Bleed" is a nationwide campaign to empower individuals to act quickly and save lives.
Remember to be aware of your surroundings and move yourself and the injured person to safety, if necessary.
Call 911.
Bystanders can take simple steps to keep the injured person alive until appropriate medical care is available.  Here are three actions you can take to help save a life:


Find where the bleeding is coming from and apply firm, steady pressure to the bleeding site with bandages or clothing


If the bleeding doesn't stop, place a tourniquet 2-3 inches closer to the torso from the bleeding. (The tourniquet may be applied and secured over clothing.)
Pull the strap through the buckle, twist the rod tightly, clip and secure the rod with the clasp or the Velcro strap.

Compress Again

Compress again
If the bleeding still doesn't stop, place a second tourniquet closer to the torso from the first tourniquet.
Pull the strap through the buckle, twist the rod tightly, clip and secure the rod with the clasp or the Velcro strap.
* One type of tourniquet is depicted in the illustrations.

More Information

You can learn more about how to “Stop the Bleed” and help save a life by accessing these training and resources:
‘A Perfect Stranger’ tells the story of Kinneil and Angelia and the event that brought the two women together. When a motorcycle accident left a frightened Angelia on the street alone and bleeding, Kinneil didn’t just stand by, she cared enough to stop and provide a comforting hand and a reassuring voice. It is a powerful reminder that at a moment’s notice, any one of us might find ourselves in a situation where we are the help until help arrives. In the end, this film calls on all Americans to remake what it means to be a bystander. Learn more at

To learn more or to get involved in the Stop the Bleed Campaign, contact us at

Last Published Date: October 7, 2015

Control de Sangrados para el Herido By NAEMT. The Hartford Consensus III

Control de Sangrados para el Herido By NAEMT.


En los últimos años cada vez más se habla de los torniquetes. Algo que originalmente parecía destinado únicamente a los terrenos de batalla, e incluso allí era tratado como algo tabú (sobre todo por la medicina de nuestro país) se va implantando cada vez más, pero no solo en tierras lejanas y por nuestras tropas, si no en la vida civil y de cada día. Los últimos atentados indiscriminados están demostrando la utilidad de un útil que tiene un coste bajo, no pesa y se puede transportar en cualquier sitio.
Pero, ¿Hay que aflojarlo? ¿Sólo lo puedes usar en caso de riesgo extremo para la vida? Vamos con los 5 mitos más habituales sobre los torniquetes.
  1. Los torniquetes se deben utilizar solamente como último recurso.
Este es un enfoque peligroso y anticuado. Hay una cantidad abrumadora de datos contrastados que tumban  este mito. Si estas está asistiendo a una clase y eso es lo que están diciendo, te aconsejamos que busques una segunda opinión.

