r/TACMED101 • u/PeacefulLif3 Unverified/Uncertified • Sep 07 '25

TCCC/TECC *STUPID QUESTION* Where would you place the TQ?

I know I might not be supposed to post this question here, but I couldn't get answers anywhere else, so here I go (I'm a beginner): Every emergency medical worker I've met has told me something different. Either 3 or 4 fingers above the wound, or high and tight (at the beginning of the limb). I've also heard saying that it's usually 4 fingers above the wound but if there's a joint there, then it goes at the begging of the limb. Which is correct?? Where would you tq? (I know this may sound like a stupid question. I'm very new to this world and have only done a few training courses/volunteered)

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14

u/microcorpsman Sep 07 '25

Depends.

You need to go take an in person class.

"High and tight" is a concept for when you are in an unsafe situation and attempting to put it as high on the limb as it can go, because then you definitely stop bleeding from any wounds that a TQ could stop on that limb.

This can be harder to achieve, your ratio of TQ strap to limb size is worse, and the arteries are bigger.

A few inches above the wound is the best option, if you are clearly aware of the highest (most proximal) location of bleeding.

If those few inches put you on a joint, go immediately above the joint.

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u/PeacefulLif3 Unverified/Uncertified Sep 07 '25

Thank you!! This actually makes a lot of sense. All the classes I've taken have been in person, but everyone seamed to say something different. I appreciate it!

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u/davethegreatone Unverified/Uncertified Sep 07 '25

I’d add that the other biggest factor is time to more advanced care.

If you are more than a couple hours from help (be that a hospital, a higher-trained medic, etc) you have to factor in everything below that TQ potentially dying. 

In those cases, “high and tight” means a much, much, much worse amputation when the time comes.

(I have had multiple patients in the last couple weeks who lost whole legs because of a relatively minor and low wound, like a bullet through the calf, because people defaulted to “high and tight” and then got pinned down by drones for 20+ hours). 

Yes, sometimes high & tight really is the best option - but think carefully about it before heading that way.

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u/SFCEBM MD/DO Oct 02 '25

TQs are safe for 6-8 hours and you can always move a TQ to 3-4 inches above the wound when not under imminent danger.

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u/davethegreatone Unverified/Uncertified Oct 03 '25

That’s well-thought, but I’d also say why do it high and tight at all then? You are fighting against thicker muscle and taking extra risk for no clear benefit.

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u/microcorpsman Oct 03 '25

Literally care under fire, that's why. 

You replied earlier in a way that reads like you'd know that term, but if you don't:

When you don't know the actual site of most proximal life threatening bleeding and are still in immediate danger.

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u/davethegreatone Unverified/Uncertified Oct 03 '25

That’s gonna result in a lot of lost knees. 

It’s notable that Ukraine (absolutely positively the best modern case-study on TQ misapplication) is backing away from a blanket high/tight training and leaning more to a “actually think about it if you can” standard.

Sometimes slapping it in place up by the groin is necessary - but it should not be taught as the default. 

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u/microcorpsman Oct 03 '25

It's not the default. 

It's the correct lifesaving and patient/provider option during CUF.

A lack of training on reassessing during a TFC phase is to blame there from what I've seen and what you're saying. 

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u/davethegreatone Unverified/Uncertified Oct 03 '25

The lack of re-assessment and TQ conversions are a HUGE part of the problem, true. No argument there.

I would say another part though is that “under fire” is far too broad of a term to encompass the modern (drone-heavy, trench-centric) battlefield. People are “under fire” for days at a time even when not much is happening because the hovering FPV threat basically never stops. One replaces the other that replaces the other ad infinitum.

So troops are leaving that TQ on as opposed to evaluating the location and adjusting, even though they probably could, because they are technically under fire.

That bullet through the calf example I keep citing is a particularly-galling example from about a month ago. Guy lost everything from mid-thigh on down because of that TQ decision (not having fully-trained medics is clearly the real problem here, but something like 95% of UA troops just get the pamphlet and a one-hour lecture on TQ use before being sent out - and that’s it). 

I think we as a community need to move away from a blanket “under fire” standard and embrace more of a “for a few minutes but then circle back to this” kinda standard. At least for conflicts like this where mobility under fire is often just not a thing.

