Most major powers, and many minor ones, now have their own antiterrorist teams. Many have been trained by the SAS. These were the so-called ‘team jobs’ where small groups of SAS antiterrorist experts would spend three months in a distant land, teaching local forces how to deal with siege situations. Buildings, boats, buses, trains, airplanes - they were all fair game. Medical training would form a significant part of a team job. It was not all about how to inflict injury, but how to treat it as well.
The secret of antiterrorist medical cover lies in good preparation. Though it may be exciting to think of hooded operatives blazing their way daily through doors and windows of embassies, real life is different. The requirement for antiterrorist troops is infrequent. A lot of time is spent training for that very rare operational requirement. A man may rehearse for several years for sometimes less than one minute of antiterrorist action. That action may be politically very sensitive, with the eyes of the world focused on the event. There is no room for error as both lives, and careers, depend on a successful outcome. Training is therefore taken seriously. This applies as much to the medical support as it does to the operatives. Antiterrorism gave me very little medical work throughout my time with the SAS, but occupied many hours in planning, negotiation and preparation. Terrorist events anywhere in the world are closely followed by all antiterrorist teams, wherever they may be, so that everyone concerned may gain maximum value from the experiences of a few.
Medical problems are diverse. Gunshot wounds, GSW, are a possibility. If the teams have performed their task efficiently, it is likely the wounds will only involve terrorists and are most probably fatal. For a doctor there is little to do except ensure a reasonable supply of body bags. Operatives train both by day and night to ensure they can reflexly distinguish a terrorist from a hostage so that only the bad guys suffer. It is not easy.
Burns and smoke inhalation are more likely. A hostage may not be able to escape, either due to terror or being forcefully immobilized by his captors. As soon as the action is complete, it is therefore vital that all innocent parties are evacuated speedily, taking care that no terrorist tries to mingle with escaping hostages. This occurred at the Iranian Embassy siege. Medically, one needs oxygen nearby and a good supply of sterile dressings to cover burned areas. Severe burns will also need an intravenous drip erected as the exposed raw flesh exudes large amounts of serum, causing shock and a fairly rapid death.
In the early days of antiterrorism, the psychiatric side was largely ignored, teams concentrating on the practical aspects of winkling out terrorists from awkward locations. However, everyone is affected in some way at a terrorist incident - hostages, terrorists and antiterrorist forces. Most civilians have never been in a position where they fear for their own life and will be unfamiliar with the terror such a feeling can create. It comes as a rude shock to many with possible profound psychiatric difficulties subsequently.
Before any assault goes in, it is natural the security forces would wish to build up a picture of what is going on between hostage and terrorist. This is where the whizz kids are needed. The intelligence services would provide technical assistance. All manner of gadgets would appear — cameras in walls, listening devices, thermal- imaging cameras. The flaw in the system was the military skill of the technicians themselves. However fancy the gadget, if you cannot position it silently and effectively, then it is no use. The terrorist will detect it and your lack of tactical skill may bring the situation to a head sooner than is safe. Whatever the technology, there is no substitute for basic military skills. Stealth, camouflage, weapon recognition, are all time-honoured techniques, but just as vital to the outcome of a siege as the most modern, whizz-bang device.
Clearing a building of hostages and terrorists is a noisy event. It can be deafening. Not only are you completely disorientated, but you cannot hear for minutes afterwards as a result. Hearing loss is something the Army now takes particularly seriously, though for years the effect of loud bangs on the human ear was not fully understood. They have been forced to comprehend by the large payouts made to sufferers. Generations of soldiers have been exposed, unprotected, to high-volume noises. In my early years of training, ear-defender devices barely existed. Now they are commonplace and insisted upon. There is one major flaw — you cannot use ear defenders happily on true active service. The same applies to realistic, live training. It is impossible to hear the enemy creep up on you when your ears are covered. Particularly at night, a soldier relies heavily on his hearing. Because of this, many will leave their ears unprotected in every scenario except a range. It is difficult to connect any one incident with deafness as its appearance is usually delayed, rather than being a major problem at the time. It is a terrible handicap.
On one occasion, I was practising close-quarter battle at an urban range on Salisbury Plain. The Army had rigged a complete town to look like a street in Northern Ireland. As I dashed up the main staircase of one building, Browning pistol in hand, but wearing neither respirator nor ear defenders, someone lobbed both stun and smoke grenades in through an open window. I did not know what hit me. Not only was the noise truly painful, but the smoke totally penetrating. I could not breathe. Stuck in the building, disorientated, I realized I had problems. It would be so easy to choke to death. I could not see where I was, the smoke was so thick. All I could do was lie on the floor, mouth wrapped in a grimy handkerchief, coughing and spluttering until the air cleared. I remember the smoke being gritty, full of particles I could almost chew. It took a week for my hearing to recover and two months for breathing to return to normal. If I become a deaf, respiratory cripple in years to come, I know exactly who I shall blame.
The Army, and the SAS, have designed many ways to remove unwilling opponents from buildings. Gas is particularly effective, provided those you are fighting do not have a respirator. There are different types of gas, some designed to kill, others to incapacitate.
