Treating horrors of battle
Captain Anthony Sayce is on the front line of the nation's medical mission in Afghanistan. He has seen the horrors of war - but last month it became personal.
On March 23, as he went about his duties in the coalition's medical facility in Tarin Kowt, the Australian army doctor reflected on the fact that he had yet to treat one of his countrymen.
Lieutenant Clint Grose, Regimental Nursing Officer with the Role 2 medical facility in Tarin Kowt, Afghanistan on 23 March 2012. Photo: Fairfax
''It's certainly something that I've thought about, I hope that it doesn't happen,'' Captain Sayce said then.
Three days later, that hope was dashed when a teenager detonated a suicide bomb next to a reconstruction patrol of Australians and Americans. AusAID staffer David Savage was critically injured.
Within an hour of the blast, Mr Savage was wheeled into one of the resuscitation bays at Tarin Kowt, where he was given life-saving treatment. And while he was the first Australian for 2012, it is almost certain he will not be the last.
Captain Sayce works in the medical facility in the Tarin Kowt military base in Afghanistan's Oruzgan province, where Australian troops have been fighting since 2006.
When Fairfax spoke to him, he had seen two local men die on the operating table and treated 17 critically injured Afghan soldiers and police officers.
With little fighting through the long, cold Afghan winter, it was the calm before the storm. The snow now melted, the spring fighting season has begun.
Captain Sayce's colleague, Captain Antony McNamara, tells another story.
His introduction to the realities of trauma work in Afghanistan was a local five-year-old girl. She was the same age and size as his daughter.
''It was an IED blast to a civilian vehicle,'' he recalls. ''It was a family. There was a couple of kids, some grandparents [who survived] as well as an uncle or an aunt deceased onsite.''
The girl had fragmentation wounds but was not seriously injured. But this was the first truly confronting moment for Captain McNamara since his tour began. Both men are doing their jobs in the most difficult of environments.
From sub-zero temperatures in the winter to plus 50 degree days in summer - and the ever-present dust - Captain McNamara and his team battle each day against a steady tide of horrific war wounds.
And for Captain Sayce: ''I had never seen a real gunshot wound until I got here. Because they're not all that common in Australia. To actually see it first hand is certainly an eye opener.''
Despite a long career in emergency medicine and years of training, he found the first few patients confronting.
''The only correlation I can draw is with motor vehicle accidents I saw back in Australia,'' he said.
''It's just a completely different pattern of injury.''
The main role of the military medics, nurses, doctors and surgeons at the Tarin Kowt Role 2 facility - NATO ranks medical facilities from 1 through 4 in order of quality of care - is to stabilise patients for ''cas-evac'' to the Role 3 facility in Kandahar, a 30-minute helicopter flight south.
The most badly wounded go on to the American Role 4 facility in Landstuhl, Germany.
Before reaching Tarin Kowt, every wounded Australian soldier will have received potentially life-saving care, or care under fire, explains the Australian army medical platoon commander, Lieutenant Clint Grose.
''That care under fire is paramount [for] saving life,'' he said.
''If it's done properly - bleeding's stopped and air is flowing - if those things are done properly on the battlefield it gives the casualty a good chance down the track.''
There are now three items provided to all Australian soldiers considered vital to saving lives.
The first is the combat application tourniquet, a small hard piece of plastic about the size of a pen attached to a strip of cloth and velcro which is wrapped around the arm or leg. The second is the emergency bandage - also known as the Israeli bandage - which can be doubled back on itself when wrapping to create constriction over a gunshot or fragmentation wound to stop blood loss.
The third item is a piece of soft plastic which is inserted into the nose to the back of the throat to allow unobstructed breathing. ''Those things, those first 10 minutes on the battlefield, are crucial,'' Lieutenant Grose says.
Australian wounded are brought to Tarin Kowt, where they are guaranteed an Australian doctor.
''If it's an Australia casualty we'll come any time, day or night, to resuscitate. For our casualties, the members out there, it's so they see a familiar face,'' he says.
That said, staff at the Tarin Kowt Role 2 facility do not exercise exclusivity but treat everyone wounded in the province - from wounded International Security Assistance Force soldiers, the Afghan National Security Forces, local civilians and even wounded Taliban fighters brought back from the battlefield.
Like many Americans in Afghanistan, Lieutenant-Commander Jeff Ricks has served multiple tours of duty in Iraq and has endured situations that would make even the toughest civilian doctor blanche. His first tour was with the Marines in 2004 to 2005 and he was based in Fallujah during the Al-Fajr offensive of November 2004, which was described as the bloodiest single battle during the Iraq War. The coalition toll: 107 soldiers killed and 613 wounded. He worked in a tiny medical facility which amounted to little more than a sick bay.
''The first two days weren't that bad, but on [the third day] we got overwhelmed and we ended up receiving over 20 casualties to our facility. For three days I had over 20 in-patients ranging from eye injuries to one guy who was shot in the head. He was fine but shot in the head.''
Commander Ricks pauses and considers what he has just said, before laughing wryly: ''I guess 'fine' is a relative concept, hey.''