By Staff Sgt. Raymond Drumsta
42nd Infantry Division Public Affairs
FORWARD OPERATING BASE SPEICHER, IRAQ -- Odd, red flecks -- like random, crimson snowflakes -- float about inside the Black Hawk helicopter where a wounded Iraqi soldier lies. Their source soon becomes clear: drops of his blood have fallen on the aircraft's warm surfaces, dried, flaked off, and are being blown around like so much confetti. Meanwhile, two Soldiers of the 1159th Medical Company work, with coolness and efficiency, to save the Iraqi soldier's life.
Scenes like this -- horrible to some -- are the daily work of the 1159th Medical Company's Soldiers. Everyday they drop from the sky to scoop up and treat wounded Iraqi and Coalition Forces Soldiers, Iraqi civilians and suspected insurgents. Their helicopters are airborne emergency rooms, and though they field a robust array of Army training and civilian medical experience, some of them say their main life-saving skills are teamwork, professionalism and dedication -- rooted in compassion.
"Some people say our job is to make sure the Thanksgiving Day table is full ... so no one is missing when everybody gets home," said Chief Warrant Officer Patrick Fallon, a medevac pilot with the 1159th. "If it was me, I"d want someone to do all they could to help me, and that's why we do everything we can to help whoever is in the back to survive."
The company, which belongs to both the New Hampshire and Maryland Army National Guard, deployed to Iraq in early February. Since then, they've flown nearly 900 patients on almost 600 missions, according to a unit fact sheet. These missions include patient transfers, blood and hospital re-supply runs and the most critical of all, aeromedical evacuation - picking up wounded, sometimes under fire, and transporting them to a Combat Surgical Hospital.
Unit flight crews consist of a flight medic, a crew chief and two pilots. The crews are on a tight, rolling on-call schedule which they call first up, second up, third up and fourth up. The schedule ensures there is always a flight crew "on deck," so to speak, and available to perform aeromedical evacuation.
"From the time you start on fourth up, you are on call for 24 hours a day for a total of 96 straight hours," said Flight Medic Sgt. Matthew Miller, of Anne Arundel, Md. "Obviously there are operating procedures for crew rest, but working within the parameters set forth by the commander, it is 96 hours of duty. The first up aircraft is the first to go, second up the second, and so on. First and second up aircraft stay on duty in the Operations Building and immediate area."
The first and second up aircraft's response time for nine-line medevac requests is also immediate, Miller said. Once the wounded are in the helicopter, their lives are in the hands of the flight crew -- especially the medic and the crew chief, who administer direct medical care to the wounded while in the air.
"Before we came here, I never had anyone's life in my hands except for my newborn daughter's," said Staff Sgt. Gary Hitch. As a medevac crew chief with the 1159th Medical Company, Hitch is part of that tight loop of communication and care which forms inside the aircraft whenever wounded are aboard. The flight medic, the crew chief and the pilots are all talking, working together to provide a stable platform for the flight medic to work, and to make every second count.
"I'm just a bus driver," Fallon said. "Our whole purpose in life is to get the medics to the patients, and the patients to the hospital. If we have a patient where every second counts, we push the aircraft harder."
"Everyone is an expert in their own field," said medevac pilot Chief Warrant Officer 4 George Munson, of Lyndeborough, N.H. "The flight crew works as a cohesive unit. So if the medic says, "Speed it up, this guy's dying," the pilot complies. They respect the professionalism of each other."
Like all medical professionals, the flight crew is trying to maximize the golden hour -- the 60 minutes immediately following the occurrence of a life-threatening injury, when they have the best chance of saving the patient's life. The golden hour starts counting down when the wound happens, and the flight crew is using every second to perform life-saving procedures.
"You just concentrate on patient assessments, like airway, breathing and circulation," said Flight Medic Sgt. Amanda Watkins. "Those are the ones that will keep them alive. Without those, you haven't got a patient. You're always thinking, "What's next?""
Watkins, who is from Lincoln, Neb., said the unit's flight medics are constantly learning from each other -- trading notes and sharing experience.
"Every call you learn something from," she said. "The crew chiefs, thank God, know some medical procedures. They know CPR, and most are combat-lifesavers."
On calls, she said, crew chiefs help perform life-saving procedures like helping to stop bleeding and helping a patient breathe using a bag-valve mask, which is called "breathing for a patient," or "bagging a patient."
"A lot of them will ask how to do things because they want to help out," Watkins said. "A lot of them can give IVs, too, if we have multiple patients."
"Everyone helps out," Hitch said. "You can't have one person taking care of the optimum of four patients that the Black Hawk can carry. You let the medic do what they do, and you help."
All the crew chiefs in the 1159th are qualified in Basic Trauma Life Support, also known as BTLS.
"That's quite a few steps higher than combat-life saver," said Hitch. "I can assess the patient, I can breathe for the patient, I can pump fluid into the patient, and I can secure the patient so their spine or limbs are not in danger."
With the crew chiefs helping out, I'm free to take care of the other things that have to be done, like administering CPR, drugs and hooking up monitors, said Flight Medic Sgt. Robert McColligan, of Baltimore.