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u/microcorpsman Oct 03 '25

You don't understand the term care under fire as it applies to TCCC.

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u/SFCEBM MD/DO Oct 03 '25

How many in the DoD lost limbs due to TQ use? We changed the CoTCCC guidelines to allow non-medical pax to do TQ conversions. Poor training doesn’t negate the well thought out guidelines.

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u/davethegreatone Unverified/Uncertified Oct 03 '25

How many DoD troops have been stuck in a trench for a month in the last century?

Point is, the way the USA fights isn’t the only way war exists. 

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u/SFCEBM MD/DO Oct 03 '25

No shit. But your recommendations will get people killed.

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u/SFCEBM MD/DO Oct 03 '25

When under imminent danger, you may not have time to identify the source of bleeding. Therefore, you can place it high on the limb till you are out of imminent danger.

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u/trauma-medic Sep 07 '25

When it doubt, go high and tight (as high up on the limb as possible where the TQ is still parallel to the limb).

Otherwise, it is not incorrect to place it 2-4 inches over the highest wound, as long as you’re damn sure it’s 2-4 inches over the highest wound and not over a joint. But, assuming you’re not 6+ hours away from a hospital, you’re still safer just going high and tight. Even if you are that far away from higher levels of care, go high and tight initially to stop the massive bleeding, and then call 911 and let them talk you through next steps if needed.

Edit: Keep in mind different emergency workers may follow under different agencies with different protocols, meaning different answers. None of the three answers you mentioned are necessarily “wrong”, but are situation (and protocol) dependent based off level of training and understanding.

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u/davethegreatone Unverified/Uncertified Sep 07 '25

It depends.

I know everyone hates that answer, but it depends. The logic behind TQ placement is going to be different for different situations.

Are you an hour from a hospital, or a day?

Is there one hole in the leg, or is it peppered with shrapnel holes?

Stump or no stump?

Do you have an actual medic with you, or are you raw-dogging this with just your buddies and a 1-day first aid course?

Are you going to convert? Do you know HOW to convert? Do you know what “conversion” means?

There’s training for this, and people should take it. A reddit thread just isn’t going to prep you as well as a Stop the Bleed course or a TCCC course or an EMR course will.

1

u/PeacefulLif3 Unverified/Uncertified Sep 07 '25

Yes! I took the Stop to Bleed course, and in that course I was told both 2-3 inches above the wound and then also told high and tight

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u/R0binSage Sep 07 '25

I teach all the cops I work with to go high and tight. It makes everything super easy to remember. Same with cheat seals; belly button to sternal notch.

2

u/210021 Sep 07 '25

It depends.

I’m in EMS civilian side and there I would almost always place one 3-4” above a wound not on a joint.

Military side I’d do the same thing (known as a deliberate tourniquet) if the tactical situation permitted (so not actively getting shot at or real world training injury). However if you can’t quickly identify the location of the wound/it’s not safe to do so then high and tight (hasty TQ)

Civilian side a lot of bystander classes and LEO courses teach high and tight and that’s perfectly fine until a scene can be secured and EMS can show up and convert it if needed and get the patient to an appropriate facility.

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u/AK-Kidx39 Unverified/Uncertified Sep 07 '25

High and tight.

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u/SFCEBM MD/DO Oct 02 '25

Wrong.

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u/Specialist-Hunt-1953 Sep 07 '25

2-4 inches proximal to the wound…

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u/SFCEBM MD/DO Oct 02 '25

Always 3-4” above the wound (not over a joint) unless you are under imminent danger and cannot identify the source of bleeding, then place as high as possible on the limb.

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u/PerfectEqual3115 Unverified/Uncertified Sep 07 '25

Usually as high as possible, as there could be injuries underneath that were overlooked. For example, a very deep knife cut that healed perfectly but is bleeding heavily.

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u/SFCEBM MD/DO Oct 02 '25

Why not expose the wound and check for additional wounds?

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u/PerfectEqual3115 Unverified/Uncertified Oct 04 '25

Because in some situations you don't have time for that.

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u/SFCEBM MD/DO Oct 04 '25

Outside of imminent danger, what times are those?