Hi! I saw quite a few of your answers to questions on comas and thought that I might drop by and ask a slightly different question. I have a character who's an Iraq War veteran and lost his leg in a helicopter crash while deployed. What sort of issues would a rescue team face getting him safely back to base/a military hospital? In addition, are there any painkillers commonly prescribed to recent amputees? Thank you!
Ooooooooh! I like this question! I like this question a lot. Thanks for this!
When you say “What sort of issues would a rescue team face getting him safely back to base/a military hospital?”, there are a few issues we need to discuss when it comes to your characters amputation, the specifics of the helicopter crash, and what may or may not complicate the SAR (Search and Rescue) op.
First, what brought down the helicopter? If it’s enemy fire, that’s a whole different ball of wax than other causes of aircraft crashes such as mechanical failure or CFIT (Controlled Flight Into Terrain–pilot error, disorientation, visual failure at night, pilot suicide, what have you).
The reason for getting shot down being a much bigger deal is that typically, after they shoot you down, people with guns will come to try and finish the job.
I am not a combat medic. I do not play one on TV. (I did consult with a veteran combat medic with service in both iterations of the Iraq war for this post.) But there was an excellent TV show called Inside Combat Rescue that followed an elite special forces group called the PJs, or Pararescuemen, who are Air Force special forces troops who are specifically adept at performing high-risk medevacs.
It’s a neat show, and I don’t typically go for neat. It was on Netflix a while back, but seems to not be anymore. Sadness. If you enjoy this type of thing, I suggest you go and find it.
Either way, there are a few phases of rescuing members of downed helicopters:
1) Learning that a crash has even taken place. Birds go down silent more often than you’d think; a pilot’s last priority is communication, her first is flying the goddamn bird, so hitting the deck without making a radio transmission is entirely possible. Also, consider that the initial hit could have incapacitated the pilot and/or co-, or destroyed comms systems in the bird. I don’t know if the US military has auto-transponders in the case of crashes; civilian birds are supposed to transmit emergency signals if they crash at anything higher that 4 Gs of force. A lot of crashes don’t hit that hard, so often times the transponder doesn’t go off even though it works perfectly in tests after the fact.
THINGS YOU LEARN BECOMING A FLIGHT MEDIC: YOUR EQUIPMENT MIGHT NOT SAVE YOUR ASS AND NO ONE IS COMING TO HELP YOU.
2) Assessing that crash. Is there another bird that can get a visual on the crash? A ground unit? A satellite? Where is it, exactly? How much bad guy is between a rescue unit and that crash? How many crew were on board?
A single medevac chopper can take several patients, but if a Black Hawk
filled with troops plus pilots plus crew chief just went down, or if
ground units have taken casualties protecting the aircraft, additional
aircraft may be required to take all the casualties.
3) Planning and executing a response. Commanders will have to weigh sending one crew out to try to save another–while the people who just shot the bird down are still around.
4) Launching the rescue mission, arriving on scene. This is relatively obvious. There may be additional units dispatched to secure the scene and provide cover for the medics while they do their job.
5) Attaining fire superiority. One of the basic rules of combat medicine, as has been told to me by military medics and what little brushes I’ve had with it in the civilian world, is: The first priority at any scene involving gunfire is shoot back. You want more lead flying the other way than toward you, because that’s how you stay safe.
6) Assessing the crew. Who’s fucked up, and how bad? Who’s dead? Who’s injured? Who needs to be boarded and collared, and who can be dragged? Who’s bleeding to death, and who can wait? Does anyone need an airway?
One major point about the mechanism by which your character loses his leg: helicopter crashes are really violent. People and equipment get thrown. He likely suffered other injuries in the crash. Many many survivers of helo crashes have significant trauma to their back and head. Spinal fractures are possible. Broken bones in other limbs are very likely, especially in the arms and hands (as people try to protect themselves and/or brace for the impact).
7) Evac and care. Patients will need to be loaded into the medevac chopper on stretchers and secured for transport. Care is ongoing during all phases of flight. People might get IVs in the air, or airways in the air (though it’s MUCH better to tube on the ground if you can). Again, it depends on how many patients there are and their condition.
If they’re shocky enough, your character may even get a blood transfusion in-flight with a unit of O- whole blood.
8) Arrive at Field Hospital. I will be honest: I don’t understand the military’s exact structure when it comes to field hospitals. I’m not sure what they’re called.
I can give you a very confusing graphic from a military lecture on joint trauma systems, but I can’t give you the explanation that goes with that chart:
Your soldier was likely medevaced (the actual term is CASEVAC, casualty evacuation) to a Combat Support Hospital, or CSH (pronounced $), where a Forward Surgical Team (FST) would have performed the amputation. He would have been stabilized there, likely with blood products, and then flown back to a hospital in a major city, such as Baghdad. The next step would have been to be flown to a hospital in a US base, such as Rammstein, Germany. Ultimately he would have been flown home to the US and likely sent to a VA hospital such as Walter Reed.
As to pain…. here’s what things might have looked like for pain management.
Field Care / CASEVAC care: Your character would likely have gotten ketamine or fentanyl for pain, if he got anything at all. Morphine tanks blood pressures too much and it’s likely that whatever caused the amputation caused enough bleeding to be life-threatening, so no morphine.
Surgical Care: Your character would have gotten an anesthetic for the surgery, and likely some intravenous fentanyl for pain management.
Post-Op Care: Opiates. Now that he’s been stabilized, he can get morphine in the first few days. After that, oxycodone with acetaminophen (Percocet) is likely. This will continue throughout the recovery process.
I hope this was helpful!
I also really want to say thank you to the vet who helped me write this answer. I am in your debt, sir, and thank you for both your time and your service.