Transporting the Wounded in Iraq

This time it wasn’t a false alarm.

Soldiers place a wounded sergeant aboard a MEDEVAC flight in Iraq’s Diyala province in October 2008. Nicole Fruges / San Antonio Express-News /

The door to the ready room swings open and our platoon leader sticks his head in. Seven hours into our workday at Joint Base Balad, in Iraq, surfing the Internet and watching DVDs on our laptops, we barely notice.

“You guys might have a nine-line coming in. Not sure if it’s urgent or priority.”

Mentally snapping out of the crew rest profile that we maintain for 24 hours at a time, we are thankful for the warning. Most of the eight crew members for our two Sikorsky UH-60 Black Hawks hustle to the operations office 50 yards away. There have been false alarms before. Sometimes missions are cancelled before we can get the engines started. Sometimes missions we think belong to us are actually closer to another MEDEVAC company. Sometimes the location changes. Sometimes what appears to be an urgent mission ends up being a routine transfer request and we get all wound up for nothing.

But sometimes minutes count, and American GIs, or Iraqi troops, or Iraqi civilians, or even enemy insurgents are in pain, bleeding, and dying as the clock ticks. So when the call for MEDEVAC goes out, we go NOW. The battle captains and operations officers and staff toads can all take their time sorting out what we should have done, if we could have gone quicker, and why we didn’t notify them sooner. We will be back long before the finger pointing has begun. In the meantime, we need to move hurt people. No GIs are going to die on our watch if we can do anything about it. It’s not heroism, or self-aggrandizing: it’s just what we do.

What we do now, in February 2009, is stare across the desk at the operations specialist on the phone. He’s getting something off the computer. There is probably some paperwork he already started. Wait, did he write down the location already? Do we know how many patients yet? He hasn’t pointed any fingers our way or called “MEDEVAC” on the radio yet. Are we wasting our time? Another phone rings. The operations specialist is still on the other phone. A senior medic answers it.

Tick. Tick. Tick.

The senior medic confirms it’s an urgent mission. But operations still has not sent the call. He probably doesn’t have all the information needed to launch us yet. Where did the pilot in command go? We should have everybody in our crew close by and within radio range. I key the radio: “Lead PC, are you up?”

The operations specialist keys his radio. “MEDEVAC, MEDEVAC, MEDEVAC.”

The familiar refrain begins every urgent mission. The scary ones, the boring ones, the ones where we wake up at 2 a.m. and are in the aircraft before our brains boot up, and the ones where the flight medics are fully engaged with critical patients in the back of the aircraft, telling us to speed up. We joke around a lot, but we rarely joke using the word MEDEVAC. The mere mention of the word raises the blood pressure of every crew member on duty.

The standard operating procedure kicks in. Operations will give the pilot in command and the medic as much information as they can, including weather and intelligence updates, while the crew chief and I, as copilot, will get the aircraft ready. Whether the mission will be a big deal or a big waste of time and jet fuel is not our problem.


We blow through the door, hoping nobody is on the other side. Between operations and the aircraft, amazing track-and-field feats have been witnessed: bicycles and boxes hurdled, old and fat National Guard crew members setting 50- and 100-yard-dash records. Very entertaining.

This will be a quick launch: It’s mid-afternoon, most of us are awake and close by, and we can see. Night launches are the same, except for the seeing part. Ever try to fasten a car seat belt in the dark? Over body armor? While full of adrenaline?

After the short run to the aircraft, we begin dressing in aviation combat gear, throwing body armor vests over our heads first, taking care not to smash ourselves in the face with the 10-pound armor plates. Over that goes the survival vests, with radios, ammunition, medical equipment, and whatever accessories we strapped to it months ago while in training. Gloves, earplugs, watches, and kneeboards are laid out in the aircraft where we left them. Or not. I notice that I am still holding the magazine I was reading in the ready room.

As I strap into my seat, a lieutenant rides by on a bicycle, stopping to ask the crew chief if the aircraft is hoist-capable, probably for some bean-counting administrative tasking from headquarters.

“Clear!” I shout.

We are not yet on intercom, nor are we wearing earplugs and helmets. Shouting does the trick for crew communications, and sometimes wakes up people who are wandering about the flightline in a daze. Plus it sounds kinda cool.

“Clear!” the crew chief shouts back, meaning there is nobody on the left side of the aircraft, by the auxiliary power unit, which will soon be quite warm and loud.

I flip on the switch for the APU. It runs the electrical systems that would otherwise be powered by the aircraft engines, and provides the compressed-air to start the engines themselves. It’s the loud jet engine noise you hear on airliners sitting at the gate, and on larger helicopters whose rotor blades are not turning.

The APU is lit and howling as a medic runs up to the aircraft, bag and rifle in hand, and begins the same dressing sequence. We’ll have to shout louder over the noise. I am flipping switches and turning on radios in sequence with the checklist. The pilot in command is still in operations, getting updates and figuring a course that will keep us clear of any friendly operations and airspace. We’d hate to fly through anybody’s firefight or air strike on the way to pick up the injured, though it happens occasionally—mostly to those who don’t get updates.

