MAIWAND, Afghanistan — He arrived wrapped in green foil and laid out on a litter, like some terrible gift from the men who tried to kill him.
The commander of an Afghan army company, he had been struck by the blast and shrapnel of a roadside bomb while on patrol and carried to a U.S. aid station for treatment. Flight medics now loaded his litter into a Black Hawk helicopter and tore open the foil wrap as the aircraft lifted. The blast had nearly amputated the left leg above the knee. A makeshift tourniquet torn from an Afghan uniform had been wrapped above the wound; bandages swaddled a bloody head.
A medic placed a breathing mask over the man’s face and squeezed the bottle at regular intervals. Another handed a bag of saline to the armed U.S. soldier escorting the casualty and shouted over the whir of the helicopter rotor.
“Squeeze it!” he yelled.
The soldier pressed the bag between his hands. The medic shook his head and motioned with his hands as if choking someone.
“No, SQUEEZE it!” he shouted.
The soldier squeezed with force this time, pressing the solution into the man’s body as the medics continued their work.
At a time when much of the ground-level U.S. role in Afghanistan is receding, medical evacuation crews like this one, the 4th Platoon, Charlie Company, out of Fort Riley, Kan., continue to play a major part in the conflict, providing a service that Afghans appear incapable of fielding on their own.
The platoon ran close to 40 missions in the two months after arriving in this rural district outside Kandahar city, nearly all of them for Afghans with wounds like those of the company commander, who was picked up in October. Most cases bore the hallmarks of insurgent attacks: the amputated limbs, shrapnel wounds and burns from roadside bomb attacks and the gunshot wounds from drive-by shootings.
U.S. units continue to pull back as the 2014 deadline for combat troops’ withdrawal approaches, raising questions of how Afghan casualties will fare without U.S. assistance. But for now, U.S. commanders continue to provide a vigorous medevac effort in the hopes of encouraging Afghans to fight, particularly before a critical presidential election in April.
“It’s a tough mission to convince a young man to go out there,” said Col. Matthew Lewis, commander of the 1st Combat Aviation Brigade, the 4th Platoon’s parent unit. “But if you know you’re going to be evacuated, if you know that someone’s got your back, you’re more likely to go out and do your mission.”
Ensconced in a corner of the base near the helicopter landing zone, 4th Platoon’s living area is a self-contained compound of anticipation. Crew members live, eat and sleep within a short radius of their Black Hawks. They carry radios in the bathroom and shower and generally stay close to the operations center, where incoming calls are taken.
Their experience with medevac varies. Staff Sgt. Omar Anderson, the platoon sergeant and a medic, deployed twice before as a flight medic, both times to Iraq. Others, like Pfc. Anthony Zacarias, a crew chief from El Paso, Texas, are on their first deployment.
“You never know how you’re going to react until you see your first patient with amputations and all that,” Zacarias said. “I didn’t take it bad.”
Their calls are typically for “Category A” patients, or those with the most severe wounds and the shortest window for survival. Soldiers and policemen, they have often been maimed by roadside bombs and gunshot wounds while on patrol or manning checkpoints. Amputations are common, blood loss a big concern.
The previous unit in Maiwand warned them they were busy every day. But 4th Platoon found that after an initial busy stretch, the tempo slowed as the fighting season let up.
The radio went almost silent during an eight-day stretch in October. Crewmembers worked out, read, played video games and sat around the fire pit at night. They decided to binge-watch “The Walking Dead,” a television show, starting with the first season.
“Everybody is fighting the boredom,” said Capt. Joel Kovach, the platoon leader.
A nearby aid station finally called with a heads up, and crewmembers crammed into the operations center to await confirmation. In silence, they leaned against the wall and sat on desks. Anderson poked his head into the room.
“Why is everybody in here?” he said, with a grin.
The confirmation came, then the radio report: “MEDIC-MEDIC-MEDIC.”
“Here we go!” Zacarias yelled as he raced out of the operations center and toward the helicopters.
Afghan battlefield care remains in the earliest stages of development. Nearly a third of Afghan soldiers and close to 40 percent of police casualties died from their wounds between April and September, according to a Defense Department report released in November. That’s an improvement from the same period in the previous year, it says.
