Letter from America: Training Pararescuemen

Rob Lawrence is chief operating officer of the Richmond Ambulance Authority in Virginia. Before coming to the U.S., he held the same position with the English county of Suffolk as part of the East of England Ambulance Service. He writes a regular “Letter from America” column for the UK publication Ambulance Life. This column is reprinted with permission from Ambulance Life. Rob is also a featured speaker at EMS World Expo, September 8–12 in Las Vegas, NV. Register today!

It is often said in the UK, that media issues involving Special Forces (SF) are either confirmed, denied or ignored. Here in the U.S., most aspects of training and operations are publicized to excellent PR effect and also available on Netflix. This leads me nicely into this month’s Letter from America.

A decade and a half ago, as an officer in the British Army's Airmobile Medical Unit, I flew regularly into Bosnian hot spots such as Vitez, Tuzla and Gornji Vakuf. To this day I remember the adrenaline rush as the sounds in the headset chirped and beeped as different types of Serb anti aircraft radar signals lit up our Army Lynx or RAF Puma helicopter, causing the pilot to indulge in seat of the pants manoeuvres known simply and innocently as Nap of the Earth (NOE) flying. Some of those vivid memories returned recently when we assisted a special group of military medics get fit for their role.

Last year, the Richmond Ambulance Authority (RAA) partnered with the University of New Mexico and local hospital group, HCA, to provide clinical and field EMS placement for U.S. Air Force Pararescuemen. This elite cadre of special operators provide combat rescue capability to U.S. and allied military operations. Pararescuemen, or "PJs" as they are known, are more than just search and rescue winch men, they are trained in special forces combat operations, static line and free fall parachuting, and combat diving, and are all nationally registered paramedics.  

If necessary, they will fight their way in and out of any rescue situation to save the injured warrior. They will openly tell you that they are prepared to sacrifice themselves to abide by their motto..."That Others May Live." They are very professional, yet humble, men, with an extreme mission focus who ultimately deliver good medicine in some very bad places.

RAA pairs the PJs up with our experienced field trainers and they spend two months in the same shift rotation and ride every call as part of the crew. They assume the role of Attendant in Charge (AIC), which gives them valuable exposure to EMS interventions, team leading and, importantly, critical thinking and clinical decision making in a live environment. When off duty at RAA, they spend time in HCA's ED and theatres. 

While we are not under combat conditions, RAA crews deal with a level of trauma akin to that seen in combat, including gunshot wounds and penetrating injuries, that may well give the PJs an operating edge when swooping in on a HH-60G Pave Hawk helicopter to execute a mission. Our endgame is to ensure the PJ is equipped not only with an impressive array of weaponry, but also the ability to save life and limb. To support this noble cause and essential training, all at RAA have thrown heart and soul into the task.

The role and story of the PJs has come to the nation’s attention as the National Geographic Channel recently concluded broadcasting a six-part reality show about the PJs titled Inside Combat Rescue, where cameras followed a PJ crew on active missions across Afghanistan. This fly-on-the-wall documentary, which became National Geographic's highest rated new series, wasn't the typical Hollywood style, gung-ho, shoot-em-up offering, but a realistic look at the life and challenges of these men, the missions they face, and the extreme injuries and death they handle on a daily basis.

The show was emotionally charged offering a portrayal of real servicemen, real lives, real trauma. On camera, the PJs wore their hearts occasionally on their sleeves, no punches were pulled and the true hell that war is came through. Sadly not all of those they attended to survived due to the horrific nature of their wounds. The series painted a picture of a band of air force brothers, doing it not for the politicians or glory, but for each other and their fellow servicemen, who as a result of enemy action needed a guardian angel in their extreme moment of need.

If one thing the PJs picked up during their training at RAA helps on the battle day, then we have achieved a wonderful thing. Passing on our experiences in the delivery of the purest world-class EMS possible, so that others may live, has given the whole organization a huge sense of pride and achievement. The impact on morale in my own organization in playing this small, but essential part, in a much bigger picture has been stellar.  

As a post script to my article, I recently met the officer in the U.S. Air Force who commissioned the series. On discovering that I was a Brit, he confided that the idea for this show in fact came from the UK series Our War, in which helmet cam footage from British army "boots on the ground" was edited together to create one powerful TV event. I immediately found and watched every second of this show, which, if you haven’t seen, you should consume too. Until next time, In Arduis Fidelis. 

Rob Lawrence is chief operating officer of the Richmond Ambulance Authority. Before coming to the USA in 2008 to work with RAA, he held the same position with the English county of Suffolk as part of the East of England Ambulance Service. He is a graduate of the Royal Military Academy Sandhurst and served in the Royal Army Medical Corps. After a 22-year military career in many prehospital and evacuation leadership roles, Rob joined the National Health Service, initially as the Commissioner of Ambulance Services in the East of England. He later served with the East Anglian Ambulance Service as director of operations. He is also a member of the EMS World editorial advisory board.