Speaker 1: Good evening and happy Saturday. I’m Danielle Lee and welcome to The Conversation with Dr. Ali Kasraeian. As always, you too can join the conversation. Give us a call 340-1045. How are you doing today Dr. Ali?
Ali Kasraeian: I am doing well. How are you?
Speaker 1: I am doing well as well. I was looking at our rundown on Twitter and it looks like we have quite a show today.
Ali Kasraeian: Today is a very exciting show. I guess the common denominator in this would be public health, and an underlying theme below that would be how physicians and in this particular case surgeons are trying to take the lead in the forefront of both the medical aspect of things but also the political aspects of the discussion surrounding two things.
One is mass casualties. Lot of incidents that we see and unfortunately we have this conversation far to often for my taste and my liking here on the show. Not because it’s not a wonderfully important topic and the things that we have learned over, in the past two to three years have improved the management of mass casualties in such a profound way. And the work of the American College of Surgeons has been really on the forefront of doing that.
But it’s sad that so many things happen so frequently to such a scale that large groups of people and scientists have to get together to come up with better ways of dealing with it. But fortunately they do, and so that’s one topic.
And the other one we’re going to talk about is the opiod epidemic and the controversy surrounding that. To lead these discussions with me is Dr. Brian Yorkgitis who is a trauma surgeon. He’s a fellowship trained surgeon at Harvard Brigham Women’s Hospital surgical critical care. And we are very fortunate to have him in Jacksonville and the assistant professor of surgery at U.F. Health in the Division of Acute Care Surgery, which essentially he’s a trauma surgeon so he’s going to us about both of these things. So Brian, welcome to the show.
Brian Yorkgitis: Thank you. Thank you, Ali.
Ali Kasraeian: Let me ask you. I always ask people who come on here, physicians who it’s their first time being on this show, how did you decide to go into medicine and what made you decide to become a surgeon and then trauma surgery?
Brian Yorkgitis: Sure. I wanted to be a doctor since I was a child. I had some illnesses myself and was frequently in the hospital and that sparked my interest. My primary care doctor, my pediatrician actually pushed me to school. And I started actually as a physician assistant and then went back to medical school when I was a physician assistant for several years and became a physician. I wanted to be a surgeon. One of the greatest things abut a surgeon is, is the immediate response that you can have to fix something.
Ali Kasraeian: I agree.
Brian Yorkgitis: So we’re going to talk today about bleeding control, and as a trauma surgeon that is my job, is to stop bleeding and act quick, act fast. And then the gratitude the patients … I was always happy to thank my physicians as a kid and the gratitude I get as a physician, just to help someone is amazing.
Ali Kasraeian: And as a trauma surgeon, you are there at the time where people are, the worst situation that they could not have expected. You know, it’s usually a surprise and in terms of immediate return on what you do, both in a positive and negative is right there. So trauma surgeons do a lot of wonderful things to save us. And having a level one trauma center in our city, makes us a safer city.
Brian Yorkgitis: Yes. We know that level one trauma centers improve outcomes and that’s been researched through any type of injury, whether it be motor vehicle crash and bad head injury, shooting victim, bowel injury, we know that, that’s the case because we train to take care of the most life-threatening injuries. And that’s our job. And we have a team with us, nurses, therapists, technicians, ready to go at any moment for any disaster that may happen for you, or for your loved one and for the city of Jacksonville.
Ali Kasraeian: And I’ll tell you, a lot of what we’re going to talk today, talk about today comes off the cusp of the Hartford Convention. And we’ve mentioned this a lot of times on the show with other trauma surgeons. It’s basically in response to heartbreaking mass casualty. The decision was made to get leaders and surgeon leaders in to find out how you can save more lives.
And one thing that came of that is getting people actually to the hospital alive and the Stop the Bleed program came from that which is the idea of a lot of those children at Sandy Hook could have been saved if they did not bleed out of potentially life saveable situations. And that lesson learned has moved the Save the Bleed program, Stop the Bleed program in which you essentially take bystanders and make them lifesavers.
