BlackFive

The responses from COL Kolb, Deputy, ISAF Public Affairs, are inserted in red bold italicized text:

Red Air: America’s Medevac Failure

12 October 2011
Afghanistan

Most of our troops in Afghanistan never see combat.  The closest they get might be the occasional rocket attacks on bases.  A relatively small number will be in so many fights that the war becomes a jumble.  For those who see fighting daily, their mental time markers are often when they or their buddies were hurt or died, or when some other serious event occurred.

The troops in 4-4 Cav have seen a great deal of fighting.  Their courage seems bottomless and for two-and-a-half months I was an eyewitness to their professionalism and courage.

This mission would be dangerous.  The Female Engagement Team was left behind and the only female Soldier to come was a medic because, as she would tell me, “I’m the badass medic.”

We sat in the morning darkness behind the helicopters waiting for them to start.  A few Soldiers were sleeping on the rocks, while others murmured about this or that.  A bomb dog looked at me, then plopped her head on the stomach of her handler, leaving her nose pointing to the sky due to the bulk of the handler’s body armor. The air was still and cool at about 0230 when the helicopters cranked engines under the waning gibbous moon.  Illumination was enough for an RPG shot on the landing which could take us all down in a ball of fire.

The helium-filled aerostat balloon tugged at its tether in the background, and light years farther in the background was Orion, pointing north.  Remarkably, all of the fighting done by 4-4 Cav has occurred within just a few miles of this base.

CH-47 lifting off on a 4-4 Cav air assault. This image was made from a previous mission. All other images in this dispatch are from the mission described herein.

The CH-47 engines were roaring under the spinning rotors as crew members inspected the aircraft with flashlights looking for any signs of trouble.  Thick, hot fumes washed over us as we boarded. Troops filled every seat and all the space on the floor.  The helicopters lifted off and soon the wheels touched down on the landing zone in tilled fields. We rushed away from the back ramp and the helicopters flew off into morning darkness leaving us among marijuana fields and the Taliban. The mission into the deadly village of Leyadira had begun.

Through night vision, the Operations Sergeant Major Gregg Larson--a fine NCO--could be seen flipping open his Army compass and checking the azimuth.

Soldiers ahead of us searched for bombs using special gear such as metal detectors and other more secret stuff, but that only works to a point. And it only covers the area where a trooper has used the gear.  I don’t trust it.  The dogs are okay, but they get blown up, too.  Often the first person to find a bomb is far back down the line and he finds it by getting killed.  Keeping your distance from the person in front is crucial.  Being too close to any other man doubles the chance of both getting hit.

The village of Leyadira was full of booby-traps waiting for us--trip wires, pressure plates, and who knows what else--but we didn’t know that yet.  As best I can tell, Specialist Chazray Clark was at least number eighteen down the line.  The village was vacant other than the enemy.  The commander, Lieutenant Colonel Mike Katona, expected a big fight.   The moon was so bright that it cast shadows.  We were maybe two hundred meters into Leyadira when the first explosion happened.

BOOM!!!  Off to front right there was a tremendous blast.  Seconds later, debris began raining down and could be heard coming through the trees on the right.  The ANA Soldier looked at me startled (image above) and started to run for cover, but there was none to be found.  I just stood still, waiting to be hit because it was better to be still in a place now known to have bombs.  We were not in small arms contact.  He saw me stand still and he did the same.

Specialist Chazray Clark had stepped on a bomb.  Some Afghan Soldiers had strayed off the cleared path and Chazray was following them because they were in front of his section.  Sergeant Edward Wooden had been close to Chazray but not wounded.  Wooden was proving yet again to be solid under pressure.  He had been wounded during a previous mission but now was good to go.  Sergeant Carroll was so close to this explosion that he was stone deaf.   Chazray was terribly wounded and had been thrown and landed on his face. The platoon was staggered by the blast yet kept their bearing.  They were amazingly calm.

In my location, the air was clear, but closer to the blast area the dust was thick.  The night vision devices were useless for those in the immediate area of the blast.  Sergeant Wooden called out the names of his men in the darkness, taking head count. Near the detonation, nobody could see each other.

Sergeant Wooden called, “Clark!” Chazray was facedown. One arm and both his legs were gone, and yet this man had the strength and presence to call out from the dust and darkness.  Chazray answered, “I’m okay. ”  Sergeant Wooden said Chazray’s voice sounded completely normal.  Chazray was carrying a good deal of explosives when he stepped on the bomb, including det-cord and caps.  Luckily, they didn’t detonate.

