by Alex Duncan
That concept delivered a senior doctor and paramedic to the scene of major traumas – traffic collisions, shootings, stabbings – where they were able to perform life-saving surgical and medical interventions, stabilising patients for transfer to major trauma centres. It’s well established that the victim’s chances of survival increase markedly if they receive care within a short period of time after a severe injury – the so-called ‘Golden Hour’ of trauma medicine.
The Chinook is the helicopter of choice for the IRT in Afghanistan due to its capacity to transport people and kit and get them where they are most needed – fast. The IRT team includes the MERT (Medical Emergency Response Team), which consists of up to four paramedics or senior nurses, usually led by a consultant anaesthetist or surgeon. They can be supplemented by two or three members of the resident RAF Fire and Rescue team, equipped with cutting equipment and other heavy-duty hydraulic gear – useful if troops are trapped inside the wreckage of vehicles following IED strikes. Finally, on every flight the IRT carries an element of force protection – soldiers from 3 Para whose job is to deploy as soon as the cab is on the ground and protect the aircraft and the medics as they work to get the casualty on board. The IRT is not an air ambulance; it’s a flying, fighting ER.
It’s a tough environment for the medics to work in – the back of a Chinook in the skies over Afghanistan has to be the most traumatic operating theatre in the world. It’s cramped; it’s dark; it’s hot and noisy. Also, it’s not the most stable of platforms, particularly if we’re flying tactically. Then there’s the prospect of turbulence, and the buffeting of the wind through the side doors and the open rear of the cab. All this, and then the threat from Taliban fighters on the ground firing small arms, heavy machine-guns and RPG rounds at the cab. At 99ft long, it represents a big and potentially valuable target to the Taliban, who will stop at nothing to bring one down; they’re a veritable bull’s-eye in the sky.
There’s a disconnect on board the Chinooks between us, in the Plexiglass-walled goldfish bowls that serve as the cockpit, and our crewmen in the back of the aircraft. We need to see in front, above, around and below and you can’t armour the glass – it’s too heavy. The fuselage which serves as home to the loadmasters, though, is Kevlar-walled and floored, giving them and their cargo – be it soldiers, medics or kit – a degree of protection. And they need it; they’re there to look after the safety of the passengers and the aircraft.
If they’re not manning the guns, the crewmen usually assist the medics in trying to stabilise badly wounded casualties. Often they’ll be confronted with a horrific collage of powdery dust, bodies, blood, appalling injuries and piercing screams. Their work environment is loud, dusty, hot, cramped and chaotic. By contrast, we’re screened off by a canvas curtain, cocooned in our glass-encased cockpit, connected to the maelstrom behind us only via the audio in our headphones. Amid this disorder, it’s our job to remain calm and composed, wringing clarity from the confusion so that we can get the cab and everyone in it back to the relative sanctuary of Camp Bastion where the casualties can be attended to by a full surgical team at Nightingale, the ten-million-pound state-of-the-art medical facility with its own HLS (helicopter landing site).
The IRT is a 24-hour, 365-day-a-year service. It lifts British soldiers, ISAF troops, members of the Afghan army and local civilians. It also flies to treat members of the Taliban. And as dogs play an extremely important role alongside British forces (they are able to sniff out roadside bombs and hidden ammunition stashes, but this also means that they are at risk of being hurt by Taliban fighters or IEDs), it will also recover them too.
Medicine, like justice, is blind.
Dogs injured in Afghanistan are flown to Camp Bastion, just like human soldiers. Humans take priority but injured dogs are rushed back as soon as possible and are taken to a small vet unit at Camp Bastion where two British vets can carry out emergency surgery. If longer-term treatment is needed they are flown to a veterinary hospital in Germany or to the Defence Animal Centre.
You hope for a quiet day when you’re on duty because it means nobody needs you, but from what Nichol tells us, days like that are rare. They’ve been averaging four call-outs per day. It’s a dynamic environment; sometimes you don’t know where you’re headed until you’re airborne. And since, more often than not, you’re flying in to pick up troops who have been shot or blown up, it’s pretty certain that the same people that attacked them will want to have a pop at the big Chinook when it comes in to land.
