The Marine had been shot in the skull. He was up ahead, at the edge of a field, where the rest of his patrol was fighting. A Black Hawk medevac helicopter flew above treetops toward him, banked and hovered dangerously before landing nearby.
Several Marines carried the man aboard. His head was bandaged, his body limp. Sgt. Ian J. Bugh, the flight medic, began the rhythms of CPR as the helicopter lifted over gunfire and zigzagged away. Could this man be saved?
Nearly nine years into the Afghan war, with the number of troops here climbing toward 100,000, the pace for air crews that retrieve the wounded has become pitched.
In each month this year, more American troops in Afghanistan have been killed than in any of the same months of any previous year. Many of those fighting on the ground, facing ambushes and powerful hidden bombs, say that as the Obama administration’s military buildup pushes more troops into Taliban strongholds, the losses could soon rival those during the worst periods in Iraq.
Under NATO guidance, all seriously wounded troops are expected to arrive at a trauma center within 60 minutes of their unit’s calling for help. In Helmand Province, Afghanistan’s most dangerous ground, most of them do.
These results can make the job seem far simpler than it is. Last week, a Black Hawk on a medevac mission in the province was shot down by a rocket-propelled grenade, and four members of its crew were killed. And the experiences in May and early June of one Army air crew, from Company C, Sixth Battalion, 101st Combat Aviation Brigade, showed the challenges of distance, sandstorms and Taliban fighters waiting near landing zones.
It also showed crews confronting sorrows as old as combat. In a guerrilla war that is turning more violent, young men in nameless places suffer wounds that, no matter a crew’s speed or skill, can quickly sap away life.
For Company C’s detachment in Helmand Province, the recent duty had been harried.
Over several days the crews had retrieved a Marine who had lost both legs and an arm to a bomb explosion; the medic had kept that man alive. They had picked up two Marines bitten by their unit’s bomb-sniffing dog. They landed for a corporal whose back had been injured in a vehicle accident.
And day after day they had scrambled to evacuate Afghans or Marines struck by bullets or blasted by bombs, including a mission that nearly took them to a landing zone where the Taliban had planted a second bomb, with hopes that an aircraft might land on it. The Marines had found the trap and directed the pilots to a safer spot.
A few days before the Marine was shot in the skull, after sandstorms had grounded aircraft, another call had come in. A bomb had exploded beside a patrol along the Helmand River. Two Marines were wounded. One was dying.
For hours the airspace had been closed; supervisors deemed the conditions too dangerous to fly. The crews wanted to evacuate the Marines. “I’ll go,” said Sgt. Jason T. Norris, a crew chief. “I’ll walk.”
A crew was given permission to try. Ordinarily, medevac flights take off with an older, experienced pilot in command and a younger aviator as co-pilot. The two take turns on the controls.
From Kandahar, the brigade commander, Col. William K. Gayler, ordered a change. This flight demanded experience. Chief Warrant Officer Joseph N. Callaway, who had nearly 3,000 flight hours, would replace a younger pilot and fly with Chief Warrant Officer Deric G. Sempsrott, who had nearly 2,000 hours.
Afghan sandstorms take many forms. Some drift by in vertical sheets of dust. Others spiral into spinning towers of grit. Many lash along the ground, obscuring vision. Powdered sand accumulates like snow.
This storm had another form: an airborne layer of dirt from 100 to 4,000 feet above the ground. It left a low-elevation slot through which the pilots might try to fly.
The Black Hawk lifted off in dimming evening light. It flew at 130 knots 30 to 40 feet above the ground, so low it created a bizarre sensation, as if the helicopter were not an aircraft, but a deafening high-speed train.
Ten minutes out, the radio updated the crew. One of the Marines had died. The crew chief, Sgt. Grayson Colby, sagged. He reached for a body bag. Then he slipped on rubber gloves and sat upright. There was still a man to save.
Just before a hill beside the river, Mr. Callaway banked the Black Hawk right, then abruptly turned left and circled. The helicopter leaned hard over. He looked down. A smoke grenade’s red plume rose, marking the patrol.
The Black Hawk landed beside dunes. Sergeant Bugh and Sergeant Colby leapt out.
A corporal, Brett Sayre, had been hit in the face by the bomb’s blast wave and debris. He staggered forward, guided by other Marines.
Sergeant Bugh examined him inside the Black Hawk. Corporal Sayre’s eyes were packed with dirt. He was large and lean, a fit young man sitting upright, trying not to choke on blood clotting and flowing from his mouth.
The sergeant asked him to lie down. The corporal waved his arm.
“You’re a Marine,” the sergeant said. “Be strong. We’ll get you out of here.”
Corporal Sayre rested stiffly on his right side.
Sergeant Colby climbed aboard. He had helped escort the dead Marine to the other aircraft. The Black Hawk took off, weaving through the air 25 feet off the ground, accelerating into haze.
The corporal was calm as Sergeant Colby cut away his uniform, looking for more wounds. Sergeant Bugh suctioned blood from his mouth. He knew this man would live. But he looked into his dirtied eyes. “Can you see?” he asked.
“No,” the corporal said.
At the trauma center later, the corporal’s eyes reacted to light.
A race to treatment
Now the crew was in the air again, this time with the Marine shot in the skull. Sergeant Colby performed CPR. The man had no pulse.
