Empowering South Carolinians to help after a mass shooting

January 10, 2018
Regina Creech speaks to a bleeding control class
The injury prevention coordinator for the MUSC Health Trauma Center, Regina Creech, left, shows students in a bleeding control class how to use a combat-style tourniquet. Photos by Sarah Pack

Nurses in two Lowcountry school districts, Berkeley County and Dorchester 2, have been trained to use combat-type tourniquets and other bleeding control techniques through the Medical University of South Carolina.

Charleston County school nurses are next, and paramedics and others who work with patients are being trained, too. The bleeding control program will eventually be open to anyone who wants the potentially lifesaving training, regardless of whether they work in health care.

Regina Creech, injury prevention coordinator at the MUSC Health Trauma Center, is helping lead the Lowcountry effort. It’s part of a national push called “Stop the Bleed,” created after the Sandy Hook Elementary School shootings of 2012.

“After some of the mass shootings across the country, a lot of people were bleeding out before first responders could get to them. Too many people,” Creech said. “We want bystander intervention. We’re Americans — we help each other.”

Combat-Style Care

People often describe mass shooting scenes as being like war zones, and the MUSC training teaches combat-style techniques designed to help a victim survive long enough to get to a hospital.

The training has two key aspects:

  • Teaching people how to use whatever they can, whether it’s a hand or a T-shirt or a cloth, to put pressure on a wound to control bleeding.
  • Showing people how to use combat application tourniquets, also known as C-A-Ts. They’ve been used by the U.S. Army for more than a decade, decreasing the number of deaths from extreme bleeding by 85 percent, according to the manufacturer.


The U.S. Army Institute of Surgical Research reports that combat application tourniquets can completely stop blood flow to an extremity, giving people who are wounded more time to get help.

 Right now, the MUSC training is only being offered to people who work with patients because they can then train other professionals, but the goal is to expand it to the general public.

In the meantime, Creech wants everyone to know the basic concepts. “To control your bleeding, one of your greatest tools is put your finger on it like the dam. Can I put my hand on it to stop it? Do we have the means? Is there a sock or a shirt, can I stuff something in it to stop it? And do I have a tourniquet?”

The training is a collaborative effort of the Lowcountry Regional Trauma Advisory Council, which consists of all first responders, emergency medical services, fire departments, trauma centers and hospitals in its Department of Health and Environmental Control region.

Success Story 

The training is already paying off for one paramedic who took the course. Aaron Bebernitz works for the Jacksonville, Florida, Fire and Rescue Department, but learned about combat application tourniquets in Charleston, where he’s a reservist at the Air Force Base.

A fellow reservist who also happens to be a trauma nurse at MUSC Health, Shawn Crowley, offered the training at the base. Bebernitz said he took what he learned from Crowley back to Jacksonville and saw immediate results.

“Sure enough, I took that class, and we had a rash of about 12 shootings within a month,” Bebernitz said. “I used combat application tourniquets on five out of those 12. In the midst of it all, I’m thinking, 'Man, I sure am glad I took that class.'”

Stop the Bleed's Start

While Bebernitz was dealing with individual shootings, not a mass shooting, his successful use of the combat-style tourniquet to save lives is exactly what the American College of Surgeons had in mind when its members worked with federal and medical leaders to create what they called a “national policy to enhance survivability from intentional mass casualty and active shooter events.”

They were horrified by what had happened at Sandy Hook and other mass shooting scenes, and knew that unfortunately, further mass shootings were likely. People needed to be ready to step in to help their fellow citizens if needed.

So they came up with the Hartford Consensus, a series of recommendations that included treating people in the general public as potential “immediate responders,” who should be taught how to:

  • Try to stay safe during a mass shooting or active shooting situation
  • Interact with police, rescuers and medical personnel
  • Know when bleeding may be life threatening
  • Use their hands to apply direct pressure to wounds
  • Apply bandages
  • Use tourniquets the right way
  • Use improvised tourniquets as a last resort

The group also recommended that professional first responders be trained in combat-style bleeding control, including tourniquets.

MUSC Health Trauma Center's Role 

For trauma surgeon Bruce Crookes, offering what he calls “B-Con,” or bleeding control training, is a no-brainer. “The B-Con course is designed to teach anyone how to save a life, in any circumstance, through basic techniques to control bleeding. By providing this education, we are extending the reach of trauma care into the community, allowing people to save lives at the scene of the injury.”

MUSC Health has the only Level 1 trauma center in the Lowcountry, staffed 24/7 with surgeons offering immediate treatment of life- and limb-threatening injuries.