Two Chinooks and two Apaches were on immediate readiness to respond, and for the duration of our tour on the IRT we would live and sleep in the IRT tent. It wasn’t the height of luxury, but it was nothing like the basic privations that the lads on the front line had to put up with either. The tent was air-conditioned, with a Rola-Trac floor and eight cots. To help kill time, we’d have a fridge freezer for keeping food and drink cold; a well-stocked tuck box and kettle, with tea and a selection of coffees; big-screen LCD TV connected to BFBS, the British Forces TV channel, via satellite; a DVD player and library of films; books, magazines and a games console. I don’t have this much stuff at home! The duty Apache crew and the MERT each had their own tents with a similar set-up. A short ladder took us over the Hesco wall, down the other side and across the dusty road and directly opposite was the JHF (A) Forward ops tent where we’d get our orders.
We would be living at the mercy of the phone. Two short rings means an admin call, but two long rings means a shout. If you need to shower, you go one at a time and take a radio. Ditto if you need the loo. And the same if you go for meals (although you can go en masse for those).
There were worse places to kill time.
9
HERCULEAN LOSS
It’s been a quiet day so far.
‘Fancy a brew, Frenchie?’ Nichol asks.
‘Nah,’ I reply. ‘But you can get me another bottle of water from the fridge. I’m fucking gasping!’
‘Hello Bond, this is Blofeld. Our location now,’ says the disembodied voice of the Joint Operations Centre (JOC) Watchkeeper from the radio.
‘Fuck it, no time for a brew now,’ says Nichol. ‘Come on fellas, we’ve got a shout.’
Jonah and I get into the Land Rover that sits baking under the high afternoon sun outside our tent. Its thin metal skin burns my hand as I open the driver’s door. While Nichol and Craig run to the JOC to get the details of the job, Jonah and I drive to the IRT cab to get her going.
I abandon the Landy at the edge of the pan and rush across the hard standing to the aircraft. ‘Christ!’ I think, as I see the MERT team sorting their kit inside the aircraft, ‘I wasn’t hanging about and they’ve beaten us here. Impressive.’
I do a quick walk-around, checking everything is as it should be – latches closed, no leaks, wheels okay, and no seepage of hydraulic fluid on the brakes. I also flick the FM aerials too; I’m a bit OCD about that and part of me thinks, ‘If you don’t flick the FM aerials you’re going to crash, Alex.’ I’ve always flicked them and I’ve never crashed – so, QED, it must be effective.
Pilots, superstitious? Who knew?!
On IRT, you set the aircraft up when you take over duty, so most of the pre-flight checks are already done – time saved on the ground translates into a faster arrival time. My flying helmet sits on the centre console and my SA80 carbine is strapped to the side of my seat. My personal issue 9mm Browning lives in a holster on my thigh, but to be honest, if it ever comes down to a situation where I’d need to use it, I’d probably be better off throwing it instead of firing it. Everything is as we left it last night.
I climb into the right-hand seat, which I’ve already adjusted for height and reach, and secure myself into the five-point harness. ‘Helmets,’ I shout, signifying to Jonah that all conversation now will be via the intercom.
I mentally run through the pre-flight checks. A few minutes later, Nichol arrives with Craig and straps in. The engines are already up and running, the rot
ors turning, after start checks complete. All good.
‘Okay, one of our Hercules C-130s has crashed at Lashkar Gah airfield about fifteen miles from here. We’ll route with the AH, which is just starting up. We’ll climb to height as soon as we depart Bastion and the Apache will follow us. He’ll probably lag behind because we’ll be at max chat. When we cross Lashkar Gah we’ll turn away from the airfield, so we’ll get good “eyes on”, then we’ll make our descent and run towards the airfield.’
‘A Herc’s crashed?’ I ask. ‘What the fuck?’
‘Details are pretty sketchy at the moment, but it appears that it struck a mine under the runway on landing and exploded shortly after.’
‘That runway at Lash isn’t actually inside the base; it’s a couple of miles away. The Brits only patrol it when flights are inbound and taking off, otherwise it’s down to the ANP, so I imagine the security is pretty lax,’ offers Jonah.
