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U.S. Army's Helicopter Medevac Corps

U.S. Army Soldier Provides Security During a Medical Evacuation

High above the war-torn Afghan front, The men and women of the U.S. Army's helicopter medevac corps race against time, tending to those injured - both friend and foe - in this nine-year-old conflict. In a world where the primary objective is taking lives, their task is to save them.

The American airfield in Jalalabad, Afghanistan lies in the Kabul river valley, right where the Khyber Pass winds up through the snow-covered mountains that border Pakistan. JAF, as the base is known, is an island of American military power in a sea of hostile territory, surrounded by razor wire, earth-filled barriers, and guard posts. The tarmac is lined with the aircraft that play a central role in the nine-year-old war: Apache and Kiowa attack helicopters armed to the teeth; huge double-rotor Chinook troop transports; and Black Hawks, the workhorses of the U.S. military presence here. Every hour or so a Predator drone - the unmanned aerial vehicles that are revolutionizing warfare - takes off with a high-pitched whine, armed with spy cameras and Hellfire missiles.

I am sitting with a handful of pilots, crew chiefs, and medics on a covered porch looking out over the runway. They are sprawled in a row of homemade lounge chairs, where they often sit for hours talking trash and smoking cigars. Rocky Blair, a shaved-headed medic from Humble, Texas, and Zack Blansett, a 24-year-old medic from Arkansas with a wide smile and a Southern drawl, swap stories of their tours in Iraq and Afghanistan. In 2007, Blansett - nicknamed Matt Damon for his resemblance to the actor - was deployed as a ground combat medic in Ramadi, Iraq when a grenade slammed into the turret of his Humvee. His right arm and left hand were shredded by red-hot shrapnel, his gunner was wounded, and his driver was knocked out cold. Blansett put a tourniquet on himself. "It wasn't very pleasant, but it probably saved my arm," he says. Then he helped carry his injured driver 400 yards to safety while laying down suppressive fire. "They tried to give me a medical discharge when I was wounded," says Blansett, shaking his head. "I was like, ‘Nope.' " He has dreams of becoming an intelligence officer, and in any event he had no desire to quit the job he had sacrificed so much for. So after three surgeries on his right arm, five surgeries on his left hand, and six months of recovery, he passed his fitness test and returned to Iraq. He's got a Purple Heart to show for it and a doctor's note to show airport security when he sets off metal detectors.

Blansett and Blair are members of DUSTOFF, the nickname for the U.S. Army's helicopter medevac corps (an acronym for "dedicated, unhesitating service to our fighting forces"). With units stationed at every large American base, Dustoff's job is to evacuate the wounded from the roadsides, villages, and outposts of eastern Afghanistan: not just coalition forces, but also Afghan civilians and even the enemy. The region is crawling with insurgents armed with surface-to-air missiles and boasts some of the most difficult flying conditions on Earth. For the past three days, blizzard conditions have kept the helicopters grounded, but now the gray ceilings of cloud are lifting, and everyone knows it's just a matter of time before a call comes in.

Medevac missions are ranked as urgent, priority, or routine. When a unit receives an urgent call, it's aloft within 15 minutes, blasting its Black Hawk choppers over the landscape at 180 mph, trying to reach the wounded within the "golden hour" - that brief window of time before a patient goes from casualty to fatality. As one medevac pilot with three tours of Iraq and Afghanistan puts it, "If the no-shit phone rings, get your shit and start running."

This is the "slow season," if a period when casualties have doubled over the previous year can be called slow. The real action will start in the spring, but for now the passes over the mountains from Pakistan are snowed in, and the bad guys are staying warm in their caves. Still, it's never long before something happens.

The call comes in on the "nine line," the medevac's coded alert system, for an evacuation at Korengal Outpost, a.k.a. KOP. One of the most frequently attacked positions in Afghanistan, KOP is a tiny base perched atop a ridgeline above the Korengal Valley. A key smuggling route for centuries, the valley is often used by militants. The locals are extremely hostile to the American presence in the region. As Rocky Blair describes the Korengal, "It's like West Virginia in the 1800s."

Blair runs for his gear, followed by the pilots Jeff Roberts, from Atlanta, and Alex Scott, a soft-spoken 28-year-old from Vermont. Kevlar body armor is strapped on, flight helmets and night-vision goggles are grabbed, and the crew jogs across the tarmac. The Geneva Conventions dictate that medevac helicopters must be unarmed apart from the small sidearms carried by the crews, so Dustoff flies with a "chase" helicopter, an Apache armed with a heavy machine gun, rockets, and missiles. I pile into the back of the medevac chopper and strap into the harness. The twin 1,600 hp engines spool up to a deafening roar, and the vibrating mass of the Black Hawk eases into the air as if dangling by a string.

