Knife Edge: Life as a Special Forces Surgeon (21 page)

I was ushered into his massive office almost immediately. Rigidly I came to attention, cracking the most perfect military salute I can recall giving. The Minister, sat behind his desk, looked up and smiled. I could see confusion in his eyes as he struggled to recognize me. I appreciated his predicament.

‘Yes, sir,’ I said. ‘I looked different when we last met.’

‘You certainly did,’ he replied, smiling. ‘How have you done?’

‘Our report is complete. I have a copy for you here. With full recommendations.’ I handed the document over, feeling a huge weight lift from my shoulders as I did so. I was delighted to see it go but hoped my happiness was not too obvious. The Minister reached up to accept the buff folder, studying me intently.

‘Thank you,’ he said. ‘I imagine a lot of work has gone into this document. I will read it with interest. Do you have the time by any chance?’

I could barely believe what I was hearing. This was it. This was how it was done. This was when I would receive my gold Rolex. My anticipation was almost uncontrollable. Taking a firm hold of myself, and the increasing, overexcited tremor in my hands, I slowly and obviously lifted my bare left wrist towards the Minister, pretending to look at an imaginary watch.

‘I’m terribly sorry, Minister. I’m not wearing a watch. I can’t help you I’m afraid.’ My chest was bursting with anticipation. Any moment now, I thought, and the Rolex would be mine. Then I glanced at the Minister’s face. For a brief moment I thought I sensed amusement in his eyes. Then came the smile and I knew he was aware of what I was up to.

‘I do believe you were wearing a watch when we met in Haruj, Dr Villar,’ he observed. ‘You will not be needing one from us. If I need the time I shall ask those outside when you’ve gone. Thank you for your work. The country is very grateful.’ His eyebrows lifted slightly, almost in challenge. I had been caught out, well and true, and now felt barely more than a few inches tall. Humbled, I saluted and left the room. The gold Rolex was not for me.

Much as I enjoyed and admired the Middle East, I was glad to return home to Hereford. It was important not to lose my civilian contacts. SAS service never lasts forever and I knew that I would one day have to leave the Regiment. In some respects it was adventurous and attractive to undertake covert projects and operations in far-flung lands. In others it was a disadvantage. To ensure some chance of progressing up an orthopaedic career ladder, I had to maintain the support of those outside the Regiment who could help me. What I needed was a reason for staying in the UK for a while. I thought hard on the problem before realizing the obvious answer. Antiterrorism. Of course — that was it. Antiterrorism it would be.

‘Go! Go! Go!’ Instantly I heard the sharp reports of the stun grenades as the teams went in. Glass shattering, earth shaking, smoke billowing from the building in front. Staying motionless beside the team commander, I waited for the order to move. With luck my medical skills would not be needed at all. My hopes were ill-founded. Sixty seconds later the call came through my Pyephone’s earpiece, ‘Starlight. You’re wanted. Come forward now.’

Antiterrorist assaults were dangerous things, large numbers of high-velocity bullets, and high explosive, being used within confined surroundings. To be successful required split-second timing, rigorous training and luck. Today luck was obviously in short supply.

I jogged forwards, breathing laboriously in my respirator. Already I could see one corner of the right-hand lens had begun to mist up. Damn! If it misted fully I would have to remove the thing. With the gaseous agents the teams had used, lack of a respirator would render me ineffective. The Kevlar body armour was heavy, particularly with the high-velocity protection plates worn front and back. My right arm felt wrenched out of its shoulder socket as I dragged the huge emergency medical pack towards the charred remains of the building’s back door.

Steve, also in full antiterrorist kit, stood outside the door to greet me, his MP5 submachine gun still held ready. ‘The stairs are first on your right, Doc. The lads will meet you there.’ His voice sounded muffled and rubbery from within the respirator.

