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I think something important would be for us to get businesses to have a trauma kit/AED on location. I would hope that shooting ranges have at least tourniquets on location. (might be an interesting question) Most will not have them because they are afraid of litigation if it "fails" to work. Washington State has CPR in high School and many business locations have AED's. Their survival rate between sudden cardiac arrest and release from the hospital with a working brain is about 5 times higher than ours. The point of my comment was to get people to think about other things that can be used instead of a store bought tourniquet. I think your training is good. It gives people the courage to get involved in an emergency. Most will stand back and video it. Someone has to take charge. Give orders to people...."you call 911 and give them our address., you go out and lead the ambulance here to the scene of the accident". It is not a given that the ambulance crew is familiar with your location. You make a very good point in that the care giver is giving that victim one more chance at life. There are no guarantees out there. Do all you can and know you tried.

How many people walk around with a tourniquet? How many have a trauma kit close at hand? You can pack a sucking chest wound until the cows come home but the victim will die without a trauma surgeon. External bleeding with a chest wound is not THE major problem. Even an upper leg wound can bleed out very quickly. Tourniquets are good for extremities and marginal for upper leg wounds. Learn to use the stuff you have on hand. Carry a sharp knife and you can make a tourniquet out of the clothes you cut off the victim. A sucking chest wound needs a hand over the wound so the victim does not collapse a lung and put pressure on the heart. Internal bleeding is the killer and the only solution to that is a trauma hospital. Learn what hospitals can handle what kind of emergency. Most don't have surgeons on standby or a cardiologist and a heart cath lab. Going to a wrong hospital could be a death sentence. I live in Houston so we have a wide variety of hospitals to chose from. Most ambulances don't have Paramedics. There is a big difference in what a Paramedic is trained/allowed to do than a basic EMT ambulance. Some Paramedics are better than other's. I was a fairly inexperienced Paramedic and there were guys/girls in my department that were very knowledgeable and skilled.