KHOWST PROVINCE, Afghanistan (July 17, 2012) -- They're the crew no one wants to see take off.
"A perfect deployment would be no missions," said Spc. Bryan Heaston, 30, of Lusby, Md.
Nearly every time Heaston, a medevac crew chief serving on Forward Operating Base Shank, climbs into a Black Hawk and fastens his seat belt, he launches knowing someone is in pain -- and may be dying.
"We always see the worst days for people," said Heaston. "Sometimes it's their best days when they all come together for a wounded friend, but it's generally the worst day of someone's life."
Medevac operations are a roller coaster of emotions, swinging from hours of overwhelming boredom to explosions of frenzied activity every time the radio crackles "Medevac! Medevac! Medevac!"
Plastic forks quickly fall to their Styrofoam takeout plates. Books drop. Boots pound the wood floor. Eight bodies are suddenly in motion, grabbing cases of medicine and weapons as they head out the door.
"That's the worst part of this job," said Heaston, whose C Company, 3/82 medevac platoon supports Task Force Corsair, 82nd Combat Aviation Brigade. "It's the sitting around, knowing something might happen at any time, but you don't know what it's going to be or how serious."
Traffic screeches to a halt on a dusty gravel road, Shank's main thoroughfare, as a ragged line of medics and pilots plunge across, each seeming to try and outrace the other. The quarter-mile sprint continues over fist-sized, unstable rocks to the airfield, then down the long runway to an awaiting aircraft. It's a fast-paced, but well-choreographed symphony of pre-laid-out vests and equipment slapping against bodies.
The rip-tear of Velcro and jingling buckles on flight vests snapping home in rapid succession pierce the solitude blanketing the helipad, just as the auxiliary power unit and huge General Electric T-700 turbine engines begin their ear-piercing screams.
Moments later, 54-feet of rotor blades chop the air, drowning out everything except the sound of radio calls in the crews' headsets. Amid the adrenaline-driven actions, each member of the crew runs down an internal checklist, mentally and physically preparing for what they're all about to head in to. Oftentimes, however, medevac crews don't know.
"That's the thing that's interesting about this job," said Heaston. "Once you get a POI [point-of-injury] call, you have no clue what you're getting into until you're there. They're all different. We've been all over this area of Afghanistan -- farmers' fields, highways -- you name it, we've been there."
On an evening quickly fading to darkness, Forward Operating Base Shank medevac birds are headed to pick up the victim of an improvised explosive device, or IED, blast near a small combat outpost in Wardak province.
In the back of a helicopter being tossed seemingly in every direction all at once by heavy winds whipping over mountains so close to the bird it seems like passengers in the helicopter could touch them, Staff Sgt. Erin Gibson, 31, a flight medic, sets up monitors and IV bags, readying herself for whatever may come her way.
"You kind of just hope for the best and prepare for the worst," said Gibson, of Covington, Ohio. "If it's somebody who has uncontrolled bleeding, I try to get all my bandages and stuff together and get IVs hung, just in case they haven't gotten any yet. I just try to mentally prepare like that."
In the near-darkness, mountaintops fly by. Medevac pilots push their aircraft harder than the usual Black Hawk cruises. Every moment that elapses between them and their injured comrade takes with it the precious gift of time.
"You are literally racing for someone's life," said 1st Lt. June Ciaramitaro, 26, of Fort Worth, Texas. "On an urgent medevac, you're going to pull as much as you can. Usually you'll go in to a 30-minute TGT [tubine gas temperature] limit, so the engine can only be at a certain temperature for 30 minutes. We go as fast as we can to get there, then based on what the medic's analysis is, we'll still pull as much as we can to get back if we need to."
As the bird touches down on a small landing area, four U.S. Soldiers crouch under the whirling blades, each bearing a corner of the stretcher carrying their fallen brother. A massive man lies on it covered in blankets and bandages, his arms interlaced across his abdomen; his wrists are secured together with a green U.S. Army issue sock.
"He had a head injury," said Gibson, "so they tied his hands together so they wouldn't be flopping around or flailing, trying to hit people."
Gibson goes to work. The inside of the helicopter is now pitch black, except for the faint glow of the bird's instrument panel. The flashlight on Gibson's head bounds back and forth across the cabin, which is tightly-packed with medical equipment of all kinds. A glimpse of her gloves feeling the Soldier's chest. A flash on an IV bag. A small glimpse of a heavily bandaged face as she leans in to reassure her patient. Tousled strands of Gibson's blonde hair glow in the white light of her headlamp; blue eyes gauge the wounded soldier's reactions just a few inches from his face.
