J Trauma Acute Care Surg. 2018 Jul 17. doi: 10.1097/TA.0000000000002027. [Epub ahead of print]

# Desin and implementation of the western Pennsylvania regional Stop the Bleed initiative.

Neal M, Reynolds B, Bertoty D, Murray K, Peitzman A, Forsythe R

BACKGROUND: Hemorrhage is the leading cause of preventable death in trauma, and nearly 40% of prehospital deaths can be attributable to blood loss. The Stop The Bleed program provides a structured curriculum for teaching hemorrhage control and the use of bleeding control kits. In order to overcome implementation barriers and to achieve the goal of making education on bleeding control as common as cardiopulmonary resuscitation, widespread implementation with outreach to the public and law enforcement is necessary.

METHODS: We provide a description and analysis of the implementation of a regional Stop The Bleed program which includes a step-by-step guide to the design of this program provided as a template to guide attempts at largescale Stop The Bleed program development.

RESULTS: Combining the efforts of regional trauma and non-trauma centers as a hub-and-spoke design, a region covering four states, 72 counties, and 30,000 square miles was targeted. 27,291 individuals were trained in a 21 month period including 3,172 trainers, 19,310 lay public, and 4,809 law enforcement officers. A total of 436 bleeding control kits were distributed to 102 public schools, and tourniquets were provided to 4,809 law enforcement officers. Program development and community outreach resulted in official recognition of the program by the Pennsylvania State Senate.

CONCLUSIONS: Utilizing a multi-center outreach program design with emphasis on law enforcement and public education while developing a train-the-trainer program, widespread and rapid dissemination of Stop The Bleed teaching is feasible. The general steps described in this manuscript may serve as a template for new or developing programs in other areas to increase the national exposure to Stop The Bleed.

LEVEL OF EVIDENCE: IV STUDY TYPE: economic/decision.