Existen multitud de ejemplos en el mundo real que atestiguan la normalidad en el uso de torniquetes y como salvan vidas a diario en la vida civil.
En un marco táctico o de tirador activo, el torniquete se convierte en un “must” y se debe utilizar ante la simple sospecha de que una víctima está sangrando por una extremidad. Durante muchos años las hemorragias de las extremidades fueron la principal causa de muerte prevenible en el campo de batalla, ahora ya superada por las hemorragias en las zonas de unión (axila, ingle, y el cuello).
Mejoras significativas en la formación, junto con la disponibilidad de torniquetes han dado como resultado una marcada disminución de la mortalidad. A través de la educación en sistemas como el TCCC y la persistencia de los militares han cambiado la forma en que vemos los torniquetes a pesar de las veces que se ha repetido lo de “sólo como último recurso”.
Durante un estudio de 7 meses en 2006 en el Combat Support Hospital en Bagdag, publicado en The Journal of TRAUMA Injury,Infection, and Critical Care en Febrero de 2008, se realizó un estudio sobre la incidencia de la aplicación de los torniquetes :
  • 232 pacientes
  • 428 torniquetes aplicados
  • El torniquete CAT fue aplicado un 79% de las veces
  • No se apreciaron lesiones causadas por su aplicación (necrosis, fallo renal, amputaciones, necesidad de fasciotomia)
  • No se realizó una sola amputación debido al uso del torniquete
ACTUALIZACIÓN-  Existe una gran diferencia entre un escenario civil urbano y uno militar. Mientras en un escenario civil, el paciente será atendido y/o evacuado durante la hora siguiente al incidente que ha conllevado la aplicación del torniquete, reduciendo a casi 0 el riesgo de lesiones en las extremidades, en un escenario militar puede ser distinto. Como hace constar la National Association of Emergency Medical Technicians (NAEMT) en su informe  Optimizing the use of Limb Tourniquets in TCCC, su utilización en Irak y Afganistan es común y sin incidencias remarcables para los pacientes, ya que cuentan con un protocolo de extracción de heridos MEDEVAC con unos periodos de respuesta muy cortos. Pero bien distinto puede ser para su uso en escenarios donde los tiempos de extracción  necesitan de un tiempo prolongado.  En general y como se sigue constatando en la última revisión de Noviembre de 2015 de las Tactical Combat Casualty Care Guidelines El uso del torniquete es seguro hasta las 2 horas de aplicación y debe ser revisado por personal especializado lo antes posible desde su aplicación. NUNCA se debe retirar, aflojar, o mover de sitio un torniquete por personal que no tenga los conocimientos acreditados para ello. Si no cesa el sangrado, se debe aplicar un segundo torniquete, o la combinación de torniquete y hemostáticos. MUY IMPORTANTE siempre siempre, SIEMPRE, marcar la hora de aplicación del torniquete.
La aplicación de torniquetes debe ser realizada de una manera consciente y selectiva, únicamente en pacientes con hemorragias exanguinantes y recibir atención médica lo antes posible.
En el mundo civil, a nivel mundial se aplica el algoritmo THREAT contenido en el Consenso Hartford (ya por su tercera edición)
  • Eliminar la amenaza (Threat supression)
  • Control de la hemorragia (Hemorrhage control)
  • Extracción rápida a un lugar seguro (Rapid Extrication to safety)
  • Evaluación por personal sanitario (Assessment by medical providers)
  • Traslado para el tratamiento definitivo (Transport to definitive care)
  1.  La colocación de un torniquete es igual a la pérdida de la extremidad.
La perdida de una extremidad por el uso de un torniquete es extremadamente rara. En cualquier caso es mucho menor que el riesgo de los efectos de una hemorragia. Es de total aplicación “Vida sobre la extremidad”. Existen multitud de casos documentados donde pacientes con torniquetes comerciales lo han tenido durante 8 horas y más y no han perdido la extremidad. En los casos que se ha producido, ha sido atribuido a una herida de bala, lesión por estallido, metralla, fragmentación, traumatismos de alta velocidad y no como resultado del flujo sanguíneo restringido de la colocación del torniquete.
