Mass casualty events — ranging from the slaughter of 26 innocents at Sandy Hook Elementary School in 2012 to the bombs that killed three and injured more than 250 at the Boston Marathon in 2013 — have highlighted the need for a well-trained citizenry, according to a doctor promoting bleeding control techniques.
After chronicling several other mass casualty attacks in the United States and Europe, Dr. Lenworth Jacobs said, “It’s a big problem, and it’s getting worse.”
Jacobs, speaking to roughly 250 people at a trauma care symposium that Gundersen Health System sponsored Friday at Western Technical College in La Crosse, noted the attacks at schools besides Sandy Hook, including Columbine and several colleges and universities.
“You don’t go to get an education to be shot,” said Jacobs, director of the Trauma Institute at Hartford (Conn.) Hospital as well as emergency medical services for the city of Boston.
Citing homemade pressure cooker bombs that killed three people and maimed or otherwise injured more than 250 near the Boston Marathon as an example, Jacobs said, “Terroristic attacks are not designed to kill you” but rather, to instill fear not only at the scene but also in the general population in the aftermath.
“They put the bombs low to take out legs” and injure as many people as possible as the shrapnel — small nails, plastic, pellets and wood — was propelled throughout the large crowd near the finish line, he said.
Similarly, several coordinated terrorist attacks in Paris in November 2015 killed 130 people, although the assaults near the Stade de France in Saint-Denis as part of that wave killed just three, while instilling widespread terror.
“If you blow up a stadium, you will not create a lot of damage, but it will create panic, and people will be injured in the panic,” he said.
The scope of attacks has become widespread, Jacobs said, adding, “It’s a ubiquitous problem.”
The onslaught also envelopes secondary targets, he said, noting threats against shopping malls between Thanksgiving Day and Christmas — the retail industry’s most lucrative time of the year.
Targeting the commercial sector “is totally unrelated to survival, values and health,” he said, but it underscores terrorist goals of disrupting as many people and institutions as possible in a small amount of time.
The pervasive nature of the attacks have made it clear that survival for many will pivot on the ability of trained civilians to tend to people’s wounds while first responders are en route instead of waiting for medical personnel to arrive, Jacobs said.
Jacobs’ world-acclaimed expertise in the issue stems from his leadership in several trauma initiatives and chairmanship of the Hartford Consensus, which the American College of Surgeons created as the Joint Committee to Increase Survival from Active Shooter and Intentional Mass Casualty Events.
The Hartford Consensus generates strategies to respond to such attacks, detailing the roles of law enforcement, first responders, medical personnel, hospitals and bystanders.
Arriving at recommendations required the planners to “check their ego at the door to make positive changes,” he said.
Among the mantras emerging from the Hartford Consensus, two follow-ups and recommendations from the Obama administration and the federal Homeland Security Department is the slogan, “Nobody should die from uncontrolled bleeding.”
Similarly, the initiative has adapted the post-9/11 rallying cry of, “If you see something, say something” to make it, “If you see something, do something,” Jacobs said.
Action is particularly important within the first few minutes of an incident because deaths from bleeding and other severe injuries are concentrated in that time span, he said.
“Civilians have to make life-or-death decisions,” he said. “We’ve got to get to the time of civilians to be more involved.”
Training — especially in bleeding control — will be paramount, he said, noting that such education is as important as longtime efforts to teach people how to use automated external defibrillator.
To illustrate his point, Jacobs showed slides in the pandemonium after the marathon bombing in which civilians jumped into the breach to apply pressure, tourniquets — some using their own belts and/or shirts or other articles of clothing — and other techniques to stop the bleeding of victims.
To highlight the fact that a bystander easily can use a shirt as a pressure pack to top bleeding, shirts sold in some stores have tags suggesting just that use, with the notation that “This shirt can save a life,” he said.
Jacobs cited statistics indicating that the military suffered a 7.4 percent rate of preventable combat deaths from bleeding in 1970 because knowledge of how to stop bleeding was concentrated in the medical corps.
By contrast, that rate dropped to 2.3 percent in 2012 because all soldiers now carry tourniquets, and that saves hundreds, perhaps thousands, of lives, he said.
The fact that other soldiers carry tourniquet kits also frees up medics to treat the more severely injured, he said.
