Stop the Bleed Public Interest Form

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Stop the Bleed Public Interest Form

NDSU Extension Farm & Ranch Safety and the NDSU School of Nursing have been awarded a grant to conduct Stop the Bleed trainings across rural North Dakota.

Stop the Bleed training is a nationally recognized, 90-minute certification program, providing participants with hands-on opportunities to properly use a tourniquet in the event of traumatic blood loss caused by a laceration or deep puncturing injury. People living in Northern Plains states have the longest travel times to the nearest hospital. Stop the Bleed training is especially beneficial for rural residents who might live miles away from the nearest medical facility.

If you are interested in participating in a Stop the Bleed training, please fill out this interest form. We also encourage you to contact your county NDSU Extension agent to learn more about Stop the Bleed trainings near you.

By filling out this interest form, you are providing us with permission to contact you (primarily via email) to notify you of Stop the Bleed classes that are available during the Fall of 2023 and Spring of 2024. A maximum of 10 to 12 participants are required to host a training, so recruit your family, friends and neighbors. Must be 13 years of age or older to participate.

Do you wish to attend a Stop the Bleed training, either hosted by your county NDSU Extension office or a nearby county?
*

Yes

Name (First Last) *

Email address: *

Mailing address:
*

Cell phone number

County
*

Please select what describes you best:
*

I am a farmer/rancher.

I am a rural resident but do not farm/ranch.

I am a town/city resident.

I am a youth (ages 13-17).

I work as a healthcare professional.

I am a volunteer or paid firefighter/EMS/ambulance/etc in my community.

Required

Are you a local EMS or first responder needing continuing education credits? This training will count for 0.5 NCCR and 0.5 LCCR credits. *

Yes

Stop the Bleed is a 90 minute, hands-on training. Please select time options that would work best for you to help us have an idea of when to plan these trainings. Please note: if you select a time option, please know that we may not be able to accommodate your selection. This is to help us have an idea of participant flexibility.

I prefer to attend a STB training over the lunch hour.

I prefer to attend a STB training in the evening.

I prefer to attend a STB training during an already scheduled event taking place within a community (can be Extension or non-Extension related).

Other:

Are you interested in becoming a Stop the Bleed Certified Instructor? Click on this link to learn more about eligibility requirements to become a STB instructor in your community.

After reviewing this list of instructor requirements, are you interested in gaining your STB certification so that you can partner with your Extension agent to offer STB trainings in your community?

Yes, I identify as an eligible instructor (based off of the link information above) and am interested in learning how to become a STB instructor/trainer within my county.

No, I am not eligible.

No, I am not interested.

Clear selection

Do you have any additional comments or questions about the program?

Submit

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