Danielle Leigh: Good evening and happy Saturday. I’m Danielle Leigh and welcome to The Conversation with Dr. Ali Kasraeian. As always, you too can join the conversation, give us a call at 340-1045. How are you doing today Dr. Ali?
Ali Kasraeian: I am doing well, how are you?
Danielle Leigh: 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’s a very exciting show, except the common denominator in this would be public health and an underlying thing 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 too 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, even 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. So that’s one topic, and the other one we’re going talk about is the opioid epidemic and the controversy surrounding that.
To lead these discussions with me is Dr. Brain Yorkgitis, he’s a trauma surgeon. He’s a fellowship trained surgeon at Harvard Brigham and Women’s Hospital in surgical critical care and we’re very fortunate to have him in Jacksonville as the assistant professor for surgery at UF Health in the division of acute care surgery, which essentially he’s a trauma surgeon, so he’s going to talk to us about both of these things.So Brian, welcome to the show.
Dr. Brian Y.: 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 the show. How did you decide to go into medicine and what made you decide to become a surgeon and then, trauma surgeon?
Dr. Brian Y.: 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, so my primary care doctor, my pediatrician, actually pushed me to go to school. When I started, I was actually a physician’s assistant and then went back to medical school when I was physician’s assistant for several years and became a physician. I wanted to be a surgeon, one of the greatest things about a surgeon is the immediate response that you can have to fix something.
Ali Kasraeian: I agree.
Dr. Brian Y.: 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. Then, the gratitude of the patients. I was always happy to thank my physicians as a kid and the gratitude you 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 in the worst situation that they could have not expected, it’s usually a surprise and in terms of immediate return on what you do, both in a positive and negative, it’s 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.
Dr. Brian Y.: 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, [inaudible 00:03:44] injury, we know that that’s the case. We train to take care of the most life threatening injuries and that’s our job. 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, or for the city of Jacksonville.
Ali Kasraeian: I’ll tell you, a lot of what we’re going to talk about today comes off the cuff 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. 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 in Sandy Hook could have been saved if they did not bleed out of potentially life-saveable situations. That lesson learned has moved this Stop the Bleed program today which you essentially take bystanders and make them lifesavers.
Dr. Brian Y.: 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’d had bleeding control techniques, if people around them were able to stop the bleed. 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.” Then government organizations, other organizations got behind it.
We’ve trained so many people, but there’s so many communities and so many other people that really need 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 troupe 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 American College of Surgeons.
Ali Kasraeian: And the hope of that is, that we did that at 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. You know, at the Hartford Convention, they came up with this concept of threat. Threat suppression, so you stop any kind of risks that may be going on, hemorrhage control, rapid extraction and then assessment by medical providers and then the transport to definitive care. If you 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 can 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.
Dr. Brian Y.: 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 talked 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 of how to save a life.
Ali Kasraeian: 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, or you’re not so overwhelmed by a very, very terrifying situation that you may find yourself in at some point.
Dr. Brian Y.: 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: That’s the other thing about the ABCs of this. One, again, the first and foremost thing of any kind of situation like this is you have to make sure that you’re safe. 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. One thing that’s very important about calling 911, doesn’t mean that you walk into the situation and you look up into the air and yell out, “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 their name to call someone because you don’t want to get into this bystander effect where people are all expecting someone else to do it. The other piece is bleeding control and the compression that Dr. Yorkgitis spoke about.
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, worried about …