In the iconic film and TV series battle-hardened war medics fought to save lives ... and their own sanity. Today a different conflict rages but operating in the theatre of war remains a test of the human spirit
By David Pratt in Iraq

THIS is the real deal," the voice of pilot Brian Ellis warns in my headphones. "One of the guys is already dead." I mumble a nervous acknowledgement into the radio mouthpiece, still breathless from the sprint to the Black Hawk helicopter, and the effort of pulling on my heavy Kevlar flak jacket and helmet.

Ellis and co-pilot Carlos Hernandez race through the preflight checklist and begin spinning up the Black Hawk's rotors as a waft of aviation fuel washes through the cabin.

Outside, it is touching 100F. Inside, the heat is almost unbearable, and we are drenched in sweat. Ellis asks whether the crew chief, Peter Priolo, can see his "bug-out bag" stashed in the back. Priolo, a quietly spoken native of Syracuse, New York, responds with a thumbs-up.

The bag contains local Iraqi clothing, a GPS device, knife, torch and other emergency gear. These objects, along with the 9mm pistol and M4 rifle the crewmen carry, are all they have to help them "escape and evade" capture in the event of being forced down in hostile territory.

Under the Geneva Convention, no medevac helicopter is allowed to have mounted guns on board. The red cross painted on the aircraft is intended to prevent them from becoming targets. But in war, such niceties rarely matter.

Ellis has already told me that should the worst happen, he has no intention of being taken alive. In Iraq, he says, there are no such things as prisoners of war. There are only hostages.

As for hostile territory, it doesn't come much more dangerous than the beat covered by his medevac unit, Charlie Company 2nd Battalion 3rd Combat Aviation Brigade.

Along with the 86th Combat Support Hospital (CSH) (pronounced "Cash") based in Baghdad, the unit represents the last line of defence between life and death for US soldiers, as well as many Iraqis. Between them, the medevacs and the Cash provide battlefield emergency care for those wounded on the frontlines, as well as saving the lives of many civilians unable to access help because of the conflict.

For many people, the acronym M*A*S*H, will be recognisable from the satirical film and television series about a Mobile Army Surgical Hospital, set during the Korean war of the 1950s. In the opening credit sequences of the show, with its famous theme song Suicide Is Painless, a small medevac Bell 47 chopper is shown bringing in wounded soldiers to the Mash.

Today, these roles are essentially the same, but the tiny Bell helicopters have been replaced with high-tech Black Hawks, and the M*A*S*H has become the state-of-the art medical facility that is today's Cash.

Like their predecessors in Vietnam and Korea, the servicemen and women who make up these teams are among the best in the business. From remote forward operating bases (or Fobs), to the dun-coloured emptiness of the desert and the teeming heart of Baghdad's most volatile streets, the medevac "dust-off" crews are the first on the scene when a soldier goes down in Iraq.

Their radio call sign of "Medicine Man" singles them out as those who would fly when others would think twice.

As we prepare to get airborne on the latest mission to uplift a badly wounded US soldier from the carnage of a roadside bomb ambush, crew medic Rob Congdon has his own mental checklist to contend with. In the Black Hawk's cramped cabin, which serves as Congdon's in-flight emergency room, the tools of his harrowing trade surround him. His job, he points out succinctly, is to "keep them breathing and prevent them bleeding out".

To help him do that, he has oxygen tanks, ventilators, saline bags and bandages. All are at the ready as "the bird" gives that familiar lurch skywards. Seconds later we are skimming over pylons at 150 knots across the Iraqi desert.

"Couldn't be a worse time of day," observes Ellis, giving the sort of prognosis that I'd rather not hear. "Electrical storms forecast, dust everywhere, and it's almost dark, which means the bad guys can see us but we can't see them," he warns, as the helicopter circles over a cluster of humvees on the road below.

Wary of nearby overhead cables and deteriorating visibility, Ellis drops the Black Hawk straight down and we bump onto the landing zone in a cloud of stifling dust.

Not a total "brown-out", as the pilots call flying virtually blind in the worst dust storms. Nevertheless, it takes seconds to clear, before revealing the ghostly figures of Congdon and Priolo in a crouched run beneath the still-churning rotor blades, heading towards the casualty.

A small group or soldiers is gathered round the wounded man, who lies sprawled on a stretcher. Four of his comrades pick him up and, guided by the two crewmen, they frantically run the litter to the helicopter.

Perhaps in his 20s, the soldier - unlike his comrade - still clings to life. He is stripped to the waist, his fatigue trousers blackened and tattered like those of a cartoon character caught in a comedy explosion.

This roadside blast, however, comes from what the military call an EFP, or explosive formed projectile. As one of the most lethal ambush weapons used by Iraqi insurgents, it burns on impact at a fearsome temperature, piercing even the best protected armoured vehicle and incinerating those on board.