Glimpsed out the window of a Black Hawk flying 500 feet above Afghanistan, the jagged, snow-covered spires of the Hindu Kush glow in the afternoon light. Below us spreads an intimate vision of rural Afghan life, an irregular patchwork of wheat fields, vineyards, and apricot orchards scattered with ancient villages. It is a pastoral scene unchanged for centuries, and for a country torn by decades of war and unimaginable human suffering, it looks surprisingly serene.

Flying low enough to make out footprints in the snow, we approach the Korengal Valley. Over the radio the pilots are notified that the landing zone at KOP is hot, taking direct, heavy machine-gun fire. We circle, waiting as another pair of Apaches strafe the position and an F16 jet flying overhead unleashes a laser-guided 500-pound bomb. After a few minutes the landing zone is declared clear and we drop in a tight spiral into the valley. "Get your middle finger ready in case they're shooting at us!" Blair shouts over the intercom, joking about the medevac's lack of any actual on-board defense options.

As we make a rapid descent onto KOP's helipad, several infantrymen crouch behind a set of earthen barriers, their rifles scanning the ridgelines. Blair runs out to meet the outpost's medic team, and several men hustle a wounded soldier onto the helicopter. Barely on the ground a minute, the chopper's engines roar as it takes off into the sky. On the stretcher lies a stocky young soldier with a full-sleeve tattoo over a hideously shattered arm. He was hit by a heavy supply box during a food drop. Blair gives him a pain-killing fentanyl lollipop and attempts to put in an IV as the helicopter strains at top speed out of the valley. In 20 minutes we are touching down in Jalalabad, safe behind the American wire in a very dangerous place.

Jalalabad is just a tiny outpost compared to Bagram, the massive former Soviet airbase where the medevac - and much of the U.S. military high command - is headquartered. Bagram is also home to one of only two Level III hospitals in Afghanistan, where the most critically wounded can be stabilized before being flown to the huge military hospitals at Landstuhl, Germany and Walter Reed Army Medical Center outside of Washington, D.C. Bagram is Fortress America, complete with a Burger King in a shipping container, as well as a Pizza Hut and a Popeyes. Afghan-run stores (with the rather un-PC nickname Haji-Marts) sell carpets, trinkets, pirated DVDs, and video games. One of the most popular is Call of Duty 2: Modern Warfare, a decidedly nonescapist choice. "We play Call of Duty because regular war isn't interesting enough," one medic jokes.

The Army's first helicopter medical evacuations were flown in Burma at the end of World War II in 1945, but it was in Vietnam that the nickname Dustoff was coined. The legendary Vietnam medevac pilot Charles "Mad Man" Kelly is the unit's patron saint. His three core principles: Never refuse a mission, never return with an empty chopper, and the needs of the patient come first. Kelly flew hundreds of missions; he was killed on July 1, 1964 by a sniper while picking up a group of injured soldiers. He'd been told to leave a landing zone that was under fire, but he refused to take off empty. His last words were, "When I have your wounded." They are Dustoff's motto to this day.

Stateside, these units - part of the 3rd Infantry Division - all train and work together at Hunter Army Airfield in Georgia, and while the wounds have not changed much since previous wars, the medicine has. Today medics can administer drugs to control blood pressure and keep patients stabilized while simultaneously monitoring vital-signs machines. "We're keeping them alive in the back of the aircraft, a couple of thousand feet over Afghanistan, in the dark, by ourselves," says Joseph McCormick, a medic based at Bagram. "It can be kind of hairy."

The very nature of medevac means that - while they are always on call - there is a good deal of downtime, and pranks are an essential stress relief. Some are straight out of The Office: a coffeepot filled with Jell-O or a hat nailed to a table. While I was there, Maj. Jason Wilson, the medevac commander at Bagram, left his helmet's weight bag in a helicopter. He proceeded to receive a series of ransom notes, along with pictures of the bag being threatened with a pistol and waterboarded. It was finally returned to him in a flag-draped shoebox.

