In a world experiencing terrorist attacks, increased violence and never-ending vehicle crashes, trauma surgeon Dr. Matthew Neal thinks everyone should be trained to control severe bleeding.

Neal gave a “Stop the Bleed” presentation on Friday during a county-sponsored training session for law enforcement officials, librarians, pastors and citizens.

“The idea is exposure so people leave with the understanding that this needs to be as common as CPR,” Neal said.

He said the Stop the Bleed program has given the presentation in four states and 72 counties in the region.

The program touts the training as well as placing bleeding control kits in every public school and other public places.

Neal said while it takes an ambulance about eight minutes to arrive on the scene of an accident or emergency, arterial bleeding from an arm or leg can cause death in three minutes.

“It's critical for the public to understand what to do in the instance of uncontrolled bleeding,” Neal said.

He said it is particularly imperative for law enforcement to be trained, as they are often the first emergency responders to arrive at a scene.

Neal said in preventing an injured person from bleeding to death from a laceration, gunshot wound, amputation or any injury, police and good Samaritans should remember their ABCs.

Alert, find the bleeding and compress are the three steps to remember in uncontrolled bleeding, he said.

Before the ABCs of controlling bleeding are administered, Neal said, would-be lifesavers must be sure they are in a safe space where they will not be injured.

Then a call to 911 or instructing someone else to call is next, Neal said.

Once that is complete, finding the bleeding is the next critical step. Neal said to do so, rescuers should look for spurting or continuously leaking blood, blood pooling on the ground or soaking clothing, loss or partial loss of a limb or confusion or unconsciousness.

Tearing away clothing to find the bleeding is often necessary, he said.

Once the source of the bleeding is found, compression or a tourniquet should be applied.

Neal said injuries to the major arteries in the arms and legs represent the most preventable deaths because a tourniquet can be used.

He said the tourniquets in the bleeding control kits are looped around the extremity as close to the heart as possible, tightened and clipped and never loosened.

The kits also carry special gauze that contains a blood-clotting agent, which should be stuffed deep into a wound.

The deep gouge in the dummy extremity Neal used on Friday took about five feet of gauze before the clotting agent touched the source of the bleeding.

If neither a kit nor gauze is available, a shirt or rags can be packed into the wound before the two hands are stacked and the rescuer's full weight is placed on the wound without stopping to see if the compression is working.

Neal said the idea is to push the artery or vessel against a bone or even the floor so it will clamp down and occlude.

“You can stop major arterial bleeding with just good, firm pressure,” he said.

In an extremely severe wound or amputation, Neal recommends a tourniquet. He said simply tying something around an extremity will not likely stop the bleeding, so a small rod on the kit tourniquet can be turned to tighten the tourniquet until the bleeding stops.

At that point, the rod should be placed into the clip and the next person to touch the victim should be an emergency medical responder.

He cautioned that a tourniquet is extremely painful for the victim.

“You need to inform that person that the tourniquet is going to hurt a lot,” Neal said. “You have to hurt them to help them.”

Unlike instructions of the past, Neal said the tourniquet is placed near the armpit or upper thigh and not directly above the wound. Neal also said the tourniquet should never be loosened.

Neal recalled a case at the UPMC hospital where he works in which a man who was cutting wood at his remote camp suffered a grievous wound when the chain saw kicked back and cut the main artery in his left arm.

A self-applied tourniquet from the bleeding control kit saved his life.

“Had he not had that tourniquet, he would have sat down and made his peace with his maker there in the woods,” Neal said.

He also advocates a tourniquet be carried on the belt of every police officer so they can save themselves, their partners or a member of the public in a tragedy.

The question-and-answer session following Neal's presentation included the possibility of HIV, hepatitis or other blood-borne pathogens passing from the victim to the rescuer.Neal said while the kits contain gloves, no one should avoid helping a bleeding person because of that concern.“There has never been a documented case of a blood-borne pathogen transferred to a good Samaritan,” Neal said.Those in attendance then broke into three groups to practice with the contents of the bleeding control kits.John Thompson of Center Township attended with his wife, who is on blood thinners.Thompson said he learned that the old advice to remove a tourniquet after 10 minutes is obsolete and that both hands and body weight should be applied to a wound to curb the bleeding.“There was a lot of information that you hope you will never need,” said Thompson. “It was great and I'm glad the county offered (the training).”Joel Benson, the pastor at Trinity Lutheran Church in Center Township, said he read about the free event and decided to attend.“In our society these days, you just never know when you're going to be at the wrong place at the wrong time,” Benson said.He also appreciated the information on tourniquets and how to use them.“It's great that the county is doing this,” Benson said.Holly Perry, who works for the county in the domestic relations department, said she attended because her daughter has a disorder that prevents her blood from clotting properly.“It was very educational,” Perry said. “I hope I don't ever need the knowledge, but he broke it down into steps that you could remember in that tense situation.”She said she was not aware of the correct way to apply a tourniquet or that gauze with clotting agents even existed.“I definitely think I'll be investing in a bleeding control kit,” she said.Sgt. Bill Stuckey of the state police in Erie said the informative seminar also helped satisfy his training requirements.He said 12 troopers from Erie and Pittsburgh attended on Friday.“Dr. Neal was outstanding,” Stuckey said. “He's very knowledgeable and articulate.”While he attended tourniquet training last year, he was surprised by the amount of gauze that Neal stuffed into the dummy wound.He agreed that bleeding control kits should be carried by every police officer.“It's one more tool in our belt to help ourselves, each other and anyone else,” Stuckey said.Shawn Pugh, the county's grant writer and criminal justice planner, organized the seminar.“It was a tremendous success,” Pugh said. “I'm happy we were able to bring this to the county for law enforcement and the general public as well.”To learn more or schedule a Stop the Bleed training, log onto www.stopthebleedtoday.com.