ALI AL SALEM, Kuwait -- During peacetime in their home country, sick and injured service members can typically rely on emergency medical services and an ambulance to transport them quickly to a nearby hospital.
When those servicemembers are sent to the front lines on foreign soil, however, conventional means of transporting injured personnel are "up in the air."
During the fighting to depose former Iraqi president Saddam Hussein and his regime, wounded warriors on both sides of the campaign have learned to trust the corpsmen and Marines flying aboard the CH-46E helicopters of the First Marine Expeditionary Force's Casualty Evacuation Teams with their lives.
To date, I MEF casevac teams have had a 99.007 percent survival success rate in the treatment of U.S. service members, enemy prisoners of war and Iraqi civilians cared for by aircrew casevac corpsmen, according to Navy Lt. Erik P. Voogd, flight surgeon of Marine Medium Helicopter Squadron 165.
In this conflict, the enemy has had the "hometown advantage" and the most intense ground fighting has been done house-to-house in urban areas. Regardless, the death rate for servicemembers during Operation Iraqi Freedom is only one-eighth what it was during the Vietnam War and the Gulf War combined, Voogd explained.
"I'd like to say medicine is better today," Voogd said of the degree of success the Casevac flights have had in saving lives. "But the one thing making a difference here is how quickly we get in there and remove those (injured) Marines from danger. That couldn't be done without combat pilots and aircrew who can get to a hostile landing zone and get the patients out."
According to Voogd, a Parkersburg, Iowa, native, the most critical period of time for anyone who is seriously injured is the "golden hour," or the interval between the occurrence of the injury and the administration of first aid. The faster a patient with a gunshot wound or shrapnel injury can get to an established medical facility, the better the victim's chances of surviving. During the operation, one of the best methods of getting out of harm's way has been aboard the "Phrogs" of the casevac team, said Voogd.
"These guys flew in horrible conditions, facing everything from Iraqi aggressors to bad weather, to get as close to an injured Marine as possible," Voogd said of the ability of the CH-46 pilots and aircrews. "During the heavier fighting, they would fly low and slow to make their way through dust storms and low visibility just to pick up a patient."
Each member of the aircrew, including the medical corpsmen, has been trained for combat situations, including operating in a "hot" landing zone, near active combat operations. The "Devil Docs" are also qualified to operate the two .50-caliber machine guns aboard the aircraft, which are meant for defending the crew and helicopter when in danger.
Other helicopters, such as the CH-53E and Army UH-60, were used opportunistically for Casevac missions, while the CH-46 belonging to the Marine Medium Helicopter Squadrons here were the primary aircraft tasked with casualty evacuation. Other types of missions flown by the Phrog squadrons include assault support and command and control flights.
"There's definitely a difference between a casevac and a medevac flight," Voogd said.
Voogd said the medical evacuation system, or "Medevac" flights, were created as a means to carry wounded or ill personnel from an established battalion aid station or an basic medical facility to a higher echelon medical clinic. The primary helicopter used for Medevac missions has been the Army UH-60A Blackhawk, with CH-53D and CH-46E and aircraft also participating in medevac operations. Casevac missions flown by Phrog squadrons have medical corpsmen on hand who are trained to treat trauma patients. The hospital corpsmen who fly aboard casevac missions have completed combat aircrew training and can assist the aircrew and pilots during flight operations. A casevac aircraft is capable of landing near an active combat zone, loading patients rapidly and defending the aircraft from enemy fire upon withdrawal.
"We can assist the pilots when landing, make sure the (landing zone) is clear, then jump out of the aircraft and take care of the wounded," said Petty Officer 2nd Class Jeff S. Coslett, search and rescue medical technician for HMM-268.
Coslett, a member of the I MEF casevac team, has experience as a civilian paramedic in his native city of San Diego.
"It's a different experience when someone is shooting at you," Coslett said, comparing his service in Iraq and San Diego. "Working in a combat zone is a reality check - it's so loud on the aircraft, we couldn't tell when (the enemy) was shooting at us and the patient can't usually tell me what's wrong with him," said Coslett.
Even in the "fog of war" created in a combat zone, Coslett said the medical corpsmen attached to the infantry units were giving the injured warriors the best treatment available.
"The corpsmen on the ground were the 'Johnny on the spot' guys," Coslett said. "The work they did for the injured was outstanding - a patient would always be packaged up and ready for evacuation by the time we were there to pick (the patient) up."
Once the wounded were flying aboard the helicopter, traveling at speeds reaching 145 knots, the work of the casevac team's corpsmen had just begun. Several of the patients were in need of constant medical attention, which was made difficult by the environment aboard the aircraft.
"If you could picture an emergency room or an ambulance back in the states, it would almost be a controlled environment," Coslett said. "Here (on a CH-46E) it's difficult to even take a pulse because of the noise and vibration. We constantly have to make decisions from our experiences and training.
The casevac team also saved the lives of several Iraqi civilians and soldiers who needed medical attention. Coslett said his team carried more injured Iraqis than coalition forces, but the language barrier was only one difficulty overcome by the Corpsmen providing medical care for the enemy.
"A Marine knows I'm there to help him, but an (Iraqi soldier) might not understand," said Coslett. "He's probably asking himself, 'Who is this, and what is he doing to me?'"
The casevac teams often risk their lives to be able to help others. During the conflict, the corpsmen and aircrew would remain as close as possible to the infantry units they were supporting, enabling them to get to a patient as fast as possible.
When on standby, the casevac team's nights were often spent near or aboard the aircraft, usually sleeping on the same stretchers used to carry the wounded. Coslett recalls long nights spent near the front lines, eating Meals Ready to Eat while listening to "talking" artillery and receiving enemy mortar attacks.
"Iraqi artillery would land nearby, almost too close sometimes," Coslett said. "Our artillery would respond with their own barrage and the enemy would usually get one more chance to return fire. By then our guys had zeroed in on their position, and we'd hear 'BOOM BOOM BOOM!' and (the Iraqis) would stop shooting back."
The skill of the medical corpsmen and aircrews of the I MEF casevac teams are evident in the amount of success they've had in saving lives during Operation Iraqi Freedom.
"I don't see how anything I'll ever do in the future for the Navy will ever compare to what I've done out here," Coslett said.