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

Introduction: Since 2015, the Stop the Bleed (STB) Campaign has trained over 3 million Americans in tourniquet application, wound packing, and extremity compression. Yet, population-level impact remains unclear. We performed a statewide evaluation of autopsy reports to quantify such deaths. Study Design: The Maryland Chief Medical Examiner’s office investigates all homicides statewide. We analyzed autopsies for all gunshot (GS) and stab wound (SW) homicide victims from 2005–2017. Homicides were categorized as isolated or non-isolated extremity injuries. We identified vascular injuries potentially amenable to STB. Multivariate logistic regressions stratified by mechanism compared odds of major vascular injury between isolated vs. non-isolated extremity injuries. Results: Among 5,765 victims (88% male, 82% Black, median age 28), 84% were GS and 16% SW. Extremity injuries occurred in 47% of GS and 35% of SW victims. Of those, 2.4% (n=55) of GS and 5.3% (n=17) of SW victims had isolated wounds. Major vascular injuries were more common in isolated vs. non-isolated extremity wounds (GS: 33% vs. 5.0%; SW: 59% vs. 9.5%). GS victims with isolated extremity wounds had 10-fold greater odds of vascular injury compared with those with non-isolated injuries (OR 10.1 95% CI 5.8–17.5, P<0.01). The difference was not significant for SW victims (OR 3.7 95% CI 0.5–17.1, P=0.11). Conclusion: We found a significant burden of extremity wounds with major vascular injury amongst a large cohort of GS and SW homicide victims. GS victims with isolated extremity injuries were substantially more likely to sustain fatal vascular injury. These findings highlight isolated extremity wounds as a prime target for bystander hemorrhage control through STB interventions.