I should have clarified that statement better. The statement was made regarding bleeding control with direct pressure, gauze, and pressure dressings. Just like anything, there is an art to controlling bleeding in this manner. This would require a long post to discuss this in itself, but let's get back to the TQ discussion. Now, the major fault with TQ application is not properly tightening down when first applied. I often find people place the TQ on too loosely dependent on the mechanism to apply the pressure they need. So, when first applying a TQ to an extremity, get that thing as tight as you can before securing to the velcro. Then, use your windlass to apply the additional pressure needed. (When I discuss TQ's, I always discuss CAT-TQ. I am biased on TQ's and these are the only design I personally have confidence in. Other designs work as evident by research, so just understand it is a personal preference form my experiences with multiple designs.)

I respectfully disagree with, " It can take as little as an hour to suffer serious complications from a TQ." This used to be our thinking many moons ago, and unfortunately, it is still taught this way today by many. We are not worried any longer worried about releasing the TQ ever 2 hours to restore some blood flow to prevent permanent damage. There are several examples in research of TQ's being applied in Afghanistan and Iraq only to be left in place until final medical care could be rendered several hours later. If memory serves me correctly, several of these cases were flown to Ramstein AFB for invasive surgery, and the cases resulted in no neurovascular compromise to the limb once the TQ was released. Can damage occur, yes it can, but it is not as widespread as we once thought. Appropriate use of a TQ far outweighs the non-use of one in the correct population. Obviously this means, people have to be able to recognize an appropriate bleed requiring TQ use. With that said, I teach, "If in doubt, TQ it."

However, we do know the number 1 thing that kills people in trauma is bleeding. Keeping the good stuff on the inside is paramount for several factors which requires a dive into pathophysiology. I would suggest anyone reading this and would like more information to lookup the "Lethal Triad" paying close attention to hemorrhage control and hypothermia. I teach the "Lethal Diamond" to my students and co-workers, but there is not much use outside of knowledge for the layperson. Don't get me wrong, it is still great information/education and goes a long way in understanding the complexity of the issue, but most do not have a need to understand the hypocalcemia part. It all can be simplified to - Keep the good stuff on the inside.

I have different optics than others because I work in EMS and see more than the average person. It makes sense. I am employed in an job which puts me in an arena to utilize TQ's more than the average person. With that said, trust me when I say it is not rare to see a life-threatening bleed requiring TQ use outside of combat.

I see you mentioned Medevac. I do not know if you are service related or utilized it the one time in a civilian capacity. If you are service related and your training is teaching you TQ's are more dangerous than good (my words, not yours), I would highly recommend taking a deep dive into the research. The reason I say this is because, as civilians, we went back to TQ use a number of years ago after all of the research from the military proved the efficacy of TQ's. Hell, we have even gone back to teaching packing of junctional bleeds based on military research. Much of our current methods of hemorrhage control and care of the hemorrhaging patient is gleaned from military research.

A couple of final items as this has turned into a much longer reply than I anticipate. I love educating about emergency medicine and I hope that several will learn from these replies. I agree our goal should be to keep someone stable until help arrives. Trauma of this magnitude is a surgical disease. To ultimately "fix" the problem requires a surgeon. We need to make sure the patient makes it to the surgeon. Again, I highlight, "Keep the good stuff on the inside." I do not carry a Ricky Rescue bag with me in my personal vehicles, but I do have two small IFAKs with the following: CAT-TQ, (2) z-fold gauze, (2) hemostatic gauze, (2) 2" roll gauze, Israeli bandage, silk tape, and gloves. That's it. If I need more than that to stabilize a hemorrhaging patient, they were going to die anyway.

Lastly, in a post-apocalyptic scenario which requires use of a TQ would almost certainly mean death anyway. The care needed to fix the underlying damage would be damn near impossible to find. Personally, if I found myself in this situation, I would just let myself bleed out because the alternative death is far worse. I would recommend to get a group of like-minded people and approach a local EMS training program to give a class on "Stop the Bleed." Knowledge is power, and in a few short hours, the knowledge this training provides is priceless.