U.S. Army medic Sgt. Jaime Adame hauled open the door and lunged from the helicopter into a cloud of dirt and confusion.
He could hear bursts of incoming fire above the thumping rotor blades. Somewhere in the billowing red smoke that marked the landing zone and the choking dust whipped up by the medevac chopper was a cluster of Marines pinned down by heavy fire, and one of them was bleeding badly.
The problem for Adame was that he did not know where.
Adame had dropped into "hot L-Zs" before but this one was especially thick with commotion. Every second of indecision mattered, so he just ran, knowing any direction was dangerous. Only then did the cloud clear enough to bring into view the blurred outline of several Marines' boots peeking out of the vehicle they were taking cover under.
"The fear I have never lost," said Adame, who's from Los Angeles. "It's absolutely risky ... and it will definitely get a lot more dangerous."
With the spring fighting season under way in Helmand province in Afghanistan's volatile south, the medics, crew chiefs and pilots with the U.S. Army's "Dustoff" medevac unit expect a rising number of casualties. Coalition troops are seeing stepped-up attacks, the use of complex weapons systems like multiple-grenade launchers and the continuing plague of improvised explosive devices on the battlefield.
By the war's blunt calculation, the worsening hostilities on the ground mean more medevac flights to ferry the wounded. For an emboldened insurgency, that equals opportunity. Increasingly they are targeting the medevac choppers as they swoop in for a rescue.
"It is kinda the wild, wild West," said pilot Lt. Terry Hill of Kellyville, Oklahoma, the senior officer at Forward Operating Base Edi. "In the back of your mind as a pilot you know that you will most likely be shot at or hit."
The Black Hawk helicopters Hill and other medevac pilots fly are unarmed, though they are always accompanied by at least one other aircraft that is. The "Dustoff" helicopters are distinguished with the emblem of the Red Cross and under international law are supposed to be off-limits to enemy fire.
Afghanistan's insurgents make no distinction.
On one recent medevac run, as the helicopter navigated a firefight to set down in a small courtyard, a rocket-propelled grenade fired from a compound exploded in the air just behind the helicopter. The pilot quickly aborted the approach. Ground units called in air support, and attack helicopters riddled insurgent positions with heavy caliber machine gun fire.
Within minutes, the medevac chopper made a second attempt at landing to rescue a critically wounded Marine who had sustained a gunshot wound near his spine.
On another mission, insurgents fired several rounds from an assault rifle into the belly of the helicopter and its rotor blades.
"They seem to want us to get killed, which is surprising because we rescue everybody, including them.," said Chief Warrant Officer Michael Otto of Irvine, California.
The medevac doesn't discriminate between the war's wounded. Beyond coalition and Afghan soldiers, helicopters and medics also pick up injured Afghans, especially children. They often act as an ambulance service ferrying ill and injured Afghans from remote villages to coalition medical facilities. Enemy fighters are evacuated from the battlefield and treated as well.
With the sound of explosions shaking the air, Adame raced to find the wounded Marine. His comrades carried him on a stretcher from the dusty chaos to the chopper and Adame and his crew chief swiftly set to work.
Cpl. Andrew Smith was suffering a life-threatening arterial bleed from a shrapnel wound. His boots were sliced from his feet with a seat belt cutter. He was losing blood at an alarming rate. The medics focused only on stabilizing the young corporal; there was no time to think about the danger they had just faced.
"If one of those grenades hit us as we're taking off or coming in to land that's close to 17,000 pounds of steel, and hydraulic fluid, and flammables," Adame said. "Falling out of the sky in one of those things isn't going to be pretty no matter how you look at it."
Smith remarkably survived and is recovering at a military hospital in Maryland.
It's those successes that give the "Dustoff" crews motivation to plunge back onto the battlefield.
"It's all about saving a human life," said Chief Warrant Officer Joe Rogers of Russellville, Kentucky, the pilot of the helicopter that was hit by assault rifle fire. "And it's definitely worth the risk."