JAMESTOWN, N.D. - While children in other classes of Stutsman County Extension Youth Activity Day learned about things like wood burning, sewing and table manners, Lucinda Nygard Lien was teaching skills she hopes no one ever has to use.

In Nygard Lien's Stop the Bleed session, children and their parents learned how to put on tourniquets, how to pack gauze into a wound and the proper way to apply compression.

When the autopsies of victims of the Sandy Hook mass shooting revealed some victims may have survived with prompt attention to their wounds, the American College of Surgeons, in cooperation with military, law enforcement and other interested groups, developed Stop the Bleed to teach easy, life-saving techniques to as many people as possible.

Lucinda Nygard Lien demonstrates using everyday objects as makeshift tourniquets during a Stop the Bleed course on Jan. 12, in Jamestown, N.D. (Jenny Schlecht/Agweek)
Lucinda Nygard Lien demonstrates using everyday objects as makeshift tourniquets during a Stop the Bleed course on Jan. 12, in Jamestown, N.D. (Jenny Schlecht/Agweek)
The training has obvious benefits for rural communities. Fatal blood loss can occur in minutes, depending on the wound, and in rural areas where ambulances might be coming from long distances, those minutes matter.

"That's the problem in North Dakota," said Dr. Mary Aaland, who brought Stop the Bleed to North Dakota. "God bless our volunteer EMS - they're doing the best they can. But it still takes time for them to get there."

"There could be nothing better for small communities than knowing how to do this training," said Nygard Lien, an emergency medical technician with Edgeley (N.D.) Ambulance.

'A mission'

Lucinda Nygard Lien, left, compresses a "wound" on a fake limb during a Stop the Bleed course on Jan. 12, in Jamestown, N.D. (Jenny Schlecht/Agweek)
Lucinda Nygard Lien, left, compresses a "wound" on a fake limb during a Stop the Bleed course on Jan. 12, in Jamestown, N.D. (Jenny Schlecht/Agweek)
Rural life can be dangerous. According to the Occupational Safety and Health Administration, agricultural workers in 2011 had a fatality rate of 24.9 deaths per 100,000 - almost seven times the rate of all workers of 3.5 deaths per 100,000. Oil and gas extraction had a similar rate from 2003 to 2010, according to OSHA statistics.

Participants in a Stop the Bleed course in Jamestown, N.D., on Jan. 12, practice packing wounds and applying pressure. (Jenny Schlecht/Agweek)
Participants in a Stop the Bleed course in Jamestown, N.D., on Jan. 12, practice packing wounds and applying pressure. (Jenny Schlecht/Agweek)
The Insurance Institute for Highway Safety reports almost half of motor vehicle deaths occur in rural areas, though only 19 percent of people in the U.S. live in rural areas and only 30 percent of vehicle miles traveled occur in rural areas. Add to that the fact that the largely volunteer emergency medical services units that respond to rural emergencies have to cover large distances to get to patients and to get to hospitals.

"We live in an unsafe state - ranching, farming, coal mining, oil field workers. Top that off with that we're so rural, and we're short of grouchy surgeons," Aaland said.

"We forget how dangerous farming is," Nygard Lien said. "People are always climbing up on grain bins. People are always working on machinery."

Rural areas also tend to have older populations, making the use of blood thinners more common. That makes even simple cuts more dangerous.

"It's not just for car crashes and farm injuries. It's for falls, simple falls," Aaland said of Stop the Bleed.

Participants in a Stop the Bleed course on Jan. 12, practice applying a tourniquet. Photo taken in Jamestown, N.D. (Jenny Schlecht/Agweek)
Participants in a Stop the Bleed course on Jan. 12, practice applying a tourniquet. Photo taken in Jamestown, N.D. (Jenny Schlecht/Agweek)
Aaland said there aren't many statistics on how many people bleed to death in rural areas. Aaland recently was part of an effort to look at autopsies from fatal motor vehicle crashes in North Dakota. With the information she had, it appeared several of the deaths were caused by blood loss. Aaland couldn't say for sure that the deaths could have been prevented, but it's a fair assumption that some could be.

