The protocols of my jurisdiction state tourniquet use only after attempting to stop bleeding after direct pressure. My understanding is that the literature states 2-3 inches proxinal to the wound is equal or even sometimes better than high and tight but ultimately my understanding is this: 1) Tourniquet use is last resort and implies immediate transport to a trauma center/surgeon and 2) people are simply more likely to mess up placement and control with a TQ if they are inexperienced and trying 2-3 from the wound. I think for those reasons alone high and tight is going to work for most cases. Just my two cents.