As the soldiers push the patient inside the helicopter, I notice that his head is badly mangled and bleeding. A large dark stain seeps through a bandage, and the flesh around his eyes and ears is seared by burns resembling melted plastic.

I feel something wet on my cheek, then realise that the down-wash from the rotors has sprayed a little of the soldier's blood into the cabin. The faces of the men who carried him display the hallmark emotions of those caught up in the maelstrom of war: a mixture of fear, anger and confusion.

One man, seemingly dazed after delivering the litter, momentarily forgets his training and almost runs into the thrashing rotor blades that would have cut him to shreds. But crew chief Priolo is there to steer the soldier safely past.

As the doors of the Black Hawk slam shut, Ellis lifts the helicopter vertically, before giving it full throttle, leaving the men on the ground shielding their faces from the curl of yellow gritty dust thrown up in our wake. Time, the greatest threat to the wounded soldier or civilian, is now the enemy to beat.

Congdon is working hard to keep the young soldier alive. For now, the skill of the flight medic and pilots are the only ally the wounded man has in his battle for life.

As we race towards the Cash in the heart of Baghdad, for some reason I find myself morbidly transfixed by the sight of the soldier's boots just inches in front of my face. The soles and uppers are caked in blood. From time to time, his feet jerk disconcertingly, perhaps in pain.

"Towers left," warns Priolo, as Ellis brings the helicopter in low over the Tigris river, past bombed-out palaces and turquoise-tiled minarets.

It's almost dark when, a few seconds later, we land on the helipad. Nurses rush forward to load the stretcher on to a motorised buggy. From there, it's a few yards to the Cash's trauma ward.

"Eleven minutes, dude," Ellis declares to no-one in particular over the radio, a note of professional satisfaction in his voice. "You'd be hard-pressed to get better service than that in the US or UK," he insists, summing up what makes medical care in this war different from all others that have gone before.

From call-out, to delivery of the patient into the hands of some of the best trauma specialists in medicine, it had taken the crew of Medicine Man 36 just 11 precious minutes: 660 seconds that made all the difference between life and death for one young soldier. Here, medical teams talk of the "golden hour" as being that crucial period after which the chances of survival rapidly diminish.

Inside the Cash, the patient is stabilised before being brought back out to the helicopter and ferried to the specialist head injuries hospital in Balad, north of Baghdad.

Throughout this time, the aircraft's engines are kept running to ensure a fast getaway. Almost daily, insurgents from nearby Sadr City have lobbed rockets and mortars into the area around the Cash, and no-one wants to be caught out on the ground.

Co-pilot Carlos Hernandez recalls how on one occasion, Medicine Man 36 almost never made it to the Cash. "The whole day was kind of crazy with the Cash getting mortared and rocketed every time we flew into it," recalls Hernandez, who is from Puerto Rico.

Nicknamed "Boost" because of his love of high performance cars, Hernandez would, say his fellow crewmen, stick a turboprop on anything bigger than a lawnmower engine.

"We were coming in and the air traffic tower came over the radio and said Medicine Man, incoming! Incoming!" he tells me, momentarily lost in the drama of that day. "All of a sudden, we found ourselves dodging mortar rounds that were hitting in front of the nose and we would turn left real fast, and then they would hit beside us."

Hernandez says it's the only time he has been really scared, simply because there was nothing they could do. "If anything hits the main rotor blades, you're done for," he says.

That night, in the TV room back at the medevac base in Camp Taji, I find what's left of my mashed potato and pork-chop dinner still lying cold on its polystyrene plate where I tossed it down seconds after our callout. Brian Ellis complains that no-one bothered to cover the freshly cut melon he was about to eat for dessert. No-one among the relief crews sprawled out on the couches is listening.

On one wall, the name of the last DVD movie shown here is scrawled across what the crews have dubbed the "dumb-ass movie board". It is Blow, starring Johnny Depp. Painted on another wall behind the snoring pilots and medics, are the badges of those medevac units previously based in Taji. On one, dangling from a pair of small silver wings attached to the plasterwork, are the dog tags of Flight Sergeant William E Brown. He met his death not in the air but on the helipad, when he was blown apart by an insurgent rocket.

Whatever one's views of the rights and wrongs of the war in Iraq, the courage of these medics and pilots is unquestionable, and their dedication to the medevac motto, "so that others may live", remains true.

Last January, Charlie Company surpassed even its own reputation, when responding to a call-out after a patrol of Stryker armoured vehicles had been attacked. Having circled the area, scouting for a place to land, the crews put down in a little ravine "a football field's length" from the stricken convoy. "By the time we found the place the insurgents had moved in, set up and were ready to ambush us," says Congdon.

Along with Staff Sergeant Aughe McQuown, who also happens to be his best friend, Congdon ran to the site of the attack and came back to the helicopters with three injured soldiers. "Just then a sniper opened fire, and if you've ever heard a bullet go past your head it's a sound you're never going to forget."

