As Army Cpl. Jamie Smith bled badly during a firefight in Somalia in 1993, a medic tried to save him. But it wasn’t enough.
Nearly 20 years after the battle popularized in the movie “Black Hawk down,” Smith’s former doctor talks of the Combat-Ready Clamp — and how it might have saved the infantryman and other troops.
“When I look at spreadsheets and numbers of people that died and the reasons why they died, I remember talking to the casualties and their families and their mothers and their wives and girlfriends,” said retired Col. John Kragh Jr., a research orthopedist at Fort Sam Houston’s Institute of Surgical Research.
Easily carried in a medic’s kit, the 1-pound device, dubbed the CRoC, is used by some special operations troops in Iraq, where around 500 remain, as well as in Afghanistan. It puts pressure on the groin to stop femoral artery bleeds, which are among the worst in combat. Because the artery is big and carries a lot of blood, a rupture can cause victims to die, some in only moments.
Smith, an energetic GI in the 3rd Ranger Battalion, suffered a long and painful death. a bullet cut his femoral artery and vein, an injury that Army Lt. Col. Robert Mabry, a former ISR researcher and Green Beret medic who survived the battle, said has a 50 percent death rate even if victims are quickly hospitalized.
Smith, 21, was one of 18 Americans to die in the raid.
“Kurt Schmid, who was the medic, did everything we trained him to do. Everything,” said Kragh, the battalion’s surgeon at the time, adding that the treatment rules then in use were flawed.
Now 48, Kragh says his work was driven by Smith’s death and a chance encounter in the Baghdad emergency room, once the world’s busiest trauma center. On his first day in the hospital, Kragh went to a desk, read a chart and saw a tourniquet had been used in one case.
“‘That’s interesting. You have an emergency use of a tourniquet during a shift,’” Kragh told an officer. “And she just looked at me and shook her head and said, ‘No, we get one every shift.’”
That was unusual. at the ER at San Antonio Military Medical Center, formerly Brooke Army Medical Center, just half a dozen emergency tourniquets have been used in as many years, said Kragh, who launched a clinical trial to see how they worked.
A one-time special operations medic who wrote a paper after the battle in Mogadishu, Somalia, Mabry debunked old notions that tourniquets should be sparingly used. He rewrote the rules for using tourniquets, calling for their use in any severe extremity hemorrhage. But despite their utility, they have limits.
“Tourniquets are good for the arms and legs, but we have what’s called junctional areas, and so that’s the groin, the armpit area and the neck, where you have vessels you can push down on. But you can’t put a tourniquet around it,” said Mabry, an emergency medicine physician.
Starting in 2006, Kragh focused on junctional areas.
The CRoC, also called a truncal tourniquet, is a U-shaped clamp that is placed under the back and over the armpits or abdomen. a medic turns a plastic disk, pressing on the artery.
Three percent of victims with an extremity injury can be helped by the device. so far, none of the 125 CRoCs has been used, but Kragh said blood-flow tests with cadavers have shown that they work. The Food and Drug Administration approved the device for difficult battlefield groin bleeds.
Long after Mogadishu, Kragh talks in a subdued tone when recalling Schmid, the medic who tried to save his buddy.
Over time, the standard of care improved, he said, but it was too late for Smith, and nothing has been the same.
“If Kurt Schmid, the Delta Force medic, had that capability, Kurt Schmid, who was trained for years to be who he was … it crushed him,” Kragh said. “The Army failed him. they taught him the wrong doctrine — of course, we didn’t realize it at the time — and we didn’t give him what he needed, and now we do.”