I agree that not every trauma/bleeder needs a tourniquet. I've never used one.

But, I bet most folks haven't had the same combat conditions, where there isn't just 1 patient at a time, and there isn't an entire ambulance and fire engine team reporting. Usually, it's 1 medic and a crap-load of casaulties happening all at once. He can't spend 5 minutes with each holding pressure, and he can't have the battle buddy do it for him - someone needs to be shooting back.

I have never felt that I needed a fancy tourniquet either. The chance of me needing one is so low that I am willing to go with a piece of paracord and a pen. I can tie the ends of the paracord together in about five seconds and use a pen or something similar as a windlass to tighten it up. I know it is not ideal but it is better than letting someone, especially me, bleed to death before someone more competent and presumably better equipped is able to help.

This is also why hemostatics and (more importantly) tourniquets are great tools in the back country or survival situations. While you probably won't need to be shooting back, you could easily find yourself in a situation where evacuation is a LONG time off and you may be the only person able to provide aid. You may even be the only patient as well as the only care giver. The quicker you stop bleeding the more blood you retain... it really is that simple.

While I am sure that this would work better then nothing, paracord is way too thin and will cause significant damage. I have use a triangular bandage as a tourniquet using a similar technique quite effectively. A cut up a shirt or other piece of clothing before using a piece of paracord.

I'm up for recertifying my WFA this year, and may step up the longer 5 day WAFA, depending on schedule: it will be interesting how the instructor deals with tourniquets and hemostatics, or if they deal with them at all. A couple years ago the response was there's no real place for tourniquets in the backcountry, they identified all sorts of issues with releasing pressure and restoring circulation after having it on for ~an hour or more: in short they said if you commit to a tourniquet you may be committing to losing a limb. And they also said the majority of bleeding is stopped with direct pressure, which is true - and when there isn't the pressure to evacuate a casualty right away as there may be with an EMT and close transportation, you can apply direct pressure much better by yourself or putting a confident Scout on the task for you. I will agree the game is to prevent blood loss and keep the patient out of shock, so it makes sense that a tourniquet may have a place on a serious bleeder. I imagine though that will probably come as a result of a fall, and they may have much more serious wounds to deal with. Anyway, I'll follow whatever protocol I'm trained in, but may carry the tourniquet on longer hikes - I think the two I have are SOFT-T types.

Perhaps something wider is in order. I still think a tourniquet is not something I am likely to need and its fairly easy to improvise. We are talking about dead versus not dead here. Thats when I would be using one. I am not going to quibble over some minor tissue damage caused by the use of a less then ideal tourniquet if the other option is dead.