The porch at Jalalabad - nicknamed Club Medic - is decorated with the insignia of every medevac crew that has rotated through; the current unit has adopted a 17th-century pirate flag as its standard, complete with raised sword, grinning skull and crossbones, and winged hourglass. They call themselves Pirate Dustoff, or just Pirates. An earlier crew built a huge brick pizza oven and barbecue pit, and Rocky Blair recently made a giant pot of Texas chili with hamburger liberated from the mess hall. The only thing missing was a keg: Army regulations forbid alcohol, and medevac crews aren't even allowed to drink the nonalcoholic beer served at the mess hall, which still contains 0.5 percent alcohol and will keep them grounded for 12 hours.

Next door the inside of a shipping container has been turned into a band room, complete with a drum kit and a half-dozen electric guitars. The crews sleep in plywood shacks, and most of them keep in touch with their families at home via cell phone and laptop. All the communication technologies of modern life are available, but that doesn't make the distance or the difficulties of communicating their experiences to the folks back home any easier to endure.

Alex Scott, the Jalalabad Dustoff captain, has a wife at home in Georgia whom he talks with on Skype every day. "I talk to her, but I don't tell her all the gory stuff," he says. This is a common thread among Dustoff crews, who see more of the worst parts of war than almost anyone else. "You can't tell your wife about the missions; it'll just upset her," says Warrant Officer 2 Clinton Carter, a pilot based at Bagram who was a pro bull rider in a previous life. "It's stuff you don't want to talk about, don't want to think about." Readjusting to "normal" life can be as daunting as going to the war zone in the first place. "What's scary is you get used to it, then you get home and wonder where it's at," says Rocky Blair.

The small semblances of ordinary life are just minor distractions from the extremely dangerous work Dustoff's missions require. This is the second or third deployment for many of the crews. They flew missions in Iraq for 14 months and had been home less than a year when they were redeployed to Afghanistan. Dustoff's choppers had even flown rescue missions after Hurricane Katrina, plucking hundreds of survivors off rooftops in New Orleans. "We're like a family," says Wilson, a 39-year-old veteran of the first Gulf War with a world-weary smile and a perpetual dip of Copenhagen. "Which is good, because we spend more time with each other than with our real families."

Because their mission is to save lives, the medevac crews are cleared to fly in much worse conditions than other helicopters, and the fact that they're unarmed makes them no less of a target to the Taliban. Speed is their best defense, and flying low to the ground at nearly 200 mph gives enemies little time to react. The Black Hawks also have a decoy system: magnesium flares that trick the guidance systems of incoming heat-seeking missiles. On a flight to pick up an Afghan policeman who had been shot near the town of Asadabad, I watched in rapt horror as flares launched themselves - bright green fireworks rocketing away from the ship. Scott assured me it was a misfire, but it was a frightening reminder of the dangers Dustoff faces every day. Referring to the ship's red cross, Wilson told me, "We've got a big target on our side." The worst-case scenario is a direct hit to the tail rotor, which can put the helicopter into an uncontrollable spin, sending it plummeting to a fiery end. If the helicopter loses power, its main rotor can serve as a kind of air brake, slowing the descent. "But you'd better hope you're over somewhere good to land," Wilson adds. In the mountains of Afghanistan, there's little guarantee of that.

The challenges of piloting are great, but Wilson gives more credit to the medics in the back, who see things up close that a pilot never has to deal with. "Even as jaded and sarcastic as you get, it gets to you," he says. "I'm just an ambulance driver, but these guys back there are up to their elbows in blood and guts."

The chance to help injured soldiers is a key motivation for many in the medevac crews. It's a deep calling, and for some it's profoundly personal. Capt. Erika Noyes, 26, with bright blue eyes and her hair tied up in a bun, is on her second deployment as a Dustoff pilot, having spent 14 months in Iraq. She graduated from West Point in 2005, in the same class as her boyfriend, Tom Martin. She joined air medevac straight out of college, while Martin became a sniper-scout platoon leader. They were soon engaged, with plans for a big wedding when they finished their deployments. In fall 2007 both were in Iraq, with Noyes' unit operating in support of Martin's.

On October 14, 2007, a nine-line call came in for an urgent injury. Noyes was on duty that night, and as soon as she heard that a sniper-scout platoon leader had been hit, "I knew it was Tom right away." She ran to pack her gear so she could meet him at the hospital, but a few minutes later there was a "commo blackout," the Army's policy of shutting down communications when a soldier has died to prevent unofficial word from reaching their families at home. Tom had been shot. Medics worked heroically to treat him, both on the ground and in the air, and the Baghdad combat support hospital where he was flown followed suit, but he was declared dead shortly after arriving. He had turned 27 just a few days before. Noyes went to see his body in the hospital morgue. In the bag of personal effects she was handed, she found his class ring from West Point, and slipped it over her thumb. Her eyes mist up when she shares the story, but she keeps her composure. Telling and retelling Tom's story is therapeutic in some way. "It keeps his memory alive," she says.