Although Chazray had answered that he was okay, everyone here knows that when someone calls out “I’m okay,” the sound of their voice only means they are still alive.  Fellow Soldiers located Chazray in the dark, and quickly put on tourniquets and unfolded a stretcher. I was not in the dust-filled area, but I could see brave men come out of it, carrying Chazray back over dangerous ground.  I heard Chazray say his arm tourniquet was too tight. He was in great pain. Through night vision I saw an Afghan Soldier rush in to help carry Chazray.

Specialist Chazray was fully conscious and talking the entire time while being medically treated and moved.

The Soldiers took Chazray back to the landing zone where we had just come in.

We waited.

And waited.  Some Afghans slipped off to pray in the dark despite that the surrounding areas were not “cleared.”  (The next day during this mission, an ANA Soldier stepped into an uncleared area and was killed instantly.)

Sergeant Carroll was so deaf from the bomb blast that he didn’t seem to hear anything, but he stayed alert and on his job pulling security.  At one point, an officer tried to talk with him, and a buddy of his said something like, “Sir, he can’t hear.  He’s deaf.”  And that’s how it went.  When someone wanted to communicate with Sergeant Carroll, they had to grab him and speak loudly in his face.

The medevac was very late.  It took us about 20 minutes to get back to the Landing Zone (LZ).  Based on my significant experience down here in southern Afghanistan, I know that the helicopter could and should have already been on orbit waiting for us. 

Medical planners use a “Golden Hour” factor   for executing Aerial MEDEVAC missions.  This hour is broken down into three different categories which take into consideration run-up, flight times, and patient load times.  Once the Region Command’s Patient Evacuation Coordination Cell (PECC) receives a MEDEVAC request, they determine the quickest way to get the Category A (CAT A) casualty from the Point of Injury (POI) to a Medical Treatment Facility (MTF) that can provide the appropriate level of medical care for the injuries suffered.  In this incident, the quickest and safest option was to use MEDEVAC assets stationed at Pasab, not Kandahar.  Based on average run-up and flight times, it would have had to have been a well below average mission execution for a MEDEVAC from Kandahar to be in orbit at the POI 20 minutes later.

Chazray was dying but fully conscious and talking the entire time.  We waited, and waited.  Finally a radio call came that the medevac was “wheels up” from KAF.  It was unbelievable to us that the medevac was just taking off from Kandahar Airfield, twenty-five miles away.

The initial 9-Line request for SPC Clark was received at 04:50 SEPT 18, with enemy activity reported in close proximity, which requires an armed escort for the MEDEVAC.   Given the situation, the PECC determined that the quickest way to get the CAT A casualty from the POI to the MTF was a MEDEVAC aircraft from Pasab escorted by an Apache team, with whom they would link up enroute to the POI.  As soon as PECC received the MEDEVAC request, they notified the Aerial Reaction Force (ARF) at Kandahar which launched to provide an armed escort.   Meanwhile, the MEDEVAC crew at Pasab was briefed on the mission.

The MEDEVAC aircraft departed Pasab at 05:24, linked up with the ARF enroute and they landed at the point of injury at 05:37. The MEDEVAC aircraft arrived at Kandahar Role 3 at 05:49. Total time of evac from receipt of MEDEVAC request: 59 minutes

 

The problem was that this was an Army Dustoff medevac, and Army medevacs don’t carry machine guns because they have red crosses emblazoned on the sides and front.  When our helicopters sport the red crosses, they can’t carry offensive weapons.  This is meaningless anyway because they are accompanied by an Apache attack helicopter, which is fully loaded with a cannon and missiles.

And so while Chazray was dying, his Dustoff medevac was sitting idly on the runway down at Kandahar Airfield.  Since there was no available Apache, the Dustoff was not cleared to depart. 

The MEDEVAC helicopter departed from Pasab and linked up with ARF Apache escorts from Kandahar enroute.  That is correct that there were no Apaches at Pasab.

The Air Force Pedros have no red crosses marking their helicopters. 

The Pedro’s primary mission is PR and/or CSAR which is why they have no Red Cross markings.  However, they are included in the rotation for MEDEVAC missions in order to maintain crew and medic proficiency.

Instead, they have .50-caliber machine guns.  The Pedro helicopter teams are parked right there on the same runway and they could have been dispatched, but for some extremely sorry reason the Pedros are not allowed to come into 4-4 Cav battlespace unless there is “red air.”

The Kandahar airfield does have Pedro’s stationed there but there were no Pedro’s available for this particular mission.

Red air means the weather is too bad for Army helicopters to come.  From my experience Dustoffs are not averse to extreme danger, but there are conditions during which they are not allowed to fly during which Pedros will go.

Somewhat true.  The basic weather minimums are the same for both airframes.  Risk assessments are done that take into consideration the weather conditions.  Due to advanced avionics on the Pedros the risk levels are lower than for Dustoffs which subsequently require a lower level Cdr to approve the mission thereby reducing the mission planning time by a short amount of time.