Inside was chaos. Glass everywhere, scorch marks on the walls, broken furniture scattered around. Two bodies lay near the foot of the stairs, motionless. They were no longer a threat. Through the smoke I could make out the broad stairway on my right as it curved upwards to the first floor. Three operatives stood on the stairs, hugging the wall, one at the top, one centre, one at the bottom. I could not recognize the one at the bottom of the stairs, but as soon as I turned to climb them, he put a hand on my shoulder. ‘Wait,’ came the rubbery instruction, ‘they’re coming down.’ Immediately he spoke I knew it was Tom. Respirators and balaclavas made even good friends unfamiliar. All you could see was a large, threatening shadow. Then the shouting began. Loud, forceful shouts with screaming in the background, ‘Go! Get out! Go! Downstairs fast! Go!’

I could see the stumbling shapes of several confused women being manhandled down the stairs, forcibly pushed from one operative to another. Finally, coughing and choking, they were expelled through the back door into the fresh air beyond. I could see how frightened they were. Though the siege had not been long they had begun to relax, trying hard to build an understanding with their captors. A desperate attempt to ensure their own safety. Then, unannounced, and with brutal aggression, the team had done its job. Within sixty seconds the task was complete, terrorists incapacitated, hostages secure. We had one casualty, not a major wound, whom I persuaded to limp out once the hostages were clear.

I never understood how the SAS developed its skills in antiterrorist warfare. It is such a contrast to its original role, sneaking behind the lines in North Africa. It probably dates from the Aden conflict, where urban terrorism first appeared, both enemy and SAS operating in civilian clothes. The Regiment, its eye always on the future, realized this was the way of things to come. By the time of the 1972 Munich massacre, an event sending politicians leaping for answers, the SAS was well placed to offer one. The ‘team’ was created, one Squadron being permanently stood by as the country’s final solution, whether the crisis was at home or overseas.

Planning had to start from basics. As the concept expanded so its technology also increased. Special weapons, communications systems, gaseous agents, tactics, transport and so on. Medicine, in the early days, was left behind. I think it was assumed that SAS medical training would be sufficient or that local hospitals would muddle through on the day. It was rather forgotten that actions often take place in major conurbations and were likely to expose civilian medical services to injuries they had never seen before. Casualties would most likely be contaminated with incapacitating gaseous agents — CS gas, for example — that could in turn contaminate civilian casualty departments as they attempted to resuscitate the wounded. This was certainly a problem after the Iranian Embassy siege of 1980.

Until the 1980 siege, basic antiterrorist medical advice given to the Regiment had probably come from high-level Ministry of Defence sources. 22 SAS’s Regimental Medical Officer was barely consulted. Medical plans and tactics were often prepared by those without firsthand experience of SAS activities. Consequently, in my day, if you wanted to play a part in events, you had to invite yourself. My participation was based on keeping an ear to the ground and learning when the teams were summoned. I would make sure I was there, uninvited but medical pack in hand, insisting I should look after my patients.

After the Iranian Embassy assault the situation changed. That year Delta had experienced a high-profile failure in Iran, while we had shown high-profile success at home. Political attention was unquestionably focused on antiterrorist warfare. ‘Doc,’ I remember the CO saying, ‘I want you to sort out the medical side.’ And so I did. From that moment I ensured the teams had their own, closely attached, medical support. I felt our role was clear. We were there for SAS casualties primarily - instant assistance at an operative’s side.

Beyond the close support provided by SAS medical personnel, such as me, there also existed SMTs - Specialist Medical Teams. Officially they were not meant to exist, being tightly controlled from the Ministry of Defence. They were designed to work independently, and not alongside civilians. This would have been regarded as a security risk. The role of SMTs, in the eyes of the hierarchy, was to keep VIPs alive. Imagine, for example, the Prime Minister is taken hostage. After days of negotiation the SAS goes in, narrowly saving the day but wounding the Premier accidentally. These things can happen. For such people to die en route to hospital is not acceptable, so immediate on-site medical cover is required. These would offer consultant-level medical assistance at or near the action. Teams would come from all three Services, their equipment being on permanent standby in Hereford. The staff involved would go about their normal jobs, but would be ready to move at a moment’s notice from wherever they happened to be. I had strong doubts about SMTs. Some were excellent, while others had no real idea of what was expected of them. It is one thing to be working in a comfortable Service hospital each day. It is another to be thrust into the back of a C130 Hercules at one hour’s notice, flown to a farflung land and asked to perform medical miracles under fire. You need to be physically and psychologically prepared for such things. Many of the SMTs were not. Nevertheless, those involved did take their job very seriously.

