Seek! And Ye Shall Find! (Hopefully)
Finding Bleeding Control Supplies in Public Spaces
Back when I was a youngster, participation in Scouting almost invariably led to some pretty good training in first aid. We learned all kinds of fun stuff, like how to fashion a litter out of a couple of tree branches, a poncho and some rope, how to splint broken extremities, and some rudimentary treatments for all kinds of creatures that would bite, sting or otherwise envenomate you. There was also all kinds of teaching around how to keep someone from bleeding to death. One of the things I remember being taught during one of these sessions was that, if you were in a bind and needed to make a tourniquet, you could use 4 tongue depressors taped together and a cravat to fashion one of these life-saving devices, lickety-split!
Eventually it dawned on me that not everyone has ready access to 4 tongue depressors, and no one knows what the hell a cravat is. Good theory, I suppose. Thank God a bunch of people figured out how to make relatively inexpensive and highly-effective commercial tourniquets.
With the advent of bleeding control classes such as Stop The Bleed, access to these commercial tourniquets has become an important question. When I teach Stop The Bleed, I make it a point to spend a few minutes talking about 2 specific points. First, I encourage all the class participants to purchase and carry a commercial tourniquet (but not the $6.99 tourniquet from Amazon, please, unless you want to run the risk of your lifesaving device failing like these did). Why do I emphasize this so much? Its simple- of the three techniques that are taught in a Stop The Bleed class, in nearly every situation or location you may find yourself, you can also find improvised material to perform direct pressure or to pack a wound. Improvising a tourniquet is much harder. My opinion on this is that, unless you are practicing tourniquet improvisation ALL THE TIME, you are not going to be able to do it quickly enough, and the tourniquet you improvise will have either a high probability of outright failure or you won’t be able to get it tight enough.
Second, I spend some time talking about where in public spaces someone who needed quick access to bleeding control supplies might be able to find them. Even if you do purchase and carry a tourniquet, you might find yourself with need for more than one or you may be in a place where you can’t get to your tourniquet. In the area where I teach I have spent a lot of time figuring out where such supplies can be found. What public buildings, businesses and organizations have invested in these lifesaving kits, and, more importantly, where can they be found? Depending on the type of organization or building, sometimes the answers are, “we keep ours in a first aid kit in the kitchen”, or “ours is located the the front desk staff at the main entry”. More often than not, however, the place where you can most often find a bleeding control kit, if there is one to be found, is in the publicly accessible automated external defibrillator (AED) cabinet.
Recently, I took a trip across the country to visit a friend and, as I teased in the last edition of What’s up in EMS, I decided to see if that was good information to give out in other areas as well. So, as I headed for fabulous Las Vegas, Nevada, I starting looking for bleeding control kits along the way.
This, by the way, was totally a convenience sample. There was no scientific method to my madness, I just started looking around for AED cabinets to see if they had bleeding control kits as well. In retrospect, I think this was a good way to go about this, as most of the time, if somebody is looking for an AED cabinet to secure, well, either an AED or potentially a bleeding control kit, they are going to be in a hurry, they are only going to have a very rough idea of where it might be, and they are going to need it to be fairly obvious and well marked. Here is what I found in various locations:
Greater Rochester International Airport
My journey started at the airport in my home city in Upstate New York. The people who live in Rochester and the greater Monroe County area should count themselves lucky, as recently there has been a lot of focus on placing more bleeding control kits (along with AEDs and narcan kits) in areas where they can be accessed by the public. Our beloved (not-so) local grocery chain, Wegmans, has placed bleeding control kits in the publicly accessible AED cabinets in all of its locations. My employer, the University of Rochester, has had bleeding control kits in every AED cabinet on campus for several years now, and has added supplemental bleeding control cabinets in areas such as the lobby and the cafeteria, places where larger numbers of people can routinely be found. Last year, Monroe County began placing “lifesaving kits” in all county public buildings and recreation facilities, including the airport.
I did not look for AEDs until I got to the secure side of the airport, and walking around the two terminals there was good news. Each terminal had an AED cabinet that also contained bleeding control and narcan kits. There was also some bad news. The AED cabinets were in fairly obscure locations, well out of normal lines of sight and not marked well at all. I think in a true emergency they would have been pretty hard to find, although I suppose being on the secure side of the airport there would be a pretty quick response by law enforcement to any emergency, so there is that to consider as well.
Chicago Midway International Airport
I had plenty of time to wander around all three concourses at Midway during my four hour layover, so wander around I did. There was also good news here. Each concourse had multiple AED cabinets that also contained bleeding control kits (and probably a narcan kit, but it was hard to confirm that just by looking). The AED cabinets were in easily accessible areas throughout each concourse, and they were better marked than those at GRIA. They weren't stick-out-like-a-sore-thumb obvious, but I think they could have been found with relative ease and fairly quickly. Additionally, I found a small, wall-mounted bleeding control cabinet containing two individual bleeding control kits on the wall outside the Chicago Police Department substation on the C concourse.
