Just got my First Responder/CPR/AED/O2 certification. OK, yea me.

Spoke with a very good friend who, as part of a full-time tac team, received quite a bit of advanced emergency trauma training. We talked about the stuff I'd learned in class and his opinion was that most of it was wishful thinking. He doesn't claim to be an expert by any means, but it raised a lot of questions that I thought the experts here might be able to explain.

Examples:

Tourniquets: Official DOT/ARC word-of-God is that you never put a tourniquet on unless you've decided, in effect, to amputate the limb. Official procedure is bandage, if bleeding continues more bandage, if bleeding continues pressure point, if bleeding continues then tourniquet if and only if medical help is > 30 minutes out.

I'm not a doctor, but I have a hard time believing someone with a sliced open femoral artery is going to last 30 minutes. When I raised this point in class, the instructor basically said, "this is what DOT/ARC teaches ... use your judgment."

My friend's take: if you know you have a serious arterial bleed, it's time for the tourniquet. By the time you've gone through all the other steps, the victim might not have enough blood left to be worth worrying about. Also, contrary to the DOT/ARC view -- "once you put a tourniquet on you've poisoned the limb and it's probably going to be lost" -- apparently there is quite a bit of evidence that limbs have survived hours after a tourniquet.

So which is it?

Open chest wound: We were taught occlusive dressing, taped down on three sides, and "burp" the air/blood from a pneumothorax or hemothorax.

Friend's take: you need to get something inserted into the chest to drain the pressure actively. This is obviously well beyond the scope of what we were taught in EFR.

CPR: Based on what my friend relayed and what I read here in the "when your patient dies" thread, it sounds like CPR has an almost 0% success rate. WTFO? Is that a matter of timing -- professional rescuers arrive too late for it to matter, but someone on the scene at the moment of arrest might be able to make a difference -- or is it really just a feel-good thing that people learn to say they've learned it?