Air Evacuation

Kandahar, Afghanistan

I could barely hear my cell phone when it rang.  I was sitting out on the edge of the flightline alternately watching loud jets take off and reading a travelogue about an insanely brilliant Scotsman who walked across Afghanistan right after 9/11.  I was distracted and it was loud.

"Get into the trauma bay - you have 5 minutes to be ready and on the flightline!"  The head of the newly-formed air evacuation team and my new ICU colleage, Jon, had taken a phone call from our Army helo squadron, Destiny.  We were needed to assist in picking up a critically ill child from a nearby base.  Not so nearby as I found out later - 30 minutes by helo when you are trying desperately to keep a child alive can seem like an eternity.

There are seven of us on the Enroute Care (ERC) team, all  with backgrounds in critical care or surgery.  Most of the time when a casualty is medevacced the medical care enroute is provided by the equivalent of an EMT, as in the folks that would be in the back of an ambulance stateside.  But on occasion - frequently as it turns out around here - the patient being cared for would benefit from having someone in the helo with a deeper breadth of understanding of critical illness.

Five minutes is not a long time when one needs to put on a flak jacket, ballistic eyewear, helmet, and gloves, get narcotics, paralytics, and the adrenaline-like drugs necessary to keep one's blood pressure acceptable when they are in shock.  We also carry extra magazines for our weapon, and lock and load.  This was my first day "on call" for the ERC and I was a caught a little off-guard.  We had actually known about this mission to get the 13 year old Afghan boy for a few days, but it kept getting cancelled for a variety of reasons.  It had again been cancelled yesterday morning.

Inside the helo with the flight medic, on our way to pick up the patient

I got to the flightline on time, but my head was spinning.  What was I missing?  How was this going to play out? My chin strap was all screwed up on my helmet and I felt like a real "nugget."

I boarded the helo from the side, as is necessary to avoid getting an unwanted "haircut."  Once inside I could hear almost nothing but the hydraulics and engine swatting the air.  It was hot yesterday - 116 degrees, and the helo was an oven.  We took off and I could see the flight tower fading behind our quarter.  I had finally escaped the wire!  First time in nearly three months.  Below me I could actually see ribbons of green, following the anemic appearing river-streams.  What was growing down there?  Poppies?  The green ribbons gave way to nobby-surfaced hills and gorges.  I was able to see a cerulean colored lake - really hard for me to believe.

We picked up our young boy and he was what we call "four-plus sick."  His breathing tube was filled with frothy blood-tinged sputum.  His blood oxygen levels were very low and his blood pressure was dropping.  My job was to help get him to Kandahar alive.

Trauma team await the arrival of the next patient at the doors leading to the trauma bay

The helo took off and I had to take turns manually bagging the boy to keep his oxygen sats at acceptable levels.  It was loud and hot, especially with our long-sleeved fire retardant shirts, covered by a fire retardant blouse, covered by a 40 pound flak jacket.  Within minutes my ballistic glasses were filled with my sweat, which by now was pouring onto the patient as I bagged him.  I frequently lost my balance as the pilot banked to and fro between the valleys - I found out later this was a tactical way to get home safely - a "nape of the earth" flight designed to make it difficult for the bad guys to target us.  Unfortunately, the result from my end was that it felt like the amusement park ride from hell.  I thought for a moment that I was going to get ill on my young patient.

I managed to make it back to Kandahar without getting sick, and most importantly, our patient managed to survive the thirty minute flight unscathed.  I should point out the incongruity of seeing the patient's bearded father, in indigenous Afghan garb, strapped to the helo seat behind the patient, the entire flight urging us to bag harder and faster.

We got back to the ICU which by now was appearing like my favorite place on earth.  Our patient was safe.  He was descended upon by our nurses, doctors and respiratory techs.  I will now understand on a completely different level what is involved in getting our patients from dangerous areas in the rugged Afghan countryside to our little hamlet inside the wire.  I took off my kevlar vest and felt 10 pounds lighter.