"I just hope by leaning over his ear and telling him what I'm doing he'll understand," said Gibson. "He might not like what I'm doing, and it might not feel good, but it's for his benefit, to make him feel better."
He's wounded in multiple places. Gibson doesn't know the extent of the horror which had recently unfolded to land this Soldier in her helicopter as she frantically works to start an IV and assess which wounds to begin treating first. Her patient is the only survivor of an IED blast that killed the other six passengers of the mine-resistant, ambush-protected vehicle, or MRAP, he was riding in. For now, the only thing that matters is the patient in front of her.
"The only thing on my mind is I have to do what it takes to make him feel better, and I can't let myself get side-tracked or start thinking about other things," said Gibson. "You kind of have to put the blinders on and stay mission-focused. You can't let that other stuff bother you, or it affects what you're doing for the patient."
As the helicopter vibrates, rattles, and sways under a buffeting of heavy winds, Gibson tries to start an IV in the soldier's hand -- the only place he's not injured. Even with hands that have done this many times before, she can't get what she needs. She moves to his leg, and affixes a needle to what looks like a little, black handheld drill. She pulls back the space blanket covering the Soldier, examines his femur for a moment, then presses down. She's starting an intraosseous infusion, drilling straight into the bone to deliver fluids through the marrow.
"I had to put that line into his leg so I could push pain medication, because the line that I started in his hand wasn't dripping fast enough," she explains.
Her patient doesn't even flinch until she irrigates the IV, pushing liquid in to make a space in the marrow. Reacting to the pain, the huge Soldier breaks free of his head restraint and bolts upright, kicking at her with his other leg, instinctively trying to push her off. Only now does it become apparent how small Gibson's tiny 4-foot-11-inch frame is compared to her patient. Where most people have to crouch low to move about the bird, Gibson can almost stand upright.
"I totally understand why he was doing that, because I'm sure it hurt really, really bad," said Gibson.
Heaston, who had been virtually motionless in his seat, transfixed by Gibson's constant motion, leaps to hold the Soldier down and save his medic from becoming a casualty herself.
"I've never seen anyone get drilled before," said Heaston. "I watched the drill go in, and thought, 'well, he handled that pretty well.' Once she started to flush and he sat up, I got over there and thought 'oh my God- his arms are bigger than my legs. How am I going to hold this guy down?'"
Just as Heaston reaches the patient, the man passes out, his head cocked at a painful angle against the helicopter floor. Heaston delicately cradles the Soldier's head, gently placing it back between the yellow foam pads on the stretcher.
Gibson doesn't miss a beat. She keeps moving, starting the IV and moving about the helicopter's cabin, seemingly engaged in a hundred careful tasks at once. She locates a needle, and then pushes drugs into the IV drip. As her patient comes back around, her face is inches from his, telling him everything is going to be all right.
"Once he settled down and I finished what I was doing, I just leaned over and explained to him what I did and why I had to do it. I think after that, he was better," she said.
Gibson said it's that perfect moment she can lean over and explain what she's doing she most hopes for.
"You want them to know you're doing everything you can to make them feel better -- to take away the pain," said Gibson, "and to reassure them they're on their way to the hospital, and the doctors there are going to do everything they can to give them the best possible outcome."
In the front of the cockpit, pilots bear forward, focused on the task in front of them, leaving the scene in back to the medic and crew chief helping the patient. Medevac pilots seem to have a universal rule.
"They've told me to never look back," said Maj. Cory Fass, 32, of Center, N.D. Fass wasn't at the stick for this mission, but flew the next night with an Afghan patient who had been seriously wounded by shrapnel.
"I never look back there," said Fass. "Like last night, there wasn't anything bad going on back there, but they told me he was still bleeding, so I kept my eyes forward. There was no way I could look back."
Just a few minutes later, the few dim lights of FOB Shank appear off to the right, approaching at extraordinary speed. In seconds, the rear wheel of the helicopter gently kisses the concrete and the front follow in feather-light unison.
"When I land, I never think about the guy in back," said Fass. "If I start thinking about what's going on back there, and how I'm going to land because of him, then I may not do it correctly. You want to make every landing perfect."
Head and chest injuries, though, bring new dimensions most pilots don't have to deal with, especially when you have to cross multiple ridgelines in the mountainous region of eastern Afghanistan.
"If it's a head or chest injury, we try not to climb or descend very quickly enroute," said Ciaramitaro. "We try to keep it at 500 feet-per-minute or less, because the change in altitude can affect their head or chest area, their lungs. It makes it a little more difficult."
