Tip:
Highlight text to annotate it
X
A soldier is shot in the chest and he needs urgent treatment.
Medics Ove and Robert get the task of stabilizing the serious injury. For *** it's a race against time.
The alarm sounds and two patients on two completely different places need evacuation at the same time.
The ground crews get a challenge when the technical equipment fails under the warm and challenging climate.
The tough battles in the offensive operations being conducted results in injured soldiers who need evacuation.
It's ugly, a lot of blood.
Medics Lars and Bjørn work to keep a critically injured Afghan policeman alive.
***'s has only 15 minutes from the alarm sounds to when they need to be in the air. Always.
Lifesavers in Afghanistan
In Afghanistan there are over 130.000 soldiers from 48 nations.
They make up the International Security Assistance Force ISAF.
Norway contributes with over 500 soldiers to different bases in northern Afghanistan.
There they have the operational responsibility for Faryab province.
An area the size of Telemark and Buskerud where over 800.000 people live.
The Norwegian soldiers main task is to train and support the Afghan Army and Police to combat Taliban.
In province capital Meymaneh the main Norwegian force of 350 men have their base with other allies.
It's from this military base that operations are planned, coordinated and conducted with Afghan military and police.
In addition several smaller operational bases have been constructed in the province.
They are called FOB, Forward Operating Bases.
Faryab has long been a calm province, but lately rebel activity has increased and there's -
- more often contacts between security forces from ISAF and rebels.
To counter this development more military operations are being conducted.
The consequence is an increased number of wounded.
They need urgent medical help and must therefore be evacuated quickest possible.
Often from an impassable terrain to the Norwegian field hospital in Meymaneh where the trauma team stands by.
It's this evacuation the helicopter evacuation service *** responsible for.
*** task in a nutshell is to save life and limit damage.
Create security so that the ground forces can operate with the certainty that if something was to happen, -
- which it so often does here, that someone will be picking them up.
When you have as goal to save life and that's what you do and all that you do should pull in that direction, -
- if you work with fuel or as a technician or firefighter.
Then it should pull in that direction that you save life.
And that does something to create a solid commitment.
Even if it's high pressure, I think the mission is so valuable -
- that people can still be passionate over time.
We have this summer been with the ambulance helicopter out on its evacuation missions.
In the morning hours there's been battles west in Faryab. One soldier has been shot and need evacuation.
The alarm goes off in *** operation center.
First information we get is that it's a gunshot to the chest.
-Has he lost a lot of blood? -Have they given him any medication?
The battles have taken place outside a Norwegian base in Ghormach, flight time is 30 minutes. Both ways.
He's first reported as category B patient.
Based on the first report both me and Robert feel that maybe it's more of a category A.
And it doesn't take many minutes before he's upgraded.
Category A means that the patient must be on the operating table within 90 minutes.
Then it's urgent, he needs to quickly get to a hospital that can take care of his life threatening injuries.
*** has 15 minutes from the alarm goes to when they need to be in the air.
While medics, pilots and other operational personnel plan the evacuation, ground crew prepares the helicopters.
Before we go out to the machine we put on bulletproof vests. Bring medicine and go out to the machine.
All the equipment we may need or should bring is always ready in the machine.
We start filling our syringes with medicine right away.
As we take off. I.e. anesthetics, painkillers.
Because when we first get the patient in we don't have any time to waste.
This type of patient would probably have some kind of breathing problem since he's been shot in the chest.
So that will be Pri-1. Maintain the patients breathing.
But we were also informed this had happened around Five O'clock.
So probably one hour, one and a half timeline here.
That could be interpreted as positive for the patient that he's still alive after the injury has occurred.
The ground crew that prepared the helicopters have not yet received any information about the mission.
Post Ghormach, gunshot to chest.
Injury apparently happened away from Ghormach and some time passed before they got him in.
I have bad experience with that kind of injury from before.
He's probably very critical.
We plan based on the worst case scenario and prepare for that.
At first glance I get a really good impression of the patient.
What I see is a patient that looks back. A bit confused.
Quickly see when we get him in that he has problems breathing.