Being on the receiving end of an SAS antiterrorist assault is not something I would advise. I have been through it on numerous occasions during training exercises. Such events are as real as they can get. The assault always happens when you least expect it. After all, the antiterrorist forces often have plenty of time to make their plans. The more a negotiator can slow talks down, the better prepared are the troops when the time comes. They can pick and choose their moment and have relays of freshly fed and slept individuals to do the task. The terrorist is surrounded by hostile forces and is unlikely to have slept or fed normally for a long time. Teams can get in anywhere. Through doors, walls, roofs or windows. You can be sure they will have been watching and listening to you intently by whatever means possible before committing themselves to an attack. By the time you realize an assault is under way it is too late to do anything about it. In come the flash bangs, the unofficial description of stun grenades, plus CS gas. Out go the lights and the next I would know was that I lay flat on my face, a large boot on top of me. It was a position I was forced to adopt on many different occasions with the Regiment. I was completely disorientated. I had no idea who was attacking, how many were attacking or from which direction they were coming. I was always utterly surprised, even though I was in the trade. With antiterrorist tactics being so finely honed worldwide, it astonishes me that terrorist groups still try hostage-taking at all.

Most major powers, and many minor ones, now have their own antiterrorist teams. Many have been trained by the SAS. These were the so-called ‘team jobs’ where small groups of SAS antiterrorist experts would spend three months in a distant land, teaching local forces how to deal with siege situations. Buildings, boats, buses, trains, airplanes - they were all fair game. Medical training would form a significant part of a team job. It was not all about how to inflict injury, but how to treat it as well.

The secret of antiterrorist medical cover lies in good preparation. Though it may be exciting to think of hooded operatives blazing their way daily through doors and windows of embassies, real life is different. The requirement for antiterrorist troops is infrequent. A lot of time is spent training for that very rare operational requirement. A man may rehearse for several years for sometimes less than one minute of antiterrorist action. That action may be politically very sensitive, with the eyes of the world focused on the event. There is no room for error as both lives, and careers, depend on a successful outcome. Training is therefore taken seriously. This applies as much to the medical support as it does to the operatives. Antiterrorism gave me very little medical work throughout my time with the SAS, but occupied many hours in planning, negotiation and preparation. Terrorist events anywhere in the world are closely followed by all antiterrorist teams, wherever they may be, so that everyone concerned may gain maximum value from the experiences of a few.

Medical problems are diverse. Gunshot wounds, GSW, are a possibility. If the teams have performed their task efficiently, it is likely the wounds will only involve terrorists and are most probably fatal. For a doctor there is little to do except ensure a reasonable supply of body bags. Operatives train both by day and night to ensure they can reflexly distinguish a terrorist from a hostage so that only the bad guys suffer. It is not easy.

Burns and smoke inhalation are more likely. A hostage may not be able to escape, either due to terror or being forcefully immobilized by his captors. As soon as the action is complete, it is therefore vital that all innocent parties are evacuated speedily, taking care that no terrorist tries to mingle with escaping hostages. This occurred at the Iranian Embassy siege. Medically, one needs oxygen nearby and a good supply of sterile dressings to cover burned areas. Severe burns will also need an intravenous drip erected as the exposed raw flesh exudes large amounts of serum, causing shock and a fairly rapid death.

In the early days of antiterrorism, the psychiatric side was largely ignored, teams concentrating on the practical aspects of winkling out terrorists from awkward locations. However, everyone is affected in some way at a terrorist incident - hostages, terrorists and antiterrorist forces. Most civilians have never been in a position where they fear for their own life and will be unfamiliar with the terror such a feeling can create. It comes as a rude shock to many with possible profound psychiatric difficulties subsequently.