Really? I have yet to find a trauma doctor here in Indy to say anything negative about them. Many taught our 1700 officers about them when they were issued their gunshot trauma kits. We've had members of our SWAT team use them on themselves after being shot. We've used them on many citizens in the field with great success.
You kind of answered your own question. "Trauma doctors" are a small part of the community of medical professionals. There are plenty of MDs, DOs, and RNs whose first reaction is never going to be tourniquet because it's contrary to their training and their emergency medicine paradigm. A dermatologist or an internal med specialist is going to seek continuing ed in their specialty, but why would they also seek updates in trauma medicine or emergency medicine. They may never be in a situation where a tourniquet is an appropriate tool, but that won't stop some of them from discouraging a non-medical professional who raises the subject. The example cited to which my message was a response is evidence of that.
Speaking from the perspective of the layman, isn't a tourniquet one of those things where, when you actually need one, nothing else will do? Your options are bleed out or tourniquet.
So the real argument is whether they should be applied first or last in the procedure to stop blood loss. This is probably hard to determine with a high degree certainty without real field experience. Because I don't have that experience I have to error on the side of "most likely to survive". If it looks like a life-threatening flow... Tourniquet. If I understand correctly, the military takes a similar approach to training the average soldier. If so, I'm assuming the reasons are similar.
As for whether I carry a med kit, I don't keep one on my person. I keep a few things in my car and my range bag. They probably need to be refreshed.
This isn't entirely correct, while I can't talk to all nursing schools, I recently graduated RN school and tourniquet use wasn't discouraged. I'd have to dig out the text books, but I do believe tourniquets weren't the primary device for bleeders, except spurters and when direct pressure isn't working. This has come a long way since I graduated with my PN in 05 when TQ use WAS discouraged. Looking through some of the association(s) materials, info is sparse.
The whole "ABC" think comes to mind, and with hemorrhage, I think it's a misnomer as it's not really a circulatory issue but a perfusion issue. I digress though.
Direct pressure is always the first line of defense. When the bleeding cannot be staunched any other way the tourniquet is literally the necessary choice.
If you do not have one it is most likely too late.
I think whether it's a first resort or a last resort depends on the circumstances beyond the wound. Do you have time and two hands to try other measures first? Or are you on the ground with one hand injured and arterial spray coming out of your leg? Or something in between. It's tough to choose a non-diagnostic approach to this.
I can't believe that no one thought of the obvious and immediate answer to the original question: You are going to hurt like a son of a b***h.
Right. I'm not looking for a completely nondiagnostic approach. But as someone with no real experience with life-threatening wounds, my ability to diagnose is more limited. I have to break things down in to bigger categories: squirting, gushing, part of limb missing, feel I may lose consciousness.... maybe it's TQ time; paper cut, clean hole with minimal blood or a bit of an ooze, superficial slashed/gashes... pressure. If I'm on the fence between the two I think go TQ first is the way.
I post these things not because I think they are the way, but so you people who are smarter than me can tell me if this approach is going to cause me problems.
I can't believe that no one thought of the obvious and immediate answer to the original question: You are going to hurt like a son of a b***h.
In that case, I'll step aside on this issue since I am not qualified!
Mindset. I hope that some of the mental gymnastics that I practice will help me to stay in the fight.
I do know that the many times that I have been injured, a couple of bad ones, I've kept my head and been able to preform first aid on myself. Only a couple times (since adulthood) have I gone to the emergency room.
The one time I have been under fire I ran to the aid if a person who was down.
I hope that I will react the way I plan.
I find when it is someone else I tend to downplay the severity... Oh, no big deal. I've seen this on TV and they were fine.
When it's me I assume death is imminent and freak out a little. I'm a pansy on that way.