"I don't have enough data to make it a firm statement," she said. "But it was really bothersome."

Aaland is director of rural surgery at the University of North Dakota School of Medicine. She has traveled across the state, teaching the basic techniques that she hopes will get a few more people successfully onto an operating table when they are injured in rural areas.

Aaland spent years working as a trauma surgeon, seeing the real harm that can be caused by injuries that lead to blood loss. And her upbringing on a Hatton, N.D., farm taught her how things can go wrong in a rural, farming community. When she heard about Stop the Bleed, she knew it could have a real impact on rural areas.

"This is a mission," Aaland said. "We need to get everybody taught."

'Every farmer needs it'

Stop the Bleed teaches easy techniques to control bleeding. (Graphic courtesy of the Department of Homeland Security)
Stop the Bleed teaches easy techniques to control bleeding. (Graphic courtesy of the Department of Homeland Security)
Aaland has trained approximately 600 people in Stop the Bleed, but that's not even close to enough for her.

On Jan. 24, she was in Linton, N.D., teaching Stop the Bleed to all students and teachers in grades eight through 12. She has taught fifth- and sixth-graders in McVille, N.D., and hundreds of people in Watford City, N.D. She's taught people as young as 5 and as old as 92. And now, additional trainers, like Nygard Lien, are able to spread the message, too.

Stop the Bleed teaches some basic points to deal with bleeding. Call 911 and make sure you're safe, Nygard Lien told her class. Then, find the source of bleeding. Apply a tourniquet. Pack wounds with gauze. Put pressure on the wound.

Participants paired up to practice getting a tourniquet tight.

"It hurts," Nygard Lien explained as she demonstrated on herself. She told students to continue tightening a tourniquet until the bleeding stops - even if it hurts the patient.

Nygard Lien asked how many of the students live on farms. Most people in the class raised their hands. Given that, she focused her class on some of the situations they might be in, explaining how to turn everyday items into makeshift tourniquets.

"You have a screwdriver and a dirty rag in the cab of the tractor," she said. "That's what we're going with."

Students had the chance to pack gauze into wounds on a training limb. Nygard Lien showed how to apply pressure to wounds and how to stabilize objects stuck in wounds to help stop bleeding.

The Stutsman County group had a few 4-H Cloverbuds in it, a program that starts at age 5. While a few looked shocked at the more graphic images in Nygard Lien's presentation, they all relished the hands-on portions.

"Little kids get into this. Little kids are in there packing wounds, and they're doing the tourniquet. And they're actually less scared of it than the adults are," she said.

"They're sponges," Aaland said of younger students.

Aaland doesn't just want people to take Stop the Bleed. She wants bleeding control kits - with tourniquets, clotting gauze, clotting bandages, pens and more - to be distributed far and wide, along with the education.

Dr. Mary Aaland would like to see bleeding control kits distributed to go along with the education in Stop the Bleed. Photo taken Jan. 12, 2019, in Jamestown, N.D. (Jenny Schlecht/Agweek)
Dr. Mary Aaland would like to see bleeding control kits distributed to go along with the education in Stop the Bleed. Photo taken Jan. 12, 2019, in Jamestown, N.D. (Jenny Schlecht/Agweek)
"These kits should be on every combine. Every farmer needs it," she said. "It should be in your backpack when you're hunting. It should be on your ATV."

She would love to see rural businesses or implement dealers step up to sponsor the program or the distribution of kits.

Aaland stresses "common sense" to keep yourself safe. Wear your seat belt. Don't drink and drive or do drugs and drive. Have safety features in place. Drive appropriately. But having Stop the Bleed training is a "foundation" of safety measures, she said.

"God willing, you don't ever have to use this skill set," Aaland said.

Anyone who wants to know more about Stop the Bleed or would like to have an instructor put on a Stop the Bleed workshop should contact Aaland at mary.aaland@und.med.edu. She also urges people to visit www.bleedingcontrol.org to learn about Stop the Bleed and to purchase bleeding control kits.