After the funeral Noyes was offered a chance to be transferred out of the war zone, but she refused. "I was going to be miserable no matter where I was," she says. "At least if I was in Iraq, I stood a chance of helping somebody else. And potentially that next person we picked up would be somebody else's Tom."

As a senior in high school, Zack Blansett was a football player unsure of what he wanted from college; he felt that joining Army would help him mature a bit while serving his country. He was interested in the medical field but also liked outdoor sports, so "combat medic" seemed the right career choice. "I left for basic training two weeks after I graduated high school, and I haven't looked back since," he says. An 18-week course certifies a ground medic, teaching how to control bleeding and other basic medical skills. Flight medevacs go through four more weeks of extensive individual training, and after Blansett was wounded in Iraq he returned to train for Dustoff. He's now been a medic, on ground and in air, for six years. Just a week ago, he was called on one of the riskiest mission he has ever flown.

Forward Operating Base Blessing, an outpost in neighboring Kunar province, comes under almost daily fire from insurgents. On February 8, right in the middle of some of the worst weather of the winter, a mortar round crashed through the roof of the base's gym, killing a contractor and causing a severe concussion to a young soldier. If he wasn't evacuated, his chances of survival were minimal.

Flying conditions were terrifying, with no missions in or out for three days. "Ceilings were on the ground, and visibility was about a half-mile," remembers Alex Scott. Despite the risks, a crew went out, with Blansett as medic and Tori Wade and Jeff Roberts as pilots. On their first attempt, they were turned back by the weather, but they landed and refueled, desperate to try again. The second time they made it, and the soldier is expected to make a full recovery. Wade, a female pilot with five years of experience, said it was the second-worst flying conditions she'd ever witnessed, after a freak snowstorm over Baghdad that nearly caused a midair collision with Alex Scott's helicopter. To Scott such risks are the essence of Dustoff's job. "If we hadn't flown that mission, nobody would have thought less of us," he says. "But that soldier could have died." He's recommending Wade and Roberts for the Distinguished Flying Cross, one of the highest honors a pilot can receive.

One afternoon at Bagram, a call is received for a priority transfer, and a pair of Black Hawks fly out over the Hindu Kush to the hospital at Salerno, a base 70 miles away. Two U.S. soldiers need to be brought to Bagram for treatment after their vehicle was struck by an improvised explosive device, or IED. The flight's medic, Joseph McCormick, oversees the soldiers as they are wheeled onto the helipad. McCormick, a 33-year-old from St. Petersburg, Florida, tends to them in the cramped back of the helicopter. He works in dim blue light, so as not to interfere with the night-vision goggles used by the pilots up front. McCormick crawls between the soldiers, making hand gestures to check their condition over the roar of the rotors. If they don't respond through the haze of morphine and valium, he'll slap them until they do. It can be an exhausting, difficult place to work, and if patients flatline in flight it's up to the medic to attempt CPR, defibrillation, anything to save their lives.

It's not only U.S. soldiers the medevac units are responsible for. A recent mission involved transferring an injured service dog that had been tangled in concertina wire. Dustoff has rescued local children hurt by Soviet-era land mines and Afghan soldiers and civilians, even wounded Taliban. One afternoon a mission is called in for an enemy prisoner of war transfer. A pair of Black Hawks land at Camp Salerno, and flight medic Keith Rudd climbs out of the helicopter and makes his way into the hospital. On a bed surrounded by life-support machines, a young Afghan lies with a glazed look in his eyes. A ventilator tube snakes out of his throat as a machine pumps air into his lungs. He was shot by a U.S. patrol while placing a roadside bomb.

A soldier whose truck had been blown up in the same spot a few days earlier had helped the medics save the insurgent, whose intestines were spilling out of his bullet wounds. This was a person who was actively trying to kill them and their comrades just days before, but Army regulations require that all patients be given the same level of care. "They're killing our brethren. I'll do my job, but I don't have to feel it here," Rudd says, tapping his heart.

The Jalalabad Dustoff shares its headquarters with the Apache attack helicopter crews, and a good-natured sibling rivalry exists between the two. All pilots, even the female ones, have a macho demeanor, but Apache pilots are a breed apart. One of them jokes about the medevac choppers being mere "flying taxis" compared to the Apaches' "two-seated attack platforms." Tori Wade, a female pilot, retorts, "Watch out or I'll put you on the ‘do not pick up' list." "I wasn't planning on getting picked up," says an Apache pilot. "Nobody ever plans it," says Wade.