Brian Yorkgitis: Yes. We know that the leading cause of trauma death is hemorrhage, uncontrolled hemorrhage, and that’s the goal here. When they did the autopsies on the children that died from Sandy Hook, they found that about half of them could have lived if they had bleeding control techniques, if people around them were able to stop the bleed. And that’s where this came from. Dr. Lenworth Jacobs from Hartford, said I’m going to lead the charge and I want the American College of Surgeons to help me lead the charge.
And then government organizations, other organizations got behind it. And we’ve trained so many people but there’s so many communities and so many other people that really need to train, to get the training. We saw a surge when CPR started coming out, that everyone wanted to get trained. This is now the extension, or CPR 2018 in really extending the training of Stop the Bleed to everyone, every citizen.
We’re partnering with several schools in the area to teach Stop the Bleed. On Monday I’m going to a Boy Scout troop down in Ponte Vedra. I’m going to teach Stop the Bleed there. And you and I were just in Tallahassee. Dr. Kasraeian and I were teaching Stop the Bleed. We were able to teach 375 people that day Stop the Bleed along with the American College of Surgeons Jacksonville chapter, and the Florida chapter of the American College of Surgeons.
Ali Kasraeian: And the hope of that is that we did that in the capital in Tallahassee and hopefully with the fact that we had so many people learn about this, they spread the word so that more people can learn about Stop the Bleed. And with the Hartford Convention, they came up with this concept of threat. Threat suppression, so you stop any kind of risk that may be going on. hemorrhage control, rapid extraction and then assessment by a medical providers and then the transport to definitive care.
If you kind of look at that, a lot of those things may sometimes be controlled by other factors. The hemorrhage control is this idea where Stop the Bleed matured out of, with the idea that essentially, if we can find some way to stop vessels from bleeding when they are injured, we could potentially get people to the hospital alive to allow the people like Dr. Yorkgitis, who are trained in dealing with casualties, whether it’s one casualty or a mass casualty, to try to find a way to save those lives.
From that, in terms of an everyday, general person looking at this and being overwhelmed by the possibility, the concepts of Stop the Bleed are not that complicated.
Brian Yorkgitis: No. It takes about an hour to teach most lay people and they go away with a renowned sense of helpfulness. They can help people. They can even help themselves. We teach you that you may need to treat somebody but that somebody may be you. And we talk about the threat and as you said, it’s great if we can extricate people right away and have EMS and police there to help but sometimes we can’t do that.
And that was the case in Sandy Hook. There was an active shooter that needed to be taken care of. We saw that in Pulse, the Pulse Nightclub. There was still an active shooter in that situation. So we can take bystanders and make them lifesavers. In the Pulse Nightclub there was a UCF medical student in the bathroom with two victims and she just held pressure on those wounds and saved those people’s lives. She didn’t have any fancy tourniquets or anything like that. So it’s amazing what we can teach you in one hour to help you save a life.
Ali Kasraeian: And it’s an amazing thing because you see the empowerment in people’s faces after they’re done learning about this. And it’s something that hopefully you’ll never use but if you need to use it, you know how to do things so you’re not so overwhelmed by a very, very terrifying situation that you may find yourself in at some point.
Brian Yorkgitis: I think it really … Again I hope that no one ever has to use it, but I think it prepares you for any situation that may come up that’s an emergency, whether it’s a motor vehicle crash or … It gets you in the mind to make sure that you’re safe first, calling for help, and then delivering help that you know.
Ali Kasraeian: And that’s something to think about. The ABCs of this is one, again the first and foremost thing of any kind of situation like this, is that you have to make sure that you are safe. Now if you’re walking yourself into the face of danger and you get injured, not only are you not going to be able to help someone, you’re now going to be in need of help yourself which could potentially put someone else at risk and injure your own life.
The ABCs of this is one, alert. Call 911 and on thing that’s very important about calling 911 doesn’t mean that you walk into a situation and you look up into the air and yell call 911. It’s very important to point out, either you call or you get someone and directly speak to them, look them in the eye, call them out by the name to call someone, because you don’t want to get into this bystander effect where people are expecting someone else to do it.
And then the other piece is, bleeding control and the compression that Dr. Yorkgitis spoke about. So those two aspects are the things that one, are the most important but also could be the most intimidating to someone who is scared of blood.