The Center for Disaster Medicine and Traumatology

National Research Center for Traumatology assigned by the Swedish National Board of Health and Welfare

Stop the Bleed

The research effort “Stop the Bleed” includes several research projects that all aim to improve society’s response to traumatic bleedings.

Several projects are ongoing within the area and are performed in collaboration with Mayo Clinic, Uniformed Services University, National Center for Disaster Medicine & Public Health and Harvard in the US.

Developing an Educational Concept for Prehospital Bleeding Control

The project will create a standardized national curriculum for teaching prehospital bleeding control techniques to rescue service workers. The educational training concept is based on Stop the Bleed but is adjusted to Swedish conditions concerning the chain of response to incidents. Similar work is being performed to develop a similar concept for the Swedish police, in collaboration with CARER (Center for Advanced Research in Emergency Response).

A pilot training session has been developed and validated. The results indicate good quality: The participants from Swedish rescue services were able to demonstrate both theoretical knowledge and practical skills concerning bleeding control after finishing the training. Validation did not lead to changes in the educational concept. The educational concept developed within the project could form the basis for a national standardized and validated training for bleeding control measures for rescue services. By extension, this can provide rescue service personnel with knowledge and skills to save lives when faced with massive bleeding.

UtVäG B – Development of Guidelines for Basic Bleeding Control

The project aims to enhance the resilience and capacity of the Swedish society to handle serious incidents, by developing the capacity of the public to perform life saving first aid actions when faced with incidents that cause massive bleeding. The project aims to explore various human factors related-issues (e.g. training effectiveness, instruction design) for bleeding control techniques.

The project will also study how a new type of tourniquet should be developed, especially to guide untrained laypersons to secure bleeding control, similar to how fully or semi-automatic defibrillators guide the user in how to act in the case of cardiac arrest.

The project will improve knowledge on the specific challenges that untrained laypersons face in dramatic situations where life-threatening injuries occur, and what is required of laypersons to be able to successfully contribute to accurate bleeding control.

Blood Loss Estimation and Evaluation Determinants – BLEED

Massive blood loss due to traumatic injury can lead to death in minutes and requires immediate lifesaving actions and activation of the trauma chain of survival. There are several medical situations in which estimations of blood loss are used as a component to determine the severity of the injury and the appropriate medical procedures. But treatment of the trauma patient is not always commenced by a professional first responder. Studies show that bystanders are present or show up shortly after an accident or injury in 39-59 percent of the cases.

Previous studies on the topic of blood loss estimations have generally concluded that people are inaccurate in their estimates. However, the level of evidence from these studies is low. The aim of the BLEED project is to develop methodology to enable controlled studies of estimation of blood loss by development of video material and a testing tool for estimation, and to apply the methodology to investigate factors and indicators that affect blood loss estimation. It is of importance to investigate which factors affect estimations, and how this influences the decision making process for bleeding control actions. Increased understanding of these factors will help develop evidence based guidelines and best practice for estimation of blood loss both in a clinical context and for situations where novice laypersons are faced with the task of estimating blood loss and acting upon that estimation.

Performance under stress

The aim of the project is to investigate how well individuals who have undergone training for pre-hospital bleeding control can perform and apply the acquired knowledge in challenging and stressful situations. The project seeks to answer the following specific questions:

  • How is the performance of civilian laypersons affected by acute stress when performing lifesaving first aid actions?
  • How are professional, civilian rescue personnel affected under the same conditions?

The study is based on previous work by Schreckengaust et al. (2018), who claims that stress has a negative impact on performing pre-hospital bleeding control actions in a military population. The project aims to replicate the study for validation and for generalization of the results in a civilian population of laypersons and professionals.


Phillips R, Friberg M, Lantz Cronqvist M, Jonson CO, Prytz E (2020)
Visual estimates of blood loss by medical laypeople: Effects of blood loss volume, victim gender, and perspective.
PLOS ONE 15(11): e0242096. Published November 12.

Goralnick E, Ezeibe C, Chaudhary MA, et al.
Defining a Research Agenda for Layperson Prehospital Hemorrhage Control: A Consensus Statement. 
JAMA Netw Open. 2020;3(7):e209393. Published July 6.

Strauss‐Riggs, K., Kirsch, T. D., Prytz, E., Hunt, R. C., Jonson, C., Krohmer, J., Nemeth, I., & Goolsby, C.
Recommended Process Outcome Measures for Stop the Bleed Education Programs. AEM Education and Training

Prytz, E. G., Hallbeck, S., Goolsby, C., Jonson, C., Langhelm, R., Mehta, R. K., … Wilson, D. P. First and Immediate Responders: Current Capability Needs and Research Challenges(2019) 

Lowndes et al: Preliminary Investigation of Civilian Clinician Perspectives & Just-in-Time Guidance for Tourniquet Use to “Stop the Bleed” (2019)

Lowndes et al: A Preliminary Comparison of Three Tourniquet Instructions for Just-in-Time Guidance of a Simulated Tourniquet Application (2017)

Forsyth et al: Improving Instructions to Stop the Bleed (2017)

Contact: Carl-Oscar Jonson & Erik Prytz