Analysis & Opinions - The Atlantic

The Day 'Stop the Bleed' Entered Civilian Life

| Apr. 16, 2023

The Boston Marathon bombing changed disaster management.

In a crisis, the best measure of how well a community reacts isn't the number of lives lost. It's the number of people who survive. When two homemade bombs went off at the Boston Marathon finish line a decade ago this month, three people died on the scene. But the number of spectators and runners who were treated at local hospitals for injuries, some of them quite severe, was much larger: 278. Improbably, every single one of them survived. The success of any disaster response always hinges on advance preparations—yet those measures can take a wide variety of forms.

The 2013 bombing was a turning point for civilian adoption of a military-inspired technique known as "stop the bleed"—the use of a tourniquet, or a shirt, towel, or some other improvisation, to halt excessive blood flow and buy time until professional medical care is available. More than two dozen of the most seriously injured patients received life-saving field tourniquets on the scene in Boston before being transported to the hospital.

Fortunately for the hundreds of people injured in the explosions, Boston and surrounding municipalities have a high concentration of hospitals that had trained for a mass-casualty event; 26 such institutions received patients after the explosions. Of the victims, 127 were evaluated at Level I trauma centers—the premier emergency-hospital category—on that Monday; 54 of them went into surgery that day. The median time from the explosions to the hospital for an injured patient was 11 minutes.

Although 12 patients underwent leg amputations either above or below the knee, the outcome could have been far worse. Massive bleeding is the most urgent risk to many bomb victims, especially if the devices are placed on the ground and affect victims' legs and larger body areas. "Stop the bleed" was not always the standard response, not even in war. By 2013, medical procedures had fundamentally changed in the battlefield. When the Iraq War started in 2003, many experts feared that using tourniquets too quickly would lead to unnecessary amputations and mixed results. Early in the war, treatment for some injured U.S. soldiers was delayed until they could be moved to medical facilities. But the military came to understand the need to prevent blood loss on the scene of an injury, and the Pentagon began to modify its training not only for medical personnel but for field soldiers. Over time, the Pentagon invested in blood-clotting medicines, foams, sponges, and even clothing....

For more information on this publication: Belfer Communications Office
For Academic Citation: Kayyem, Juliette.“The Day 'Stop the Bleed' Entered Civilian Life.” The Atlantic, April 16, 2023.

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