Chicagoans are also the beneficiaries of the Safe Chicago Program, which has, in part, seen more than a thousand bleeding control kits placed in city-owned facilities all across Chicago.
And let’s not forgot the super-fun Midway Airport CPR kiosk where you can teach yourself that lifesaving skill while running from one gate to another.
Bozeman Yellowstone International Airport
The news was less good at this charming little airport where my flight from Midway to Vegas was supposed to make a quick stopover that ended up being about an hour delay. I was able to deplane and stretch my legs during the stop, which, of course, meant locating and ogling the AED cabinets (and I hit the bar for a glass of wine). I found two AED cabinets in the small terminal, but neither, as far as I could tell, had a bleeding control kit nor were they very well marked. They did have a curious little pouch stuffed in with the AED that was marked “First Responder Kit”. Never having seen one of those before, and thinking it was possibly large enough to contain a tourniquet, I did a little research. Here is what the First Responder Kit contains:
Lots of good stuff in there to help treat someone suffering cardiac arrest, but if you need a tourniquet you better hope that somebody has four tongue depressors and a cravat.
Fabulous Las Vegas
My destination on this trip was Sin City, sometimes also referred to as Lost Wages. I would be spending two brief days there and I had grand plans to spend some time walking around the strip to see where, if anywhere, I might be able to find bleeding control kits in that area. I figured that given the tragic event that took place in Las Vegas on October 1, 2017, there were be a reasonable likelihood that I could find what I was looking for. However, there was one little problem.
It was hot.
Like over 110 degrees Fahrenheit hot. I’d been to Las Vegas in late July and early August before, but looking back, I never really spent that much time on the Strip in those temps because I was there during COVID. So, while we did head down there in the late afternoon, it quickly became clear to my friend and me that if we spent much time walking around outside we’d not only be looking for bleeding control supplies, but also for an emergency IV rehydration station. There might actually have been fatalities. Did I mention it was really hot?
So, searching for bleeding control kits on the Strip will have to wait until next time around.
The one place we did spend a bit of time wandering around looking for an AED cabinet and bleeding control supplies was a local Walmart. I was hopeful that we would easily find those items there. I’ve seen Walmarts in my area that have really elaborate and well-marked AEDs and bleeding control stations, so I was hopeful.
No dice. (See what I did there?)
We found a Walmart not far from my friend’s pad, and headed in. I opined that the first aid station would be near the front of the store, probably not too far from the bathrooms. We checked there and didn’t find anything. So we proceeded to walk around the entire perimeter of the store, looking for at least an AED, but we came up empty. I thought maybe they had one in a more obscure location but my friend made a good point. We spent about 10 minutes looking for an AED and/or bleeding control kit but couldn’t find it. If it’s not in an obvious location and well marked its very likely that it will take someone far too long to find it to be of any use.
Harry Reid International Airport
After my two days in Vegas it was time to head home, but I still had one more location to check on the way. The Las Vegas airport was pretty busy as I checked in and got through security. Unlike the day I arrived, when I was just focused on getting out of the airport, I had a couple hours to kill before my flight. So I grabbed a quick breakfast, a cup of warm liquid that was advertised as coffee but was something else entirely, and wandered a bit.
I was able to find a few AED cabinets in the A and B terminals (I did not visit any of the other terminals). In addition to the AED itself was the now-familiar First Responder Kit, but no bleeding control supplies that I could see. The AEDs were in obvious locations and fairly well-marked, so there was that. But you’ll need to break out those tongue depressors and rip the necktie off someone if you need a tourniquet (please don’t actually do that).
And that was the end of my quest. I hopped in the plane and headed home. Overall, I was disappointed. I had really hoped to find a higher proportion of locations that had easily accessible, well-marked stations where first aid supplies and equipment, such as AEDs and bleeding control kits could be found. I knew what I was going to find at the Rochester Airport, having worked around here for a few years. I knew what I would find at Midway because I’d looked in their AED cabinets on a prior trip. Honestly, I was surprised at what I found (or rather didn’t find) in the Las Vegas area. I really thought that, given both the recent history of a mass shooting in that city, along with many, many locations that routinely have crowds containing large numbers of people, there would be much better access to bleeding control equipment.
And perhaps there is. That’s something I’d like to explore more the next time I visit.
The simple fact of the matter is this: it only takes about three to five minutes for a person who is bleeding severely to bleed to death. Maybe first responders will get there in time, maybe they won’t, but I do know this: more and more people are taking classes that teach them a few simple techniques to control severe external bleeding. Direct pressure and wound packing can still be highly effective with improvised materials, such as a t-shirt, towel, napkins, or any number of other similar materials that can be found pretty easily. But it’s really, really hard to improvise a tourniquet. Doesn’t it make sense to have those devices accessible to trained individuals in public spaces?
I think it does.