How to stop the bleeding

A year after Chris died, I was still shocked by how little I knew about being in combat zones. It was time to learn

Published May 30, 2012 12:00AM (EDT)

 The author with his friend Chris Hondros, right, who died in Libya in 2011.     (Nicole Tung)
The author with his friend Chris Hondros, right, who died in Libya in 2011. (Nicole Tung)

A tourniquet is a simple tool, but I found it practically impossible to deal with when I needed it the most. Slickened with blood, the inch-wide Velcro-backed webbing slid through my gloved hands like a wet snake when I tried to pull it tight. In an adrenaline panic fueled by the sound of gunfire and explosions, I hadn’t noticed that it had twisted under Darryl’s heavily bleeding leg, giving the Velcro nothing to grab when I was finally able to cinch it down. I needed to sort it out fast, or my colleague was going to die.

Darryl was severely injured. Both legs had been blown off at the knees and he lost his left arm at the elbow. Another journalist, freelance reporter Carmen Gentile, was working to stop the bleeding from the arm, fumbling with a tourniquet of his own and appearing to have a better go of it.

“How are you doing?” he shouted to me over the din of battle.

I took a deep breath and forced myself to focus. I ripped off my already tattered rubber gloves to get a better grip and started over, willing myself to be calm.

It was April 20, and although my heart was pounding like I was back in Libya, Carmen and I raced to save the life of our fallen colleague — who was really a 185-pound medical dummy clad in camo fatigues — on the back patio of the Bronx Documentary Center in New York. Next to us, two other freelancers, photographers Liam Maloney and Nicole Tung, worked on another victim. The realism was provided by stage blood (a lot of it), helmets and body armor, smoke bombs and recorded sounds of combat. Hovering over our frenzied work and making sure we didn’t miss anything fatal were medical professionals from Maine-based Wilderness Medical Associates.

“Did you flip him over? Does he have any wounds on his back?” shouted Sawyer Alberi, a spitfire of a former Army Reserve medic. Then to me: “You need to stop that bleeding.”

If there was a theme to what I’d been doing for the past three days, along with 23 other freelance reporters and photographers from around the globe, that was it — to stop the bleeding. Exactly a year before, on April 20, 2011, two of the world’s best conflict photographers — Tim Hetherington and my best friend since freshmen year of high school Chris Hondros — laid dying in the rubble of Tripoli Street in the besieged city of Misurata, Libya. A mortar round fired by Gadhafi forces had landed in their midst, and Chris had been hit in the head with shrapnel, just under the brim of his helmet, inflicting a massive brain injury from which he would die after languishing in a coma for several hours. Tim had been hit high on his leg, his femoral artery severed. It might not have been a fatal wound, but no one around him knew how to stop the bleeding. He bled to death within minutes.

The journalists in my squad stabilized Darryl and prepared him for medevac. We stripped off our bloody body armor and rotated to another exercise — stuffing absorbent gauze into a chicken carcass that was being pumped through with a continuous stream of fake blood. This was meant to simulate a wound to the groin or armpit, where the bleeding artery is too deep in the body to easily pinch off using well-aimed direct pressure. It was the sort of wound Tim had died from.

Our friends were certainly not the first reporters to be killed in combat, but they were among the first of what became a wave of deaths among highly experienced journalists in the year that followed. New York Times reporter Anthony Shadid died during a severe asthma attack while leaving Syria. Marie Colvin of the Sunday Times was killed alongside French photographer Remi Ochlik in an artillery barrage in Homs. South African freelancer Anton Hammerl, thought for weeks to have been captured and missing in Libya, was later confirmed shot and killed. Scores of journalists were captured by repressive regimes. It was, in short, a terrible year.

Especially for people who were close to those who died. A week before Chris and Tim were killed, I worked alongside them on Libya’s eastern front around Ajdabiya and Benghazi. It was extremely dangerous. We were caught in firefights, targeted by mortar fire and, in one instance, stuck for half an hour between Gadhafi forces and rebel soldiers who pounded each other with heavy artillery and machine gun fire, the shells streaking in both directions overhead. But — foolishly, in retrospect — it never occurred to me to be scared for my own well-being or that of my friends. When I left them to return home to Colorado a week before their deaths, they plotted their trip to Misurata, and I did not even consider the possibility that they wouldn’t return.

So the news, which I learned from a stranger’s Twitter post just 30 minutes after I sent Chris an email, blindsided me. Complete disbelief was my dominant emotion, mixed with a combination of guilt and shame. I’ll always wonder what would have happened if I’d stayed, if I would have changed the equation that led them to that fatal spot on Tripoli Street. Would I have talked them out of returning to a very dangerous scene that they’d been lucky to survive earlier in the day? Or would I have gone with them and been killed myself? There was nothing to be done about Chris’s injuries. But would I have known what to do to save Tim’s life?

The answer was no.