Kneeling beside the man, encased in the roaring whine of the Black Hawk’s dual engines, the sergeants took turns at CPR. Mr. Sempsrott flew at 150 knots — as fast as the aircraft would go.
The helicopter came to a rolling landing at Camp Dwyer. Litter bearers ran the Marine inside.
The flight’s young co-pilot, First Lt. Matthew E. Stewart, loitered in the sudden quiet. He was calmly self-critical. It had been a nerve-racking landing zone, a high-speed approach to evacuate a dying man and a descent into a firefight. He said he had made a new pilot’s mistake.
He had not rolled the aircraft into a steep enough bank as he turned. Then the helicopter’s nose had pitched up. The aircraft had risen, climbing to more than 200 feet from 70 feet and almost floating above a gunfight, exposed.
Mr. Sempsrott had taken the controls and completed the landing. “I was going way too fast for my experience level,” the lieutenant said, humbly.
No one blamed him; this, the crew said, was how young pilots learned. And everyone involved understood the need to move quickly. It was necessary to evade ground fire and to improve a dying patient’s odds.
Beside the helicopter, inside a tent, doctors kept working on the Marine.
Sergeant Colby sat, red-eyed. He had seen the man’s wound. Soon, he knew, the Marine would be moved to the morgue. Morning had not yet come to the United States. In a few hours, the news would reach home.
“A family’s life has been completely changed,” the lieutenant said. “And they don’t even know it yet.”
Barreling into a firefight
A few days later, the crew was barreling into Marja again. Another Marine had been shot.
The pilots passed the landing zone, banked and looked down. An Afghan in uniform crawled though dirt. Marines huddled along a ditch. A firefight raged around the green smoke grenade.
The Black Hawk completed its turn, this time low to the ground, and descended. Gunfire could be heard all around. The casualty was not in sight.
“Where is he?” Mr. Sempsrott asked over the radio.
The sergeants dashed for the trees, where a Marine, Cpl. Zachary K. Kruger, was being tended to by his squad. He had been shot in the thigh, near his groin. He could not walk. The patrol had no stretcher.
A hundred yards separated the group from the aircraft, a sprint to be made across the open, on soft soil, under Taliban fire. Sergeant Bugh ran back. Sergeant Colby began firing his M-4 carbine toward the Taliban.
Inside the shuddering aircraft, the pilots tried to radiate calm. They were motionless, vulnerable, sitting upright in plain view.
The Taliban, they knew, had offered a bounty for destroyed American aircraft. Bullets cracked past. The pilots saw their medic return, grab a stretcher, run again for the trees.
They looked this way, then that. Their escort aircraft buzzed low-elevation circles around the zone, gunners leaning out. Bullets kept coming. “Taking fire from the east,” Mr. Sempsrott said.
These are the moments when time slows.
At the airfield, the crews had talked about what propelled them. Some of them mentioned a luxury: They did not wonder, as some soldiers do, if their efforts mattered, if this patrol or that meeting with Afghans or this convoy affected anything in a lasting way.
Their work could be measured, life by life. They spoke of the infantry, living without comforts in outposts, patrolling in the sweltering heat over ground spiced with hidden bombs and watched over by Afghans preparing complex ambushes. When the Marines called, the air crews said, they needed help.
Now the bullets whipped by.
A hot landing zone
Cobra attack helicopters were en route. Mr. Sempsrott and Lieutenant Stewart had the option of taking off and circling back after the gunships arrived. It would mean leaving their crew on the ground, and delaying the patient’s ride, if only for minutes.
At the tents, Mr. Sempsrott had discussed the choices in a hot landing zone. The discussion ended like this: “I don’t leave people behind.”
More rounds snapped past. “Taking fire from the southeast,” he said.
He looked out. Four minutes, headed to five.
“This is ridiculous,” he said. It was exclamation, not complaint.
His crew broke from the tree line. The Marines and Sergeant Bugh were carrying Corporal Kruger, who craned his neck as they bounced across the field. They fell, found their feet, ran again, fell and reached the Black Hawk and shoved the stretcher in.
A Marine leaned through the open cargo door. He gripped the corporal in a fierce handshake. “We love you, buddy!” he shouted, ducked, and ran back toward the firefight.
Six and a half minutes after landing, the Black Hawk lifted, tilted forward and cleared the vegetation, gaining speed.
Corporal Kruger had questions as his blood pooled beneath him.
Where are we going? Camp Dwyer. How long to get there? Ten minutes.
Can I have some water? Sergeant Colby produced a bottle.
After leaving behind Marja, the aircraft climbed to 200 feet and flew level over the open desert, where Taliban fighters cannot hide. The bullet had caromed up and inside the corporal. He needed surgery.
The crew had reached him in time. As the Black Hawk touched down, he sensed he would live.
“Thank you, guys,” he shouted.
“Thank you,” he shouted, and the litter bearers ran him to the medical tent.
The pilots shut the Black Hawk down. Another crew rinsed away the blood. Before inspecting the aircraft for bullet holes, Sergeant Bugh and Sergeant Colby removed their helmets, slipped out of their body armor and gripped each other in a brief, silent hug.
This story, "," first appeared in The New York Times.