He struggles with getting air into his lungs so we give him some extra oxygen.
The patient had an injury tag on him which said the patient also couldn't move his legs.
We did a simple function test to see if he had any mobility in his legs. No response.
Robert connects the monitoring equipment and we see he's got problems getting enough oxygen in his blood.
What we call "low saturation".
He's got very white lips and tongue which could indicate that he has lost a lot of blood.
Also looked for blood traces, maybe there is bleeding behind him.
Which there was. So we needed to turn him to apply some bandages there.
It later turns out that that was also a gunshot injury.
Most probably it went through his arm and into his right side.
The Afghan soldier was shot some distance outside the base in Ghormach.
And itt took one and a half hour before *** was alerted.
It has now been over two hours since the patient was shot.
At the field hospital in Meymaneh the trauma team prepares to receive the patient.
He's very restless, doesn't want any pressure towards his face.
It could also be because he has so low oxygen in his blood. His brain suffers a bit because of that.
After a while we give him painkillers. We don't do it right away.
We wanted to form a picture of the patient before we initiate too many measures.
He was very thirsty. In his situation it's very dangerous to give patients beverages.
If he was to start throwing up in addition to being so bad.
But I choose to simply take some water on my finger and apply it over his lips.
To give some feeling ... take the worst edge off the thirst.
Think he appreciated it.
Before we land we send a patient update to the hospital here in Meymaneh.
So they are more prepared for what they are waiting for.
Ok. Thanks.
The patient reaches the trauma room and the surgeons take over.
*** suffers technical problems during mission.
A serious head injury becomes a challenge for everyone involved.
An allied Afghan soldier is shot in the chest and has serious breathing problems.
Medics Ove and Robert work to stabilize him all the way to the waiting emergency ward.
In Faryab province there are over 350 Norwegian soldiers.
They support the Afghan Army and Police in their fight against Taliban.
*** evacuates patients back to the field hospital in the Norwegian camp in Meymaneh, -
- where a trauma team stands ready.
We accompany their evacuation mission.
There's been battles during the morning hours in Ghormach, -
- and *** has evacuated an injured soldier.
It's now almost three hours since the allied soldier was shot in his chest outside the base in Ghormach.
Ground crews stand ready to transport the patient to the trauma ward.
It's only 200 meters from the landing pad to the field hospital, -
- where the trauma team is ready to receive the patient.
They've received all the patient data. Along with the patient update we sent underway.
When we get there we often supplement the info to give them the best possible picture of the patient's status.
Decompressing his chest since it's filling with blood.
Inserting tubes to the side to remove the stress on the lungs so they can remove the blood inside.
The patient was prepared for operation.
But somewhere along there the patient dies before the operation begins.
After every mission *** fly there's a routine debriefing.
Both to review the technical and operative routines, but also with focus on each individual's experience.
A mission like the one we have down here carries strong stresses.
It's difficult to imagine running a mission involving saving life without having feelings present.
And those feelings affect how you manage to solve the mission.
Therefore we do something called overall debriefing in order to reduce the negative effects.
So that you are always trying to process and air out the experiences you have.
It's easier to open up when you are not sitting so many together.
You have it easier to tell what you really saw and really felt.
Maybe something that wasn't so pleasant to see. Something that got to you.
If we are going to take care, work optimally at all time. Then we need to have this kind of debrief.
It does so one catches things early. At an early stage if things go wrong.
And you get them adjusted and corrected.
The individual's irritation becomes much lower.
The desired effect is increased professionalism and that we increase our ability to solve missions efficiently.
That's the whole point.
It's important to focus on the positive things and look on the contributions you bring -
- instead of focusing on all the misery.
We were sleeping. Quickly went to the operations room for briefing.
Informed that there are two category C patients. Not life-threatening but still to hospital as fast as possible.
The challenge is that one patient is in Ghormach 30 minutes away to the west, -
- while the other patient is 25 minutes to the east.
We got as priority to take the patient in Ghormach first.
An Afghan soldier has a gunshot wound to his hand. The damage is under control and not life-threatening.
But *** works on routine and have 15 minutes to get into the air.