Apaches certainly have some bragging rights. They are among the most efficient killing machines ever devised, carrying a dizzying array of weaponry: 30 mm cannon with exploding rounds, Hellfire missiles, and rockets loaded with white phosphorus high explosives or fléchettes, which are essentially razor-sharp darts. They are frighteningly effective.

By nature the war is imbalanced, with 21st-century weaponry fighting a scattered and battle-hardened insurgency often armed with rusting Soviet machine guns and deploying roadside bombs and suicide attacks. On a level playing field there's no contest, but as one pilot memorably puts it: "Them Talibanese fuckers ain't dumb."

A 25-year-old Apache pilot, so baby-faced he still gets carded for tobacco, sits at a monitor watching video of a recent mission. The display shows an infrared image of three figures sprinting down a mountainside. They are Taliban fighters who have just narrowly avoided being killed by a 500-pound bomb dropped by a fighter jet. The pilot is hovering a mile away, watching their every move. A small laser-guided cross follows the group as he secures permission to launch a Hellfire. A black dot drops in from the upper corner of the screen, and the three men are obliterated in a bloom of white fire.

The footage is surreal, like a nightmarish video game with real-world deaths, and the Apache pilots have made a greatest-hits album of sorts from such missions, commonly called "Apache porn," set to a soundtrack by Slayer. This is his first kill, and he's indignant when the Air Force tries to take credit when clearly they missed. Between the bomb and the Hellfire, it was an expensive hit, perhaps $100,000 in munitions on three raggedy Taliban. But such is the nature of the war. He doesn't worry too much about the larger implications of taking people out; this is the job he has trained for years to do. "I don't lose any sleep over it. They're the bad guys," he says. "There's consequences for being a dumb-ass."

Although a crucial part of the war may now be conducted by remote-controlled drones or from the Xbox-like distance of an Apache, the work of Dustoff is still as hands-on as it gets, and a
willingness to push the limits, of both themselves and their aircraft, is essential to the job. If someone is wounded, the men and women of Dustoff will do whatever they can to help them. It's as simple as that. An early experience caused a great deal of frustration in this regard. On October 9, a remote outpost called FOB Keating came under a massive coordinated attack. Three hundred Taliban fighters swarmed at the camp from two directions with mortars, RPGs, and heavy machine guns.

Dozens of U.S. troops were wounded, but because the base was still under attack, the riskaverse
higher command wouldn't let medevac flights in. The Dustoff Black Hawks were forced to wait for hours before gaining clearance to gather up the wounded . "It was a mess," says Alex Scott. "It finally came down to us getting into a shouting match with the task force commanders. Then they let us go." Blansett still resents being held back: "We could have saved people if they'd allowed us in. There were two fatalities at the beginning of the day, and there were eight at the end of the day." By now they feel like they've earned the trust of their commanders to decide just how far they can push themselves; the bad-weather rescue mission was clear evidence of that. "We showed these guys we could basically pull a rabbit out of a hat at will," says Scott. Their sense of confidence and determination is enviable, at least in a war where clarity of purpose is a rare commodity.

While the U.S. military in Afghanistan is desperate to avoid civilian casualties, the other side plays by an entirely different set of rules, where any American death can be used to their advantage. Dustoff flies unarmed into the heart of a war zone - risking all to help injured Afghans - but it's unclear yet whether that strategy is paying off in goodwill.

Whether the coalition policy of trying to win Afghan hearts and minds ultimately ends the war or becomes another cruel irony in the bloody march of the country's history is yet to be seen, but as long as the U.S. is there, the air medevacs will be flying their missions. On the porch in Jalalabad and the hangar at Bagram, the Dustoff crews will sit around and tell the endless stories they have collected: the unfortunately named Captain Brown, who crapped his flight suit in a helicopter; the ambulance driver in Baghdad who was knocked out cold when the propeller wash slammed his door open; the lucky medic who accidentally stabbed himself with an auto-injector of morphine. The stories and trash talk and camaraderie will fill the hours (which get shorter and shorter as the summer season picks up) before that robotic voice crackles once again over the radio: nine line, nine line, nine line. And then they'll drop everything and go.

Matthew Power. M*A*S*H Elevation: 10,000 Feet. Maxim [Print + Kindle] . May 2010.

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