Blood buys time and spans the vast distances of the Alaska landscape when someone is critically injured in the remote wilderness.
The moment a hunter was mauled by a grizzly bear shortly after midnight June 10 near Galena, Alaska, there already wasn't much sand left in the hourglass counting down the hours and minutes he had to get to a hospital.
Grizzly bears possess incredible strength and are armed with a brace of piercing claws and a jaw full of bone-crushing teeth. The hunter's encounter with the bear dealt him life-threatening injuries and wounds.
There wasn't a highway for 150 miles, so there was no wheeled ambulance on the way. Help would have to come from the air.
The Alaska Rescue Coordination Center at Joint Base Elmendorf-Richardson is the nerve center for civil search and rescue operations for the majority of the state and is staffed 24 hours a day, 365 days a year, providing a critical lifeline for people isolated in what can often be an unforgiving Alaska wilderness.
When Alaska Air National Guard Tech. Sgt. Katelyn Magnuson, AK RCC senior search-and-rescue controller, took the call detailing the harrowing peril of the mauled hunter, she knew time was an invaluable commodity she couldn't afford to squander.
It was her job to coordinate the most appropriate life-saving capability from a number of options.
Based on the distance and complexity, Magnuson selected the 176th Wing's "rescue triad." She would need pararescuemen (PJs) from 212th Rescue Squadron, an HH-60G Pave Hawk from 210th Rescue Squadron, and an HC-130J Combat King II from 211th Rescue Squadron.
Close to a shift-change, the controller knew it couldn't wait a few more hours for fresh crews to come on line.
"If the call comes in the middle of the night, they are always willing to do whatever it takes to get to the individual," she said, elaborating how the Airmen were ready to go despite nearing quitting time.
Knowing the HC-130 could close the distance quicker than the HH-60, Magnuson figured the pararescuemen on the King could don parachutes and jump to the isolated hunter, saving precious time.
She placed a call to Maj. Aaron Hunter, a combat rescue officer with 212th RQS serving as the search and rescue duty officer. She told Hunter times was of the essence, and she recommended jumping PJs to expedite the rescue. In turn, Hunter called 176th Operations Group commander, Col. Kenneth Radford, and was given the green light for the mission based on favorable conditions.
"I have been here for 10 years, and it has been my goal to get a PJ jump mission," she said, explaining this was the first real-world rescue jump since the J-model HC-130 was fielded in Alaska. "For me to get on (satellite communications) radio and say, 'PJs are cleared to jump,' it was probably one my proudest moments here at the RCC."
Aware the injured hunter would need a lot of blood, Magnuson reached out to Providence Alaska Medical Center and the JBER hospital to get the needed units, having them go on the King and the Pave Hawk. Both aircraft would race to deliver the lifesaving fluid first.
With wheels up for the rescue aircraft, both laden with PJs champing at the bit to help, Magnuson's symphony of contingencies, backup plans and burning aviation gas would play against the backdrop of the ticking clock.
"In addition to communication with leadership, you're talking to medical facilities, you're talking to pilots, you're talking to weather, you're talking to all of these different agencies," Magnuson said of her job. "There are a lot of different people who are involved with this mission, and I'm the one who has to keep it all straight."
Going into shock on the ground, the mauled hunter's blood circulation was shutting down. Keeping warm was not a luxury despite relatively warmer summer temperatures. He needed a source of warmth right away.
Circling overhead, good Samaritan Jared Cummings piloted his Cessna 206 in a race track formation, keeping in radio contact with the HC-130 and the hunting party.
Launching from Kotzebue, much closer to the party's location than JBER, Cummings brought his cousin and two sleeping bags.
"Once our airplane showed up, the guy on the ground said (the hunter's) whole demeanor had changed because he knew someone was on the way," the pilot said. "Once we got an ETA on the (HC-130) and pararescue, it turned the whole thing around."
Steering toward the party's location, Cummings approached as if he was landing. The sleeping bags, wedged between the wing and the wing struts, were pushed out at just the right time when Cummings' cousin gave them a good nudge with a kick of the door.
With the means to keep the hunter warm, Cummings added precious sand to the hourglass of time.
Pararescue is the only career in which service members in the Department of Defense train for combat search and rescue operations.
Tasked with infiltrating behind enemy lines to find, protect, medically treat, and extract downed air crew and other isolated troops, PJs endure a two-year training pipeline where they learn everything from airborne operations and paramedic skills to combat diving and survival.
Within the close-knit circle of special operations, PJs are commonly called "Guardian Angels."
Senior Master Sgt. Jeremy Diola and Master Sgt. Cody Inman, both 212th RQS PJs, received an alert call late that night.
"When you get a phone call at that time, especially when you're so close to day crew coming on, you know it's something significant," Inman said.
While Diola planned the mission, Inman packed their gear -- weighing between 90 and 110 pounds each and including a parachute, medical kit and survival gear.
Though Magnuson had requested an airborne insertion early on, everyone in the chain had to be on board, from the wing leadership to the aircrews, but especially the PJs who would be stepping out of the aircraft.
Fortunately, weather and terrain were ideal for the operation.
