Medic: Saving Lives - From Dunkirk to Afghanistan

by John Nichol

  By now, a full-scale battle was in progress. More casualties came to the ambulance for help, injured by bricks or with burns. The medical team spilled out on to the dusty road to treat them. The convoy then started up again, the Warriors surrounding the ambulance, inching its way past buildings from which gunfire was crackling. A crowd, grown to five hundred or more, was in pursuit and clamouring around every time the convoy was forced to a halt. The troops, in full riot gear, were strung out in a defensive line and taking a heavy battering. They concentrated their limited fire on the petrol-bombers, who were becoming increasingly daring, egged on by the baying crowd.

  Twenty yards away, a Warrior took a direct hit. Burning petrol seeped inside, and a ball of fire shot up from the turret. The bodies of men came cannoning out through the air, arms frantically beating at the flames enveloping them, their dramatic exit captured in photographs that went round the world, illustrating the chaos into which Iraq was descending. What the cameras did not see that day was that the gunner was still trapped inside and had to be dragged clear. Mincher ran towards him, tugging off his body armour as he went and using it to try to beat out the flames. To his surprise – Iraq was never less than unpredictable – a local man rushed forward with a bucket of water from the canal, broke through the cordon gathered around the casualty and drenched the burning soldier, helping to douse the flames. ‘It was bizarre,’ said Mincher. ‘He was lucky our boys didn’t shoot him.’

  Inside the ambulance, a full drill was underway to save the casualty’s life. The burns to his face and neck were severe, and he needed morphine and emergency fluids. ‘His head was swollen up like a football, he was deteriorating fast, and I was sure he was going to die. As I worked to save him, bricks and petrol bombs were still landing on the roof. I knew that if I didn’t get him away quickly, I would need to get a tube into his throat to open up his airways, and that would not have been easy in the circumstances.’

  The only chance the soldier had was if a helicopter could get in to evacuate him. The Warriors and troops fanned out to secure a big enough square for a single-rotor and extra-manoeuvrable Merlin, a recent addition to the air fleet, to land. It came in under fire, and half a dozen casualties were bundled on board. Mincher found himself pulled inside too. As the Merlin took off, a wave of relief flowed over him. After dropping off his patients, ‘I was shaking and soaked with sweat, but also very thirsty. And very, very tired after six hours out there, constantly on the move, in very hot conditions and in full body armour.’

  Meanwhile, the confrontation he had managed to get away from with his life was still unresolved. Back at the police station, a beleaguered Woodham was losing the battle to keep the lid on the pressure cooker. Local people had been hurt in the ruckus outside, and their friends, mullahs and militia among them, invaded the building to exact revenge. Dozens crammed into the small room where he was trying to work out a deal with a judge, and the major found himself at the wrong end of an AK47 held by a screaming Iraqi, his finger twitching on the trigger. ‘There was nothing I could do if he chose to shoot,’ he recalled. ‘For some reason he chose not to.’ But the stand-off went on for hours until, as night fell, the troublemakers seemed to lose interest and drift away. The switch that historian Richard Holmes spoke of in relation to Iraqi violence had clicked off. The next day, British tanks made a frontal assault on the police station, but the hostages had by then been smuggled out. They were found in a house a mile away and released. The incident was over, though it was not without repercussions. Relations between the British and the people of Basra plummeted, never fully to recover.

  At Shaiba, however, Mincher reflected on his good fortune. ‘We had done our bit and come away relatively unscathed.’ He was even back in time to go on the leave he had been so concerned about missing. When he boarded the transporter plane the next day to go home, the Warrior soldier he had rescued was there too, sedated, hooked up to a ventilator and looking ‘terrible’. But he was alive. He had been kept breathing and hydrated in the vital period between going up in flames and reaching the hospital. The efforts of the medics had saved him from certain death. In fact, there were, surprisingly, no British fatalities from that explosive encounter at the police station. And Mincher was happy to have played his part. ‘We treated nineteen casualties that day [19 September 2005], and nobody died, which in a very bad, deteriorating situation, with rocks, small arms, petrol bombs, lots of flames and vehicles going up, was a pretty good result!’

