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U.S. Army Institute of Surgical Research tourniquet expert helping save lives through research

By David DeKunder | 502nd Air Base Wing Public Affairs | Sept. 6, 2017


Whether it’s been at the operating table or doing medical research, Dr. John Kragh Jr. has dedicated 32 years of his life to saving the lives of service members.

Kragh, an orthopedic surgeon at the U.S. Army Institute of Surgical Research at Joint Base San Antonio-Fort Sam Houston, is a renowned expert on the usage and effectiveness of tourniquets in treating both wounded service members and civilians with injured limbs.

The retired Army colonel has written and participated in numerous studies covering the usage of tourniquets in the treatment of wounded service members. His work and research, along with those of other surgeons and researchers, has led to better education for service members on tourniquet usage.

Kragh started his military medicine career in 1985 after graduating for the U.S. Military Academy at West Point, N.Y. That same year, he became a student at the Uniformed Services University of the Health Sciences at Bethesda, Md., graduating in 1989.

His first duty assignment was as a flight surgeon for a Ranger battalion at Fort Benning, Ga., where he served for three years. Later on, Kragh was a surgeon at several other Army posts, including Fort Gordon, Ga.; Fort Bragg, N.C.; and Brooke Army Medical Center, where he worked from 2001-2004.

In 2004, Kragh joined the U.S. Army Institute of Surgical Research, where he began his work studying tourniquets, making a career transition from surgeon to researcher.

Kragh’s expertise on tourniquets helped him when he conducted a clinical study on the use of the devices at Ibn Sina Hospital in Baghdad, Iraq, in 2006. When he conducted the study, he was a surgeon assigned to the hospital, which was the busiest trauma center in the world at that time due to its proximity to the conflict in Iraq.

He decided to do the clinical study on the first day at the hospital when he noticed on the emergency room clipboard that a tourniquet had been used during a shift. After reading the clipboard, Kragh said he told the emergency room nurse on duty,” That’s interesting, you had a tourniquet used during your shift. And she goes, “No, that’s not interesting. We get one every shift.”

That conversation led to a study on tourniquets that lasted 466 days, from late March 2006 to late June 2007, in the hospital’s emergency room. The study included observations on 727 casualties, 952 affected limbs and more than 1,200 tourniquets.

Kragh said the study was based on his observations and included data put on spreadsheets, photos of patients and boxes of used tourniquets.

The study , which was continued by two nurses after Kragh left the Baghdad hospital in October 2006, found the miss rate – the number of patients who died need a tourniquet but didn’t get one – decreased over time as Soldiers and combat medics got better at applying tourniquets to wounded service members to stop bleeding and prevent shock.

“Essentially, everybody got up to speed,” Kragh said. “The results were changing in front of our eyes and the miss rate went down because the number of uses went way up. We were saving people who otherwise would have died.”

He published the results of the first seven months of the study in a medical journal in 2008.

Kragh is part of a team of researchers and doctors who test tourniquets on mannequins and on each other at the USAISR. The studies and research they have done is helping to put a more positive perspective on the usage of tourniquets, a device that in the past had gotten a bad reputation for possibly causing morbidity or other side effects on patients.

In addition, Kragh was a member of a research team that helped develop the SAM Junctional Tourniquet, which is designed to be used on junctional areas of the body, including the pelvic area and armpits. That design team was selected as the winner of the 2015 Maj. Gen. Harold “Harry” J. Greene Award for Innovation.

Kragh is also sharing his expertise and knowledge of tourniquets with military medical instructors, including those at the Medical Education and Training Campus and the U.S. Army Medical Department Center & School, both located at JBSA-Fort Sam Houston.

Kragh said he has been surprised by how quickly people have picked up on the lessons and information from the studies and research on tourniquets he has been part of.

“I’ve seen people on TV carrying wounded people with tourniquets on,” he said. “Normally, medicine moves like a glacier. This knowledge has been broadcast rapidly and adopted pretty quickly.”

Kragh said he finds his job as a researcher rewarding because he is having an impact on the lives of service members.

“When I was a kid I only had one job … I was a lifeguard,” he said. “I still am. When a service member is in shock because they are bleeding out, it’s like reaching over the side of the pool and bringing them back. There’s nothing like that. That’s the reward.”