And so the armed Pedros, which could have flown to us in about 13 minutes, sat on the runaway twenty-five miles

This figure only considers actual flight time and does not take into consideration the planning/run-up time which adds several minutes to the overall mission.

away, doing nothing.  I know first-hand the skill of the Pedros having flown with them in 2009.

Specialist Chazray Clark was dying due to politics, and the Army and Air Force pilots are very angry about this.  Chazray’s is not the only such case.  Army medevac helicopters fall under the Medical Services Corps,

Aerial MEDEVAC assets are organic to Army Aviation, medical planners provide recommendations where those assets should be located in order to maximize aerial MEDEVAC coverage for the military population at risk.

who mark medevacs with red crosses. 

Based on the Geneva Conventions and Standing NATO Agreement (STANAG) 2931, medical aircraft shall bear, clearly marked, the distinctive RED CROSS emblem together with their national colors on their lower, upper, and lateral surfaces.  The US is a party to the 1949 Geneva Conventions and will adhere to their tenants.

Officers will tell you face-to-face that the Medical Corps does not want to give up its helicopters because senior officers want their own helicopters to shuttle them from here to there.

Completely false accusation.  It would be a gross and criminal misuse of MEDEVAC helicopters if this was the case, since regulations prohibit the use of MEDEVAC aircraft for anything except the medical evacuation of the wounded.  It would be quite evident if Army MEDEVAC helicopters emblazoned with red crosses were being used for general transport.

It is important to be absolutely clear--this is not about the Dustoff pilots and crews, who are incredibly courageous.  They have earned enormous respect.  They’ll fly into hell to get one of our wounded troopers.  This is about politics getting in the way of saving lives.

Yet despite everyone here knowing we are perpetually short on helicopters in Afghanistan, and while Pedros would have had Chazray to the hospital less than 35 minutes after the blast, Chazray lay dying. 

Again, this would assume a near perfect mission execution and not likely, considering the MEDEVAC was coming into a potential hot LZ.  Overall the average total mission time for Pedro’s operating in the RC-S area of operations is just under 45 minutes.

There is no doubt in my mind—after seeing Pedros in action many times—that Chazray would have been at the trauma center in less than 35 minutes if the Pedros team had been scrambled.  Instead, it took 65 minutes for Chazray to get to the hospital. 

Actual operational logs have notification to wheels down (WD) at the Medical Treatment Facility at 59 minutes.

Chazray was fully conscious when he was finally put on the bird. But he died at Kandahar Airfield.  The General in charge of this fiasco needs to be fired.

Unarmed Army medevac helicopters are not even allowed to go into certain combat areas because they may get shot up and have no way of defending themselves.  And so if the air is too dangerous due to bullets or bad weather, Air Force Pedros are sent because they fly in all weather and they shoot back with .50-caliber machine guns.

Pedros do not fly in all- weather; there are weather conditions under which they will not fly.  Also, allocating Apaches to be armed escorts does not appreciably add to overall MEDEVAC mission times

I asked Colonel Patrick Frank, the 4-4 Cav brigade commander, and Lieutenant Colonel Mike Katona, the squadron commander, if they have any discretion about which birds are called.  Can we request Pedros instead of Army Dustoff?  No.  The answer is simple, clear and ultimately disastrous: There is no discretion.

There is a very deliberate yet streamlined decision-making process to provide the quickest medical evacuation of CAT A casualties from the POI to the MTF.  The decision which air frame to use is done by who is “first up”, location, patient category and assets available.  Pedro’s and Dustoffs are routinely rotated to be “first up” on a periodic basis to ensure crew and medic proficiency.  Using the criteria given in the 9 line MEDEVAC request, the option to use a Pedro was not a consideration because there were no Pedro’s available for use that were in proximity to the POI.

Chazray is fully conscious and talking in the darkness waiting for an Apache escort.

Finally a courageous Army Dustoff crew lands.

Because of his proximity to the bomb blast, Sergeant Carroll was stone deaf. He was put on the bird with Chazray.

Chazray is loaded.

Now loaded with the two casualties, the Dustoff medevac heads to Kandahar Airfield. The Dustoff is wheels down at the hospital approximately 65 minutes after the blast. 

Official operational logs show WD at 59 minutes

Specialist Chazray Clark died at the hospital while we continued the mission.

This is not the only time that medevacs have been delayed in responding to 4-4 Cav requests, or had to switch landing zones due to heavy enemy fire.  If the Pedros were dispatched they would come right in because they can shoot back.

