Quicker access to bleeding control interventions, such as those taught in the American College of Surgeons (ACS) Stop the Bleed program, could have prevented deaths among Maryland homicide victims, according to a new analysis published in the Journal of the American College of Surgeons (JACS).
The study examined data from over 5,000 homicide victims in Maryland and found that almost half who died from gunshot or stabbing wounds suffered severe bleeding injuries to their arms or legs.
"We know that the skills taught in Stop the Bleed can save lives, but we have very little population-level data telling us how often injuries that are treatable with techniques learned in Stop the Bleed occur," said Joseph V. Sakran, MD, MPH, MPA, FACS, senior author of the study and executive vice chair of surgery at Johns Hopkins Medicine in Baltimore. "Maryland has a high burden of violent injury and a robust medical examiner system, providing us with a unique opportunity to study how many homicide victims sustained injuries that might have been survivable with rapid bleeding control."
The ACS Stop the Bleed program trains bystanders to use three methods for controlling severe bleeding: applying pressure, packing wounds, and using tourniquets. Since its launch, more than five million people have received training.
Researchers reviewed 5,765 autopsy reports from Maryland homicide victims killed by gunshot or stabbing between 2005 and 2017. They categorized cases based on whether they involved isolated extremity injuries—wounds only to arms or legs—or included other body parts such as head or chest. The team also looked for evidence of significant blood vessel damage.
Potentially preventable deaths were identified among those with isolated extremity injuries—the clearest cases where bystander intervention could be effective.
"This research tells us that while isolated extremity wounds are relatively uncommon, they are high-yield opportunities for bystander hemorrhage control - and that's the exact type of injuries that the ACS Stop the Bleed training targets," Dr. Sakran said. "While 1% may sound small, in public health, every preventable death matters. Every one of these individuals was a brother, sister, family member, or friend, and we need to think about them in those terms, not just statistics."
Dr. Sakran noted that because non-isolated injuries were not evaluated for potential survivability through bleeding control measures in this study, more lives could possibly be saved than estimated here. He added that while these findings are specific to Maryland—a state with many Level 1 and 2 trauma centers—they point out an important gap between when severe bleeding occurs and when first responders arrive. The Stop the Bleed program aims to close this gap across all communities. Future studies will examine how effective Stop the Bleed is for more complex injury patterns.
"You don't have to be a doctor to save a life; you just need to know what to do in the first few minutes of a bleeding injury before first responders arrive," he said. "And those first few minutes often belong to the community, not the hospital."
Coauthors on this study include Samuel Okum; Ambar Mehta; Nicole Lunardi; James P. Byrne; Elliott R. Haut; and David Efron.