ACTUALIZACIÓN- Si bien se han constatado algunos casos donde el uso del torniquete ha superado varias horas de aplicación sin lesiones graves e irreversibles para el paciente, se debe aplicar de una manera consciente y únicamente en casos de hemorragias exanguinantes y buscar atención médica especializada en un periodo que no debería superar las dos horas desde su aplicación.
  1. Los cinturones son el mejor torniquete.
Este es un completo disparate. El cinturón es un terrible torniquete; es extremadamente difícil, si no imposible para ocluir completamente el flujo de sangre arterial utilizando un cinturón. La utilización de un cinturón de hebilla nunca estará suficientemente apretado y tratar de apretar el cinturón retorciéndolo es un problema  debido a su rigidez. El palo para poder apretarlo debería ser algo tan grande como la pata de una silla. Si es mejor que nada, pero lo importante es concienciarse que es mucho mejor un torniquete comercial.
  1. Los torniquetes improvisados constituyen equipación médica adecuada.
Usar medios de fortuna en caso de urgencia no sólo es aceptable es encomiable. Existen multitud de historias de personas que han actuado como primer interviniente proporcionando unos primeros auxilios fundamentales. Brian Ludmer, un maestro de escuela que fue disparado en la pierna durante el tiroteo de Los Angeles, se arrastró hasta una tienda y consiguió encerrarse en el almacén. Encontró una sudadera y se la ató alrededor de la pierna para frenar la hemorragia. Frenar la hemorragia es exactamente lo que pueden hacer los medios de fortuna,  no detener. Instituciones sanitarias, bomberos, policías, protección civil y cualquier otra institución al cuidado de los ciudadanos se comportarían de manera negligente si no están equipados con torniquetes de fabricación comercial, que SI detienen las hemorragias.
Tras el atentado del maratón de Bostón, donde muchas vidas se salvaron gracias a la improvisación, la policía ha sido dotada de torniquetes. Cuando alguien esta sangrando significativamente, no es el momento para el arte y la artesanía.
  1. Este es el mejor torniquete.
Los torniquetes comerciales al igual que cualquier otro elemento de la equipación tienen ventajas y desventajas, fortalezas y debilidades. Todos ellos tienen matices sutiles y reglas generales con respecto a su uso. Si buscamos el más recomendable la pregunta sería “¿El más recomendable para quién, cuándo y dónde?”
El torniquete que funciona bien para un infante de marina en su chaleco balístico, puede no ser la mejor opción para alguien que hace trabajo de paisano. ACTUALIZACIÓNEl torniquete prehospitalario empleado en adultos es igual para cualquier escenario o situación.
El torniquete que se lleva en operaciones policiales de equipos especiales, sería una mala elección en un tiroteo en la escuela con pacientes pediátricos esperadosExisten torniquetes específicos pediátricos pero son de aplicación hospitalaria mayoritariamente. El uso de torniquetes estandar en caso de emergencia, en niños, esta plenamente extendido. El torniquete que se utiliza en un área controlada de urgencias sería difícil de utilizar en un ambiente estresante con poca luz.
Aplicación de torniquete CAT en niños
Los torniquetes vienen en todas las formas, tamaños, colores, y realizan el trabajo de múltiples formas. Al igual que con cualquier otro trabajo, una tarea o misión la respuesta sensata es elegir la herramienta más adecuada para el.
ACTUALIZACIÓN Podríamos concluir que el uso del torniquete en los primeros intervinientes en escenarios urbanos es altamente recomendable y no requiere de una gran formación o conocimientos sanitarios. En un caso de tirador activo, o atentado indiscriminado, el primer interviniente puede ser decisivo con la simple aplicación de torniquetes a los civiles que hayan sido gravemente heridos en sus extremidades.
Recomendamos encarecidamente a todo aquel que realice algún servicio público de seguridad a tomar parte de algún curso  LEFRTCC de los que se vienen realizando periódicamente en nuestro país.
Este artículo fue publicado en la revista Tactical Online en su número de Mayo de 2016
Hartford Consensus III

