FOXBOROUGH — When the bombs exploded at the Boston Marathon four years ago, many rushed to aid the injured — kindness on display amid the horror.
Now, a project at Gillette Stadium aims to boost the life-saving skills of future Good Samaritans.
Researchers from Brigham and Women’s Hospital are testing ways to teach laypeople how to properly apply a tourniquet. Their work contributes to a nationwide campaign, called Stop the Bleed, which seeks to empower untrained bystanders to prevent an injured person from dying of blood loss.
Because the old method — the one seen in movies, where the hero rips off his shirt and ties it around his buddy’s gushing limb — rarely works in real life.
The research at Gillette is funded by a charity founded in its aftermath, the Stepping Strong Center for Trauma Innovation.
“The Boston Marathon bombing in this community brought to the forefront the importance of understanding how to respond in an emergency situation,” said Audrey Epstein Reny, who established Stepping Strong after her daughter, Gillian Reny, was hurt in the attack.
Reny was among 66 people with limb injuries. Of them, 27 had tourniquets applied at the scene, according to a study by Dr. David R. King, a trauma surgeon at Massachusetts General Hospital and a lieutenant colonel in the US Army.
But all 27 tourniquets were improvised — shirts and belts and such. These ad hoc devices may have helped by temporarily stopping the bleeding, but most were too loose to do lasting good. No one, King said, has the strength to knot a T-shirt tight enough to compress the arteries. Instead, people need the mechanical boost provided by commercial tourniquets, which feature a sturdy plastic rod that twists the band tight.
First responders at the Marathon did not have such specialized tourniquets on hand, but now they are standard equipment for rescue workers in Boston and most other major cities, King said.
And King has since conducted tourniquet training — and provided tourniquet kits — for schools, hospitals, ambulance companies, and workplaces, even the Roman Catholic Archdiocese of Boston.
But many people have not received the training or the tourniquets. Dr. Eric Goralnick, medical director of emergency preparedness at the Brigham, is looking for ways to enable laypeople to acquire tourniquet skills on the spot, without ever taking a class. He is testing the effectiveness of a kit with voice instructions and a card with written ones.
The ultimate goal is make commercial tourniquets as ubiquitous as the automated external defibrillators, or AEDs, found at malls, airports, and other places where people gather, along with some sort of instruction that has been shown to work. AEDs provide voice commands that can instruct anyone, including people with no training, in how to re-start a stopped heart.
The stadium and public safety officials in the region welcomed the Brigham’s project, Goralnick said. After the 2015 attacks outside a stadium and in a concert hall in France, the idea of a mass-casualty event at 66,829-seat Gillette seemed not at all far-fetched. And unlike the Marathon finish line, the suburban venue is not minutes away from world’s best hospitals. In a disaster, bystanders would play an especially critical role.
Working with dozens of volunteer physicians, nurses, and paramedics, Goralnick divided the employees into four groups. Two were control groups: one received no training and the other received complete hands-on instruction. The remaining two groups received either the flash card or the talking kit.
Each participant listened to an instructor describe a scenario: A bomb has just gone off at the stadium. A victim with a severed leg lies on the ground, and rescue can’t get there for 15 minutes.
Then they each went to work on a pair of mannequin legs, with one torn off below the knee.
The results have not yet been analyzed, but the responses of those observed at a recent session hint at the challenges of knowing what to do in a stressful situation.
Bronson Green, the New England Patriots’ site operations manager, was one of the employees who received the talking kit, a box containing tourniquets and bandages, with printed instructions and a small button that activated voice instructions. But Green never noticed the box could talk. Instead, he quickly grabbed the tourniquet and strapped it on the mannequin leg.
“I was kind of caught up in the moment, more focused on getting the tourniquet on as fast as possible,” Green said later.
But his haste resulted in an improper job. When he was done, the instructor, Dr. Muhammad Ali Chaudhary, explained that the tourniquet was too loose, and showed Green how to tighten it by twisting the plastic rod.
Rick Mitchell, a security guard at Gillette, was in a group that received the card with written instructions. But he never looked at it. “I just had to figure it out myself,” he said. His tourniquet was also too loose.
Chaudhary, a postdoctoral fellow at the Brigham, said that in general, those who received training ahead of time had no problems properly applying the tourniquet. But many of the others ran into problems.
In the two test groups, he said, most reacted as Green and Mitchell had — too worried about acting quickly to look at the instructions. Most applied the tourniquet incorrectly, usually failing to tighten it enough.
Dave Hammond, president of DLH Inc., the company that made the audio kits, said that most people did not even turn on the sound during the Gillette sessions. He saw only two people who pressed the button, listened to the narration, and followed it. He has redesigned the kit so that the “on” button is more prominent and the written instructions streamlined. For the next version, he’s contemplating having the audio instructions start automatically when the box lid is opened.
After the last few training sessions this month, all 500 Gillette employees will eventually learn how to use a tourniquet, and the facility is now equipped with hundreds of tourniquet kits. Goralnick plans to follow up to see how well people remembered the lessons.
“In general, people felt very empowered and were very positive about the training,” Goralnick said.
Dr. Nomi Levy-Carrick, a Brigham psychiatrist who interviewed some of the participants, said that such training can give people a sense of mastery, enabling them to think of potential terrorist attacks “through a lens of ‘How do we help? What can we do?’ rather than being helpless and defenseless.”
“If people gain confidence in their ability to react and cope in this high-intensity situation, that’s only a good thing,” she said.
Green, the stadium operations manager, felt that way. He said it was “comforting” to learn the skill, which may prove useful for daily workplace injuries, not just for a disaster.
“I would by no means say I’m an expert now, but I feel more comfortable and relaxed in that situation,” he said.Felice J. Freyer can be reached at firstname.lastname@example.org. Follow her on Twitter @felicejfreyer.