Afghan war offers medical lessons put to use back home

Doctor Louis-Philippe Palerme, right, from Gatineau, Quebec, is getting assistance from a Danish doctor, Captain Sacha Soelbeck, during a surgery at the Role 3 Multinational Medical Unit in Afghanistan. (Sgt. Paz Quille / Department of National Defence)

"Tourniquets were once completely out of style, absolutely," he says.

One of the arguments against their use was that when tourniquets are tightened around a damaged limb, they cause tissue below to die. So doctors and hospitals discouraged their use. But Tien says battlefield surgery is very different from surgery in a city, where many of the decisions on such things are often made.

"Battlefield injuries are usually not puncture wounds, like the gunshot wounds and stabbings you'd see in a city," he says.

The wait for medical help is also not nearly as long in the city as it might be for a soldier injured in a hard-to-reach outpost in Afghanistan. And in the case of a limb amputation from an IED, the biggest worry is that the soldier will bleed to death while he waits for medical help.

So in recent years, there's been a revival of tourniquets.

"They made a comeback for Canadians around 2004-2005. And by the time we got to Kandahar [in 2006], it was part of the kit we gave to medics," Tien says.

Today's tourniquets are not what they once were. Now, they look like short belts made of nylon webbing that can be wrapped around a limb and tightened off with one hand. Every soldier is issued one and instructed on how to use them as part of their pre-deployment training. Soldiers report that some comrades even strap their tourniquets on each leg every morning before setting out on a patrol, just in case.

Tien calls tourniquets "a 90 per cent solution to the bleeding issues that come up in the field." But in cases where a tourniquet won't help, such as an abdominal wound or shoulder injury, other new and effective tools called "hemostatic agents" are being put to use.

Hemostatic agents limit blood loss

One of them is called QuikClot. It was originally a powder that every soldier carried in their packs. The powder was made of a mineral called zeolite that was poured directly on wounds to stop bleeding. While it was effective in stopping bleeding, it created a great deal of heat and often caused chemical burns that made repairing the wound more difficult. So it was discontinued.

QuikClot's manufacturer then switched approaches and created a gauze containing kaolin, a mineral found in clay. Kaolin activates a key clotting factor in the blood, allowing blood under the gauze to clot and block off broken vessels.

The gauze is now part of the kit carried by Canadian medics, as are HemCon bandages, a kind of bandage that works much the same way as QuikClot.

HemCon bandages actually made from crushed shrimp and crab shells. The shells contain chitin, which attracts the blood's platelets and red blood cells and causes them to form a gel-like clot that seals a bleeding vessel.

The bandages and gauze offer medics one more tool to minimize blood loss when a tourniquet won't work. They're also being tested for use in civilian hospital settings and among first responders, such as paramedics. The manufacturers of both products are marketing their products to consumers as well, though it seems just through their websites for now.

More intense training for soldiers, medics

Training on how to use hemostatic agents is just one component of a new type of first aid training that all soldiers now undergo, called "tactical combat casualty care." Tien says TCCC is another development that is having a big impact on saving lives in the field, by ensuring that more injured soldier and civilians make it to the hospital quickly.

The Canadian military adopted TCCC after the devastating "friendly fire" incident in 2002, in which four Canadian soldiers died. All Canadian combat soldiers now undergo two weeks of TCCC training that focuses on teaching them how to suppress enemy action first, so that they can quickly evacuate injured comrades.

Once they can tend to the wounded, the soldiers put to use their training on how to stop bleeding quickly, when to use tourniquets and when not to, and how to quickly treat collapsed lungs.

Tien says another key advancement he's witnessed in the field in Afghanistan is the better training of medics, who are a critical link in treating injured soldiers and civilians.

"I was in Yugoslavia in the mid-90s and the way we train our medics is just completely different. They're so much better prepared now," he says.

Medics are now trained to deal with multiple traumas, even while still under fire, tending to multiple patients at once if needed. They, too, focus on quickly stopping bleeding and stabilizing the injured to prepare them for evacuations.

While these small changes to first aid approaches may seem modest, they can make a big difference, since 90 per cent of soldier deaths occur in the field and the most common reason for trauma deaths in war is massive blood loss.

Australia to boost medics serving in Afghanistan

Canada has had great success with civilian medical professionals in Afghanistan.... maybe the Aussie"s should look at this option.

Flight Lieutenant Jo Darby with US Navy administrator Lieutenant Commander Ron Schoonover. Picture: Gary RamageSource: The Daily Telegraph

PRESSURE is building for Australia to boost medics serving in Afghanistan as the Canadians and Dutch leave.

The priority need is for trauma specialists at the new Role Three hospital at Kandahar airfield where just a handful of Australian medical staff work in support of the US run facility.