Because of the genuine threat from certain overseas powers, not counting the antiterrorist requirement, how to behave in a gas-contaminated environment is widely practised in the Services. Called ‘NBC’ - Nuclear, Biological and Chemical - you must be able to function in all ways while fully kitted out in respirator and protective clothing, the noddy suit.
There are various ways in which a gaseous agent can penetrate your body. For most antiterrorist and riot situations, the agent is either inhaled or irritates exposed areas such as the eye conjunctiva and open mouth. The instant feeling when CS gas affects you is of burning eyes, tight throat and copious dribbling. It is most uncivilized and totally incapacitating. It is worth remembering that CS deaths have been suggested. In previous wars, though not with antiterrorism, blister agents have been used. These can be delivered in droplet form, causing blistering of any living tissue the tiny droplets touch. When inhaled, blistering can irreversibly damage the lungs. Sometimes it can strip a soldier completely of his skin. The use of mustard gas in the First World War is a good example. The cruelty of man to man never ceases to horrify me. John Parker’s Killing Factory is a remarkable review of NBC methods should your stomach be strong enough to read it.
Nerve agents are different again. These paralyse the nervous system, with only tiny quantities being required for devastating effects. They were discovered by accident during efforts to find a chemical to kill lice. Tabun gas was the first, followed by sarin. Injections exist to reverse or prevent the lethal damage they cause, but you must act very quickly if in contact with the poison. The necessary antidote must be into your system within seconds. Biological warfare, such as cholera, anthrax or typhus, is also a major threat to the Armed Services, but of no use to antiterrorist agencies. These, or nerve agents, would kill everyone, not only the bad guys. Incapacitating, irritating vapours are therefore employed. To ensure all involved know how to handle such things, you are occasionally required to practise in a gas chamber. To me, this was a horrific, claustrophobic experience.
Positioned in some out of the way location
, a gas chamber is little more than a concrete building, perhaps ten metres square. A single metal door, unmarked, leads into the one room. Each wall contains a window, properly sealable to prevent gas escape - or soldier escape if you are me. In the big Army, several of you are marched into these things, though in the SAS you stroll. However you enter, you must be fully togged up in noddy suit and respirator. Once inside, the door is shut tight and your small group stood to one end of the room. An instructor does remain with you, in the very likely event that someone panics. Then the action starts. Like one overcast Wednesday morning, late in March.
‘OK lads?’ said the instructor confidently from within his respirator. ‘Ready?’
‘Mmmm… mmmm… mmmm,’ came the faint, rubbery, mumbling replies in unison, from behind a handful of gas masks. Heads nodded consent as they mumbled. No one was enthusiastic.
‘Villar, you can go first. OK? Villar? Villar! Come on man! Wake up! Pay attention!’
My mind was full of questions. Couldn’t someone else go first this time? I was first last year. What had I done to deserve it?
At this point the instructor produced the small white tablet, ignited it and threw it on the floor. I saw the white vapour, like stage smoke, begin to stream from it. Oh damn, I thought. Here we go.
‘OK, Villar,’ ordered the instructor, our heads now surrounded by gaseous fronds, visibility reduced to a few feet. ‘Off you go.’
I hesitated for a brief moment. The instructor allowed no quarter. ‘Come on, Villar! Get on with it!’
With a trembling, irregular effort I took a deep breath through my respirator and ripped the thing off. Its green, elastic strap caught my right ear as I did so. Never mind, I’m committed now, I thought. As soon as the mask was removed I felt the tearing, scratchy sensation in my eyes, my nose, my throat. God this is awful! I struggled to spit out the required words in the short time left.
‘241984…’ I choked. ‘241984… (cough)… Trooper…’ I choked again. ‘241984…’ I gave up as the searing pain attacked my throat. I must get out! I had to escape! I could not speak. It was too painful.
As I dashed for the closed door in my panic, the instructor’s firm hands grabbed me by each shoulder. ‘Come on man! Speak! Name! Rank! Number!’
It was too late. Nothing would stop me. With superhuman effort I threw the instructor to one side, regardless of later consequences. I watched him thud forcibly against the far wall as I lunged for the sealed door. With a click it was open and I stumbled into the fresh, clear air beyond. I coughed, I vomited, my eyes streamed.
As I wheezed towards recovery, lying on my back on the damp, grassy ground, I began to feel angry. Each year I had to do this. Familiarization they called it. Building confidence in your equipment. Seemed bloody stupid to me.
