India has extremely high traffic-accident casualty rates, according to the World Health Organization, with one crash approximately every 10 seconds and 1,000 fatalities a year in the city of Bangalore alone, according to city records. Forty percent of preventable deaths are due to victims bleeding out without the aid of citizen action before an ambulance arrives.
Those statistics can seem overwhelming, but an innovative pilot program launched by Vinay Nadkarni, a professor of anesthesiology, pediatrics, and critical care at the Hospital of the University of Pennsylvania and Children’s Hospital of Philadelphia (CHOP), and his colleagues based in India is tackling the problem by offering basic training on how to recognize and stop life-threatening bleeding to those first on the scene, including rickshaw drivers, shop owners, bystanders, and others.
“It’s turning ‘bystanders’ into ‘try’-standers,” Nadkarni says.
Since its inception in 2018, the ABC-Active Bleeding Control: Stop the Bleed program has trained more than 1,000 first responders and helped to save at least 164 lives in the city of Hyderabad.
“It might sound like a drop in the bucket, but it’s a demonstration that, by collaborating together to address huge problems, we can make a small difference,” Nadkarni says. “If we study the problem and make people aware of it, we have the ability to slowly change the world, to make it a better place.”
The idea is to train people who are likely first on the scene of a crash in how to recognize life-threatening bleeding, call the EMS service, and apply pressure or use a tourniquet to stop bleeding until emergency responders arrive.
In addition to his research and day job at CHOP’s intensive care unit, Nadkarni is also the founding director of CHOP’s Academy for Resuscitation of Children and the CHOP Center for Simulation, Advanced Education, and Innovation, which is where the idea for the “Stop the Bleed” program was hatched. Visiting fellows from four leading health institutes in India had been training at the Center, and through this scholarly exchange, Nadkarni says he became aware of the huge problem with traffic accidents in India.
“This project brought together the clinical care, the education, the research, and the advocacy aspects of my career to address this problem that they were having in India with life-threatening bleeding, particularly in the streets after a car accident or bike accident,” he says.
The pilot program involves working with the GVK-EMRI, an emergency medical response system, and PediSTARS, a not-for-profit simulation training society, to train their paramedics on how to educate the public on basic ways to stop bleeding. This has resulted in more than 1,000 trained bystanders. Using advanced analytics geo-locating at the most troublesome accident “hot-spots,” those trainers go out to the rickshaw stands and roadside shops lining the road corridors and, using a poster, video, and low-tech simulation methods, show the workers the basics of applying pressure or using a tourniquet. They help the soon-to-be-first responders practice these new skills with a simulated leg and a simulated arm and leave the newly trained civilians with a kit that had a tourniquet and bandages. They use the social media platform WhatsApp to keep in touch with the citizens and encourage them to act in an emergency.
“What we know from research in the area is, if those procedures are not done, and it’s a serious injury, about 40% of lives and limbs that could have been saved are not being saved,” Nadkarni says.
They are now in the process of tweaking the training program to engage schoolchildren and teach high school students how to multiply the effect by training their parents and family members, says Nadkarni. So far, 420 students from seven schools and more than 2,000 families in have been trained through a high school program.
After that, he says, they plan to work with companies based in India that must reinvest 2% of their profits in the country as part of their corporate and social responsibility plans.
“We are trying to make those groups aware so that they can invest in their communities to support the training and expand the program,” he says.
The program is supported by Penn Global’s India Research and Engagement Fund, which focuses on research that advances the interdisciplinary study, teaching, and engagement of India and positions Penn as a key source of knowledge and ideas on India-related issues, topics, and challenges.
With additional support from CHOP and another grant, managed by the University of Pennsylvania Institute for the Advanced Study of India in New Delhi (UPIASI), the program has expanded from Hyderabad to Bangalore, with plans for more cities in the future.
Eventually, they hope to incorporate the use of drones in delivering “Stop the Bleed” kits and telephone-operator coaching at accident scenes, Nadkarni says.
Geetha Ramachandra is a pediatric intensivist in Hyderabad and co-founder of PediSTARS, which focuses on simulation-based interventions in pediatric health care. She has worked with Nadkarni in Hyderabad and Bangalore to make the “Stop the Bleed” program a success.
“It’s the finest example that we have created for the common [person] to realize the potential to save lives,” she says. “The project is very close to my heart because every three to four minutes we lose a precious life to road injuries. We are so thankful to the University of Pennsylvania, Children’s Hospital of Philadelphia, UPIASI, and our national collaborators for creating this movement in India.”
Ramana Rao is the director of GVK-EMRI, the largest professional emergency service provider in India, and has partnered with Nadkarni in launching the program in Hyderabad.
“Active bleeding control, or ABC, using this simulation education and equipping people like bus drivers, police, and roadside shopkeepers with ABC kits is a real solution for the developing world to address the public health problem of road crashes,” Rao says. “For our group, ABC also means ‘Always Be the Change’ and ‘Always Believe in Collaboration.’”
