The top three trauma injuries are extremity hemorrhage, tension pneumothorax and airway obstruction. All of these are treatable with minimal supplies, but are time sensitive injuries. The Committee of Tactical Emergency Casualty Care (C-TECC) guidelines place control of external hemorrhage ahead of airway control (2015). For example, victims in an active shooter incident are more likely to suffer exsanguinating extremity wounds than an airway injury. A person can bleed to death from a large arterial wound in 2-3 minutes while it may take 4-5 minutes to die from a compromised airway- this leads to replacing the traditional ABC mnemonic (for airway, breathing, circulation) with MARCH (Massive hemorrhage control/Airway support/Respiratory threats/Circulation [prevent shock]/Hypothermia). Hemorrhage is the second leading cause of death for patients injured in the prehospital environment. Hemorrhage accounts for 30-40 percent of all mortality. In one study, 57 percent of the patients who died had injuries that might have been amenable to tourniquet application (Navarro, 2016). With EMS response time around eight minutes (varies on situations like active shooter, or road blockages from natural disasters) this leads school nurses and faculty as the very first responders. Time is of the essence when treating trauma injuries, the schools need to have medical supplies available to allow for fast treatment and prevent loss of life.
Many Maryland public schools lack the most basic supplies to help treat trauma injuries, which puts the lives of the students and the faculty members at risk. Trauma kits are a solution. Items in a trauma kit can include but not limited to: tourniquets, chest seals, trauma dressings, pressure bandages, bleeding control dressings, CPR micro shield mask, nitrile gloves and trauma shears. One of the most important supplies included in trauma kits are tourniquets. Tourniquets are effective in decreasing the number of treatable exsanguination deaths due to extremity hemorrhage. In US combat fatalities: from 2001 to 2011 treatable exsanguination deaths dropped from 7.8% to 2.6% (2015). There is a decrease in preventable deaths though widespread training, dissemination and use of tourniquets (Shackleford, et al.). Ideally, it would be most beneficial to have tourniquets in every classroom.
The cost of trauma kits can range from $100 and up. The number of trauma kits in a school would depend on the school size. Ideally, there should be supplies in every room (in case of an active shooter scenario). Teachers and faculty should also be trained on how to use the supplies. “Within 20 minutes of training, nearly anyone can become efficient in tourniquet application”- Deputy Godlove, School Resource Officer, Frederick County Sheriff Department. The supplies do come with instructions printed on them, so a lay person without training can still utilize them.
Ultimately, it is up to the school district on providing trauma kits for the schools. But without them, they are putting many lives at risk. The statement of “Oh that will not happen here” is blatantly wrong. We should be asking ourselves “When something does happen, are we prepared?” Maryland public schools are not prepared, and unfortunately is putting the safety and wellbeing of students at risk. Trauma kits can be utilized for many different types of injuries and can prevent loss of life. Being prepared keeps our students safe, and ensures the best possible outcome if trauma injuries were to occur.
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