  He was not untouched by the experience, however. The enormity of what he had been through hit him once he was home. ‘My wife had watched the burning Warrior on television, but she had no idea I was there. She knew that, as a medic, my work involved helicopters and evacuation, but not that I actually went out on the ground. When I looked back, I realized it was probably the worst day of my career and also the best, the most frightening day but the most satisfying.’ He was rightly proud of what he had done. ‘You really learn things about yourself. You always wonder how you’re going to react under fire and, when it happens, there is a horrendous level of fear going on, but that’s what drives you along.’

  He was proud too at being in the vanguard of military medicine as it changed and adapted to the new circumstances of twenty-first-century warfare. The job medics did was taking on a fresh urgency and importance. ‘Our soldiers at the front deserve the best care and treatment, and we should be continually pushing the borders to get better and more expert care to them. I think we can be very proud of our medical services, really proud.’

  That sense of achievement stretched to the way the medics handled the hardest part of their job – death. The troops, who had stood their ground outside the police station and refused to be intimidated by a mob urged on by Mahdi army militants, now felt the backlash of that encounter. With relations between occupying army and the occupied hopelessly soured, the number of bombings, booby traps and sniper attacks shot up to new levels.

  Major John Mayhead, company commander in the 1st battalion, whose beat covered the northern half of Basra, began ticking up one serious incident a day. The killing of a popular sergeant, Chris Hickey, whom he had known for fourteen years, was a hard blow, not least because it happened on the very day the battalion’s tour was ending and they were due to hand over to an incoming regiment. Some of the pain was eased by the dignified behaviour of the medical staff at Shaiba. It fell to Mayhead and his company sergeant major to identify the body. ‘We were met by the padre and the commander of the field hospital. They were superb. They talked about Sergeant Hickey as a person and reassured us that nothing more could have been done to save him. They prepared us for his injuries before we were taken to where Chris lay. We bowed our heads in prayer, then quietly left. It wasn’t clinical at all, but very calm and respectful.’

  Later, Mayhead returned to retrieve the body and was ‘amazed and humbled’ as the entire medical team turned out to honour the sergeant as he was brought out to begin his last journey back to his home in Yorkshire. They lined the path from the entrance of the hospital to a waiting helicopter. A piper played a lament as the coffin, draped in a union flag and flanked by six doctors, was slow-marched with great dignity and solemnity, as if they were on parade at the Cenotaph in London. ‘I hand to your care the body of your brave comrade, Sergeant Chris Hickey,’ the hospital commander declared, and saluted. Mayhead was overwhelmed by the simple grace of the occasion. ‘There was not one dry eye out there,’ he recollected. ‘I was incredibly moved by the entire experience, and I know that it meant a great deal to my men to see their dead comrade treated with such respect.’7 He said as much to the doctor, whose response still rings in his ears. ‘He told me forcefully, “Any soldier in this hospital, alive or dead, comes under my command. They deserve the greatest of respect, and I will make absolutely sure they are given it.” ’

  The ceremony, Mayhead discovered, was held for every soldier who died at Shaiba and, though the parades were voluntary for hospital staff, attendance wa
s always 100 per cent. ‘It is easy to assume that in such a place as a field hospital, in the middle of a conflict, the medical services could become hardened and matter-of-fact about the issue of death,’ he said later. ‘The compassion and respect shown to Sergeant Hickey showed that they understood one of the most important tenets of military power – the moral component. As soldiers, risking our lives every day, we need to know that someone appreciates our sacrifice, especially when lives are lost. And in that dusty, arid piece of desert just outside of Basra, we realized that people did care, and cared a great deal.’

  14. A Woman’s Place

  Who would ever have thought that something resembling powdered soup or gravy granules would be a battlefield life-saver? But that was precisely what a revolutionary product called Quik-Clot became as science came to the aid of military medicine in the twenty-first century, just as it had done in the past with chloroform, morphine and penicillin. Derived from high-absorbent volcanic ash, QuikClot did just what the name on the sachet said. It accelerated the clotting process by soaking up water in the blood, activating crucial cells known as platelets and concentrating the bio-chemical elements that cause coagulation. To treat a deep wound in an emergency, one medic would hold apart the ruptured flesh while another ripped open the package, poured in the contents and then carefully added water. The powder fizzed like sherbet or liver salts as it went to work under a hastily applied bandage, and gave off considerable heat in the process, painful for those treated with it and occasionally causing burns. The discomfort was, however, slight against the benefits of shutting off a bleed, particularly given that those to whom it was administered were likely to be badly wounded and suffering anyway. The side effects were a small price to pay for the gain in survival prospects. ‘Bleeding marvellous’ was the verdict of the army magazine Soldier1 on this important development and it became a standard piece of kit in the Bergens of British medics in Iraq. They also carried Hemcon, a new dressing impregnated with a substance derived from crushed shrimp shells that formed an instant sterile seal over open wounds.