Another advantage to the expanded training is “they can put a tourniquet on and move on to the next person,” instead of having to remain with an injured colleague to apply pressure.
“It frees up two people,” Jacobs said.
The Stop the Bleed Campaign, in part, applies the lessons learned in combat to training for civilians, which Jacobs said should include a certification certificate like CPR training does.
The Stop the Bleed campaign also advocates putting “bleed bags,” with supplies such as protective gloves, scissors, tourniquets, blood-stopping bandages and other first-aid supplies next to AED machines, as well as private citizens’ carrying smaller versions in their cars.
President Barack Obama lent his cloud to the endeavor, Jacobs said, “to build national resilience in stopping life-threatening bleeding.
“Become a change agent to increase survival,” Jacobs concluded.
MADISON — The biggest question in the Statehouse is how Gov. Scott Walker and fellow Republicans will resolve a dispute over how to pay for roads.
But often lost in the debate is what the final answer will mean for the pocketbooks of drivers and taxpayers.
Walker wants to borrow more and avoid tax increases. Assembly Republicans wants to increase the price at the pump and borrow less. Senate Republicans are looking at borrowing along with instituting toll roads.
Here is a closer look at where things stand on plugging the projected $1 billion transportation budget hole.
The state doesn’t have enough money in its transportation fund to pay for needed road work — it needs about $1 billion more. The fund is built largely on revenue from gas tax and vehicle registration fees, which have dwindled as people drive less and use more fuel efficient vehicles.
In his two-year budget that would take effect in July, Walker proposed delaying some projects, including an expansion of Interstate 94 east-west near Milwaukee, and keeping other projects on track, including U.S. Hwy. 18/151, Interstate 39/90, U.S. Hwy. 10/441 and State Hwy. 15. He also wants to take out $500 million in debt to fund transportation projects.
Legislative Republicans aren’t biting and instead are looking at other alternatives.
Assembly Speaker Robin Vos and other Assembly Republicans argue that taking out more debt gives taxpayers less bang for their buck because more and more money will go toward paying off what is owed each year. The portion of transportation fund revenue that goes toward debt payments grew from 7 percent in 2000 to 20 percent in 2017, according to the Wisconsin Taxpayers Alliance, a nonpartisan research organization. Under Walker’s plan, the organization estimates it would rise to almost 24 percent by 2019.
Assembly Republicans offered a sweeping plan earlier this month that appears to be dead on arrival. Some said the proposal, spearheaded by Rep. Dale Kooyenga, looked more like a policy wish list than a transportation plan. Among the ideas: Cut the gas tax by 5 cents per gallon but impose sales tax on gasoline and — over several years — transition the state to a flat income tax rate by eliminating a handful of credits.
Walker rejected fiddling with taxes at the gas pump, saying the Assembly plan would increase drivers’ tax bills by $433 million over two years. A Legislative Fiscal Bureau analysis of the group’s income tax plan, on the other hand, found it would cut income taxes by about $80 for most filers, with millionaires benefiting the most.
The Assembly Republicans also want to charge hybrid vehicles a $30 fee and electric car owners a $125 fee to ensure they pitch in for road costs. They didn’t specify any projects to prioritize or delay.
Walker and Senate Majority Leader Scott Fitzgerald have both floated tapping the state’s general tax revenues to plug the transportation deficit. But borrowing from the all-purpose fund that helps pay for everything from health care to schools to prisons would require cuts elsewhere in the budget. Critics, including Democrats, say it would only be a temporary fix. And Republican Rep. John Nygren, co-chair of the powerful budget committee, is skeptical, too.
Democratic budget committee member Rep. Katrina Shankland has said Democrats would prefer reinstating a system where the gas tax increases with inflation.
Fitzgerald has also said the state should consider toll roads as a long-term funding solution. The Assembly Republicans are also open to tolls, which would require federal approval.
Where do things stand?
The various camps are no closer to a solution than they were four months ago. Republican Sen. Alberta Darling, the budget committee’s other co-chair, has said all options remain on the table. The biggest decisions could easily linger until the end of June.
CONCORD, Mass. (AP) — The U.S. Postal Service is dedicating its new Henry David Thoreau postage stamp at a ceremony at Walden Pond, where the 19th century American philosopher and naturalist spent two years in solitude and reflection.
