SIOUX FALLS, S.D. (AP) — Amy Gage, the Harrisburg School District nursing supervisor, was one of the first on the scene when her former principal took a bullet to his arm in September 2015, after a student brought a gun to Harrisburg High School.

The student had more than 50 bullets on him at the time of the shooting. When his firearm malfunctioned, he was stopped by two other administrators before the situation escalated to something worse.

"I was in the building, and I was a first-responder to the situation," Gage said. "We had just an amazing support system, both during the situation and the time after."

In the days that followed, rattled parents and students echoed sentiments often found in a small, quiet town. They said things like, "That kind of thing doesn't happen here," or "It's a wake-up call."

Three years later, that wake-up call has now transformed into a statewide effort by the Sioux Falls Emergency Management Department and other community stakeholders to "Stop the Bleed," a national campaign by the U.S. Department of Homeland Security and the American College of Surgeons focused on training as many people as possible on how to use tourniquets in critical situations, the Argus Leader reported.

Gage is one of nine nurses in the district who recently received training or a refresher in how to tie tourniquets in case of an active shooter situation, or another incident occurs on campus.

Her staff will be one of hundreds of school employees, including teachers, who will soon join in the statewide effort, said Lynn DeYoung, the Emergency Management Department director.

"Anytime you have more tools in your toolbox, it's a positive thing," Gage said. "This is a new thing, but we also have a mass casualty trauma kit if we have to vacate the property or go and supply aide to somebody. ... We try to be as prepared as we can in those situations, and this is just another tool to assist that."

The national campaign started after the Sandy Hook Elementary School shooting in Colorado in 2012, which left 26 dead, DeYoung said.

And 2018 school shootings in other small towns (like the Parkland, Florida shooting in February, which left 17 dead, and the Santa Fe, Texas shooting in May, which left 10 dead) has been pause enough for concern, DeYoung said.

"In South Dakota, most of the places we see tourniquet usage would be for farm accidents, industrial accidents or motorcycle accidents," he said. "But because of the time we're in, that also crosses over to shooting incidents and other things."

Since the Columbine High School shooting 19 years ago, more than 215,000 students have been exposed to gun violence at school, according to the Washington Post in May.

If school district officials were trained to use a tourniquet in a situation similar to Harrisburg or elsewhere, the chances of survival can increase for 30 percent of victims, DeYoung said.

"That may not seem like a lot, but it is," DeYoung said. "If you're one of the 30 percent, you're going to want your neighbor, your buddy or your friend to know how to do this."

The goal for DeYoung's department is to put one "Stop the Bleed" kit at each of the 877 schools under the South Dakota Department of Education at no cost to public school districts, DeYoung said.

The kits come with at least five tourniquets, and DeYoung wants to eventually expand the effort out to have at least one tourniquet in each of South Dakota's 6,500 classrooms, he said.

Local stakeholders for the program want each school trained and equipped by Jan. 1, 2019, he said.

So far, training has been done in Harrisburg and the Tri-Valley school districts, and the emergency management department has plans to train Sioux Falls School District teachers later this summer and fall, DeYoung said.

But getting the supplies into schools won't happen quickly if fundraisers can't raise the nearly $400,000 needed to accomplish their goal, DeYoung said.

His department is working closely with the Avera Health, Sanford Health and the South Dakota Advanced Trauma Life Support Task Force and seven other state and local agencies to raise the funds, he said. The group has raised about $60,000 so far, including a $30,000 grant from the South Dakota Office of Homeland Security, DeYoung said.

"Victims can quickly die from uncontrolled bleeding, within five or 10 minutes," said Dr. Gary Timmerman, a Sioux Falls-based regent for the American College of Surgeons, in a signed letter by other South Dakota doctors about the initiative. "Similar to how the general public learns and performs CPR, the public must learn proper bleeding control techniques, including how to use their hands, dressing and tourniquets. Anyone at the scene can act as an immediate responder and save lives if they knew how to stop the bleed."

While only nurses in Harrisburg have gone through the training so far, in the Sioux Falls School District, teachers taking on role of saving someone's life in a critical situation is just another layer to care they already provide, the district's Community Relations Supervisor DeeAnn Konrad said.

Sioux Falls School District employees will have the chance to go through tourniquet training at the third annual Teacher Swap Meet on July 27, and again during in-service and professional development days this fall, she said.

The district has about 3,400 employees for 21,000 students, and all of the district's nurses have already gone through the training, she said.

"I don't think any of us ever thought we would be at this point, but it's a necessary conversation," Konrad said. "It's a necessary skill. The skills that come through this program are skills any person at any time could need.

"The thought of needing those during the school day is unsettling, but we have to be realists in today's world. We've seen things like this play out, and the Sioux Falls School District has been extremely forward thinking in its safety practices."

Pushing the initiative statewide just makes sense, Konrad said. While the district and other surrounding districts have partnerships with law enforcement and other emergency personnel, a concern still exists about how quickly those agencies can respond, she said.

"If there was a situation, I know that teacher, that custodian, that lunch lady or clerical person would want to help and want to do the right thing," Konrad said. "This affords us the opportunity to learn a skill we hope we never have to use, but it's a skill everyone should know how to use. The schools are a great place to push that out."

The training isn't only in case of active shooter situations, echoed DeYoung. With South Dakota's reliance on farming and industrial work, he wants school district employees to have the skills necessary to handle any kind of major wound, he said.

And similar to the state's mandated CPR training for students to graduate, which passed in 2017, DeYoung would like to eventually see children learning the same tourniquet training in school health classes, he said. But that may be a ways down the road.

Back in the Harrisburg School District, where students regularly take welding or wood shop course, Gage said the kits will bring another level and security for the "what if's" that could happen in those hands-on courses.

"It's that umbrella you hope you never need," Gage said. "But if you do, it's a really valuable tool to have."

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Information from: Argus Leader, http://www.argusleader.com