PHTLS B-Con Bleeding Control  for the Injured Course / Control de Sangrados para el Herido By NAEMT

Mejorando la supervivencia en Incidentes con Tiradores Activos (B-Con Course) Curso Control de Sangrados en el Herido

(Active Shooter Events): El Consenso Hartford

Comité Conjunto para Crear una Política Nacional para Mejorar la Supervivencia en

Incidentes De Múltiples Víctimas en Tiroteos
Hartford, CT 2 de Abril de 2013
Dr. Lenworth Jacobs, Hartford Hospital, Board of Regents, American College of Surgeons
Dr. Norman McSwain, Medical Director, Prehospital Trauma Life Support
Dr. Michael Rotondo, Chair, American College of Surgeons Committee on Trauma
Dr. David Wade, Chief Medical Officer, FBI
Dr. William Fabbri, Medical Director, Emergency Medical Support Program, FBI
Dr. Alexander Eastman, Major Cities Chiefs Association (Lt. Dallas Police Department)
Dr. Frank Butler, Chairman, Committee on Tactical Combat Casualty Care
John Sinclair, International Director and Immediate Past Chair International Association of Fire Chiefs- EMS Section (Fire Chief, Kittitas Valley Fire and Rescue)
Los recientes sucesos de múltiples víctimas en tiroteos ocurridos en América han tenido un
profundo efecto en todos los sectores de la sociedad. Las comunidades médicas, de las
Fuerzas de Seguridad, de rescate/bomberos y de los SEM han sentido la necesidad de dar
respuestas. Es importante que estos esfuerzos se realicen de manera coordinada para crear
políticas que puedan mejorar la supervivencia de las víctimas producidas en estos
incidentes. Tales políticas deben proporcionar una aproximación sincronizada entre las
múltiples agencias que se encuentre inmediatamente disponible para las comunidades
afectadas por dichas tragedias.
El Colegio Americano de Cirujanos y el Federal Bureau of Investigation (FBI) han
colaborado conjuntamente para proporcionar altos representantes de todas las disciplinas
anteriormente mencionadas, para elaborar un documento que estimule el debate y en última
instancia conduzca a estrategias para mejorar la supervivencia de las víctimas. La
conferencia de un día de duración, el 2 de Abril de 2013 en Hartford, Connecticut, recibió
contribuciones de expertos médicos, de las Fuerzas de Seguridad, de
bomberos/rescatadores, de primeros intervinientes del SEM y de militares. La conferencia
consistió en actualizaciones de datos y evidencias extraídos de experiencias civiles y
militares recientes y, fue sensible al papel desempeñado por múltiples agencias que
participaron en incidentes de múltiples víctimas por tiroteo. La reunión, conocida como
Conferencia del Consenso Hartford (Hartford Consensus Conference), generó un
documento conceptual titulado “Mejora de la Supervivencia en Incidentes de Tiradores
Activos” (“Improving Survival from Active Shooter Events.”) El propósito de este
documento es promover las políticas locales, estatales y nacionales para mejorar la
supervivencia en estas situaciones poco comunes, pero terroríficas. Este ensayo corto
describe métodos para minimizar la pérdida de vidas humanas en estos terribles incidentes.
Planteamiento del Problema
Los incidentes de tiradores activos/múltiples víctimas son una realidad en la vida actual
americana. A medida que nuestra experiencia en este tipo de eventos se va acumulando, va
quedando claro que las respuestas tradicionales por parte de las Fuerzas de Seguridad,
bomberos/rescatadores y SEM no están adecuadamente alineadas para maximizar la
supervivencia de las víctimas.
Control Precoz de la Hemorragia para Mejorar la Supervivencia
Históricamente, la respuesta a los tiroteos ha consistido en una operación segmentada y
secuencial de seguridad pública, con la priorización de la seguridad como uno de los
objetivos de las Fuerzas de Seguridad (detener el tiroteo), seguido por el resto de medidas
de respuesta y recuperación. A medida que evolucionamos, las acciones iniciales para el
control de la hemorragia deben formar parte de la respuesta de las Fuerzas de Seguridad y,
los conocimientos para el control de la hemorragia, tienen que ser una parte central de sus
habilidades. Maximizar la supervivencia implica un sistema actualizado e integrado que
pueda alcanzar múltiples objetivos de forma simultánea.
Las lesiones de riesgo vital en incidentes con tiradores activos, como los producidos en Fort
Hood, Tucson y en Aurora, son similares a las que nos podemos encontrar en combate. La
experiencia militar nos ha enseñado que la causa principal de muerte evitable en una
víctima con trauma penetrante es la hemorragia. Los programas Tactical Combat Casualty
Care (TCCC), cuando son implementados con un apoyo sólido de los jefes, han producido
una reducción drástica de las muertes evitables. Reconociendo que los incidentes con
tiradores activos pueden ocurrir en cualquier comunidad, el Consenso Hartford anima al uso
de las técnicas y equipos existentes, validados por más de una década de evidencia clínica
bien documentada.
El Consenso Hartford recomienda que una respuesta integrada para tirador activo debe
incluir las acciones críticas contenidas en el acrónimo THREAT:
1. Eliminar la amenaza (Threat suppression)
2. Control del la Hemorragia (Hemorrhage control)
3. Extracción Rápida a zona segura (Rapid Extrication to safety)
4. Evaluación por personal sanitario (Assessment by medical providers)
5. Traslado para el tratamiento definitivo (Transport to definitive care)
Mientras que algunos pueden considerar añadir habilidades para el control de la hemorragia
como otro requisito en la formación en tiempos de recursos económicos limitados, los
conceptos son simples, probados y relativamente económicos; ya han sido adoptadas como
la mejor práctica por muchas agencias de las fuerzas de seguridad. La mejor forma de
controlar la hemorragia exanguinante por lesiones en extremidades se consigue mediante el
uso de torniquetes, mientras que la mejor forma de controlar la hemorragia interna
producida por heridas penetrantes en el tórax y el tronco se consigue mediante el traslado
rápido al hospital. Una respuesta óptima a un suceso con tirador activo incluye la
identificación y la enseñanza de conjuntos de habilidades apropiados a cada nivel de
respuesta, sin tener en cuenta la afiliación de las Fuerzas de Seguridad o de los
bomberos/rescatadores/SEM. El algoritmo THREAT incorpora los conceptos probados de
autoayuda y de ayuda por el compañero (self-care and buddy-care).