Again, the MEDEVAC aircraft had AH-64 escort, whose 30 mm cannon and rocket weapon systems are much more capable than the PEDRO weapon systems.  The assumption here is not backed up by evidence.  Every mission is assessed to evaluate risk and to select the most appropriate air frame in order to achieve the quickest and safest casualty evacuation in order to save lives.

After ten years of war, the Army has had every opportunity to fix this problem.  If the Army intended to right this wrong it would have been improved years ago.  Clearly, the Army lacks the will to address this issue.  We need courageous leadership.  This issue should be elevated to the level of the Secretary of Defense Leon Panetta, who needs to shake the Army’s political tree and fix our medevac issue before more troops die.

MEDEVAC missions in theatre are a success story.  Resources are allocated throughout the theatre to ensure patients receive the care they need within the “Golden Hour” which has proven to be vital in order to improve survivability.  Since 1 Nov 2010 there have been 2240 CAT MEDEVACs in the RC-S area of responsibility.  RC-S has a 98% survival rate for CAT A.  Out of Standard mission rate for RC-S is 1.56% with 0% of these having a negative clinical impact on the patient. 

We continued the mission. There was another KIA the next day from another IED.  No helicopter was called this time because the Afghan Soldier was killed instantly.  He was zipped up in a body bag and carried out that night.

And

Michael Yon's blog article of October 12, "Red Air: America's Medevac Failure," contains numerous omissions of key information and errors in fact.
For starters, Yon says the Army lacks the political will to configure its MEDEVAC aircraft like the Air Force's Combat Search and Rescue "Pedros" (Pedros are armed and do not have the red cross markings on the side of the aircraft). Yon is comparing apples to oranges. The primary mission of the Pedros is to rescue downed aircrews and other isolated personnel; their secondary mission is to support special operations forces. Both of these missions require them to be armed. If available, Pedros do also perform MEDEVAC missions - again, if available. Pedros can't carry as many litter patients as the Army Dustoffs and there are seven times the numbers of Dustoff helicopters compared to Pedros in
Afghanistan. Yon never mentions these critical points.
Yon's point that the Army should arm and remove the red cross from its MEDEVAC aircraft fails to acknowledge larger issues. Doing so would place the US outside its commitment to conducting MEDEVACs under the guidelines of the Geneva Conventions and moral norm for how Western nations identify their aircraft dedicated to medical evacuation.
Furthermore, the Pedro's 7.62 mm or .50 cal. machine gun does provide a level of self-protection but it is not on the level of an accompanying
AH-64 Apache carrying 30mm cannon and rockets. The Apache escorts give the MEDEVAC aircraft a much higher level of firepower and protection; something our Soldiers take confidence from when scrambling under fire to evacuate wounded comrades.
As for factual inaccuracies, Yon states that it took 65 minutes to
evacuate the Soldier who subsequently died. Not true, the official
operational logs show that the mission was wheels down (WD) at the medical treatment facility in 59 minutes; and the MEDEVAC aircraft didn't come from Kandahar, the Dustoff was launched from nearby FOB Pasab and linked up with its armed Apache escort from Kandahar enroute to the Point of Injury (POI). The fact is that despite extended distances and enemy forces in the area, this evacuation was accomplished under the US standard of one hour. Of the 2240 MEDEVAC missions conducted in the RC-S area of operations since 1 Nov 2010 only 1.5% were Out of Standard and 0% of those were assessed to having a clinical
impact on the patient.
Yon also states that commanders on the ground have no discretion to call for a Pedro over an Army medevac - an insinuation that they would if given the choice. Yon fails to mention that all requests for air evacuation are called into a central point in each Regional Command called a Patient Evacuation Coordination Cell (PECC). The PECC receives a MEDEVAC request, then determines the quickest way to get the Category A (CAT A) casualty from the Point of Injury (POI) to a Medical Treatment Facility (MTF) that can provide the appropriate level of medical care for the injuries suffered. The ground force commander does not have the capacity to make this call while in the close fight. The system is designed to allow for the most efficient response across the battle space with the assets of not only our MEDEVAC aircraft, but all rotary wing assets. Commanders understand the requirement for rapid evacuation of our wounded Soldiers and every effort is made to
execute the MEDEVAC mission safely and effectively. The highest survival rates in the history of armed conflict bears out this fact. In the RC-S area of operations there have been 2240 MEDEVAC missions since 1 Nov 2010 with a 98% survival rate.
Michael Yon's omissions of key information and factual errors have done a disservice to our Soldiers and all those who care about them. These inaccuracies may unnecessarily cause some to doubt the US medical evacuation system in Afghanistan. Further, it could undermine Soldier confidence in what should most certainly be described as the world's finest battlefield evacuation system.