Northern Ireland is as big a centre for terrorism as one gets. It is here that the UK has earned its justified reputation as the antiterrorist expert of the world. On whichever side of the political argument you lie, the province offers immense counter-revolutionary challenges. My first visit was by accident, one bitterly cold Hereford morning. Barely a month into my job as RMO, I had decided the covert, long-haired look was not for me. Before reaching Hereford I had been terrified to be recognized as SAS, so had initially grown lanky hair and respectable stubble. I was assured that SAS medical cover in Northern Ireland was not my responsibility. The routine, big Army would deal with it. Once I started my RMO post, I realized I did not have to resemble a drug-addicted dropout to disguise the nature of my job. Consequently, and being sure I would not be asked to visit Northern Ireland at all, I decided to have my hair cut short again. I felt the image I portrayed was not in keeping with a hygienic medic. Literally as I returned from the barber, crewcutted almost to skin, I was summoned to the Kremlin, Regimental HQ. ‘Doc,’ said the second-in-command, ‘I think it would be a good idea if you went over the water. We need to be sure the guys’ medical cover is as good as possible. How about the end of the week?’
Having agreed to go, I walked away from the Kremlin kicking myself. How stupid I’d been to get my hair cut so short. I could not have looked more Army if I had tried. The second-in-command had allowed me three days’ training before I went. Though familiar with traditional SAS techniques, this new world of covert operations seemed very strange. Entirely in civilian clothes, I was taught the basics of personal security in the province, how to avoid or detect a follower, and how to follow someone oneself. I was struck by the recommendation I should be able to change my appearance instantly to confuse those who would wish to do me harm. A reversible jacket was an excellent method, plus an assortment of hats of varying design.
Immediately, I went into Hereford town to buy a reversible, corduroy bomber jacket. It was blue on the outside, but cream on the inside. I was delighted with the transforming effects it allowed. Delighted that was until I received my close-quarter battle training in the killing house. There the experts showed me every conceivable way of inflicting injury on others with a 9 mm Browning automatic pistol. I am hopeless with the weapon but managed to master the ‘double-tap’, two bullets fired in quick succession, reasonably well. My problem came when I was taught to shoot and roll. The principle is to double-tap one target, roll and double-tap another. Your pistol sits in a holster inside the waistband of your trousers. I had not noticed my new, reversible jacket not only had different colours inside and out, but also pockets on both sides. Thus, the moment I tried the quick draw needed to set off the shoot and roll sequence, the inner pocket caught on the butt of my pistol. Physically I could not remove the weapon from its holster, nearly shot my own left foot and the instructor, and finished in a laughing heap on the floor. IRA, I thought, as I lay in hysterics before two untouched targets, you are unquestionably safe in my hands. I resolved then that such things were best left for the professionals. I could probably inflict greater harm with my scalpel than a Browning.
Whether or not to carry a weapon can be a difficult decision for a doctor. Regulations state you should carry one, for use in the defence of your patients. This may be good in theory, but the situation is different in practice. There is a great contrast between being an excellent shot on a peaceful range and surviving a close-quarter shootout with an enemy. Often the best range shot will not be the best during close contact. You are also surrounded by professional soldiers, be they SAS or otherwise. They can knock spots off you when it comes to shooting. They do it all the time. I had to sympathize with the woman RAMC doctor, so famed in Northern Ireland, for her refusal to carry a pistol. First, she loved tight skirts, making it impossible to hide the bulk of her Browning if she wished to carry one. Secondly, she felt no match for an IRA man if confronted. This was despite her classification as an accurate pistol shot on a military range. Native wit was her weapon and with it she would drive alone through the province’s most dangerous areas. Her Scottish roots were also her protection. It is not so much the British the IRA dislike. It is the English. Her bloodline was on her side - a formidable creature.
I was collected from the Officers’ Mess early one Friday morning for my journey to Northern Ireland. Scheduled to fly by civilian airliner from Birmingham airport, the young man tasked to drive me had no idea who I was. He had simply been asked to pick up one male passenger and drive to the airport, or so I thought. The car was unmarked, with civilian number plates. I was beginning to feel more confident. Apart from my haircut, which made me look as if I had recently undergone brain surgery, I felt well-prepared. It was as we drove towards Birmingham that I developed the first inklings of the dangers that could face me.
The driver had only been attached to the Regiment for a matter of weeks. Barely twenty-one years old, he was obviously overcome by the male passenger he had been asked to chauffeur. I am not a small man and was fairly fit, so I looked the part of the killer, even if in reality I could not untangle my jacket from a Browning.
‘Are you going to… well you know?’ said the young man with a quizzical wink
. I was in the death seat, immediately to his left.
‘Yes,’ I grunted. ‘I’m off to… you know.’ I noticed the car’s speed pick up slowly as the young man questioned me further.
‘I mean it’s pretty dangerous over there, isn’t it? With the IRA ‘n all.’
‘I guess that’s true,’ I replied, trying to sound relaxed as the speedometer inched steadily towards 160 kilometres per hour. Instinctively I could feel my foot pressing hard on the passenger well, forcing my body against the near-vertical seat back. I tightened my seat belt for extra security.
‘How many deaths have you seen?’ pursued the driver. ‘You must be dealing with it all the time in your game.’ The statement took me slightly aback. I had not realized the young man knew I was a doctor. Still, it made no difference.
‘Plenty, I’m afraid,’ I replied. ‘Must be well over a hundred by now. It’s my trade in a way.’
Knife Edge: Life as a Special Forces Surgeon Page 17