‘We’ve got authorisation, so lift when ready,’ Nichol tells me.
Ah, the weighty question of authorisation. If it was down to us as crew, we’d lift for every single ISAF casualty the minute we have a location, but it’s never that simple to the higher-ups who have to balance the potential loss of a cab, its crew, the MERT and the QRF team against the life or lives that we might save. They say that with rank goes responsibility and I guess that authorising the launch of the IRT is a graphic illustration of that maxim.
‘Okay, we have six QRF and the MERT onboard. Clear above and behind,’ says Craig.
‘Lifting,’ I say, pulling power. The Chinook lifts gracefully and effortlessly into the sky. Fifteen minutes from first call to lift-off.
Nichol calls Bastion to let them know we’re on our way: ‘Buzzard, Hardwood One Three, airborne on task at this time.’
I’ve just turned towards Lashkar Gah, which is no more than ten minutes flying time away, when the plan changes.
‘Hardwood One Three, Buzzard. Change task. Footballs have been evacuated by vehicle to Viking. You are to route to Viking, pick up footballs and return to Normandy. Confirm copy?’
Nichol okays it and plots me a route to Viking, the British base at Lash, rather than the airfield. The ‘footballs’ are casualties and Normandy is Bastion. Straightforward enough.
‘Okay mate, we’re going to approach from the east,’ Nichol advises me. ‘You okay with it?’
I have a pretty good idea where Lashkar Gah is. I remember some markers on the run in from my TQ, so I say, ‘Yeah, all good.’
The early evening haze lends everything a warm glow as I make my run in. The markers are all there: bright pink house; blue school; across the big avenue with a right turn at the big green house; pass the right-hand side of the mast; re-cross the avenue again for a left-hand turn and a quick stop and flare at Lashkar Gah.
Lesson one: Afghanistan isn’t the UK, so air density and temperature mean the flare isn’t going to be anywhere near as effective in scrubbing off my speed here as it is at home. My hands have just written a cheque that my talent can’t pay.
It’s a very public way of eating humble pie, but there’s nothing else for it: I swallow my pride and overshoot, flying us through the HLS, a quick teardrop around, and I land on with Nichol looking at me, a wry smirk on his face. Oh well, I got us down. And I won’t be making that mistake again!
We take on six casualties, all walking wounded but none serious. We’re advised that there are more en route from the crash site, so Nichol makes an executive decision that we’re not going to wait for them. It makes more sense to drop off the casualties we have and fly back for the others. If all things are equal, we should get back to Viking at the same time as the rest of the casualties.
So I lift and fly us back to Bastion. When I land at Nightingale, the ambulances are already waiting for us and swiftly move the casualties. There’s no major trauma – some bruises and shock but that’s about it.
More details come in as we sit on the pan at Bastion doing a rotors-turning refuel. The Hercules had flown from Kabul with an armoured car for the governor of Helmand on-board, along with seven aircrew and twenty passengers, including the governor’s brother and His Excellency Mr Stephen Evans, HM Ambassador to Afghanistan. It was also carrying a sizeable amount of cash, which was destined for local warlords in exchange for their influence and intelligence. Apparently, the aircraft had barely touched down on the dirt runway when it was engulfed in flames, sending black smoke billowing into the sky. Afghan fire-fighters tackled the blaze, but ammunition in the hold was cooking off and exploding. When the fire was extinguished, all that remained was the Herc’s tail section and the burnt-out carcass of the bullet-proof car.
An investigation later concluded that the aircraft was destroyed after detonating an anti-tank landmine buried in the surface of the runway, resulting in aircraft debris puncturing the port wing fuel tanks, leading to an uncontrollable fire. The aircraft captain managed to evacuate all the aircraft’s passengers without major injury.
By now, it’s early evening. The light is fading but it’s not dark enough to warrant using NVGs. Nichol errs on the side of caution and tells the guys down the back to get them ready; if we’re delayed for any reason at Lash, we’ll need them for the return leg of the sortie.