Pinned down at the vehicle, the two medics now faced a terrible dilemma. Stay put, and the remaining wounded might bleed to death. Make a run for it, and they could all be gunned down.

Congdon describes what he recalls of what happened next: "McQuown carried one over his shoulder and another infantry guy and I carried the other guy, who was pretty big."

What went through their minds at that moment?

"The wounded guy still had all his gear on, and that's about 250lbs. There was a 100-yard dash to the aircraft and everything's racing, your heart pounding against your body armour, and all you can think is, Please don't hit me'," McQuown replies.

Along with trainee medic Sergeant Donald Dedmon, who throughout the time on the ground had moved between the two helicopters treating the wounded, Congdon and McQuown were awarded the Bronze Star for valour for their actions that day. But, they tell me, learning that all five men they had brought to the Cash had survived was reward enough.

Ask the doctors and nurses who staff the Cash what they think of the medevac crews and their reply verges on awe. Talk to the crews and they say much the same thing about the Cash staff.

Nurses' Week is an annual celebration in the United States, which happens to coincide with my time spent at the 86th Combat Support Hospital, or Ibn Sina as it is known in Baghdad.

At the reception desk just outside the trauma wards a sign says Baghdad ER, and on the wall a rack of stethoscopes hangs next to a US flag.

A Nurses' Week commemorative poster made up by the staff, shows a picture of a uniformed young nurse from the Korean war, who could have stepped straight from an episode of M*A*S*H.

As it turns out, the bespectacled woman in the photograph is the mother one of the cash doctors. Army medicine, it seems, often runs in the family. Ibn Sina hospital also has something of a lineage, named as it is after the great Muslim scholar and physician, better known in the West as Avicenna, who was born in Persia around the year 980.

Here, around the clock, some of the war's worst casualties arrive, among them coalition and Iraqi personnel, civilians and insurgents. Many are in an unimaginable state.

"Even though I thought I was prepared, I don't think anything prepares you for what you see over here," says Major Deborah Chappel from Indiana, one of the trauma team's head nurses. "The toughest for me," she recalls, "was when an Iraqi dad brought in his four-year-old daughter. We worked so hard and she died, and it was hard on him and all of us." Chappel struggles, then fails, to hold back tears. "To sit there with the father and grieve and to have kids of my own that same age it was rough."

There are occasions, she says, when it helps to show emotion in front of the soldiers. "But as the one in charge, I'm the mom, so I try to be a stabiliser."

Remaining sane in such an environment cannot be easy. During my time with the medevac and Cash teams, there are many surreal moments that could have come from the pages of Joseph Heller's war satire Catch 22. One crewman tells me of a wounded soldier's amputated leg being left behind in the chaos after he was transferred rapidly from one helicopter to another.

Then there is the the sight of recovering Iraq insurgents - known here as "security internees" - being ferried around the hospital corridors in wheelchairs, their faces masked to prevent them being recognised after treatment at an "enemy" hospital.

For the staff at the Cash, however, a patient is simply that - a patient. On occasion, there have even been Iraqi insurgents and American soldiers who were involved in the same battle, lying side by side in the trauma room.

Some days, when the casualties arrive in numbers, the floors become slick with blood and littered with saturated dressings, shreds of clothing, fragments of bone and pieces of charred flesh. On those days, even the Black Hawks that brought in the wounded need to be flushed out with high-pressure hoses.

And for those soldiers who make it through thanks to the skill of these medics, there is often a greater battle to come. "We have dealt with patients who have suffered extraordinary, extensive burns, or who have lost three limbs, both legs and an arm," says Colonel Larry Crozier, the head of surgical nursing. "As time goes by you can't help wondering how those people are faring, because you know that despite everything we've done for them their journey has just begun."

On my last day at Ibn Sina, an announcement comes over on the hospital loudspeaker. Free ice-cream is being served by a handful of male staff dressed in female nurses' hats. The gesture is part of the nurses' week celebrations, but the scene - just a few yards from the trauma room - is reminiscent of an episode of M*A*S*H. Here, humour appears to be a coping mechanism: a fact that is underlined when, moments later, the same announcer warns of incoming rockets, which boom on impact, rattling the windows.

"The biggest thing we do to switch off," says Captain Jason Cohen, whose father was an army doctor in Vietnam, "is to sit on the roof with the other docs and smoke some cigars and decompress to each other. We're all in this together and having the ability to sit down with a bunch of people that go through the same things that you do, keeps us all sane while we are here."

And if he weren't here - what would he be doing right now?

"Playing with my kids probably," he smiles.

If Cohen had to identify with one character from M*A*S*H, it would be Hawkeye Pierce. "But I'm not as funny," he adds, before his words are drowned out by the clatter of another arriving medevac.