This case study is of a good friend of mine (written with his consent) who sustained a through-and-through gunshot wound from an AK47 round from a range of approximately 200m. The operator who was shot was a DEA FAST agent, and my element and his were on a combined counter-narcotic job in Southern Afghanistan at the time. To set the scene, we had two targets to hit that day, the first of which was a raw opium deal in a Taliban-held village, and the second being the clearance of a known Taliban weapons and drugs cache.

We had planned a daytime raid for the first job as to catch the opium trade at the time that intelligence suggested it was taking place. The intel was good, and we were met with minimal resistance as we inserted on target, with the following photos showing some the haul of wet opium and IED components, including a bunch of low metal signature anti-personnel mines.

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The Taliban had fled the center of town as we inserted, however as time passed on target they began to regroup in several compounds on the outskirts of town and started to engage us with harassing fire. As extraction approached the fire intensified and by the time the last helicopter of our extraction package landed we were engaged in a decent gunfight. Unfortunately the final extraction bird overflew the designated, and relatively protected, landing zone and landed in an exposed area approximately 200m from a cemetery in which several Talibs had taken up firing positions. The following video is of our chalk running to meet the extraction helicopter as it sits exposed in open ground. The operator who sustains the gunshot wound is the one who I kneel immediately next to. As luck would have it he chose the split second before he was shot to stand and turn to board the helicopter, causing the bullet to rip through his buttock and exit the front of his thigh, whereas it would have likely struck his head if he had remained kneeling.

As with any casualty in a tactical or high-threat environment the highest priorities are to control the threat situation if possible, minimize the likelihood of sustaining further casualties, or becoming a casualty yourself, and only then move on to casualty assessment and treatment. The video below demonstrates these principles in what has been coined by the Committee on Tactical Combat Casualty Care (CoTCCC) as Care Under Fire. The video is of a Reality Based Training (RBT) scenario in which an operator in the open has sustained a gunshot wound to the leg and is bleeding arterially. The responding operators assess the situation without exposing themselves to the fire-lane in which the simulated casualty has been shot. After encouraging the casualty to apply his own tourniquet and crawl to them, the responding operators use a combination of suppressing fire and smoke to suppress the threat and conceal the extraction of the casualty to a position of cover. From there a rapid assessment and treatment of only the immediately life-threatening injury is performed before further extracting the casualty to a safer locality.