Evacuating the Injured

A Marine Corps pilot flies CASEVAC missions in Iraq.

(Cpl Mark Sixbey/Courtesy Rocky Checca)
Air & Space Magazine

After graduation from the Naval Academy and commissioning as a Marine Corps pilot, I went to flight school and selected the CH-46E Sea Knight out of Marine Corps Base Camp Pendleton, California. The CH-46 is the Marine Corps’ medium-lift assault support platform. I was detailed to join Marine Medium Helicopter Squadron 364 (HMM-364), the “Purple Foxes,” deploying to Iraq. Combat operations had supposedly concluded in May 2003 while I was still in flight school, well before I arrived on station. After I arrived, however, the insurgency began, and the situation in Iraq rapidly deteriorated. From early 2004 to February 2010, HMM-364, HMM-268, and HMM-161 operated on a continuous eighteen-month rotation at al-Taqaddum Air Base in Iraq.

Al-Taqaddum Air Base was located in the heart of the insurgency, halfway between the cities of Fallujah and Ramadi, in the infamous Sunni Triangle in al-Anbar province, in western Iraq. The primary role and mission of our squadron was casualty evacuations, CASEVAC. We also flew hard-hit raids, insertions, extractions, snap vehicle checkpoints, and night external resupply missions. The commanding general considered CASEVAC the “no-fail” mission in Iraq, making it clear to us that there would be no dropped CASEVAC missions for any reason.

Although CASEVAC were flown on a daily basis, multiple times a day, there was absolutely nothing routine about any of them. Each one presented unique challenges and problems. The pilots, aircrew, maintainers, and corpsmen prepared for the known task, but with ample contingencies for the “fog of war.” We had to be prepared to fly through any and all weather conditions, at any time, and into all kinds of enemy situations to save the lives of the people we were called on to evacuate.

The CASEVAC process was important to everyone in theater. If an individual can be provided medical treatment within one hour of an incident, the chances of survival increase exponentially. This is known as the “golden hour,” and that is why the entire CASEVAC process, from start to finish, is standardized, efficient, and quick.

Being on standby for CASEVAC was physically and mentally exhausting. We couldn’t leave the squadron area; food was brought to us; and if we had to use the bathroom, we hoped that the bell wouldn’t ring while we were sitting on the can. When the bell rang, we sprinted to the helicopters and would have a primary, a secondary, and a backup aircraft up and spinning four minutes after the CASEVAC bell rang. Many times we would be in the aircraft ready to taxi for takeoff having no idea where we were flying to or exactly what situation we would find once we got there. On many days the bell seemed to ring constantly, and we would fly CASEVAC after CASEVAC. Even on slow days, including days when no CASEVACs were flown, we would still be exhausted by the end of the shift because of the constant state of anticipation.

We flew CASEVACs for all coalition personnel, Iraqi civilians, and even insurgents. The lives of our forces took priority over the insurgents’, but if an insurgent’s life could be saved, he potentially could provide valuable intelligence that might save American lives. There were times when we would pick up insurgents and Marines who had just been fighting each other and would load them together into the back of the helicopter.

I experienced several close calls while flying. During my first deployment, on one of my first flights at night in Iraq, we received multiple RPG (rocket-propelled grenade) shots and small-arms fire while flying on final approach and on departure for a mass casualty call at Combat Outpost in Ramadi. The first RPG was shot from directly in front of us on final approach and passed 10 or 15 feet above our rotors. Another was fired from behind us on departure and passed the left side of the aircraft. RPGs and small arms were shot at our aircraft numerous times, and on several occasions aircraft took battle damage or were shot down. HMM-268 even had an incident where an RPG entered the bottom of the aircraft while it was flying, hit the crew chief in his back on his SAPI [Small Arms Protective Insert] protective plate and helmet—knocking him out—and then exited through the top of the aircraft, miraculously missing all the vital flight components and never detonating.

I distinctly remember evacuating a Navy SEAL on my second deployment in 2006 from the very same zone. He was the first SEAL killed in action in Iraq. One of his fellow SEALs came with him on the flight when we picked him up. He had a severe gunshot wound to the head and face but was alive during the transit. He succumbed to his injuries after we dropped him off. It became clear early on that no one was invincible here, not even a SEAL.

Mass casualties were the worst because improvised explosive devices and car bombs were usually the culprits. The odor of burned flesh is something I hope to never again smell. Lots of times, people with missing limbs were bleeding to death in the back of the aircraft. If it weren’t for the Navy corpsmen, who worked tirelessly to keep the wounded alive while in transit, many more would have died. They did the dirty work to keep everyone breathing or from losing that extra pint of blood that might cost the individual his or her life. They stopped bleeding from massive wounds or held someone’s guts in during the flight to keep them alive.

One of the worst things to hear a corpsmen say to a pilot is “Fly faster,” because that means the patient is slipping away. During CASEVAC, the pilots already fly as fast as the aircraft can go, so to get such a request from a corpsman leaves one with a helpless feeling. There were times when patients would expire in the aircraft en route. Those are some of the longest and quietest flights a pilot experiences. No matter what the situation is regarding the enemy or what is occurring in the back of the aircraft, you must force yourself to compartmentalize what you are seeing and hearing, separating it from the task at hand, which is to get everyone out of there as quickly as possible.

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