Wednesday, December 03, 2025

Statewide analysis quantifies life-saving potential of stop the bleed

A small but meaningful number of Maryland homicide victims killed by gunshots or stabbings could have been saved with Stop the Bleed, analysis finds

American College of Surgeons

Key Takeaways

In an analysis of more than 5,000 Maryland homicide victims who died from gunshot or stabbing wounds, more than 70 individuals could have survived if bleeding control techniques had been applied before arriving at the hospital — a small but significant and likely under-reported number, trauma experts said.

Research underscores the life-saving potential of Stop the Bleed for both urban and rural communities, where access to trauma care may be delayed.

CHICAGO — Quicker access to bleeding control interventions taught in the American College of Surgeons (ACS) Stop the Bleed program could have prevented the deaths of numerous homicide victims in Maryland, according to a first-of-its-kind analysis published in the Journal of the American College of Surgeons (JACS).

The analysis included data from more than 5,000 homicide victims in Maryland and showed that nearly half of the victims who died from gunshot or stabbing wounds sustained severe bleeding injuries affecting their arms or legs.

“We know that the skills taught in Stop the Bleed can save lives, but we have very little population-level data telling us how often injuries that are treatable with techniques learned in Stop the Bleed occur,” said Joseph V. Sakran, MD, MPH, MPA, FACS, senior author of the study and executive vice chair of surgery at Johns Hopkins Medicine in Baltimore, Maryland. “Maryland has a high burden of violent injury and a robust medical examiner system, providing us with a unique opportunity to study how many homicide victims sustained injuries that might have been survivable with rapid bleeding control.”

The ACS Stop the Bleed program teaches bystanders how to use three techniques for severe bleeding emergencies while waiting for first responders: applying pressure, packing the wound, and using a tourniquet. Since the program’s launch, more than 5 million people have been trained.

For the JACS study, researchers reviewed 5,765 autopsy reports from Maryland homicide victims killed by gunshot or stabbing wounds between 2005 and 2017. They categorized cases as isolated extremity injuries (arms or legs only) or non-isolated extremity injuries (involving other body parts, such as the head, neck, chest, or abdomen). They also reviewed reports for evidence of significant blood vessel damage, such as wounds to the femoral or brachial arteries.

Potentially preventable deaths were identified for victims who had isolated extremity injuries, which the researchers said represent the clearest scenarios where bystander intervention with bleeding control techniques is likely to be effective.

Study Results

The majority of homicides occurred due to gunshot wounds (84%), followed by stabbing wounds (16%), and combined mechanisms (<1%).
Nearly half of gunshot wound victims and a third of stabbing victims sustained multiple injuries that included their arms or legs. A smaller but meaningful fraction of those killed — about 1% of gunshot wound victims and 2% of stabbing wound victims — had isolated limb injuries that could have been survivable if bleeding control techniques had been applied at the scene. That translates into 72 potentially preventable deaths.
Gunshot victims with isolated limb wounds were 10 times more likely to have a significant vascular injury — an injury causing life-threatening bleeding — than those who sustained multiple injuries.
Victims were predominantly Black men under 30, underscoring the need for community outreach and violence prevention efforts reaching at-risk communities, the authors said.

“This research tells us that while isolated extremity wounds are relatively uncommon, they are high-yield opportunities for bystander hemorrhage control — and that’s the exact type of injuries that the ACS Stop the Bleed training targets,” Dr. Sakran said. “While 1% may sound small, in public health, every preventable death matters. Every one of these individuals was a brother, sister, family member, or friend, and we need to think about them in those terms, not just statistics.”

Dr. Sakran noted that because the study did not evaluate non-isolated injuries that may have been survivable with bleeding control, the number of potentially saved lives is likely higher. He added that while the results are specific to Maryland, which has a high density of Level 1 and 2 trauma centers, the findings highlight a critical gap between severe bleeding and first response that Stop the Bleed helps close across all communities. Future research will investigate the role of Stop the Bleed in preventing deaths from more complex, multi-site injuries.

“You don’t have to be a doctor to save a life; you just need to know what to do in the first few minutes of a bleeding injury before first responders arrive,” he said. “And those first few minutes often belong to the community, not the hospital.”

Coauthors are Samuel Okum, BA; Ambar Mehta, MD, MPH; Nicole Lunardi, MD, MSPH; James P. Byrne, MD, PhD; Elliott R. Haut, MD, PhD; and David Efron, MD.

This study is published as an article in press on the JACS website.

Citation: Okum S, Mehta A, Lunardi N, et al. Could We Have Stopped the Bleed? An Examination of 5765 Homicide Autopsies Across 13 Years. Journal of the American College of Surgeons, 2025. DOI: 10.1097/XCS.0000000000001695

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About the American College of Surgeons

The American College of Surgeons (ACS) is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for all surgical patients. The ACS is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The ACS has approximately 90,000 members and is the largest organization of surgeons in the world. “FACS” designates that a surgeon is a Fellow of the ACS.

