WASHINGTON — After 16 years of war, Afghan forces still lack efficient means to evacuate wounded and dead off battlefields in Afghanistan. And its air force is still in its infancy, making it difficult to dedicate air assets to helping wounded troops.

U.S. Marines in Helmand province have taken the initiative in assisting Afghan partner forces in building a capability to move wounded off the battlefield in one of Afghanistan’s most unmanageable provinces. 

Throughout the months of August and September, U.S. military advisers with the roughly 300 U.S. Marine Task Force Southwest have been assisting their Afghan counterpart, according to Maj. Kendra Motz, a spokesperson for the Marine task force.

The Marine unit “considers efficient, effective and sustainable CASEVAC procedures a priority and is training, advising and assisting the 215th Corps in an effort to improve response time, casualty survivability and to provide a model that other units in Afghanistan can use for implementation of the same training,” Motz told Military Times.

Navy Lt. Laura Cargill, the lead medical planner for Task Force Southwest, said, “As it stands now, the Afghans are primarily moving their casualties from point of injury to the nearest camp by ground and then relying on rotary wing helicopters to pick casualties up from the camp unless the injury occurs within reasonable driving distance from Lashkar Gah.” 

Before the Marines began providing training to the 215th Corps, evacuating wounded Afghan soldiers off the battlefield could take anywhere from two hours to four days, according to Cargill.

Those numbers are astounding when compared to the sixty minutes mandated for U.S. forces by then-Secretary of Defense Robert Gates back in 2009 known as the golden hour mandate.

Under the golden hour, U.S. forces were required to evacuate wounded soldiers within one hour of injury. That rule has saved hundreds of lives, according to one study.

With the lack of a dedicated medevac air platform, moving wounded troops on ground can be an arduous and deadly task, especially as the Taliban are known to place improvised explosives on roads to hinder the movements of Afghan forces. Afghan soldiers risk bleeding out from easily treatable wounds without air assets to whisk them off the battlefield. 

But, building an air medevac capability in Afghanistan is no easy task, especially while the country is still amid a growing Taliban insurgency and an incomplete air force without dedicated helicopters for medical evacuations.

“It is a challenge even for our own military,” said Ret. U.S. Navy Senior Chief Blair Dell, a former Corpsman with Marine Special Operations Command. “It is not as simple as an aircraft falling out of the sky and picking a guy up.”

The logistics and command and control needed to effectively run air medevac system is enormous and challenging, according to Blair. 

“You need a ready alert crew which is a minimum of 16 people,” he said. ”You have to have the logistics of getting medical supplies to that helicopter, and make sure the aircraft is maintained, and that people are trained to medicine in flight.”

“If I put in an [endotracheal tube] in someone at 5,000 feet, actually let’s say we are in the Hindu Kush, if I put that ET tube in and we fly even higher it can explode in his throat if you aren’t using saline instead of air,” Blair said.

On top of all that, Afghans would need a proper command and control structure to identify proper hospitals that have the right capabilities to treat the wounds of the soldiers being evacuated. Knowing which hospitals can treat stomach wounds or head trauma is vitally important, Blair said.  

Nevertheless, “Afghanistan is no further behind than many countries in the sense that they must use their helicopters in a “multiuse” capacity,” Cargill told Military Times. “The United States is the only country with a dedicated medevac rotary wing capability.”

The day and night training provided by the Marines appears to already be paying dividends.

During a recent operation in Nawa, Afghanistan, Afghan forces successfully rerouted an Mi-17 helicopter on a supply run to evacuate a wounded Afghan soldier, according to Cargill. The helicopter reached the wounded soldier in twenty minutes, Cargill told Military Times.

In another instance, it only took 15 minutes between call and contact with a wounded Afghan soldier, Cargill said in a story posted by Task Force Southwest.

The ability to successfully move wounded troops off the battlefield goes beyond saving lives, it can also be a major morale booster for weary and fatigued forces fighting on the front lines in Helmand.

There have already been three iterations of the CASEVAC training, according to Motz.

The training has included medics and soldiers from 7th Special Operations Kandak and 2nd Kandak, 4th Brigade, 215th Corps participate, as well as the air officers in the 215th Corps Tactical Operations Center and Afghan Air Force Mi-17 pilots.