"Getting to the ground is really routine for us," Diola said. "It's when the winds are high or the cloud deck is low when risks are elevated.
"It was one of those times when those risk factors were absent," Diola continued. "It was a lower risk from the jump side, and the benefits of getting there faster -- even if it's minutes -- made for the course of action we took."
Under different circumstances, the PJ pair could have undertaken a jumpmaster-directed precision jump, employing instruments like wind-drift indicators to get them on target. Because the process takes more time, the PJs agreed to have the HC-130 combat systems operator, Capt. Sara Warren take the lead.
An experienced CSO, Warren has a host of missions on the HC-130. She is responsible for running the hoses during air-to-air refueling of the HH-60s, she monitors all of the aircraft's sensors like the electro-optical infrared system during search patterns, and calculates airborne drops for personnel and equipment at various altitudes and configurations.
On June 10, it was Warren's responsibility to figure out precisely when and where to drop Diola and Inman to get them as close to the hunting party as possible.
"There was very little wind," she recalled. "It was a perfect scenario for a jump mission. It was a big open area without a whole lot of mountains."
The rescue effort was coming to a head after little notification and a compressed planning timeline.
"All of us are seasoned professionals who are used to the dynamic, ever-changing mission environment where you think on the fly and think outside the box, operating with very little to no pre-mission planning," Warren said. "You just have to make real-time decisions. That is something we up here in Alaska are really good at."
Knees to the breeze
With the drop calculated by Warren, the green light let the PJs know it was time to step. At 3,000 feet above ground level, Diola -- with his heavy equipment strapped to his legs -- waddled to the edge of the ramp and stepped into emptiness. Three seconds later, Inman followed.
Both piloted their steerable parachutes to the rescue objective, pulling on the air brake before carrying out a parachute landing fall to soften the landing about 500 meters from the hunting party. Both were wary of the very real possibility of an angry bear lurking about.
"We were making a lot of noise because we knew there potentially was an injured animal out there," Inman said.
When the pair could finally assess the patient, his wounds were as grievous as they had anticipated.
"Our assessment he was severely injured -- what we call a cat alpha or an urgent surgical patient -- was confirmed," Inman said.
Inman used the tried-and-true MARCH methodology: stop Massive hemorrhaging, open the Airway, ensure good Respiration, check Circulation, and treat Hypothermia.
A team of teams
After treating the patient and carefully packaging him on a litter, the HH-60 arrived and picked up the two PJs and the patient. On board was fellow PJ, Staff Sgt. Thomas McArthur, who took over as primary medic.
"We're at home; it's time to go to work," Inman said of the 30-minute flight to Galena. "It might sound a little crazy, but one of my favorite things about this job is being in the aircraft and working in that environment. It's difficult to take care of someone back there, but it's what we excel at."
Throughout the mission, Magnuson never forgot her duty -- to provide the highest level of care in the most expeditious manner. She did some rapid, accurate math and coordinated a new plan with Warren and Williams.
The Pavehawk would fly directly to Galena airport, where the HC-130 would be waiting on the ground. The patient would then be loaded into the much faster aircraft for a "transload" to rapidly get the patient to Anchorage and the Providence Alaska Medical Center, one of the state's most capable hospitals.
During the flight back to base, Warren established a communications link with a Providence Alaska Medical Center level 1 trauma team, who liaised with the PJs to give the patient the best stabilizing care.
At JBER, the process continued in reverse. Magnuson reached out with a medical evacuation request to the Alaska Army National Guard's 1st Battalion, 207th Aviation Regiment.
Together they arranged for a UH-60 Black Hawk helicopter to pre-position at the HC-130 parking area. Within minutes of landing, the PJs loaded the patient on board the third National Guard aircraft involved in this mission.
The three-minute flight took him directly to the rooftop emergency room helipad at Providence, which saved dozens of minutes over using a ground ambulance. From the helipad he was handed off to the Level 1 trauma team.
The clock had stopped, and the patient was stabilized.
That others may live
All involved cite how the rescue effort consisted of a team of teams -- maintenance sections, air crews, loadmasters, enlisted crew chiefs called special-mission aviators, pilots, CSOs, civilian good Samaritan pilots, and administrative Airmen who provide the paperwork allowing aviators to fly.
"I'm proud to be involved, but any member of the rescue triad would have gotten the same results," Warren said of her work as CSO. "The commanders set very high standards, and they make it very clear to us that life and death depend on our ability on a daily basis to be good at our jobs individually and to be able to work well together as a team."
Diola echoed Warren's opinion of the rescue community dynamic.
"It's incredible the relationship we have in this wing, group and the squadrons across the board," the PJ said. "We train for this every week, and this mission is a testament to the teamwork with hundreds of people coming together to get one guy out of a remote part of Alaska. That's why it was successful and smooth."
Cummings, who spends his life spanning Alaska as a bush pilot, said he is thankful the 176th Wing is there if he ever lands in a scrape.
"We were so impressed with their ability to respond so quickly," the pilot said. "It makes all of us out here in the field doing this on a daily basis feel better knowing that if something like that happened to us, our chances are a lot greater because we have a team like that to respond."