I was dangerously unprepared for the environments I’d put myself into throughout my career as a journalist, and I wasn’t alone. Most freelancers don’t have the first clue what to do if one of us is gravely wounded. We arrive in war zones fully stocked with memory cards, extra camera bodies and battery chargers, but with no knowledge about how to save our own lives or the lives of our colleagues. The first-aid kit I brought to Libya was filled with items that would have been useless in an acute trauma situation—Band-Aids and Pepto Bismol. I didn’t even know my blood type. My plan for a medical emergency was simply to hope for a quick death.

“There’s a bit of fatalism to people,” said author Sebastian Junger when we discussed this last month, marveling, as many conflict journalists have in the past year, at the vast scope of all we don’t know about how to render aid to our friends in situations where we should expect to need to do so. “There certainly was for me.”

Sebastian and Tim were close friends. The two had co-directed the documentary “Restrepo” about a group of U.S. soldiers manning a remote and dangerous outpost in Afghanistan. He was affected by Tim’s death the same way I was affected by Chris’s — although he and Tim had had a day’s worth of informal medical training from one of the “Restrepo” medics while shooting their film, he admitted that he knew next to nothing about the human body or what to do for injuries sustained in combat.

“It just occurred to me,” he said, “that it doesn’t have to be this way.”

When he learned that Tim’s injury might not have been fatal if someone had known how to apply pressure to slow his bleeding, Sebastian founded Reporters Instructed in Saving Colleagues (RISC), an organization that offers an intensive three-day combat medicine training course at no cost to participating journalists. Priority is given to freelancers, who compose an ever-increasing percentage of the foreign press corps in dangerous areas. Freelancers take the biggest risks in journalism, but they have the fewest resources to afford this sort of training. Most can barely afford body armor.

When I was asked to participate in the inaugural course, I wasn’t sure how I would handle it. The previous year had been spent in a daze that combined denial, grief and inertia in roughly equal proportions. I simply couldn’t get my head around the fact of Chris’s death, even though I’d seen him in his casket and helped carry him to his grave. It was as if the clock had stopped on April 20, and I was eternally stuck in the horror of that first moment of realization and disbelief. I coped by piling on more work than I could handle to avoid having to think about a future without him. I clung to the past and replayed memories incessantly, as if trying to fuse them into my brain. I was afraid of moving forward and forgetting. I started smoking again. I ignored my friends and family.

I was a wreck, and I morbidly ticked off the milestones counting down toward the one-year anniversary of his death: The day Chris texted me and asked me to go to Libya with him; the last day we were together in his Brooklyn apartment and he lectured me — almost as if he’d had some presentiment — about the trajectory of shrapnel and how small pieces can find their way into your brain even if you’re wearing a helmet; the last thing he said to me as we said goodbye in Benghazi, “We got you out of here unscathed.”

The RISC training promised to at least stop the spiraling orbit that made me feel like I was circling a drain as April 20 approached. I wasn’t the only one coping with memories and close calls. My classmates included Nicole Tung, who held vigil by Chris’s bedside in Misurata until he passed and helped get his remains on a ship bound for Benghazi; Mike Brown, who had been wounded in the same mortar blast; Jim Foley, who had been captured by Gadhafi forces with two other colleagues during the incident in which Hammerl was shot and killed; and Carmen, my partner in rescuing Darryl, who had miraculously survived being shot in the face by an RPG in Afghanistan (the warhead didn’t detonate, which is the only reason he’s alive).

I’m sure there were many other war stories I didn’t hear. There simply wasn’t time. The three-day crash course in emergency medicine didn’t leave much time for reflection. We learned how to stabilize broken limbs and how to assess for internal bleeding. We practiced “un-pretzeling” people who’ve been blown into a heap by a concussive force without further damaging their spinal columns. We were taught to recognize the signs of shock and hypothermia (even in warm climates, hypothermia is the fourth leading cause of preventable death on the battlefield). We learned how to stop arterial bleeds, apply a tourniquet and seal a sucking chest wound. We practiced CPR and rescue breathing by taking turns playing victims and rescuers in a variety of scenarios. We took the 6 train back to our Chelsea hotel sticky with fake blood and worried that the sheer volume of information being crammed into our heads would evaporate by morning.

Graduation was purposely scheduled for April 20. I expected to be more grief stricken than ever, but I found myself unexpectedly calm and energized. For the first time in a long time, I was unwilling to let grief overtake me. It is one of the primary lessons of RISC training, actually, that to dwell on the immutable past is to create peril for yourself and others. You must always be reacting to the present and preparing for the future.

At its heart, our training was about coping with wounds. I didn’t expect to bandage my own.

By Greg Campbell

Greg Campbell's new book is called "Pot, Inc.: Inside Medical Marijuana, America's Most Outlaw Industry." He is the author of "Flawless: Inside the Largest Diamond Heist in History," "Blood Diamonds: Tracing the Deadly Path of the World's Most Precious Stones" (the source material for the Leonardo DiCaprio movie of the same name) and "The Road to Kosovo: A Balkan Diary." Campbell is also an award-winning journalist whose his writing has appeared in The Wall Street Journal Magazine, The Economist, The San Francisco Times, Paris Match, and The Christian Science Monitor, among others. He lives in Fort Collins, CO.

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