Battleworn (7 page)

It’s a short distance to Tony, so we get there quickly. Stomach churning, I dread what we will find. As I said, no incident is ever the same, so our systematic approach to treatment must happen without delay. Tony’s body is abnormally twisted, and I initially spot a mangled hand with fingers missing. Relieved that it is only fingers and not limbs, I take a deep breath. Like clockwork, our treatment begins. Already in enough cover so no movement is required, I talk through each section of MARCH-P in my head, making sure not to miss a single thing. My assessment takes less than sixty seconds, getting the all-important tourniquet applied to a heavy bleed on his left arm. It’s care under fire, so the initial survey is super quick – we are just lucky enough to carry out any medical interventions at all. As the gunfire resumes, we drag Tony into the cover of the CAP.

Once there, our next move is to identify the need for early surgery. More often than not, injuries sustained on the battlefield require minimal first aid and super-quick evacuation to the hands of the highly skilled surgeons in Camp Bastion, the world’s busiest trauma centre. No fingers are found on initial assessment and no lives are ever risked hunting for those fingers. Jen starts to dress his wounds before Tony can get eyes on them.

Noise from the guns engaging the enemy from above make it hard to concentrate, and the failing light offers up its own set of problems. I relay to Kev that we have at least one cat-B, which signifies that he is an urgent surgical case and has life-/limb-threatening injuries. The UK military have an established system to prioritise injuries into three groups, which indicate to everyone involved the urgency of the sustained injuries:

Cat-A – Life-threatening injuries, and the casualty requires urgent medical treatment.

Cat-B – Life-threatening injuries, and the casualty requires urgent surgical treatment.

Cat-C – Non-life-threatening injuries, and the casualty can be held for up to four hours.

Kev initiates a ‘nine-liner’ to HQ. This set of nine questions is answered by call signs on the ground and then sent up via the radio net to brigade HQ. These answers are then assessed at the medical desk, resulting in a decision which will see an instant response if relevant or a timely extraction, depending on the injury. This was the same call I received when I covered the desk; but now I am the one on the ground making the desperate call for support, a completely different perspective.

The nine-liner provides vital information to the chain of command, and all UK medical teams use it on operations:

Line 1: Location of the pick-up site.

Line 2: Radio frequency, call sign, and suffix.

Line 3: Number of patients, by precedence (cat-A, cat-B, or cat-C).

Line 4: Special equipment required.

Line 5: Number of patients by type (stretcher/walking wounded).

Line 6: Security at pick-up site.

Line 7: Method of marking pick-up site.

Line 8: Patient nationality and status.

Line 9: Contamination.

While I have assessed that Tony is stable, I do not have the luxury of a CT scan, and I would never assume that something far more sinister isn’t going on. An X-ray computed tomography, or CT scan, is a medical imaging method employing tomography to create a three-dimensional image of the inside of an object; in medical usage, images of internal organs. In simpler terms, the CT is a body scanner that looks for abnormalities or potential bleeds that aren’t showing on the outside.

The trouble with treating physically fit soldiers is that they can often disguise severe injuries until it’s too late. Their fit bodies will sometimes mislead medics into thinking that all is well. The human body is an amazing piece of engineering: it’s designed to shut down and protect itself. It will fool an untrained eye before free-falling at a rapid rate. I remember my time in Sierra Leone, when a British army officer walked away from a helicopter that had crash-landed. She died minutes later from a massive internal bleed. On the ground, we treat for the worst and hope for the best.

A close encounter with an RPG does not leave a healthy outcome in anyone, so with an air of caution, I administer Tony 10 mg of morphine. Because it’s intramuscular (IM), it could take up to thirty minutes to take effect.

An IM medication is given by needle into the muscle. This is as opposed to a medication that is given by a needle, for example, into the skin (intradermal [ID]), just below the skin (subcutaneous [SC]), or into a vein (intravenous [IV]). Medics are issued morphine auto jets, each holding a one-hit IM dose of 10 mg. The method works when time is limited. I have never been a fan of this system; it’s easier to monitor a patient’s progress if the morphine is given intravenously. It can be titrated (diluted), and, therefore, faster acting and with less likelihood of overdose. In my view, this process can be very helpful. For example, in 2006, surgeons in Camp Bastion had to deal with an opiate overdose before getting stuck into the actual wounds. My theory on the administration of morphine is that a tiny amount of pain lets a casualty know that he is still alive; better still, it lets me know that he is alive.

