Gil, I work a lot with institutions regarding technical standards. Sounds as though the folks at your institution have come to the right conclusions on their own. Instead of the standards focusing on Why and How, they should focus on WHAT... WHAT must be done. It is the difference between "sufficient dexterity to apply a tourniquet" and "apply a tourniquet with appropriate sterile technique." *I* have sufficient dexterity to apply a tourniquet. Trust me, though, you don't want ME to be the one who shows up to help you in an emergency. Dr. Jane Jarrow