For this apparatus to work every man has his specific task that is drilled down to the smallest detail.
Among other I have as job to open the gates. And the gate to the fuel trucks.
So that the fuel trucks can get out.
Open the hangar doors so we can get out the helicopters.
The helicopters are ready and the crews are on their way.
There are four men onboard the ambulance helicopter.
Besides the pilot there's a system operator with technical competence who also assists the pilots flying.
Back in the ambulance helicopter are emergency medical personnel.
*** always fly two helicopters.
One ambulance helicopter and one escort helicopter that provides the ambulance protection.
10 minutes after departure I got indication that the missile warning system on my helicopter was broken.
It's a concern since it's the system that tells us if we are being fired upon by enemy AA-missiles.
And it's a system we would prefer to have working.
If we get problems we should be able to either fix the problem or come with alternative solutions, -
- so that we can fly home with the kind of snag we have, or error on the machine.
We opted to change the flight profile to low height where we are better secured against missiles, -
- but the down side being that we are more vulnerable to handguns.
But that was a decision we made there and then and we chose to go low.
I also notified the operations room in Meymaneh that they needed to prepare the reserve machine.
"Ensure it's prepared".
Can you take the machine over there.
You take "Mother Theresa" and drive out the helicopter. Then we transport the baggage.
-Are we switching machines? -Yes.
-They say they are coming in with snag on the AM-lock. -Ok yeah.
Two helicopters coming in, do you have an update on the situation?
5 minutes out from Ghormach we get contact with Norwegian OMLT on the ground.
Get a good linkup and a good situation picture of how the situation is in Ghormach.
-Have marked with red smoke. -Copy.
Escort did his job, flew in and checked around the landing area and reported to us we were clear to land.
-He's received antibiotics and that's everything. -Ok thanks.
The Afghan soldier shot himself in his arm, he's received first aid treatment from medics in Ghormach -
- but hasn't received any medication besides antibiotics so Bjørn and Lars decide to give him painkillers.
-I 'll check his lungs. -Very good, he breathes calmly, totally calm.
130 over 80 in pressure.
5 milligrams of Mafibran and two Morphine.
After takeoff from Ghormach we tested the missile warning system and it turned out to be working.
We no longer need the reserve helicopter. We decided to just continue the other mission with the same helicopter.
-Should we let them carry him in since he's drugged now? -Sure.
Then I'll just ask Jon Bjarne to notify them that we need a backboard.
When it's passed I'll talk to the crew and you can wave me in.
The ground crews are also stretcher teams, they now prepare to receive the laying patient.
For the helicopter crew the mission isn't over yet.
They have now delivered the first patient to the field hospital.
But before they can get the next patient they need to refuel.
Something that's very critical for us is getting the right amount of fuel in the helicopter.
Since it's so warm here we don't have the option to fly with full tanks since it can become too heavy for liftoff.
Therefore we need to fill the right fuel amount before each trip.
In order to save time we fill fuel with engine and rotors still going.
With hot refuel there's increased risk. Especially for fire.
Standing there with all systems on. Rotors spinning. Hot exhaust fumes coming from the helicopter.
A lot of personnel around the helicopter when this is taking place.
So increased risk no doubt.
One patient going out in two minutes.
There are no intruders in the landing zone.
-Green smoke on my command, copy. -Roger that we are going just over the valley.
Over the fields to the right of the houses.
A-B-C is normal. Pop smoke. Pop smoke.
Green smoke on the field.
The Norwegian mobile force is participating in an ongoing operation.
One of the soldiers is injured and they need to evacuate him quickly.
Was a category C patient.
Getting him out of the combat area was most important since he becomes a liability if he can't fight adequately.
He becomes a danger to himself if he can't defend himself properly.
At the field hospital the Afghan soldier that shot himself in his hand has received necessary treatment.
He's received antibiotics during the operation which here is very important.
Then he'll go to the local hospital where he hopefully gets good follow-up.
Incredibly it was just a hole, with a bullet trajectory.
That bullet trajectory you could just follow through. It missed both bones. It missed veins and major nerves.
Just incredible, he still had pulse in his hand. Full mobility.