I can manage a casualty easily if he is still with it. If the security situation deteriorates, his treatment will stop until our safety is re-established. Titration of morphine is the way forward, and most forward-operating medics like this system, along with the use of other pain-relieving drugs. Many of the grunts (infantry soldiers) on the ground often refuse morphine. No one wants to lie helplessly in such a hostile environment.

Without warning, Tony now starts to act erratically.
Did I misjudge the severity of his head injury?
For a second, I question myself. My own pulse increases, and my palms are suddenly sweaty. Shining my torch, I look deep into Tony’s eyes, and then I reassess the wound. I check behind his ears and look up his nose, searching for anything that I may have missed. Any abnormal posture or seizures?

My panic is short-lived as Scotty McFadden comes in, telling Tony, ‘Man up, ya fucker, and stop acting like a fuckin’ lunatic.’

Tony starts to laugh. Using the buddy system to identify any type of traumatic brain injury is a great tool. Guys know their own soldiers, and Tony’s behaviour wasn’t at all out of character. Relief for me, and a morale boost for the troops watching the theatrics unfold.

Adding to all this, Abbie and Sean come bounding into the CAP with three additional casualties. All have multiple shrapnel wounds; one in particular requires urgent surgery to a wound penetrating his abdomen. We have a potential mass-casualty scenario, and Kev quickly updates the nine-liner.

Within twenty minutes, all casualties are stabilised. As my team finish off preparing our injured for evacuation, I disappear into the ops room to update the boss and get a ‘wheels up’ time from Kev. Wheels up is the time that the helo (or rescue bird) will leave Camp Bastion. This allows me, together with my team, the time we need to manoeuvre our injured out to the HLZ.

The attack came at last light, an age-old tactic adopted by every fighting force since the very barbaric yet successful days of both Genghis Khan in the East and the Romans in the West. The Taliban are creatures of habit, and generally attack from positions that have been successfully used before; this was employed time and time again to systematically slaughter the Russian occupiers during the late 1970s early ’80s. It ensures that the attack is on the Taliban’s terms and at a time of their choosing. They also know the area and all potential escape routes, including ours. In military terms, it’s all about controlling the battle space – another piece of information I picked up during my time on the medical desk.

In 2006, our government believed that we could control Helmand with fewer than 4,000 troops. We sent 40,000 to Iraq, and by 2008, we had around 8,000 soldiers in southern Afghanistan – the most dangerous place on the planet. I didn’t need a PhD to understand that our politicians may have underestimated just how many jihadists we were taking on.

News from Camp Bastion says that wheels are up; we have what is known as the ‘golden hour’ – a window of time in which to get casualties off the ground and into surgery as quickly as possible. Including our own treatment, the evacuation will be complete in just under an hour, including flight time. This is reassuring, and it offers our casualties the best possible chance of survival; hearing that the medical emergency response team (MERT) helicopter is airborne is welcome news. The MERT offers our casualties a secondary lifeline should they deteriorate on the rescue bird. The MERT are the unsung heroes of the battle to secure Helmand. The team is made up of highly qualified medical personnel who are capable of giving in-flight lifesaving treatment if and when required.

Sgt Maj. Davey Robertson leads a patrol from our base to secure the route to and from the HLZ. The chosen site is an old football pitch opposite our base on the other side of the canal. All of this is happening under the cover of darkness, and the young Jocks rely heavily on the basic low-level soldiering skills, which cover movement at night. With technology ever moving forward, it is sometimes easy to forget the basics. My team and I are on foot and carrying four extremely heavy casualties. Davey relays via a runner, confirming that the landing site is secure. My extraction group is ready, and we prepare to move.