Respuesta Integrada

La asistencia a las víctimas es una responsabilidad compartida por las Fuerzas de
Seguridad, bomberos/rescatadores, y SEM. Los resultados óptimos dependen de la
comunicación entre el personal de seguridad pública. La respuesta a un incidente con
tirador activo es un proceso que requiere la coordinación entre las Fuerzas de Seguridad y el
personal sanitario/de evacuación. Dicha coordinación incluye:
 Definiciones compartidas de términos empleados en incidentes con heridos en tiroteos.
 Desarrollo conjunto de protocolos locales para la respuesta a incidentes con tiradores activos.
 Prioridad de la inclusión de incidentes con tiradores activos en el entrenamiento y simulacros para mejorar la familiarización con los protocolos conjuntos desarrollados.


El Consenso Hartford busca mejorar la supervivencia en los incidentes con tiradores activos. El uso del algoritmo THREAT y una mejor respuesta integrada por parte de las Fuerzas de Seguridad, bombeos/rescatadores y SEM, ofrecen a las comunidades un mecanismo para minimizar la pérdida de vidas humanas en estos incidentes.

La Asociación Nacional de Técnicos de Emergencias Médicas (NAEMT) anunció la publicación de un curso para enseñar al personal civil las mismas técnicas de control de sangrados aprendidas en Iraq y Afganistán que han demostrado aumentar la supervivencia a lesiones mortalmente peligrosas. El curso “Bleeding Control for the Injured”, o mejor conocido como B-Con, está basado en la evidencia más actualizada de cómo atender una persona severamente herida.

El curso Bleeding Control for the Injured (B-Con) enseña a los participantes intervenciones que salvan vidas, incluyendo el control de sangrados con un torniquete, cómo empacar una herida con gazas o agentes hemostáticos, y a abrir una vía aérea para permitir que la víctima respire.
Contacto en Republica Dominicana: Alexander Pacheco  +1809 849 9295 
The following are links to news items relating to bleeding control and the use of tourniquets:
PHTLS Medical Director Attends Hartford Consensus III
Dr. Norman McSwain (front left), medical director of the Prehospital Trauma Life Support (PHTLS) Committee and professor of Surgery at Tulane University, attended the third meeting of the Hartford Consensus group last month in Hartford, Conn. Participants from public safety and the medical community developed strategies to increase survivability in mass casualty shootings. This third meeting builds on documents known as the Hartford Consensus I and II, which outline the needed response to active shooters as THREAT (Threat suppression; Hemorrhage control; Rapid Extrication to safety; Assessment by medical providers; and Transport to definitive care). Learn more about the Hartford Consensus

Curso PHTLS Bcon Bleeding Control for the Injured Course / Control de Sangrados para el Herido By NAEMT

