Bleeding Control Programs Howard County, Maryland Brief Overview John S. Butler Fire Chief, Howard County (Md.) Department of Fire & Rescue Services

Howard County, Maryland Located between Baltimore and Washington DC Population 299,400 254 Square Miles Columbia A planned community comprising 10 self-contained villages Population 99,600 32.2 Square Miles

Program Overview County-Wide Hemorrhage Control Initiative Goal: To reduce the impact of hemorrhage in victims of traumatic injury and to improve mass casualty response by increasing knowledge of hemorrhage control techniques and improving access to hemorrhage control supplies. Key Components: Ensuring that public safety personnel have access to the bleeding control equipment. Public Access Bleeding Control kits co-located with select AEDs throughout Howard County. Bleeding control training for members of the public safety community and the general public.

Program Details Went Live Spring 2016 Fire & Rescue: Lead Agency Key partners include: Howard County Police Office of Emergency Management Public School System Howard Community College Other County agencies Recreation and Parks Facilities Fleet services

Public Safety Components County Police All officers receive active shooter training All officers are issued IFAK with TQ, Combat Gauze, Gloves Police supervisors carry mass casualty bleeding control kits. SWAT Officers carry additional gear including chest seals & NPAs Tactical Paramedics (Fire/Rescue) ALS skills NDC/Surgical Airway/ALS meds Fire Rescue Department-wide training in active assailant response Ballistic gear being placed on front line apparatus All personnel trained in “Life Sustaining Interventions” (TCCC/TECC) “LSI” kits placed on apparatus. Mass casualty kits designed around principles of MARCH. Additional mass casualty bleeding control kits on key units. County-wide joint Police/Fire active shooter response plan. Includes “mixed asset” hybrid teams that focus on LSI & Extraction Joint training efforts

Public Access Components Terminal Goal: Bleeding Control Kits (BCKs) co-located with every county AED (~250 total) Each kit contains 3TQs, 3 Rolls Combat Gauze, Gloves, Trauma Sheers, Pressure Dressings, Just in Time instructions. In addition to 18 mass trauma kits in public safety vehicles (greater quantity of supplies). Initial Goal: 100 BCKs placed at “high risk” locations including (grant funded): Schools, Libraries, Recreation centers, Court house Other county buildings Some county agencies purchased additional individual kits out of their operating budget Additional 170+ individual kits purchased so far. Current Stats (1/2017) 277 Kits placed throughout the county

Identifying Kit Locations Schools: Located with the AED in the health suite. All BCK equipped AEDs are labeled. Also geo-tagged. Working with Pulse Point App to indicate BCK equipped AED locations.

Public Access Bleeding Control Training PABC programs will only work if people know how and when to use the equipment. National training models continue to emerge. Howard County uses a 1hr version of the NAEMT B-Con course. “Basics of Bleeding Control” High degree of success with our free 1hr CPR course. Trained over 45,000 people in CPR (since 2012). Partnership with schools trains 8,500 6th and 9th graders/year Since May 2016 trained over 1000 people with a free 1hr bleeding control course. 120+ school nurses and health aides trained Working with the schools to incorporate this into the health curriculum. 277 bleeding control kits were purchased and placed in schools, County buildings, government vehicles, and other public-facing locations in 2016 (100 purchased by DFRS, 177 purchased by other County agencies with direct guidance from DFRS). 18 mass trauma bags were purchased and deployed to EMS and law enforcement vehicles in 2016. 1,063 community members and public employees were trained by HCDFRS in bleeding control since the program's start in May, 2016.

Implementation Lessons Learned Overall concept was widely well received. This stuff is on everyone’s minds. Make this an “all hazards” program. Be prepared to address issues of Good Samaritan laws. Multiple stakeholders beyond the emergency services. Engage the schools early. Very hard to “fast track” agency-wide projects, but it can be done. Have a project plan, share the plan, get buy in. A successful training program needs its own sub-plan. Think about downstream costs / funding. Have a plan for volunteers who want to help. Getting the equipment is the easy part!

End… Questions?