“Where we going?” I ask the medic.

“Warhorse,” he answers. Great.

Forward Operating Base Warhorse. It’s near Baqubah, at one time the hangout of Abu Musab al-Zarqawi, once Al Qaeda’s leader in Iraq before the U.S. Air Force delivered him a pair of 500-pound bombs one evening in 2006.

I punch up the navigation system preset for Warhorse so the destination will be loaded when we take off. The pilot in command arrives, with sticky-note updates, and begins dressing. A couple of hundred feet away, an identical crew dance is happening in our chase aircraft.

Tick. Tick. Tick.

I gesture a request to start the engines: the pilot nods. “Clear one.” The crew chief verifies it is clear. The GE turboshaft engine, with its near-2,000 horsepower, fires up with a low moan. The blades begin to turn. The second the number-one engine starter switches off, I am clearing the number-two engine. In a minute, both engines are started and the aircraft systems are beginning to stabilize. Our chase aircraft will not be far behind us in the start sequence; I can see its blades turning. When chase is ready to go, the crew transmits the code word over the radio. We acknowledge and are already calling the air traffic control tower as we go light on the tires. “Tower, Alamo 10, flight of two UH-60s, request immediate departure Alpha Bravo, urgent MEDEVAC.”

“Alamo 10, cleared for immediate departure, report Bravo.”

In the combat environment, locations and directions of departures and arrivals are encoded—indecipherable to anyone monitoring the radio who does not have a current airfield diagram. No sense making it easy for the bad guys to figure out where we are going.

Picking up to a high hover, I nose the aircraft over and accelerate over the compound, housing units, and military vehicles and warehouses, and between Saddam-era aircraft shelters now filled with Air Force aircraft and support equipment. Our chase aircraft falls in behind us and we cross the fence into greater Iraq, approaching maximum level speed. Eight minutes from notification, Alamo flight is en route. Not bad.

We avoid overflying buildings as best we can. At this altitude and speed, we can just barely make out Iraqi people in red and black robes going about their business in the fields and small villages surrounding the base. From the air, it seems peaceful below. We wonder what the Iraqis think of us as we blow over their houses, day and night, on our way to lifesaving missions. Probably nothing good. One of our pilots has remarked that when they fire at our aircraft, half the time they probably don’t know that they are shooting at Iraqi patients. Today, we don’t notice if anyone shoots at us. Our plan is to be half a mile away by the time they can aim their weapons.

“Did you see that?” says the pilot.

Few of us did, but a few miles away, very near where we plan to fly, a thick column of black smoke rises from a burning vehicle. The pilot just saw the vehicle explode. We consider reporting what we have seen to headquarters, until we see two AH-64 Apache helicopters already circling the scene.

For now, we avoid the site by several miles. We will find out many hours later that this burning vehicle is where our casualties had come from, and the unit had hauled them back to Warhorse instead of calling us directly to the site.

We look ahead on the map and out the window for a clear approach to the base. A fairly large city is in our path, but working our way in from the north, we can avoid most of the built-up areas and not shake too many roofs. A few minutes out, the pilot is already talking to the base tower on one radio, and the medic has contacted the medics on the ground. We are less than a mile out now, on a close-in downwind approach that keeps us clear of the base, the built-up areas off base, and a big antenna right in the middle. I radio the chase aircraft to give us plenty of space for our turn to the base leg of the approach.

The pad is hard enough to see in daylight, and near impossible at night, when it is lost in the dark spots between blinding lights elsewhere on the base. In seconds we are calling “landing” to the tower and touching down on the helipads surrounded by protective barriers; just outside the walls, an ambulance waits. As soon as the parking brake is set and the flight controls are centered, the medics and crew chiefs of both aircraft are scrambling out their windows to get to the ambulance.

There is still some confusion as to how many patients we will have. The final vote is two, one for each aircraft. The infantrymen who have taken shrapnel have some burns, but they look okay. Stripped down to an army blanket and oxygen mask, our patient gives us a thumbs-up as he is loaded into the litter pan in back.

A quick before-takeoff check, and we are airborne again, over the fence, and speeding back to the hospital. The vehicle we saw earlier appears to have stopped burning. We avoid the area anyway. Everyone is happy that the two wounded are stable and will make it to the hospital for the hand-off to advanced care.

Halfway back, the medics transmit patient information to the emergency room, and within minutes we are touching down on the hospital pad. Seconds later, the medics and crew chiefs jump out and are met by several members of the hospital staff and litter team, who wheel the patients into the hospital. Inside, the medics will confer with the receiving medical personnel and make a speedy hand-off. Two more satisfied customers.

Our medics return with new litters, and we make the short flight to our unit, where oxygen tanks and medical supplies are restocked and the aircraft gets a final walk-around in case we need to launch again soon. Engines are shut down, the blades stop, and the paperwork and after-action review process begins. We’re not sure what the night will hold, but we are ready. So we go to dinner. It’s chicken again.

Having retired from the Army National Guard in 2011, Chris Ryan continues to fly helicopters in the civilian sector.