In the mass shooting at the Pulse night club in Orlando that left 49 victims dead, it took law enforcement hours to secure the building and for first responders to reach some of the wounded. In the wait, it’s very likely some of the victims died from bleeding from their gunshot wounds.

But a San Diego trauma surgeon thinks a centuries old device — the tourniquet — applied by bystanders trained how to use them could provide crucial care in a life-or-death situation.

The nature of injuries in situations like this aren’t known as events unfold, but very likely some of the wounded died from a treatable injury that couldn’t be quickly tended to because first responders couldn’t reach the victims, according to Dr. Jay Doucet, a trauma surgeon and the director of the Surgical Intensive Care Unit at the University of California San Diego Health System said.

Tourniquets and people trained to apply them could stop massive blood loss, keeping people alive before they can get to a hospital. Of gunshot victims who do make it through the trauma bay doors, 97 percent survive their injuries, he said.

Doucet and others would like to see tourniquets and the training to apply them reach the level of CPR courses that have schooled millions of people on how to help someone in cardiac arrest, or the AED devices that can jump-start a malfunctioning heart that are now common in offices, malls, schools, and the trunks of police cruisers.

Doucet’s comments came as Rep. Scott Peters, D-San Diego, toured UCSD’s trauma center, meeting with physicians and nurses and others who care for victims of gun violence and other serious injuries. In Washington, he’s supporting legislation that requires background checks for all gun sales in an attempt to keep criminals from buying the weapons as well as a measure that bars anyone who is on the government’s terrorism “no-fly list” from purchasing a firearm.

Peters was a participant in the recent House Democrats’ sit-in where members took over their chamber to highlight the Republicans’ refusal to allow a vote on gun control legislation. Peters gained national attention for broadcasting the demonstration live over social media with Periscope, the Twitter live-streaming app.

“After last week, I was so tired of protests and rallies I thought it would be a good thing to do something constructive,” Peters said.

The tourniquet idea resonated with him, he said. Besides the legislative duties, his position comes with a soapbox that helps him promote programs that train volunteers how to stop bleeding from major wounds, he said.

“The more citizens understand what to do, the better off we’ll be,” he said. It might make sense to include training in high school so that students learn the procedures, he said.

Late last year the White House unveiled “Stop the Bleed,” an initiative to encourage ordinary citizens to learn how to stop blood loss from major wounds. Additionally, the National Association of Emergency Medical Technicians offers a course where students learn how to use tourniquets and blood-clotting bandages, as well as other basic trauma care.

First responders are increasingly learning how to tie a tourniquet, and besides paramedics, San Diego police officers and county sheriff’s deputies are equipped and trained to use the devices. And besides medics and corpsmen, deployed service members also learn how to use the gear.

“The problem now is drilling to down to individual citizens, what can individuals do to improve survival until help arrives” Doucet said.

The tourniquets are more effective but possibly easier to use than the repurposed leather belts or shoelaces depicted in movies, or the leather bands used by Alexander the Great’s army. Modern tourniquets consist of a nylon strap with a buckle that is wrapped around the wounded limb, a pen-like rod that is twisted to tighten the strap so it will stop blood flow, and a clasp to keep the bar held in place so it won’t unwind.

In addition to showing proper protocols, training reduces reluctance to intervene, particularly in a grisly trauma situation, said Aaron Byzak, UCSD Health's director of government and community affairs and a former EMT.

“You have the extra component of a lot of blood on the scene and they have a visceral response to run in the opposite direction” Bzyak said.

But the procedures, Doucet said, are pretty simple.

“Anyone who can do first aid can do this stuff,” he said.