The future of school safety in the post-Parkland era increasingly looks like the large duffel bags that the Central Bucks School District is deploying in every school this fall — a medical kit aimed at keeping gunshot victims from bleeding to death.
The new trauma kits bring to American classrooms lifesaving methods tested on Afghanistan's battlefields. They include tourniquets to stop bleeding from arms or legs, hyfin vents that can be applied to a chest wound, and medicated gauze pads treated with a coagulant to stop blood oozing from a bullet hole.
"It's very sad that we have to think about this, but we have to be prepared," said Mary Anne Canales, nursing coordinator for Central Bucks, which is placing 33 of the rolling duffel bags in all 23 district schools to provide "a safety net for our kids and staff" — echoing a conversation that's grown louder with each mass killing in U.S. schools.
Similar bleeding-prevention kits are coming to dozens of schools across the Philadelphia region this fall, including those in Lower Merion Township and across Bucks and Chester Counties, as well as private schools such as Shipley and Haverford.
In New Jersey, Roxbury, Morris County, touted itself in 2016 as the first town in the country to put such kits in all its schools.
It's not clear that having such a trauma kit on hand would have saved lives in any of the recent mass killings. But the stockpiling of supplies is the mark of a grim admission that — with most gun-control proposals on hold and no consensus on how to stop the spike in mass killings — educators need to focus on how best to keep child gunshot victims alive.
"This is one thing that people can do," said Matthew Levy, chairman of a nationwide coalition of public-health officials and medical professionals called Stop the Bleed. "Most mass shootings are over in a matter of minutes, but it may take responders a substantial amount of time to secure that scene and get resources to the injured."
Even students are being trained. Levy, director of emergency medical services in Howard County, Md., said bleeding control was taught at one county high school this year and may become part of the curriculum.
Kits range from $45 to $100. Some schools put one in a nurse's offices, while others stock every classroom or place them in hallway cabinets. The idea is that after a shooting, those trained to stop bleeding would be able to get to the wounded and help them before medics arrive.
The push for medical supplies and for training hundreds of teachers and other potential bystanders in how to use them shows how school officials on the ground are increasingly scrambling for practical safety solutions.
St. Cornelius Catholic School in Chadds Ford made headlines last week by announcing that every eighth grade graduate will get an advanced protective shield that fits inside a backpack and stops bullets from a handgun, or a knife attack.
"I think about it every day," said Robert Vito, CEO of Glen Mills-based Unequal Technologies — which manufactures the SafeShields implant — and a parent of two kids at the school. "We are in the protection business, and I want to give students and faculty a defensive option that they don't have right now."
Both Unequal Technologies' quarter-inch thick bullet-resistant shield and the new emphasis on bleeding-control measures such as tourniquets emerged from lessons learned in Iraq and Afghanistan, where officials say that combat-tested trauma kits reduced preventable deaths for U.S. and British troops by as much as 25 percent.
Trauma is the leading cause of death for Americans 45 and younger, killing nearly 148,000 people in 2014, according to experts. About half of those deaths occurred at the scene of the injury or en route to the hospital.
A National Institute of Health study of civilian tourniquet application found a six-fold reduction in death for injuries to arteries and veins in limbs.
Some doctors worry that bleeding-prevention training might provide a false sense of security, noting that tourniquets help only wounds to the extremities and that improvised tourniquets — such as one fashioned from a shirt — often don't work well. Other experts question whether enough is being done to prevent gun violence in the first place.
"This kind of seems like one of those reactionary things when we need to deal with how are people getting the guns, are there warning signs among students that people should be concerned about," said Shira Goodman, executive director of CeaseFirePA.
Lars Ola Sjoholm, chief of trauma and surgical critical care at Temple University Hospital, thinks the training is a good idea.
"If they're shot in the limbs, it can be a lifesaving measure," he said, adding that Temple teaches the same technique to people in its North Philadelphia neighborhood. If they're shot in the chest or abdomen, "obviously these measures are not going to work," he said.
Karen Borrelli-Luke, a health and phys ed teacher in Camden, works at Dr. Charles Brimm Medical Arts High School, where kids are taught first aid and CPR. She thinks they could also learn how to stop bleeding.
"I find more times than not people don't know what to do, but they want to help. The more that we train them, the better," she said, though she noted that she had also seen staff freeze up during a crisis.
It's not clear if Philadelphia schools have explored the idea; district officials didn't respond to requests for comment.
Ohio-based citizenAID, which adapted a British model for trauma kits and stresses teacher training as well as a free app for responding to a mass casualty, opened its doors just eight days before February's Parkland, Fla., shooting and has trained more than 6,000 educators, according to CEO Bob Otter.
Said Otter, "Someone can die from a femoral wound in under five minutes — and a paramedic is not going to get to a person in under five minutes."
Levy, the Stop the Bleed chair, said the coalition was spearheaded by the American College of Surgeons after the 2012 school shooting in Newtown, Conn., that killed 26. The Stop the Bleed campaign was launched by the White House after an October 2015 conference focused on training bystanders in bleeding prevention during a crisis.
While all schools have first-aid supplies, many do not stock advanced wound care equipment such as tourniquets, which require specialized training to use properly.
In Bucks County, officials at St. Mary's Medical Center, the county's highest-rated trauma center, offered free training sessions to nearby school districts in the aftermath of Parkland.
"This is a piece of the puzzle," said Kim Everett, the hospital's trauma prevention coordinator, who acknowledged that teachers are already overburdened but nonetheless wants to see them trained in first aid, including CPR and applying tourniquets. "Do I think it's asking too much of them? No."
At Central Bucks — hailed by Everett as "a model for the county" — officials are spending $19,800 to $26,400 on the new kits and planning to train some 150 educators over the summer. For now, Canales said, the plan is to deploy one of the rolling bags — which contain from five to eight individual kits — in each grade school and two in middle and high schools.
Stop the Bleed kits also will be placed in every Chester County school. An initial $17,000 grant from the Southeast Pennsylvania Regional Task Force will pay for 84 kits and staff training, followed by another grant for 84 more kits this fall.
"We're not just focusing on shooting in schools — it's bigger than that," said Chrissy DePaolantonio, Safe Schools planning coordinator for the county's emergency services department. "Even if they fall down the bleachers and get a big gash, it's really controlling a bleed so they don't bleed out."
In Lower Merion, officials recently bought trauma kits for the nurses' offices at each of its 10 schools as well as 30 others that will be placed near existing automated external defibrillators (AEDs). The program, spearheaded by Narberth Ambulance, includes staff training and will cost about $5,000. Paramedics are also training and supplying the private Shipley and Haverford Schools.