"Once I'm on the aircraft, the pilots are flying it, and they give me room to work," McColligan said. "The crew chief is a little more than that. All our crew chiefs are BTLS qualified. They understand trauma and basic airway management skills. If we need to bag a patient, they know how to do it. They help us dress lacerations and cuts."
The crew chiefs are like "another care provider in the aircraft with the medic," said Miller. "You're able to get a whole lot done quickly."
Miller is the unit medical standardization instructor. He and unit member Sgt. James Phipps were the driving force behind getting the unit's crew chiefs BTLS-qualified.
"Sgt. James Phipps and I recognized a long time ago that there were some shortfalls in combat medicine," said Miller. "One of those shortfalls is that the crew chief is left out of the loop." The BTLS training, which the unit approved and carried out while mobilizing at Fort Dix last year, taught the crew chiefs rapid trauma assessment, airway assessment and knowledge of injuries and how to treat them.
"It gives them a better understanding of what's going on with the patient," Miller said. He added that the crew chiefs learn medical jargon, which expedites communication.
"We can get things done a whole lot faster," Miller said.
The time in the aircraft, when the patient is being transported is the "platinum 10" said Miller -- the time period when the flight medic is "rapidly finding injuries, treating lethal injuries and restoring breathing."
"These are interventions that need to be done," Miller said.
It's an "awesome feeling" to work with the flight medics, Hitch said.
"The stuff they have to know is amazing," he said, "like what drugs to use, and how to counteract those drugs, because you don't know if an Iraqi is allergic to morphine. When something goes wrong with the aircraft, I can stop what I'm doing and look it up in a technical manual. When something goes wrong with a patient, the medic can't stop caring to look it up in a manual -- they just have to keep trying."
As a National Guard unit, the 1159th Medical Company's ranks are full of Soldiers who are full-time, civilian medical professionals.
"In the 1159th, we're lucky, because out of our 15 medics, seven are paramedics, and all of them have critical care experience," Miller said. "Three are emergency medical technician intermediates. They all practice on the outside. They all work for fire departments or ambulance services."
The unit's Black Hawk helicopters are equipped with medical equipment like oxygen, monitors, and a defibrillator.
"The equipment you see in the back of our Black Hawks is the same equipment used by critical care transport teams on the highways of America," Miller said.
To do the job, Miller said, takes flexibility.
"The medical treatment portion of our mission happens as the event unfolds," he said. "You need to be able to change gears quickly."
Though they call it "ground hog day" because the same things happen everyday, the type of call varies, Hitch said.
"You know it's going to be something different, until you get out to the site," Hitch said, 'then adrenaline just takes over."
Getting to and from the site, called the "point of injury," is the job of the pilot and pilot-in-command, who also navigates and works the radio. Miller stressed however, that the entire crew calls out hazards like suspicious vehicles, rising terrain, or changes in the road structure -- a sign of a possible improvised explosive device (IED).
"It's a lot of stress," Miller said. "It's a lot to deal with. It can be a little overwhelming. Not only are you dealing with a trauma patient, you're working in a hazardous environment. The insurgents don't care about the Red Cross on the aircraft. They don't care if we're trying to help someone. We're just another target to them."
McColligan was part of the medical teams targeted while evacuating IED victims in February. The flight crews treated and evacuated their patients while under direct fire and secondary IED attacks. While on the ground, McColligan said it took a couple of seconds to realize they were firing at him.
"When I was 30 yards away from the aircraft, the third IED went off about 50 feet from it," McColligan said. "The adrenaline didn't hit me until I got in the aircraft, and I saw how bad off the Soldier was. I started counting my fingers and toes and checking for wounds." He "used about every dressing in my bag" on the wounded soldier, McColligan added.
As an emergency medical technician volunteer back home, McColligan said he worked about 30 hours a month.
"I went from sprained ankles and chipped teeth to people who were getting ready to die," McColligan said. "It was a big change."
Before coming to Iraq, McColligan said one of the worst things he had seen was a car accident. The trauma he's witnessed here, he said, "is the worst I've ever seen."
"I think I've seen every type of trauma here, with the exception of drowning," McColligan said. "You've got to have a good mindset. You have to take everything in stride and be very flexible."
Dealing with battlefield trauma can be traumatic for the crews, Miller said, and they sometimes look fatigued or mentally drained. Crews are routinely ordered to undergo combat stress control -- after going through what unit members refer to as "bad calls."
"Sometimes you're so focused, you don't realize you're under that amount of stress," Miller said. "It takes someone from the outside to look at you, and talk to you. Then, you don't have someone going home with more ghosts in their head than they want," he said.
"Everyone's there for each other," Watkins said. "There could be a major or captain flying the aircraft, but they're paying attention to the NCO medic in the back. It's all about the patient."
It's like a brotherhood, said Miller.
"The medevac flight crew is a very tight group," Miller said. "There is a lot of emotion that revolves around one of our soldiers that is wounded. We take this medical duty very seriously and our patients become part of our tight group. When one of them dies, a piece of us dies with them."
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