What we can see with this kind of ammunition... he could simply have gotten his entire arm torn off.
But he was lucky, very lucky.
I went like that. Then got my weight here.
-This leg here? -This leg.
-Did they apply compress? -Yepp.
So they did everything they should.
Want any painkillers? -No Did you get anti-inflammatory? -No
It's doctor Erik that's the chief for the field hospital, and he's going to treat the Norwegian soldier.
Things we consider trivial at home. Sprained ankle. They get big consequences out there.
These small things may mean a soldier is unable to do his job. And by that I mean combat capable, combat ready.
If you can't walk properly, if you have a sprained ankle then you may not be able to run properly, -
- if you can't run properly then that would be a risk for yourself and the team.
The best, simplest, get a helicopter in and evacuate out.
It goes on security, it goes on the operative, to complete the operation.
Both missions have been completed.
Now technicians will check the helicopter to find the reason for the missile warning system failure.
Ground forces further west in Faryab have requested immediate evacuation of a seriously injured soldier.
Everyone must prepare. Also mentally.
It's ugly, there's a lot of blood.
In Afghanistan all ground forces are dependent on evacuation from combat areas.
In Faryab province it's the Norwegian helicopter contribution *** who's responsible for this support.
***'s mission in a nutshell -
- is really to save life and limit damage.
Create security so that the ground forces can operate with the certainty that if something were to happen, -
- which it so often does here. That someone will be picking them up.
For every operation conducted in the province it's vital that *** is operational.
Every offensive operation in our responsibility zone would stop if we weren't operational.
So that soldier in the task unit or MOT team. They would be pulled back until we were operational.
Because that's the security and lifeline they have if things were to go wrong out there.
They're not allowed to operate unless we are ready.
In order to stand ready 24 hours a day 7 days a week the helicopters must work 100%.
Technical maintenance follow set daily, weekly and monthly routines.
When doing this every day it of course becomes routine.
So you have to watch out that you are "there".
While working, that you don't start thinking of something else.
Because it isn't every day you find something. But sometimes you find something.
Something that maybe haven't yet become faulty but might become later.
Technicians are now checking the main shaft. This is a part of the 30 day inspection.
Our responsibility is to deliver two operational helicopters at all time.
This means we always have one helicopter we can work on, reparations or planned maintenance.
So in some situations we can borrow one piece from the reserve machine in order to keep the other two operative.
This is a very vital part. It's the main shaft.
Power transfer from motor to transmission and up.
The landing medic machine is the one most exposed to dust.
Because it builds up like a cover of dust, it's like fine powder, so if it gets inside components, -
- then of course the life expectancy on things that turn around which get powder inside which grinds the parts.
That can be drastically reduced.
We can have two teethes next to each other that are damaged or four in total.
After close inspection they decide to replace the entire main shaft.
They also get the missile warning error fixed and now all helicopters are ready for mission again.
We had plans for a MEDEX. An exercise with a team out in the field.
So everyone was ready for a training scramble. But when the alarm went we heard it wasn't an exercise.
So blood ran hot and it was just to run and get changed before going to OPS as fast as possible.
Turns out it's an Afghan soldier who's been shot and is seriously injured.
Talk about head injury and the situation is very critical.
We are going back to Ghormach, a district marked by conflict.
Taliban and other militant rebel groups have long been operating in this area.
We know very well Ghormach area. Which is more or less characterized as a wasp's nest.
An area where there is a lot of attacks on both ISAF personnel and Norwegians.
So every time we fly that way I think extra about that this is especially "hot".
Medically we were informed that he was being ventilated, that he wasn't breathing on his own.
Told us quite a bit about his condition, in addition to him being shot in the head.
Also that he was unconscious.
We prepared so we could put the patient into coma.
So we could intubate him and get a pipe down his throat if that wasn't already done.
And we draw up powerful painkillers and other medications related to serious head injuries.
For the patient time is crucial.
And it's important for the helicopter to be as little on the ground as possible since they are vulnerable when landed.
When we landed in the FOB, Forward Operating Base, -
- it turns out the patient wasn't fully stabilized by the doctor on the ground so we had to wait.