  QuikClot and Hemcon were American in origin, as were a number of other innovations that emergency-medicine specialist Colonel Tim Hodgetts and his RAMC colleagues were now assembling. Knowledge in this area had come a long way since the Falklands, pushed along in no small part by the contribution of the fiercely professional Israeli army, whose experience of hard-hitting military operations (along with the extra incentive to preserve lives that comes from being a small nation with limited manpower) was second to none. They were long-term exponents of the very sort of asymmetric war that the coalition forces were learning on their feet to fight in Iraq.

  From the US special forces came a new and faster field tourniquet. It was a wide nylon band with a Velcro fastening, a friction buckle and a tightening rod that could be twisted with one hand. A man could apply it to himself, unlike the traditional pencil-thin rubber piping and crude weighted metal clasp, a garrotte-like device that had changed little in a hundred years and which tended to cause additional problems by slicing into the skin. The new tourniquet got an immediate thumbs-up from medics and casualties alike.

  All these innovations were a response to the growing realization that the biggest threat to life on the battlefield was not breathing difficulties but catastrophic bleeding. A man could ‘bleed out’ in a matter of minutes. Now, the process could be slowed and even halted.

  At the Centre for Defence Medicine at Birmingham University, his British research base, Tim Hodgetts encouraged feedback from the front line to establish what worked and what didn’t at the sharp end. When medics complained that the regulation field dressings, still based on a Second World War model, were fiddly and wasteful, he had them re-designed. Training was stepped up, and the new role of ‘team medic’ was created. One in four soldiers going into action, whether on an offensive operation or a routine patrol, was trained to give advanced first aid within seconds of someone being wounded. In the Falklands, doctor Steven Hughes had done his best to get just one in ten of his Paras to this level.

  Full-time medics, too, were now much better equipped. In the pouches of the specially packed rucksacks on their backs, they had every possible device to deal with a traumatic haemorrhage, including spare tourniquets and dressings, a pump to suck out vomit and blood from the mouth, and special seals with a release valve to go over a chest wound. Ultimately, though, it was better to prevent soldiers being wounded in the first place. Hodgetts saw it as part of his job description to harry the Ministry of Defence to improve personal body armour and, above all, to do something to strengthen the thin-skinned Snatch Land Rovers used as patrol vehicles and ambulances, absurdly (and almost criminally, in the view of coroners at inquests on some victims) under-protected from IED attack.

  The clearest sign of the upgraded, new-look medical services, however, could be seen by glancing along the lines of medics as they prepared to go into action. The ranks were no longer all men. For the first time, women had been cleared to go into the front line. Equality of opportunity had not stretched to giving them aggressive infantry tasks as such, but they were welcomed in a medical role at every level, as paramedics, nurses and doctors. There was an added benefit. Treating civilians as well as soldiers had become a major part of the job, and it was noticeable that local women and children felt more at ease with a female medic than with a man, particularly in Islamic lands. In every other respect, however, the changing nature of war meant there was almost no difference between what they and the men were expected to do. Old, clear-cut distinctions between active and support roles no longer applied. The girls went into battle armed, armoured and ready for action alongside the blokes.

  Private Holly Percival was one. Like many a medic, she had a personal reason for her choice of career, one tinged with great sadness. ‘I was twelve when my brother was killed in a car crash. A few months later, my mother killed herself. My mum was a paramedic. From a young age my ambition was to be a paramedic like her.’2 Some children hit by such a double tragedy might have shied away from anything to do with hospitals and accidents. But, far from being repelled, Holly was drawn towards the fascinating subject of medical trauma. Aged eighteen, she was thinking about taking a degree course in paramedical science.

