Addressing Isolated Extremity Wounds with Stop the Bleed Interventions Could Save Lives

Okum S, Mehta A, Lunardi N, et al. Could We Have Stopped the Bleed? An Examination of 5765 Homicide Autopsies Across 13 Years. J Am Coll Surg. December 2025.

The study analyzed autopsies for all gunshot (GS) and stab wound (SW) homicide victims 2005–2017 in Maryland based on data from the Maryland Chief Medical Examiner’s office. Homicides were categorized as isolated or non-isolated extremity injuries. Authors identified vascular injuries potentially amenable to Stop the Bleed (STB) techniques. Multivariate logistic regressions stratified by mechanism compared odds of major vascular injury between isolated vs. non-isolated extremity injuries.

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).

Results showed 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.

Since 2015, more than 5 million people have been instructed in ACS Stop the Bleed (STB) program techniques, including tourniquet application, wound packing, and extremity compression.