-Where is the patient? -Unsure.
-Anybody see the patient? -No.
When such a situation occurs where you are standing on the ground for a long time, -
- we all get very ... on the alert. This isn't exactly how we want it to be.
15 minutes is a long time to stay on the ground since the helicopter becomes an easier target for the enemy.
Their standard is only 30 seconds.
We chose to stay on the ground the time it took -
- because the threat in the area can be high if we fly for extended time over the same area.
At the field hospital in Meymaneh the trauma team is making preparations.
What we know is we will receive one ANP. Afghan National Police from Ghormac, -
And he's got an head injury, how big it is we aren't sure.
He is being ventilated but we don't know if he's been intubated.
Or that he is breathing on it or not. So we're waiting for an update on that.
Bit unclear if it was a gunshot or a car accident, but it was a very serious injury anyway.
And those carrying him were evidently his colleagues. Or people that knew him, so they were quite affected by the situation.
They ... looked very sad and depressed. One was crying a bit. So...
It certainly dawned on me it was a serious injury.
Those on the ground probably didn't have 100% confidence that it would go very good.
After 15 minutes the patient is finally lifted onto the helicopter, -
- and medics Lars and Bjørn can start treating the soldier.
-Got control on the airways? -Yeah.
He was entirely unconscious, wasn't breathing.
He had a lot of blood in his face plus a big bandage wrapped around his head that blood dripped through.
He lay on a rescue foil, some kind of aluminium foil where he was more or less sloshing in blood.
A lot of blood in there.
He's got brain matter protruding. Brain matter showing.
He had bled quite a bit, low blood pressure.
He had only a small intravenous cannula that the Americans had set up, -
- it's an access to the blood veins where the American system doesn't quite match the Norwegian.
So what we did was get up an additional access so we could provide more fluid and increase pressure.
He got air. He had heartbeat. He had good pressure after Lars got the other cannula set.
He won't slip between our hands now. We'll get him to the hospital alive.
In Meymaneh the ground crews are going to prepare to receive the patient.
He's critical and intubated now. So when he's out of the machine he's going to be bagged.
So we'll have to take that into account.
-Is he ventil? -I don't know. No they were in a hurry back there.
The patient isn't breathing on his own so he's intubated and receives help for this.
This is called "bagging".
It's ugly, a lot of blood.
-Report as they are coming in. -Alright.
Get gloves on.
As the situation looked from the helicopter it didn't look too bright as we delivered him from us -
- in terms of him even surviving rest of the day.
We both understood that he probably wouldn't be up and running around functioning 100% normal again, -
- but that he would maybe pull through.
The frontal lobe is shattered part of the brain is sticking out.
You can see brain mass sticking out of the frontal lobe.
That's what we can see so far. Now they are packing it, cramming compress in to get it back in place.
Not something we can do anything about down here.
There's an entry wound left side forehead. No exit wound which means the bullet's still there.
Probably massive damages inside there. Depending on caliber and ... distance but major damages regardless.
Here, exactly here a piece of skull is missing. And what you see here is a loose piece.
All this is fracture lines.
We can't see the bullet.
Does it mean that there's a small entry wound on the backside and that this is the exit wound?
Does it mean he may have gotten the bullet like this? Just taken a piece of the head and moved on.
If that's the case then there's a completely different survival rate on this.
Could be much better, means that there isn't any damage through since it's taken a piece of the head like that.
But that we don't know!
Would be interesting to see if there was a tiny entrance wound on the backside because the bullet isn't there.
The Afghan policeman is prepared for transport to the German field hospital in Mazar-E-Sharif.
The serious injury requires neurosurgery and advanced equipment that doesn't exist here in Meymaneh.
This hospitals function is to stabilize, do the emergency surgery that needs to be done.
So that the patient is stable enough to be transported onwards.
The policeman survives the night.
But dies the day after.
Next week we follow as a Norwegian soldier with shrapnel injuries must be evacuated from combat.
A soldier that doesn't breathe falls into cardiac arrest and needs CPR all the way to the trauma ward.
An American vehicle under attack has been hit by two RPG's, seven soldiers need evacuation.