The evacuation must be measured at all times with clear command and control. My role ends only when our casualties are airborne; until that time, I must keep a grip on the situation. Hearing the sound of the Chinook in the distance, my mind is buzzing with questions as I mentally check that I have covered everything. Which way is it going to land? Are we at the right end of the football pitch? Are my casualties stable enough? Who am I going to hand over to? My list is endless, and no one can answer the questions. My heart races again, and my palms are still sweaty.

The Chinook comes in low and fast, touching down amidst a huge cloud of debris. On the ground, the cool night air on my face is quickly warmed by the downdraught of the powerful double engines to the rear of the aircraft.

A small green light in the back allows me to identify the loadmaster, and also gives me a path to follow with my casualties. I give the handover notes to whoever is available, and then count off all of my team before giving a thumbs up to the door gunner. It was painless and went perfectly, just as we like it.

As the Chinook takes off, my team take cover. The downdraught almost blows me over.
Good positioning, Taylor,
I think to myself, replaying the landing in my head.

We double back to the safety of the PB. All command elements gather in the ops room for hasty orders. No surprise to find out that B Company and its support are staying in Nad-e Ali for the foreseeable future. The unstable tactical situation here has become a major cause for concern; with so few boots on the ground, we will struggle to provide total security. I expect more soldiers will be inbound, bringing with them supplies and equipment. All we can do as a company minus is kill as many Taliban as we can in an attempt to cripple the enemy’s grip on the area. Isolated and very much alone, this could turn into a sizeable undertaking for the troops around me. As medics, we will of course support them as best we can.

Maj. Clark is concerned about Tony’s condition, and Lt Col Nazim, the Afghan commander, is worried about his men. I reassure them both that I didn’t envisage any major problems; however, any number of complications could occur. The balance of survivability is definitely in our favour; all we can do is wait for news from Camp Bastion. Another long day culminating in a casualty evacuation (casevac) has left every man exhausted.

Scanning our medical room and thinking about the questions that I often have that are never answered, I notice the silent, wide-eyed, panic-stricken faces. I am probably wearing the same expression myself. How were people reacting to combat stress and fatigue? In just forty-eight hours, so much already happened. The base was unsafe, and the blokes had yet to patrol out of it. I realise then that these men will come to rely heavily on me and my team; all of us in B Company know our roles tonight.

I need a decent night’s sleep, but not before cleaning up the mess left behind by our injured. One thing is for sure: we haven’t seen the last of spilt blood. Creatures of habit, we always square away our medical room, preparing to receive again at any time. Sorting through used bandages, my attention is diverted to something else, I overhear a conversation between the boss and the kandak commander. It seems like a heated argument, as both of them speak in slightly raised voices.

As I listen, I learn that the direct hit from the RPG has come from inside the base. An Afghan soldier fired low from the roof. Tony was manning the outer wall when he was struck by the RPG round.

The Jocks don’t welcome this information at all. It’s not the best start to relations between the two sets of soldiers. Amazingly, the grunts take the news in their usual relaxed and politically correct stride. Cries of ‘cunts!’ echo around the PB for the rest of the evening. Too tired to care, I laugh quietly at the absolute outrage of it all.

When all is said and done, the young Jocks realise that we have to fight alongside the Afghans if we are to stand any chance of surviving down here. The Afghan fighters are as knowledgeable as the Taliban when it comes to knowing the ground and terrain; their input is priceless, and it is our job to mentor them and introduce them to battle discipline. They have a medical team just like we do, and I am happy to mentor and guide them.

My throat is parched, and I down two bottles of water one straight after the other. I need sleep, and look down with less-than-eager eyes at my thin roll mat and my even thinner bivvy bag. A quick brush of teeth, and I lay my head for the night. Thinking about what will become of us, I still hold on to a glimmer of hope that we may return to Lashkar Gah.

In addition to being the capital of Helmand Province, Lashkar Gah is the seat of the provincial Afghan government. The base, in the centre of a heavily populated area, is home to the UK task force commander. I flew into Lash on a Chinook when I arrived twelve weeks ago, after initially landing in Kandahar aboard a Tristar.