| | This form is intended to assist NTRAC in surveillance of the Stop the Bleed tourniquet training. Please fill out this form completely after each use of a tourniquet, including improvised tourniquets. Do not place any protected health information on this form. This information will be kept secure and used for process improvement and data collection only. |
| Q4 | Was Stop the Bleed training used | | |
| Q5 | Style of tourniquet used | | |
| Q6 | Was application successful | | |
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