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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.

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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