In the flickering light of a flare drifting to earth, Army flight medic Daniel "Buzz" Buzard spots a scrum of U.S. soldiers bearing a wounded comrade across a stony Afghan riverbed en route to his helicopter.
Only night-vision goggles illuminate on this moonless night, and a glimpse of the casualty leaves Buzard cold.
"He's just mangled," the medic recalls.
He's looking at Army Staff Sgt. Christopher Walker, 28, a bomb technician with a 7-year-old daughter named Kali waiting back home.
"He's missing his left arm, his right arm. His left leg is just all chewed up, and there's blood all over his face," Buzard says. "I'm looking at this going: 'Where do you start?'"
This is as bad as it gets, doctors and nurses working in Afghanistan say.
It is a cost of fighting in Afghanistan that continues even as the war winds down. Combat tactics in a land of agrarian vastness dictate that U.S. troops patrol on foot — rather than in heavily armored vehicles, as often occurred in Iraq — and risk stepping on the buried explosives that litter the countryside.
The result: More than half of the nearly 460 Americans who lost multiple limbs to combat in Iraq and Afghanistan since 2001 suffered those wounds here in Afghanistan in just the past two and a half years. From 2001 through 2009, seven troops had triple amputations in combat and one lost all four limbs; all occurred in Iraq. Since 2010, after President Obama ordered a surge in combat against the Taliban, there have been 36 triple amputees and four quadruple amputees, all in Afghanistan, Army data show.
The wave of blast-devastated casualties has left military medicine grasping for better ways to treat what doctors say are the worst casualties they have seen in 11 long years of fighting two wars. Even as U.S. forces draw down in Afghanistan, the military is ramping up medical resources to counter this wrenching pattern of wounds in the waning months of this war.
It has led to multiplying by nearly a factor of six — from 12 to 70 — the number of medevac helicopters operating in Afghanistan, instituting six months of advanced-care training for hundreds of flight medics, performing dozens of blood transfusions on these wounded even as they are lifted off the battlefield and placing more highly trained medical personnel on medevac flights.