Heaston quickly throws the sliding door back as five or six Soldiers, each wearing blue rubber gloves, emerge from behind a barrier wall in the murky darkness, crouch-sprinting to the helicopter. Now amid a tangle of IV and oxygen lines, it takes a second to maneuver the heavy stretcher in the dark cabin and get the patient out. He's quickly hurried off the helipad and disappears into the darkness.
Gibson follows the crew just to the barrier wall at the edge of the pad, and returns a few moments later. With her same measured frenzy, she quickly collects a mess of wrappers and plastic caps littering the cabin floor. Then suddenly, as she settles into her seat, she's perfectly still. Another call is done, and she's back talking to the pilots as if nothing had happened.
"It's just one of those things," said Gibson. "You can't let every scenario personally affect you, or else your job's really going to get to you and it's going to be harder for you to do. I mean, to some extent, it's going to, but you just have to kind of compartmentalize, and as soon as you take him to the FST (hospital), you know he's in the best hands he can be in, and you've just got to kind of let that be the end of it. You have to put your focus back on putting your aircraft together and getting ready for the next mission, should it come."
Resembling the final scenes of an action-packed play, the aircrew goes through the process of turning knobs and flicking switches to shut down their bird. Meanwhile, Heaston and Gibson re-organize the jumble of equipment packed just about anywhere it fits in the helicopter cabin in preparation for the next call. Once complete with their post-flight chores, they begin their speechless, somber walk under a sea of stars in a moon-less sky, a far cry from the frenzied race to spin up their bird less than an hour before.
Inside the wood shack that functions as a combination command post, lounge, office, operations center and storage facility, the television is on, still playing the same DVD that had been playing when the crew took off. The stench of grease and gravy rises from half-eaten meals. Heaston flops on a worn faux-black-leather couch, opens his green Army-issue laptop to begin filling out maintenance reports, and "Medevac! Medevac! Medevac!" The radio begins a night-time stampede out the door again,
Crews at Shank are on duty for 24-hour periods. This time, Gibson comes back with blood on her boots and uniform. The toe of her right boot is solid crimson. The next morning, the blood is still there. She's wearing the same clothes. She slept in her uniform waiting for the next call.
"Usually with those urgent medevacs in the middle of the night, when you're half-asleep, it's a lot better to sleep in most of your uniform so you don't have to reach for things in the dark, knock things over, or trip over things," said Gibson. "You're putting yourself in more danger by doing that. All I have to do is grab my top and my weapon and run out the door."
Medevac crews in Afghanistan are available any time a Soldier is in trouble. FOB Shank's average time to get from being completely asleep to airborne is just eight minutes -- six minutes during the day. It's often a mad dash in the dead of night.
"We go from dead asleep to flying in our most dangerous mode of flight in just eight minutes, so you have to get your 'A' game on really quickly," said Ciaramitaro. "Even when your radio breaks squelch in the middle of the night, your heart races. Even if you're not on duty and someone else's radio goes off, your heart races, and that interrupts your sleep no matter what."
It's a call no one wants to hear, but helping a wounded Soldier on the battlefield is the only thing that matters to medevac crews.
"It's something you always dread," said Gibson. "But when it comes, it comes. I'm always here to do my job, no matter what time of day or night it is. Sometimes I think, 'It's three in the morning, why am I running to a helicopter?' But that's our job, and you just get out and you do it."
The following day, the waiting begins again. Hours and hours of boredom pass as crews wait to rescue a Soldier on the worst day of his or her life. It's a constant cycle of waiting for the worst, doing their best, and starting the cycle all over again.
"I can't say it doesn't affect me sometimes, and if you ask any of us, they'd probably tell you the same thing," said Gibson. "That's when it helps to have your peers around that you can sit and talk to and get support from, because they understand what's going on and what you're going through. We have a pretty good support group down here."
The redemption from all that stress comes from knowing what they do matters. Since their arrival late last year, 82nd CAB Medevac units in Regional Command-East have treated more than 3,400 patients.
Gibson's patient, the massive Soldier she cared for in the helicopter, survives. He's been sent home from Afghanistan to complete his treatment in the United States.
Ciaramitaro said while the medevac unit itself seems to get all the glory for saving lives, it takes a concerted effort across Task Force Corsair to get each one of those patients to safety. From AH-64 Apaches providing security to fuelers and maintainers keeping birds in the air, to air traffic control clearing Shank's busy airspace when an urgent call comes in, everyone plays a part.
"Every single person in our unit cares so much about the mission," said Ciaramitaro. "Every day you know you made an impact on someone's life. It's amazing to be able to feel that way."