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Journal

Journal of the American College of Surgeons

DOI

10.1097/XCS.0000000000001695

Method of Research

Data/statistical analysis

Subject of Research

People

Article Title

Could We Have Stopped the Bleed? An Examination of 5765 Homicide Autopsies Across 13 Years

Article Publication Date

3-Dec-2025

COI Statement

Disclosures outside the scope of this work: Dr. Sakran has received consultant and speaking fees from Intuitive Surgical. Other authors have nothing to disclose.

Complex life developed earlier than previously thought, Nature study reveals

Royal Netherlands Institute for Sea Research

image:
Complex and simple cells (credit: dr. Christopher Kay)
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Credit: Dr. Christopher Kay

The research led by the University of Bristol was published in the scientific journal Nature 3 December, the research indicates that complex organisms evolved long before there were substantial levels of oxygen in the atmosphere, something which had previously been considered a prerequisite to the evolution of complex life.

Prokaryotes as the only forms of life

‘The earth is approximately 4.5 billion years old, with the first microbial life forms appearing over 4 billion years ago. These organisms consisted of two groups – bacteria and the distinct but related archaea, collectively known as prokaryotes,’ said co-author Anja Spang, from the Department of Marine Microbiology & Biogeochemistry at the Royal Netherlands Institute for Sea Research (NIOZ). Spang had previously made important discoveries in this field and was involved in the analysis and interpretation of the results within this new study.

Prokaryotes were the only form of life on earth for hundreds of millions of years, until more complex eukaryotic cells including organisms such as algae, fungi, plants and animals evolved.

Previous ideas were speculation

Davide Pisani, Professor of Phylogenomics in the School of Biological Sciences at the University Bristol, explained: ‘Previous ideas on how and when early prokaryotes transformed into complex eukaryotes has largely been in the realm of speculation. Estimates have spanned a billion years, as no intermediate forms exist and definitive fossil evidence has been lacking.’

Molecular clocks

However, the collaborative research team has developed a new way of probing these questions, by extending on the ‘molecular clocks’ method which is used to estimate how long ago two species shared a common ancestor.

‘The approach was two-fold: by collecting sequence data from hundreds of species and combining this with known fossil evidence, we were able to create a time-resolved tree of life. We could then apply this framework to better resolve the timing of historical events within individual gene families,’ added co-lead author Professor Tom Williams in the Department of Life Sciences at the University of Bath.

The researchers collected evidence from more than a hundred gene families in multiple biological systems. In doing so, they focused on the characteristics that distinguish eukaryotes from prokaryotes, such as the transport of compounds within the cell via vesicles. With that information the team were able to begin to piece together the developmental pathway for complex life.

The cell nucleus existed before the mitochondrion

Surprisingly the researchers found evidence that the transition began almost 2.9 billion years ago – almost a billion years earlier than by some other estimates – suggesting that the nucleus and other internal structures appear to have evolved significantly before mitochondria. ‘The process of cumulative complexification took place over a much longer time period than previously thought,’ said author Gergely Szöllősi, head of the Model-Based Evolutionary Genomics Unit at the Okinawa Institute of Science and Technology (OIST).

The new scenario: CALM

The data meant the scientists have been able to reject some scenarios put forward for eukaryogenesis (the evolution of complex life), and their data did not neatly fit with any existing theory. Consequently, the team has proposed a new evidence-based scenario for the emergence of complex life they have called ‘CALM’ - Complex Archaeon, Late Mitochondrion.

A number of disciplines

Lead author Dr Christopher Kay, Research Associate in the School of Biological Sciences at the University of Bristol, explained: ‘What sets this study apart is looking into detail about what these gene families actually do - and which proteins interact with which - all in absolute time. It has required the combination of a number of disciplines to do this: palaeontology to inform the timeline, phylogenetics to create faithful and useful trees, and molecular biology to give these gene families a context. It was a big job.’

Mitochondria arrived later than previously thought

‘One of our most significant findings was that the mitochondria arose significantly later than expected. The timing coincides with the first substantial rise in atmospheric oxygen,’ said author Philip Donoghue, Professor of Palaeobiology in the School of Earth Sciences at the University of Bristol.

‘This insight ties evolutionary biology directly to Earth’s geochemical history. The archaeal ancestor of eukaryotes began evolving complex features roughly a billion years before oxygen became abundant, in oceans that were entirely anoxic.’

Paper
‘Dated gene duplications elucidate the evolutionary assembly of eukaryotes’ by C. Kay, A. Sprang, G. Szöllősi, D. Pisani, and P. Donoghue in Nature

The CALM scenario (credit: dr. Christopher Kay)

Evolution timeline (credit: Dr. Christopher Kay)