Writer of “Walden” and “Civil Disobedience,” Thoreau is being honored on the bicentennial year of his birth in Concord, Massachusetts. The postal service says Thoreau’s way of living simply and rejecting materialism continues to inspire people.
Actor and environmentalist Ed Begley Jr., a board member of the Walden Woods Project , plans to attend the ceremony Tuesday in Concord along with Massachusetts and U.S. Postal Service officials.
The stamp image comes from an oil-on-panel painting of Thoreau’s face based on an 1856 daguerreotype by Benjamin Maxham. It also includes his signature and a branch of sumac leaves.
This summer, darkness will fall across the face of America. Birds will stop singing. Temperatures will drop. Stars will become visible in the daytime sky.
In about 100 days, a total solar eclipse will sweep across the continental United States for the first time since 1918. Astronomers are calling it the Great American Eclipse.
For the amateur sky-watcher, a total eclipse presents a rare opportunity to witness a cosmic hiccup in our day-night cycle.
For solar astronomers, the eclipse offers something else: three minutes (give or take) to collect as much data as possible about the sun’s usually hidden outer atmosphere.
Researchers have been anticipating the event for years.
Some will take measurements from the sky; others have engaged vast networks of citizen scientists to track the eclipse as its shadow moves across the ground. Ultimately, they hope their findings will tell them more about the sun’s magnetic field, the temperature of its outer atmosphere and how energy moves through the star and out into space.
Doing science during a total eclipse may be exciting, but it can also put you on edge. No matter how carefully you plan, nature may conspire against you with something as trivial as a cloud momentarily passing through the wrong patch of sky.
“I’ve had those experiences, and it’s heartbreaking,” said Shadia Habbal, who studies the solar wind at the University of Hawaii’s Institute for Astronomy.
If you remember donning those paper eclipse glasses to watch as the moon appears to take a bite out of the sun, you may think you have seen a total eclipse. But you haven’t.
What you witnessed was a partial eclipse, a phenomenon as different from a total eclipse as day is from night. Literally.
The sun is so bright that even when 99 percent of it is covered by the moon, the remaining 1 percent is still bright enough to make the sky blue, said Jay Pasachoff, an astronomer at Williams College in Massachusetts who has seen 33 total eclipses and 32 partial eclipses. During a total solar eclipse, the moon completely obscures the face of the sun, causing the daytime sky to darken by a factor of 1 million.
This moment of totality lasts only a few minutes. Those who have seen it say it’s unlike anything they’ve ever experienced.
“It’s a really unique feeling, standing in the shadow of the moon,” said Matt Penn, an astronomer at the National Solar Observatory in Tucson who has witnessed two total eclipses. “Crickets start to chirp. Birds start to roost. Chickens do weird things. And it’s all in reaction to the strange light.”
A total solar eclipse occurs somewhere on Earth about once every 18 months, and it can happen absolutely anywhere. That means most eclipse-chasers have to travel far from home to see one for themselves.
On Aug. 21, however, what’s known as the path of totality will cut a 60-mile-wide arc across the United States, beginning in Oregon at 10:15 a.m. local time and ending in South Carolina about an hour and a half later.
Experts estimate that 11 million people won’t have to travel at all to observe the total eclipse, and an estimated 76 million more will be within a 200-mile drive of it.
Because of this unusual accessibility, it will probably be the most-viewed eclipse of all time.
Scientists expect it will be the most-studied eclipse of all time as well.
Most researchers plan to study the sun’s outer atmosphere, or corona. This is a vast region of superheated gas held in place by the sun’s magnetic field.
Under normal circumstances, we can’t see the corona from the ground because it is overwhelmed by the brightness of the photosphere, the sun’s main disk. But with the photosphere blocked, the corona will become the main event in the sky — a pale, spiky halo of streamers that appears to radiate from the blacked-out solar surface.
Composite images and measurements made during other eclipses reveal that the corona is composed of a complex swirl of gases much hotter than what you’d find on the surface of the sun. The surface is a toasty 6,000 degrees Kelvin (more than 10,000 degrees Fahrenheit), but the temperature of the corona averages 1 million degrees Kelvin (1.8 million degrees Fahrenheit).
“The fundamental question we are asking is, what is causing the atmosphere to heat up like that?” said Habbal. “This is one of the scientific mysteries regarding the sun that remains unanswered.”
