The First Seven Minutes

In 2017 a team of emergency physicians published the response times of 485 ambulance services across the United States for the whole of 2015, in JAMA Surgery. The median time from a 911 call to an ambulance arriving on scene was seven minutes. In the suburbs it was six. In rural areas it was thirteen, and one rural call in ten waited twenty-six minutes or more.

Those are good numbers. They describe a system that works. They are also the reason this article exists, because of a second number from the same field of medicine: the American College of Surgeons, which runs the national bleeding-control program, states that a person can die of severe blood loss in as little as five minutes, and that severe bleeding from injury is a leading cause of preventable death in this country.

Seven minutes for help to arrive, and about five for severe bleeding to kill. Nobody designed that gap and the system is not at fault for it. Someone is standing in it all the same, and in most houses nobody has thought about who.

In December 2012, after the shooting at Sandy Hook Elementary School in Newtown, Connecticut, a trauma surgeon named Lenworth Jacobs convened a panel of national experts to ask one question: what would have had to be true for more of those victims to survive? The group met several times, two of them in Hartford, and its recommendations became known as the Hartford Consensus.

The finding concerned the minutes before a hospital or an ambulance comes into it. The military had already shown, in a 2012 review of tourniquet use in Iraq and Afghanistan, that controlling bleeding early produced a clear survival benefit, and that the outcome depended on how quickly it was done. The Hartford Consensus said the same thing applied to civilians, and that the person best placed to act is whoever happens to be standing there.

In October 2015 the White House launched the result as a national campaign called Stop the Bleed. The American College of Surgeons reports that nearly five million people have since been trained.

Most families think of medical preparedness as a kit in a closet. The record says it is a person in the room. The kit matters, but a kit that nobody in the house has been shown how to use is a box.

So the medical question for a household comes in three parts, in this order. Who in this house can keep someone alive for seven minutes? Where is what they would need, and could they find it in the dark? And how many days of anything a member of this household depends on are on the shelf right now?

Most families, honestly counted, can answer the third question with some effort and the first two not at all. Work on the first two. They are cheaper, faster, and they are where the record says people die.

The bleeding-control class is about ninety minutes. It is taught by hospitals, fire departments and trauma centers, and in most places it is free. It covers three actions: pressure, packing a wound, and a tourniquet. You practice all three on a trainer until you can do them without thinking. I took the hands-on portion last week at a hospital in north Georgia, with a trauma nurse checking my work, and the thing that stayed with me was how ordinary it felt. Nothing in it requires a medical background. It requires ninety minutes and the willingness to be the person in the room.

If you do one thing from this article, find a class. The national finder is at stopthebleed.org. Then send the second adult in the house, because a skill one person holds is a skill the household does not have on the day that person is the patient.

Once someone in the house has the skill, the kit stops being a guess. A bleeding-control kit is small: gauze, a pressure bandage, a tourniquet of the kind the class trains on, gloves. The class will tell you what to buy and what not to. The household's job is placement: one where the family spends its time, one in each vehicle, and everyone in the house able to say where they are without looking.

Then the third question. For every prescription, every piece of equipment, every supply a member of the household cannot go without, count the days on the shelf. Write the number down. Whatever it is, it is a fact worth knowing, and your pharmacist and your physician are the people to ask about extending it.

If someone in this house were badly hurt at the kitchen table tonight, who here would know what to do in the seven minutes before the ambulance, and where would they go to get what they needed?

Not in general. Specifically. Which person? Which drawer?

Medical preparedness is one of the eight domains the Sentinel Resilience assessment scores. It is the domain where households most often confuse owning with being ready, because a kit is easy to buy and a skill has to be practiced. The assessment does not ask what is in the closet. It asks who in the house could act, whether they have been shown how, and how long the shelf would last.

The Hartford Consensus was written for people who were minutes from a hospital and did not have the minutes. That gap is the same in every house, and it is the one a household can close in a single evening, for nothing.