Download the The Hartford Consensus III,  July 2015 in PDF

Animation of gunshot wound
PHTLS B-Con Bleeding Control for the Injured Course

Tiny sponges close up gunshot wound in 15 seconds
PHTLS B-Con Bleeding Control for the Injured Course

5 MITOS SOBRE EL USO DE TORNIQUETES  English/Español  Control for the Injured Course "Stop The Bleed" / Control de Sangrados para el Herido

5 MITOS SOBRE EL USO DE TORNIQUETES  English/Español  Control for the Injured Course "Stop The Bleed" / Control de Sangrados para el Herido

By Dr. Ramon REYES, MD 

PARÍS, 23 Agosto 2015 (Reuters/EP)
Gracias al entrenamiento B-Con Control de Sangrados para el Herido By NAEMT 
"El militar herido en el tren francés taponó la herida de otro pasajero con sus dedos "
ampliar información:

PHTLS en Republica Dominicana

By Comité de Trauma Colegio Dominicano de Cirujanos

Otros documentos o post que le pueden interesar:



+1 849 865 4142 Rep. Dominicana
+34 640 220 306 (Numero Internacional en España)
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¿Por qué el Desfibrilador TELEFUNKEN?
El DESFIBRILADOR de Telefunken es un DESFIBRILADOR AUTOMÁTICO sumamente avanzado y muy fácil de manejar.
Fruto de más de 10 años de desarrollo, y avalado por TELEFUNKEN, fabricante con más de 80 años de historia en la fabricación de dispositivos electrónicos.
El desfibrilador TELEFUNKEN cuenta con las más exigentes certificaciones.
Realiza automáticamente autodiagnósticos diarios y mensuales.
Incluye bolsa y accesorios.
  1. Dispone de electrodos de "ADULTO" y "PEDIÁTRICOS".
  2. Tiene 6 años de garantía.
  3. Componentes kit de emergencias
  4. Máscarilla de respiración con conexión de oxígeno.
  5. Tijeras para cortar la ropa
  6. Rasuradora.
  7. Guantes desechables.

¿ Qué es una Parada Cardíaca?
Cada año solo en paises como España mueren más de 25.000 personas por muerte súbita.
La mayoría en entornos extrahospitalarios, y casi el 80-90 % ocasionadas por un trastorno eléctrico del corazón llamado"FIBRILACIÓN VENTRICULAR"
El único tratamiento efectivo en estos casos es la "Desfibrilación precoz".
"Por cada minuto de retraso en realizar la desfibrilación, las posibilidades de supervivencia disminuyen en más de un 10%".
¿ Qué es un desfibrilador ?
El desfibrilador semiautomático (DESA) es un pequeño aparato que se conecta a la víctima que supuestamente ha sufrido una parada cardíaca por medio de parches (electrodos adhesivos).
¿ Cómo funciona ?

El DESA "Desfibrilador" analiza automáticamente el ritmo del corazón. Si identifica un ritmo de parada cardíaca tratable mediante la desfibrilación ( fibrilación ventricular), recomendará una descarga y deberá realizarse la misma pulsando un botón.
El desfibrilador va guiando al reanimador durante todo el proceso, por medio de mensajes de voz, realizando las órdenes paso a paso.

Únicamente si detecta este ritmo de parada desfibrilable (FV) y (Taquicardia Ventricular sin Pulso) permite la aplicación de la descarga. (Si por ejemplo nos encontrásemos ante una víctima inconsciente que únicamente ha sufrido un desmayo, el desfibrilador no permitiría nunca aplicar una descarga).