  The second Gulf war in 2003 altered her university plans. ‘I’d always been a fan of the military. At home, we loved watching Trooping the Colour, and all the old war films. I grew up with that sort of thing. So I looked into the idea of a medical career in the army. When Iraq happened, I wanted to get out there and do the job for real.’ She joined the RAMC to train as a combat medical technician and, in late 2005, she was posted to Basra. Aged twenty, she said goodbye to her father, a London taxi driver, and sister, and went to war. They must have been terrified for her. Surely two premature deaths in one small family was enough? ‘But they didn’t show it. My dad was quietly confident about how I’d get on.’

  Her first month on call at the waterside Shattal-Arab Hotel in Basra, which doubled as an army base, was quiet. She was on standby to go out in the back of an emergency ambulance, but nothing happened apart from routine sick parades. Lulled into a false sense of security, she was checking equipment and drugs one afternoon when there was a loud boom in the distance. On a quiet backstreet, a routine patrol from the Royal Regiment of Fusiliers had been hit by a roadside bomb. ‘Si’ – Corporal Simon Proctor, her crew commander – ‘rushed from the ops room to say we’d been crashed out.’ Holly dashed to put on her body armour, helmet and webbing, grabbed her med bag of kit and equipment and then raced for the ambulance. ‘Scouse, our radio operator, yelled at me to get my rifle. I’d forgotten it. I’d been so busy concentrating on my medical pack it hadn’t occurred to me I’d need it. I ran back and picked it up and then climbed into the ambulance.’

  As the vehicle hared out on to the Basra streets, she was told to ‘prep’ for casualties. ‘All we’d been told was that there were two casualties, but no one knew how serious their
injuries were.’ She turned on the oxygen regulators, put on her gloves and clipped a pen to her watch strap so it would be easy to get at to write up her notes. ‘I was really excited, because it was my first call-out in a combat situation. But I was nervous.’

  She had every reason to be. Later, fingers of suspicion would point at the Iraqi police for having lured the fusiliers into a trap. A policeman was seen using his mobile phone at the time the bomb went off, possibly detonating it from a distance. It was an indication of the dangerous and unpredictable complexity of the type of warfare the British forces were engaged in, where unknown enemies lurked around every corner. The ambulance in which Holly rode might itself be heading into another ambush. A double hit was par for the course. As the ambulance bounced and rattled along, she bent down and peered through the hatch into the driver’s cabin. In the windscreen ahead she could see nothing but a thick fog of dust and sand. She had no idea how the driver was managing to find his way.

  Poor visibility was the least of their problems. Their arrival at the scene was greeted by a hail of rocks, hurled by Iraqi youths and thudding against the side of the ambulance. Holly put on her rucksack, undid the steps at the back and readied herself to leap out into this mayhem. ‘Then Si opened the rear doors and I jumped.’

  It was like stepping into a newsreel. On one side of the dirt road a Snatch Land Rover, its flimsy armour no protection against the exploding IED, lay crashed and crushed against a wall under a dazzling and baking sun. On the other, on a high grassy bank, sat groups of local people, just watching. Beneath them were the stone-throwers. The quick reaction force was already setting up perimeters, the first five yards from the incident, the second at twenty yards, and checking for any more devices.

  Two bodies lay by the wreck of the Land Rover. The thought that went through Holly’s mind was how closely this resembled the training exercises she had been on before deployment. But the ‘casualties’ on the training ground in Aldershot had spurted stage blood and moaned in fake agony, play-acting for effect. The sounds of distress that filled the air here were all too real, the blood hot and freshly spilt. The shock on the faces of the other members of the patrol was also the genuine article, as was the change in that look to one of relief when they caught sight of the red cross on her arm. Their belief in her scared her. ‘I was a young, inexperienced medic, and everyone was looking at me and Si for help. They weren’t to know this was my first time in action.’ It was her first experience of that daunting weight of expectation soldiers place on medics. ‘They look to you as the expert. Their mates were lying on the ground terribly injured, and they put all their faith in us, in me. It’s a huge responsibility.’ She couldn’t help wondering if they were disappointed that it was her. ‘The medics are all they have left to pin their hopes on, and then this young girl pitches up! I’m sure they’d rather have seen a strapping man coming towards them!’