U.S. Combat Medics mostly from 3.2 Cavalry and newly deployed to Afghanistan, surround the gurneys, five or six per victim, as if they were hungry animals at a feeding trough. Each renders a service; ventilating with a bag-valve-mask device, registering a pulse oximeter, taking blood pressure, assessing pupil size, pushing medications through an IV or just writing down what interventions are being done at precisely what time.

At this point, the facts are sketchy, no one even knows the names of the men, but they are all security workers who either hit a roadside bomb or were attacked by the Taliban while providing protection to a commercial convoy ferrying goods to U.S. military bases in the region. They are the lucky ones so far. Two of their co-workers are already dead, killed in the attack.

While the 3.2 medics are handling the early morning trauma with fitting competence—none possess the calm conviction of Cpt. Matthew Rodgers and Specialist Michael Piegaro, who look like they’re doing nothing more challenging than the New York Times Sunday crossword puzzle.

Both spent the last year working cases like this almost every day—more than more than 350 total in Afghanistan’s most volatile
region. Both are on their way home at the end of their deployments—but have responded to one last call while waiting for transport out.

Rodgers, the Battalion Surgeon attached to the 2nd Infantry Division is from Dupont, Washington and is the medical ringmaster of this event. He moves from table to table assessing the interventions, providing clear direction and advisement to the new medics, many with sweat beading on their foreheads—in what appears to be a combination of heat and intense concentration.

Rodgers is clearly qualified—in one mass casualty incident here, he claims to have treated 13 gunshot wound victims with only one other medic. All of them survived.

Rodgers offers simple but sage advice.

“I tell them the most important vital sign they can take is their own pulse,” says Rodgers, emphasizing the need for calm.

“For this table here,” he says to those treating the less seriously wounded Afghan, “I know you want to get him more stabilized, but that’s a bird spinning up out there and we have to get him packaged and ready to go…try to find a space blanket, because he’s exposed and hypothermia is a possibility.”

Meanwhile Piegaro, from West Palm Beach, Florida and just 21—is assisting the incoming Doctor, Cpt. John Gartside, pushing a paralytic medication through the patient’s IV—which will make it easier to mechanically ventilate him. While Piegaro’s medical certification level is technically just the civilian equivalent of an EMT Basic, whose normal scope of practice is limited to providing oxygen and minor
Interventions that don’t include medications or anything that breaks the skin such as setting up an IV, his work here more closely resembles that of emergency room MD.

“I work under the guidance the medical license of a PA,” says Piegaro, after the event, “and he’s extremely confidant in my abilities, especially after working so many cases like this over the last year.”

With so much kinetic activity happening here—it might be easy to miss both the minor and major trauma drama worthy of fictional TV programs like ER or Gray’s Anatomy.

For instance when Cpt. Gartside sinks an endotrachial tube into one of the severely injured Afghans, a difficult maneuver requiring both careful positioning and the inflation of a small-balloon catheter to keep it in place, Cpt. Rodgers is concerned it may have gone to deep.

The patient’s stomach is rising with each ventilation rather than his chest, indicating that the oxygen may be pumping into his stomach rather than lungs, which could cause him to vomit and occlude the very airway the medics are attempting to keep open.

While the patient seems to stabilize and his vitals reflect the increased delivery of oxygen Gartside decides to adjust the endotrachial tube by a few millimeters.