Have you used AutoTQ to stop blood loss? If you have used AutoTQ to stop a bleed, please fill out the form below to receive an AutoTQ cuff replacement free of charge. Applier name * First Name Last Name Email * State where the blood loss incident took place * City where the blood loss incident took place * Station # (If Applicable) Age of patient * Patient gender * Male Female Indications (if any) * Cause of blood loss * Applicant's level of training * Position of patient when AutoTQ applied? * Number of uses of AutoTQ attempted? * Bleed successfully stopped with AutoTQ? * Yes No Do you believe AutoTQ saved the life of the person bleeding? * What complications were found, if any, following AutoTQ removal? * How can we improve AutoTQ? * Leave any feedback for us here. How did you hear about AutoTQ? * Terms of Submission * By submitting this form, you acknowledge and consent that the information provided herein will be used for the purposes of research and analysis in relation to tourniquet effectiveness, application techniques, and related medical studies. We may utilize the data you provide in various analyses to improve understanding, enhance training protocols, develop new methodologies, and contribute to broader research in the field of emergency medical care and tourniquet usage. All personal information will be kept confidential and will only be used for the stated research purposes. Your participation in this research is voluntary. By proceeding with this submission, you are granting us permission to process and analyze your data in accordance with the aims of our research. We are committed to maintaining the highest standards of data protection and ethical research practices. If you have any questions or require further information regarding how your data will be used, please do not hesitate to contact us. By selecting "I accept", I have read and understand the above disclaimer and give my consent for the use of my data as described. I acknowledge that all data submitted in this form is true. I accept AutoTQ Replacement Cuff Size Small Large Thank you! We will send your AutoTQ replacement cuff by mail.