Lt. Col. Jeff Klotz, an Army doctor who runs the U.S. aid station in Maiwand, has seen most of the patients delivered to the station by Afghans since he arrived in August. Wounds are often more severe due to deficient protective gear. A lack of medical equipment and some cultural taboos make matters worse, he said. Amputees arrive without tourniquets to stem blood loss. Wounds are improperly dressed. Clothing is left untouched for fear of exposing the body.
Even Afghans’ best efforts are often misguided. Klotz recalled one man brought in after accidentally shooting himself in the hand.
“They didn’t put any dressing around the wound itself,” he said. “They took a piece of cloth ripped off a shirt and wrapped it around his wrist as a kind of make-shift tourniquet. It stopped the bleeding a little bit, I guess, but it was unnecessary and ineffective.”
At the Afghan aid station next door, Dr. Fazalurahman, a thin man with a wispy beard, eagerly gave a tour of his facility. Oxygen tanks rested against the wall of the operating room, with boxes of gauze and bandages stacked on nearby racks. A closet-sized room with shelves of medications served as the pharmacy.
Fazalurahman, who like many Afghans goes by one name, said most police and soldiers lack medical supplies, which is why casualties sometimes don’t get proper care on arrival. The brigade handed out tourniquets awhile back, and he had requested more.
“Most soldiers have already used their tourniquet, and they don’t have any more,” he said.
The lack fo care for incoming patients was underlined one day at the clinic, as an Afghan truck arrived carrying two badly wounded soldiers. The pair had struck a roadside bomb while on dismounted patrol. One, a double amputee, lay dead on a table shortly after arrival. He had come in without tourniquets and had lost too much blood.
An order for medical equipment supposedly resided with the Afghan National Army corps responsible for soldiers at the base, and U.S. officials expressed hope it would arrive in the following months. U.S. commanders, meanwhile, asked a combat unit on base to check whether the Afghan units they work with carry tourniquets on them, as American soldiers are required to do.
Even with proper tourniquet use, the aid station will struggle to get its patients to a better clinic without air evacuation, Fazalurahman said. The nearest hospital is 80 kilometers (50 miles) away. The closest thing to an Afghan medevac unit, the Kandahar Air Wing, has only a few helicopters and doesn’t fly at night.
The urgency for a solution is rising as the end of 2014 approaches and casualty rates remain high. The Afghan National Army’s Medical Command is finalizing a medevac plan, according to the DOD report. Their greatest need is clear to many Afghans. “The helicopter, that’s the only thing we don’t have right now,” Fazalurahman said.
After receiving their first call in more than a week, the 4th Platoon medics set to work before the helicopters were off the ground, connecting blood tubing, hanging it from brackets on the ceiling and opening a blood warmer. Flight medics began performing blood transfusions on board last year.
The platoon’s lead helicopter landed, its doors opened, and after a brief wait, two litters were placed inside. One man had a blackened face, charred with severe burns. The other was ghostly pale and missing both legs. He occasionally sat upright as if looking toward his missing limbs, and he thrashed as the crew tried to put an IV in his arm.
“Americans are more laid back,” one of the medics, Sgt. Gaston Garcia said. “They know you’re trying to help them. These guys don’t know what’s going on. They’re in an aircraft. They’re scared.”
The helicopter landed at the Afghan military hospital, unloaded the two patients, refueled and headed back. The mission lasted just over an hour, door to door. Flight time with the patients was only 16 minutes.
Crewmembers cleaned and restocked the helicopters, and they returned to their compound to clean up, grab food and gather for a post-mission review.
“That’s good work for going a week without a (mission),” Kovach told them. “So good job everybody for not getting complacent.”
No one knew when the next mission would come, and few would openly wish for it. As much as 4th Platoon enjoys flying and being on mission, crewmembers knew it came with a downside, said Chief Warrant Officer 3 Daniel Dahl.
“Every time we fly, someone else is having a bad day,” he said. It’s an honor to be able to fly those guys, but I wish we didn’t have to fly them.”
Stars and Stripes reporter Josh DeMotts contributed to this report.