Page 153 - JSOM Spring 2018

An Ongoing Series

You Never Know, Until You Know, and Then You Know

An Interview With COL (Ret) John F. Kragh Jr, MD

Interviewed by COL (Ret) Andre Pennardt

Please provide our readers a brief What motivated you to focus on
overview of your military career. the use of tourniquets in the tac-
Thanks, Andy. My father was a po- tical environment?
liceman, and the family had some Palmer died. It was a cold, dark
firemen or military Servicepersons, night in the Mojave, 1992. Big op-
so, as a boy, such service was my eration, live fire, seven hits. Ma-
aim. I went to West Point for col- rines, Air Force, Rangers, 160th,
lege then to Uniformed Services Bragg brothers. I was with the
University for medical school. I in- main element. Elsewhere, Jeffrey
terned at Walter Reed. I went to the Palmer landed in a Blackhawk he-
Ranger Battalion at Fort Benning licopter. He was a corporal, a team
for 3 years when we missed the leader of four Rangers in two pairs
Gulf War and felt our team missed of a machine gunner with an assis-
a Super Bowl. I went to orthopedic tant. He exited with one pair out
residency at Fort Gordon, as the the left door and the other pair
Rangers soon went to Somalia. I exited out the right door to jointly
longed to be with the team. Four lay down crossing fires promptly
years of orthopedics at Fort Bragg onto their targets. Soon a bul-
were busy. Our research there got let went through his thigh above
the attention of Fort Sam Houston, his knee and took out a length of
where I went in 2001. I remain. both his bone and artery. A few
bloody minutes later, the rescue
What do you currently do?
I research prehospital bleeding “Someone with imagination and helicopter and PFC Richard ‘Doc’
control. If someone said, years ago, Strous were on the ground. He
that was to be my job, I would have grit can own a lane like no one else did everything right. He had just
laughed. has ever owned it before.” finished a Special Forces trauma
training course the prior week, so
How did you become involved — COL (Ret) John F Kragh Jr he knew all the right stuff: dressed,
with the Committee for Tactical splinted, gave 2L of intravenous
Combat Casualty Care (CoTCCC)? fluid, packaged, and transported to the base hospital within
In 2008, I spoke to the committee about new developments 30 minutes after injury. Palmer got no damage control, like
in tourniquet use. In 2006, in Iraq, Dr John Holcomb and I a tourniquet, because damage control was then just an un-
were busy in Baghdad. We saw a lot. We gathered data then proved idea used in a couple of cities. He got a couple more
and had just finished its analysis. Results were timely and a liters of fluid, an external fixation of the thigh bone, an at-
big win for the committee. The original deduction of TCCC tempted artery repair, and he bled to death. Everyone did
was right: context matters—trying to do ATLS [advanced everything almost perfectly by the book, but life or death is
trauma life support] on a runway while being shot at was a close-run thing. It turns out the research then of such fluids
nutty. ATLS was a default approach for years, but it presumed was fairly clear that 2L was the limit, and the teaching in ATLS
civilian care, because it started with an orthopedist and his was that. However, an intuition was that if 2 is good, then
family as patients; [they had] crashed their plane on the Great why is not 3 better? The research was clear that a lot of fluid
Plains of middle America. Reading of SEAL firefights during is a good way to bleed dogs longer until they are exhausted
combat at Punta Paitilla Airport in Panama made me think: and die, but translating that judgment to learners was weak.
‘Toto, I’ve a feeling we’re not in Kansas anymore.’ The Op- To better translate is why I am a researcher now, so fewer
erators and the committee were right. We empirically con- have to lose their husband, son, buddy. Palmer’s death, for
firmed a part of that. me, was my first pivot from serving the operational health

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