¿Quién puede usar un desfibrilador TELEFUNKEN?
No es necesario que el reanimador sea médico, Enfermero o Tecnico en Emergencias Sanitarias para poder utilizar el desfibrilador.
Cualquier persona (no médico) que haya superado un curso de formación específico impartido por un centro homologado y acreditado estará capacitado y legalmente autorizado para utilizar el DESFIBRILADOR (En nuestro caso la certificacion es de validez mundial por seguir los protolos internacionales del ILCOR International Liaison Committee on Resuscitation. y Una institucion de prestigio internacional que avale que se han seguido los procedimientos tanto de formacion, ademas de los lineamientos del fabricante como es el caso de
TELEFUNKEN en Rep. Dominicana es parte de Emergency Educational Institute International de Florida. Estados Unidos, siendo Centro de Entrenamiento Autorizado por la American Heart Association y American Safety and Health Institute (Por lo que podemos certificar ILCOR) Acreditacion con validez en todo el mundo y al mismo tiempo certificar el lugar en donde son colocados nuestros Desfibriladores como Centros Cardioprotegidos que cumplen con todos los estanderes tanto Europeos CE como de Estados Unidos y Canada
Dimensiones: 220 x 275 x 85mm
Peso: 2,6 Kg.
Clase de equipo: IIb
Temperatura: 0° C – + 50° C (sin electrodos)
Presión: 800 – 1060 hPa
Humedad: 0% – 95%
Máximo Grado de protección contra la humedad: IP 55
Máximo grado de protección contra golpes:IEC 601-1:1988+A1:1991+A2:1995
Tiempo en espera de las baterías: 3 años (Deben de ser cambiadas para garantizar un servicio optimo del aparato a los 3 años de uso)
Tiempo en espera de los electrodos: 3 años (Recomendamos sustitucion para mantener estandares internacionales de calidad)
Número de choques: >200
Capacidad de monitorización: > 20 horas (Significa que con una sola bateria tienes 20 horas de monitorizacion continua del paciente en caso de desastre, es optimo por el tiempo que podemos permanecer en monitorizacion del paciente posterior a la reanimacion)
Tiempo análisis ECG: < 10 segundos (En menos de 10 seg. TELEFUNKEN AED, ha hecho el diagnostico y estara listo para suministrar tratamiento de forma automatica)
Ciclo análisis + preparación del shock: < 15 segundos
Botón información: Informa sobre el tiempo de uso y el número de descargas administradas durante el evento con sólo pulsar un botón
Claras señales acústicas y visuales: guía por voz y mediante señales luminosas al reanimador durante todo el proceso de reanimación.
Metrónomo: que indica la frecuencia correcta para las compresiones torácicas. con las Guias 2015-2020, esto garantiza que al seguir el ritmo pautado de compresiones que nos indica el aparato de forma acustica y visual, podremos dar RCP de ALTA calidad con un aparato extremadamente moderno, pero economico.
Normas aplicadas: EN 60601-1:2006, EN 60601-1-4:1996, EN 60601-1:2007, EN 60601-2-4:2003
Sensibilidad y precisión:
Sensibilidad > 90%, tip. 98%,
Especificidad > 95%, tip. 96%,
Asistolia umbral < ±80μV

Protocolo de reanimación: ILCOR 2015-2020
Análisis ECG: Ritmos cardiacos tratables (VF, VT rápida), Ritmos cardiacos no tratables (asistolia, NSR, etc.)
Control de impedancia: Medición9 de la impedancia continua, detección de movimiento, detección de respiración
Control de los electrodos : Calidad del contacto
Identificación de ritmo normal de marcapasos
Lenguas: Holandés, inglés, alemán, francésespañol, sueco, danés, noruega, italiano, ruso, chino
Comunicación-interfaz: USB 2.0 (El mas simple y economico del mercado)
Usuarios-interfaz: Operación de tres botones (botón de encendido/apagado , botón de choque/información.
Indicación LED: para el estado del proceso de reanimación. (Para ambientes ruidosos y en caso de personas con limitaciones acusticas)
Impulso-desfibrilación: Bifásico (Bajo Nivel de Energia, pero mayor calidad que causa menos daño al musculo cardiaco), tensión controlada
Energía de choque máxima: Energía Alta 300J (impedancia de paciente 75Ω), Energía Baja 200J
(impedancia de paciente 100Ω)

Lo prometido es deudad Enlace para solicitar acceso como instructor Bleeding Control Course Basic..