Most people consider lifesaving technologies to be machinery. The new monitors are a prime example. The newest devices are considered lifesaving technologies. The latest gadgets offer the fastest transportation available. However, the most powerful technologies in trauma care may not be advanced devices; instead, they may be the skills of the caregivers. And the best tool of skill is education/training — put into the right hands at the right moment — and it will save lives just as efficiently as any machine.
I based my participation in the Hartford Consensus on this belief. After multiple high-profile mass casualty/active shooter events, it became apparent that our nation’s response models were archaic. Far too many people were dying from uncontrollable bleeding before medical teams could safely arrive on the scene. This was not an issue of lack of knowledge. This was an issue of access. Rather than waiting longer, the answer needed to be action.
THREAT MODEL
The Hartford Consensus developed a framework for aligning medical response with the nature of the threats faced today. The THREAT model offers a common language among law enforcement, EMS personnel, and healthcare providers.
Threat suppression must occur first. The environment must be rendered as safe as feasible so that treatment can proceed. Hemorrhage control occurs immediately after. Unchecked bleeding causes death far quicker than nearly any other traumatic injury. Once hemorrhage has been controlled, rapid extrication removes the patient from danger. Assessment identifies potentially fatal injuries early in the process. Transport delivers the patient to definitive care as quickly as possible.
Various organizations used different training methods and procedures prior to the Hartford Consensus, each with their own rigid protocols regarding “handoffs.” Agencies would wait for optimal conditions before responding. Agencies now act under reasonable circumstances based upon the priorities established by the THREAT model. The focus remains where it should be: on saving lives in the initial minutes.
Democratizing Medical Care
Another significant outcome of the Hartford Consensus was the recognition that professional emergency responders cannot always be present at the exact location and time of every incident. Oftentimes, the first person to be in proximity to a bleeding victim is not a medic but a student, a co-worker, a parent, or a stranger.
As a result of this realization, the Stop the Bleed initiative was launched nationally. The basic premise of Stop the Bleed was simple yet revolutionary. Educate civilians on controlling life-threatening bleeding. Provide bleeding-control kits in public spaces. Encourage citizen action rather than inaction.
Controlling bleeding is not complicated. The process involves applying direct pressure to the wounds. Packing wounds. Using tourniquets. All are skills that can be easily and quickly taught to civilians. When civilian populations are educated and equipped with these skills, the time line of the response to emergencies dramatically changes. Emergency treatment occurs in seconds, not minutes. Therefore, survival rates increase.
This is what democratizing medical care truly means. It does not replace the role of medical professionals. It enhances them. It creates the gap that results in loss of life when no one feels able to take action.
National Resilience
Perhaps the greatest and longest-lasting impact of the Hartford Consensus is the paradigmatic shift in attitude it embodies. We are evolving beyond the notion of the passive bystander. The Hartford Consensus is introducing the concept of the immediate responder.
Immediate responders do not require badges or uniforms. Immediate responders require education and the confidence to apply that education. As communities prepare themselves through collective training and engagement, resilience develops. Paralyzing fear transforms into motivating purpose. Chaos becomes manageable.
I have witnessed this transformation personally. I have observed ordinary individuals responding in extraordinary ways during extraordinary moments due to their education/knowledge of what to do. That was not an accident. It was the result of intentional education/training and community engagement.
Trauma care will evolve past improved hospitals. Trauma care will evolve toward improved communities. Education/training scales. Technology obsolescence. Skills persist. As we invest in people, we create a more responsive and resilient system that can respond sooner, more powerfully, and with fewer preventable deaths.
