BAGRAM AIR FIELD, Afghanistan -- It isn't difficult to spot a medevac operator here. They usually have a radio glued to one hip and when it chirps or squawks, everything else stops.
This airfield, or "BAF" as those stationed here call it, is nestled in the mountainous eastern region of the country and serves as a ground zero for wounded fighters. It is one of the largest hospitals capable of treating the injured in-country, and also home to the Department of Defense's busiest airstrip.
It serves as the lifeline for evacuating the grievously wounded out of harm's way and toward Western medicine, regardless of if they are coalition troops, Afghan National Security Fighters or even Taliban insurgents.
Whether from the storied Army Dustoff squadrons or elite Air Force Pararescue "PJs," all these forward troops envision is someone who needs help within an hour, or their chances of survival plummet.
SOMEWHERE OVER NANGARHAR PROVINCE
The roar of the UH-60 Black Hawk makes it almost impossible to hear anything inside it. Three medical crew members of 10th Mountain Dustoff, Charlie Company squadron are a veritable flurry of activity over the Afghan National Army soldier they just picked up in Jalalabad. A bank of electronic medical equipment mounted over his stretcher is helping to keep him from succumbing to the gunshot wound to his chest.
The crew from a 10th Mountain Dustoff, Charlie Company medevac unit transports a wounded ANA fighter on a stretcher.
The interior of a Dustoff helicopter, stripped of its usual medical support supplies to make the aircraft lighter in the hot, thin Afghan air.
The crew chief, who controls who can come on and off the aircraft as well as directs the activity inside, turns around to explain what each of the dials and screens means.
"Is he controlling his own breathing?" U.S. News asks over the closed-circuit radio system, of the slow rise and fall of the young man's chest.
"No!" the chief responds, grinning. "We've taken over his entire body. Pretty cool, huh?"
The Black Hawk, now bound for Kabul, emerges from mountain passes and skims over the capital city's skyline as daylight turns to dusk. It eventually touches down on a small helicopter pad where another medical crew picks up the unconscious fighter, and takes him to the hospital where the most grievously wounded locals end up.
Earlier that day had been calm in the Bagram hangar that serves as this squadron's headquarters. The soldiers were studying for masters degrees, tuning the Black Hawks due for service or watching movies on iPads. They snapped to attention as soon as the alert came down on their radios that an ANA fighter was shot in the increasingly violent Kunar Province in the northeasterly reaches of the country.
Computer screens in their control center spit out the "nine-line," a simple document that informs any medevac crew of everything they need to know for the rescue mission, including the likelihood of an attack on the ground.
Every Dustoff mission includes two helicopters. One marked with a Red Cross, which Geneva Convention regulations dictate cannot carry heavy weapons on board. It is usually accompanied by a sister helicopter that traded these markings for twin M-240 Hotel machine guns.
Within an hour of the initial alert, a medevac unit similar to Dustoff brought the fighter to Jalalabad for initial surgery. Less than an hour after receiving this care, he was delivered to Kabul where he would likely survive his injuries to fight again.
Army Capt. Travis Bonney adjusts his helmet as he prepares to leave Bagram on a medevac mission.
"The Afghans are seeing the brunt of the fighting, they're seeing more casualties," says Maj. Christopher Logan, the company commander whose previous life included stints as a guard at a maximum security prison.
He is proud of the capabilities his squadron can offer the Afghans. They launch their helicopters within 11 minutes of receiving a nine-line, and usually bring their quarry back to a base less than 40 minutes later in an attempt to achieve the industry standard "golden hour."
Work for his crews has dropped sharply since 2010 and 2011, when coalition forces were engaged deeply in a surge of troops in Afghanistan. Since that time, and the planned transition of fighting to the Afghan troops, business has been cut in half.
He offers the same cautious optimism echoed at the top levels of the Pentagon, regarding whether the local forces will be able to provide the same level of care to wounded fighters after the U.S. drawdown of combat forces in 2014.
"The threat is still the same, it's real and its out there," he says. "The enemy has a vote."
'IT TAKES SIX YEARS TO MAKE A SIXTH GRADER'
It's a common phrase among those who regularly respond to questions about the Afghans' capabilities. President Barack Obama has declared the U.S. war in Afghanistan will be over by the end of 2014, and has not yet offered any indication of what sized force may be left behind, if any at all.
Army Gen. Martin Dempsey, chairman of the Joint Chiefs, was in Kabul in late July negotiating with President Hamid Karzai about the size of this prospective "enduring force." They were not yet able to reach a bilateral security agreement, or BSA.
The U.S. has been honing its ability to save wounded troops with a superpower budget and more than four decades of trial and error since first broaching the idea during World War II and the Korean War. Squadrons with the callsign DUSTOFF first cut their teeth in Vietnam saving wounded troops from remote jungle bases.
The Afghan's version will likely begin as a strictly casevac operation, where aircraft simply transport a wounded troop without in-flight treatment. Yet the program and its likelihood for success has many critics.
"I have so many people tell me all the time, 'The Afghans don't do casevac,'" says Air Force Lt. Col. Michael McBeth, surgeon general of the 438th Air Expeditionary Air Wing, from his headquarters in Kabul where he trains Afghan pilots and crews. "That's so frustrating to me because three times a week I'm getting an urgent call to jump on a helicopter and go out with the Afghan medevacs to pick up one to six patients right off the battlefield."
