Lots of information, and misinformation, in this thread. Some points:

- In general (there are exceptions) ER personnel bring a rose-colored perspective to trauma care. They are accustomed to working in a secure environment with fast access to surgeons, operating rooms, advanced diagnostics (X-ray, CT, MRI, labs) and lots of hands to help them. This perspective often does not translate to even civilian prehospital care, and it most certainly does not translate to military battlefield care or remote wilderness care. The ER people who do understand these different environments are usually the ones who have spent some time in them.

- The current PHTLS protocol for extremity bleeding control is 1) direct pressure and 2) tourniquets. Elevation and pressure points have been dropped... because for REAL bleeding they don't help, they just waste time & blood before moving on to a tourniquet. If the bleeding is minor enough for elevation & pressure points to help, then direct pressure would have worked in the first place.

- The idea that "tourniquet = lost limb" is outmoded and has been soundly disproved in even the harshest environments. Read up on TCCC for details. Here is another informative link. Think back to the situation we're talking about: you've opened up an artery and are squirting blood like mad. Are you going to [censored] about what might happen to the limb in hours, or focus on what WILL happen in minutes if you don't stop the flow?

- For those of you who think that if you get shot or stabbed that EMS will be charging in to save you, think again. Whenever we have a call that in any way involves weapons or violence, the police are sent in first and have to secure it before they will allow us to enter. It takes time for the police to get there, and it takes time for them to secure the scene. How much will you bleed from a serious wound in 5, 10... or 60 minutes? I've seen it take that long. You need to know how to do your own immediate action trauma care, and you need to have the tools to do it.