Stop the bleed

Stop the Bleed uses washable beet juice as "blood" during the simulations of emergency. 

The rubber wound pulsed with a clench and release as warm blood spewed. The challenge: Cram as many square inches of gauze into the two-inch artificial wound before the blood soaks the material like a wave washing onto a shoreline.

Then, it’s all hands on deck — literally. With both hands crossed in CPR position, maximum pressure is applied. The evaluator says to hold it for 3-5 minutes, but if it were real, it could be much longer before help shows up.

Nearby, a white Igloo cooler with stained red edges sits perched on a folding table, ready to dispense more washable beet juice when the station runs out of “blood.”

Stop the Bleed is a program designed in 2015 by the U.S. Department of Homeland Security to train people to slow bleeding before paramedics arrive. While the training is for anyone, JMU nursing professor Julie Strunk has launched Stop the Bleed training for school nurses in Virginia.

Strunk belongs to the School Nurse Institute Partnership, a state board. When a Virginia Department of Health board representative introduced the idea of integrating Stop the Bleed training in schools, Strunk jumped at the opportunity.

“My goal is to get it into all the schools in the state of Virginia and then to press on nationally and make sure that all the schools nationally have some type of training,” Strunk said.

Since Strunk decided to facilitate the training, she’s been conducting research for a manuscript she’s looking to publish. From 2000 to 2017, there were 250 mass shootings. Of those, 52 were in schools. In the past 10 years, there have been 2.4 times more mass shootings compared to the decade before, and for the first three-fourths of 2018 alone, there were 65 shootings on school property.

“We never used to have to worry about things like that,” Strunk said.

Jess Robison, of Chesterfield County Fire and EMS, explained that EMS — emergency medical services’ — response time is usually six to nine minutes, and in this time, people can die.

“The notion of first responders in today’s society has shifted from the paid public safety now to those who are on scene, so, everyday people who are bystanders,” Robison said. “So, we need to be able to educate and empower the community to take meaningful action when there’s an event to get a jumpstart on saving peoples’ lives.”

Strunk originally looked to begin in the Harrisonburg community. However, due to logistical obstacles such as needing insurance, she started in the Richmond area with the help of Kate Challis, trauma program manager at Johnston-Willis Hospital. The hospital funded the project and paid for emergency kits for the 20 participants. Each kit is worth $700 and has six smaller kits inside with supplies such as gauze; QuikClot, a powder to stop bleeding and tourniquets with timers that light up to indicate how long they’ve been on.  

Strunk explained that if there were a school shooting, the first to show up would be the SWAT team, and it’s not going to start by helping the injured.

“Most people have this assumption that they’re going to go around and help those people who are injured, but that’s not their job,” Strunk said. “Their job is to track down the active shooter and to make the scene safe so that EMS people can then come in.”

But police can throw the kits through open doorways as they run by. Strunk said hemorrhage bleeding is the No. 1 cause of death in mass shootings, and this is preventable.

“Our school divisions are pretty rural, and they may or may not have very fast … responding time from EMS,” Tracy White, school health nurse specialist for the Virginia Department of Education, said. “So, it’s really important to have somebody there that really knows how to stop that bleeding.”

Part 1 of a two-part training took place in Powhatan, Virginia, on Oct. 12, 2018 for two hours. The PowerPoint and demonstration taught two methods for stopping the bleed: wound packing and tourniquets. A common mistake in wound care is not applying enough pressure or not tightening the tourniquet enough due to fear of further injuring the person. Part 2 was a “practical” on Jan. 25 with three simulations to allow hands-on practice.

“If I sit in the passenger seat with somebody who knows where they’re going, I’m not going to pay that much attention,” Strunk said. “But when I’m actually in the driver’s seat, I’m going to pay attention to the directions.”

The first simulation was a power tool accident in a shop class. Carl, a patient made of rubber, lay still. A bike pump-type device kept the blood gushing from his groin.

An eighth-grader with acting ambitions called for help.

“Come in, you have to help him!” she shouted as two nurses rushed to assist Carl.

“You did a great job, Hun,” they reassured her as she paced with frantic breathing.

Zoe Cochrane, the young actress dubbed “hysterical girl,” bounced through the hall smiling after the simulation. This gave her service hours like many of the other young “victims” and, more importantly, gave her acting experience. Zoe jumped at the chance when an organizer asked for someone to play the role.

“When she said, ‘I need someone dramatic,’ I was like, ‘I’m here!”’ Zoe said.

The second simulation was a tornado modeled after the one in Chesterfield County. The nurses had to practice triage, or assessing which victims need care first.

“Our primary goal is to save lives,” Strunk said, “but if there’s somebody that’s really far gone, we don’t want to waste our time.”

The last simulation was a school shooting. The room was filled with the young actors’ cries — a continuous one-pitched whine. Sirens from a phone speaker added to the chaos.

Each simulation ended with feedback from the EMS evaluator and reflection time. A common observation was that there may only be one nurse and several more students, at which point they’d have to triage and tell bystanders how to help.

Strunk hopes participants won’t only bring back what they learned but be able to train others as well. Susan Farrell, teacher of health and medical sciences at Powhatan High School, looks to share what she learned by incorporating it into her curriculum.

“I feel confident that we will have good administrative support for bringing this to our staff and students,” Farrell said.

Strunk’s next move is hosting the program again this summer at the Virginia Association of School Nurses State Conference and is hoping to bring the program to JMU next semester. Her goal is to continue getting the word out so that as many nurses as possible are trained and ready.

“As much as we don’t want something like this to happen, it could very well happen,” Strunk said.

Contact Shanna Kelly at breezecopy@gmail.com. For more coverage of JMU and Harrisonburg news, follow the news desk on Twitter @BreezeNewsJMU.

Shanna Kelly is a double major in SMAD (journalism) and Spanish with a double minor in translation and interpretation and honors interdisciplinary studies. In addition to The Breeze, Shanna is also an active member of Kappa Alpha Theta.