Refuelling complete, I lift to height and fly us on a different route to Lashkar Gah – if the Taliban have eyes on, it’s common sense to vary the direction of your approach. My route in is much better this time around – I pick my markers and come in from the south with a low-level sweeping left-hand turn that scrubs off our speed in plenty of time. This time I don’t overshoot, and land on the target with a perfectly executed descent.
Some of the casualties from the crash are there when I touch down, but a handful are still on their way from the crash site, so we end up turning and burning on the HLS for ten minutes waiting for them. We don NVGs for the flight back, although the light’s at that annoying level where it’s not really dark enough for the goggles to be effective, but it’s too dark for the Mk.1 Human Eyeball to see properly. It’s not ideal for my first operational ‘night’ flight in theatre, but then this is a war zone and let’s be honest, nothing is ideal here.
It is 22:00 by the time I land on at Nightingale. The casualties are transferred to the hospital and I transition to the pan, where we put the aircraft to bed. So concludes my first operational sortie in Afghanistan where I did something useful.
We’re on sixty minutes notice to move on the IRT at night, thirty during the day, although the crews are always much quicker than that.
I remember thinking: ‘If it carries on like this I might be able to cope with this Det.’
If. Such a small but significant word.
10
EYES WIDE SHUT
The next few days did nothing to dispel my optimism that my first Afghan Det was going to be relatively benign. I’d had a quiet first twenty-four hours on the IRT, and the following days saw some pretty routine taskings on the HRF. It was all good experience for me, as I was a far less capable pilot than I am now and some of the dust landings took me right to the edge of my ability. It was a steep learning curve, but flying with Nichol really opened my eyes to what was possible. He was, and is, an incredibly skilful pilot.
That first mission on the IRT opened my eyes too, in other ways. Having flown on ops in Iraq, I was used to flying in body armour, with my own sidearm and carbine, but I guess I’d never really considered that nurses and doctors would have to do the same. It’s pretty fucked up when you think about it, doctors and nurses carrying weapons, because although they work within the accords of the Hippocratic axiom ‘Primum non nocere’ – ‘Above all, do no harm’ – they may be forced into taking a life in order to preserve one.
I was getting into my stride on the admin front too. Communication with home was quite good, considering. We had email, and every soldier, sailor and airman in theatre got twenty minutes a week of free phone calls (since increased to thirty minutes). Alison and I were l
uckier than most – because of her role in the Cabinet Office, she had a phone on her desk connected to the Military Network so we could talk pretty much at will.
The next couple of weeks passed in a blur, with quite a few taskings which, although they threatened much, didn’t come to anything. They were all instructive and educational in their own way though, whether in terms of improving my skills as a pilot or opening my eyes to the weird and bizarre reality of life in Helmand Province. I flew a sortie on May 25th with Nichol which had me a bit worried, because it was the first sortie I’d flown where there was a clear and present danger from the Taliban.
A 3 Para platoon had gone out on a recce just north of what would later become the HLS at Sangin. They were patrolling in vehicles and a Pinzgauer High Mobility ATV had become bogged down at a wadi where it crossed the Helmand River. It was causing Lt Col Stuart Tootal, the 3 Para CO, a rather large headache, and we were in the frame to be his painkiller.
The mission was a good example of the ‘small picture’ effect, and the frustration that it puts on those of us at the lower end of the command chain. There were probably very good reasons why Col Tootal wanted the vehicle recovered, but we couldn’t for the life of us imagine what they might be. To me, the solution seemed simple, and I said as much to Nichol as we were flying in towards the stricken truck: ‘Can’t we just drop a bomb on it and deny it to the enemy that way?’ He was of the same view, but those at the JOC had other ideas.
So we flew on in tactical formation with the Apache, call sign Ugly Five Zero; our mission, to deliver some troops from the JHSU (Joint Helicopter Support Unit) to assess what the options were for recovering the Pinzgauer. We were flying well above the threat from small arms fire (SAFIRE), but there are other threats, and the Apache was picking up a lot of what we call ICOM chatter – basically, radio traffic between Taliban groups. The radio intercepts told us that the Taliban were moving into position and were about two klicks away; they’d been seen with weapons and heard saying that they wanted to have a go at the aircraft.