But not for lack of trying. Habbal has led 14 eclipse expeditions since 1995, traveling as far as the Arctic.
This year, she and her colleagues will make the most of the Great American Eclipse by viewing it from five distinct sites from Oregon to Nebraska.
Each group will wield custom-made cameras with long focal lenses that can capture images of the corona in the spectrum of visible light. The teams will also take spectra measurements to see which elements are in the corona and how hot they are.
Any answers Habbal comes up with would shed light on the processes that shape not only the solar atmosphere, but the atmosphere of other stars that are similar to the sun, she said.
On the other side of the country, researchers from the Harvard-Smithsonian Center for Astrophysics are planning to study the corona from a plane flying at 49,000 feet.
The group, led by solar physicist Ed DeLuca, is building an instrument that will allow them to examine the solar atmosphere in infrared wavelengths. Their ultimate goal is to better understand the magnetic fields in this outer region of the sun — in part because this is where coronal mass ejections originate.
“Measuring these magnetic fields is really useful for understanding how energy is stored in the corona and when we expect it to be released,” DeLuca said. “Once we understand that, we can make better space weather predictions.”
A coronal mass ejection sends millions of tons of the sun’s material hurtling through space. If a well-aimed one hits Earth, it can mess with the planet’s magnetosphere and inflict damage on satellites, astronauts and even the power grid.
Water in Earth’s atmosphere can interfere with infrared measurements, but the higher up in the atmosphere you go, the less water you’ll find. At an altitude of nearly 50,000 feet, the researchers say, their instruments will be able to measure 100 times more infrared light coming from the corona than if they were at sea level.
DeLuca is hoping the weather won’t be a problem. The flight is happening over Tennessee, where thunderstorms have been known to go quite high, but they usually don’t develop until later in the afternoon.
“The flight’s at noon, so we should be OK,” he said.
This isn’t just any plane. The modified Gulfstream GV jet is owned by the National Science Foundation and has been turned into a flying laboratory.
On the day of the eclipse, the researchers will have to make sure the light from the solar atmosphere comes through a 6-by-9-inch window on the right side of the plane. Then it will hit a telescope that feeds a spectrograph enclosed in a cryogenic vacuum chamber positioned on the floor of the cabin.
The plane will fly along with the shadow of the moon, giving the scientists an additional minute of observing time. That may not sound impressive, but every minute counts when you have less than five minutes to collect data.
Pasachoff, who is recognized among eclipse chasers as the person who has seen more eclipses than anyone else on the planet, started planning his Great American Eclipse observations more than four years ago.
After traveling to Ternate in Indonesia, Svalbard in the Norwegian Arctic archipelago and Gabon in West Africa to observe these cosmic events, he said it’s going to be quite a change to see an eclipse here in the U.S.
His team of a dozen astronomers will be stationed near Salem, Ore., a site they selected because the region has an excellent chance of clear skies in August. (Knock on wood.)
Pasachoff and his collaborators plan to use two spectrometers and several telescopes with high-resolution imaging capabilities to measure the different gases in the solar atmosphere, study the dynamics of the corona, determine how hot it is and compare its overall shape to scientists’ predictions.
There are other observing plans afoot as well. Penn, of the National Solar Observatory, is leading an ambitious effort to watch how the corona changes over the full 90 minutes that the eclipse will be visible somewhere in the U.S. He calls it the Citizen CATE Experiment (short for Continental America Telescopic Eclipse).
On the big day, 70 volunteers will use specially designed telescopes to film the corona for the roughly 2 minutes of totality in their area. Those images will be stitched together into a movie.
Penn said his team’s primary focus will be to measure the velocity of the solar wind, the outflow of particles coming from the sun.
“These particles are accelerated at high speeds, but we don’t know how that acceleration works,” he said.
Another group from the University of California, Berkeley’s Space Sciences Laboratory has partnered with Google to collect images from more than 1,000 citizen scientists. By combining them into a “megamovie,” they hope to see how the corona changes over time.
Amidst all this activity, the scientists are budgeting a little time to marvel at the rare intersection of our daily lives and the mechanics of our solar system.
“It’s a cosmic event we are witnessing and a reminder of how puny we are,” Penn said.