The ongoing war on terror has ushered in many beneficial advancements in fighting and emergency medical treatment, some of which have drastically influenced the world of civilian self-defense. The ability to both inflict trauma and treat it has emerged as the mandatory paradigm among those who believe in self-reliance and preparedness. The carry of medical gear is well established as a lifesaving habit, and the skills to apply this gear is, of course, pre-requisite. The use of tourniquets, in particular, was once considered a last resort and to be avoided. Now we have clear statistics that prove how effective they are.
Tourniquets are an obvious asset on the modern battlefield as many soldiers die from wounds to the extremities. This has been the case due to the nature and wounding pattern of explosive threats combined with the fact that soldiers wear body armor. The unarmored lower extremities or arms remain vulnerable. There tends to be some debate of late regarding the necessity of tourniquets in a civilian context and this has been derived from a study of active shooter casualties; statistically, most victims of active shooter attacks die from upper chest or head wounds, leaving the application of tourniquets limited in such incidents.
I would suggest that basing our emergency medical carry on outlier active shooter events is barking up the wrong tree. While it should play into our considerations, it should not exclusively dictate our gear or our training. These remain outlier events to be considered and prepared for, but I would suggest that the need for a tourniquet to stop bleeding from an extremity in the wake of a car wreck or industrial accident is a far more likely scenario for anyone to face than is an active shooter incident.
I would also suggest that the best trauma kit for dealing with an active shooter is the kit that inflicts rapid blood loss in the neighborhood of 1200 feet per second. Thus another reason to always carry both. The best way to reduce casualties at the hands of a mass killer is to shoot him in the face when he enters the premises. This is the 21st Century, carry your handgun and a tourniquet; both are proven life-savers.