"Afghan casevac capability has been overshadowed and lost by the drawdown of ISAF capability," he adds. "Most stories I've seen have been the hard luck story of 'ISAF air is going away," and so, what now?"
Afghan pilots have flown 640 missions since May 2013, the beginning of the fighting season, an Army spokesman in Bagram confirms. Afghan crews now perform roughly 80 percent of the maintenance on their Russian-made Mi-17 helicopters with oversight from contractors and U.S. troops, which has drawn criticism from government watchdogs.
An Afghan Russian-made Mi-17 helicopter returns to base at Jalalabad.
A majority of these missions are conducted autonomously. But the Afghans still have a long way to go. No conventional Afghan Air Force pilots are qualified to fly using night vision technology, and pilots still have to rely on coalition troops for invaluable close air support.
"There is a misconception that casualty evacuation is not a priority for the Afghans," says McBeth. "From my experiences, working directly with Afghan air crews flying joint casualty evacuation missions, not only is that absolutely false for the guys who are doing these missions, but they think of this as their number one priority."
'THAT OTHERS MAY LIVE'
On the opposite side of the Bagram Air Strip lies the inconspicuous headquarters of an elite unit that outside observers describe as "Navy SEALs with medical skills," search-and-rescue operators with a "surgical, clandestine" streak or just simply as the "Guardian Angels" espoused on their insignia. U.S. Air Force Pararescuemen are known as PJs for their ability to jump out of airplanes – among other skills – to rescue sensitive forces caught behind enemy lines. They came out of the jungles of Vietnam when the military realized it needed a highly trained force that could fight or sneak its way to a downed pilot and return him home alive.
In Afghanistan they share the duties of combat medevacs with Dustoff, with a few differences.
"We shoot back," says Air Force Lt. Col. Brad Dow, pararescue commander of the 83rd Expeditionary Rescue Squadron.
The gear used by Pararescue pilot Chris Obranovich includes a sidearm.
Pararescumen Staff Sgt. Taras Ivaniuk prepares the interior of his helicopter for its next mission.
Dustoff helicopters are stripped of their usual medical, oxygen and lighting equipment to accommodate for the hotter, thinner air high up in the Afghan mountains. They can thus fly slightly higher than the PJs' HH-60s, but only because there are some things pararescue won't do without.
Every one of their Pavehawks is decorated with a telltale moustache on the nose, an homage to their combat callsign "PEDRO." They also all have twin .50 caliber machine guns on both sides in addition to the arsenals each operator carries with him on board.
The telltale nose of a Pararescue "PEDRO" helicopter.
An ammunition belt feeds into one of the two .50 caliber machine guns mounted to each side of the Pararescue helicopter.
But there is less need for that in this current war, versus the 10 missions per day they encountered at the height of the surge. PJs have only activated for these kinetic missions around Bagram four times since last fall, Dow says. They have had roughly 150 wounded-in-action missions and transferred 12 troops who were killed.
"Afghanistan is almost exclusively not special tactics," says Air Force Capt. William Chase, the combat rescue officer for the unit on duty the day he spoke with U.S News. PJs have traded the time they would usually spend stalking through enemy territory to find a comrade for instead honing their medical skills.
The frequency of work in Afghanistan has allowed the unit a chance to work on the combat trauma training that has proven critical in fighting the wounds that have become ubiquitous in this war, largely from deadly improvised explosive devices.
"But it's not a complete snapshot of what we're doing," Chase says. Pararescue has maintained a large contingent off the Horn of Africa, conducting its own missions and training local doctors and veterinarians.
They participated in the 2009 Airbus 310 crash into the Indian Ocean miles off the Comoros Islands and helped rescue the 14-year-old girl who survived.
That Pararescue can cover this large swath of the world and adapt to the mission in Afghanistan helps to demonstrate the kind of men who can withstand the years of training necessary to join the units. Its history has been one of taking on new challenges.
This includes the ability to leap from an airplane with a jetski and successfully parachute into the open ocean.
That mission stems from the Space Shuttle Challenger disaster, Chase explains. A review board discovered the astronauts in the jettisoned capsule survived the initial explosion and were still alive as it fell into the sea.
Pararescue then set up procedures to be based in France or Spain during every launch, and packed the necessary equipment to follow a disaster into the ocean and recover any survivors.
'WHEN I HAVE YOUR WOUNDED'
In this war, helping the wounded includes treating the enemy. U.S. News witnessed the transportation of a captured Taliban fighter who sought medical attention for what he believed might be kidney stones.
"A person is a person," says Army Sgt. Julia Bringloe, standing on the tarmac outside the Dustoff hangar with the telltale radio close to her side.
Bringloe received the Distinguished Flying Cross last year for repeatedly dropping into heavy fire on her helicopter's winch and cable to rescue pinned-down troops. She disregarded her fractured leg to rescue an Afghan translator among the fray.
She humbly points to the crew she worked on the mission and shirks any claims of individual heroism.
"The duty of a medevac is to treat any patient," she says.
- U.S. Charges for Benghazi Attack Suspect Open U.S. Options
- Defense Secretary Hagel Reduces Civilian Furloughs to 6 Days
- Memo Outlines Pentagon's New Plan for Same-Sex Benefits
Correction 08/09/2013: A previous version of this story misidentified the Army’s rescue helicopter. It is the UH-60 Black Hawk and uses M-240 machine guns. The story also misidentified Capt. Travis Bonney and Sgt. Julia Bringloe. They serve in the Army.