Adelaide RAAF doctor Squadron Leader Jo Darby, who undertakes shifts at the trauma unit in between her duties at the Australian camp, said medical teams working at the hospital treated all patients as if they were their own nationals.

"We really appreciate their efforts ... we owe a massive debt to the US Navy guys," Flight Lieutenant Darby said.

Most seriously wounded Australian troops are treated at the Kandahar facility before being transported to Germany or back home for specialist care.

Flight Lieutenant Darby said it would be greatly appreciated if Australian trauma teams could be permanently based at the facility when the 35 Canadian and Dutch specialists depart in November this year.

"It is going to be a manpower juggle," she said.

During a visit to the hospital, administrator US Navy Lieutenant Commander Ron Schoonover said that it was as busy as the top seven trauma hospitals in the US but was only one-tenth of the size.

The hospital treats up to 260 trauma cases a week and averages well above 150-a-week with its three operating theatres often occupied around the clock. 

"The mission won't change and when they go we will be short-staffed," he said.

Flight Lieutenant Darby is the medical officer at Camp Baker, the Australian headquarters at Kandahar airfield. She also spends about three days a week working at the trauma facility.

"It is a great opportunity because there is nowhere else like this," Flight Lieutenant Darby said.

According to Defence there has been no formal request for Australians to replace the departing medicos.

"It is important to note that the health care provided to deployed Australian personnel will not be diminished by the departure of the Canadian doctors," it said.

Meanwhile, coalition medical staff across southern Afghanistan are bracing for an influx of casualties as insurgent suicide bombers prepare to attack civilian targets.

KANDAHAR AIRFIELD, AFGHANISTAN - MARCH 21: U.S. Navy Chaplain LCDR. Charles Hodges photographs as doctors perform brain surgery on an Afghan civilian on March 21, 2010 at the military hospital at Kandahar Airfield in southern Afghanistan. Chaplain Hodges is stationed at the hospital and also serves as the photographer for the medical unit. As part of his job, he also comforts wounded patients and counsels medical staff who often deal with a heavy caseload of patients, many suffering from traumatic injuries.

Denelle Balfour, CTV News

Date: Mon. Aug. 13 2007 11:46 AM ET

KANDAHAR, Afghanistan — They are the battered and broken. Afghanistan's war wounded arrive at the Canadian Forces trauma hospital on the Kandahar base on a daily basis.

Capt. Helen Wright, a family doctor for the military when at home in Calgary, says this is a different kind of practice.

"I have seen far more acute traumas in the six months," she says, "than certainly I have seen in my entire training and likely more than I will ever see in my time back in North America."

In the past six months, about 400 patients have passed through the front doors of the hospital and into the capable hands of multi-national medical teams. The teams include both military and civilian doctors.

The hospital's commanding officer, Col. Colin MacKay explains that civilian doctors are needed. "We have civilian surgeons here right now, because with the Canadian military right now, we have a shortage of uniformed surgeons at the present time."

This is, after all, Canada's first combat field hospital since the Korean War. Subsequent peacekeeping missions have not pressed the military's medical services the way they are being challenged now.

Coalition soldiers, Afghan security forces, Taliban fighters and the civilians caught in the crossfire, ncluding numerous children, all have been treated here.

"I have to say that I have been quite taken by the amount of damage that can occur to a human being in a conflict like this," MacKay told CTV News. "And it is difficult to see the soldiers, both Canadian and multi national partners, the Afghan security forces and local nationals that have become victims of the conflict."

I was granted several days access to observe how things are done at the hospital. For people who have laboured here saving lives and limbs, it was a story they wanted told and it is an experience I will never forget.

"Role 3," as the hospital is called on the base, happens to be a collection of containers and plywood rooms that house several trauma bays, two operating theatres, an X-ray room, CT scanner, a lab and about 13 beds in three rooms that make up the wards.

"We have a very small compact facility that has tremendous capability," MacKay said. "It has many of the capabilities you would find in a hospital back in Canada."

On this day, the badly injured are Afghan National Police, victims of a Taliban ambush. At least eight of them were killed, two are in trauma bays and one is already in the operating room. In all, some 30 people have assembled, including specialists, doctors, nurses.

Lt. Tobi Barter, a nursing officer, says: "Some days you hear the communications, and you may have four or five patients coming in. They all have amputations, missing body parts and you never know what to expect day to day."

While it seems chaotic, amid the shouts for X-rays, fluids, vital signs, there is order and humanity.

"For the most part, we are able to help them recover from those injuries and see them go out the door and that's very rewarding," MacKay says.

It's also rewarding for the civilian specialists, who answered military ads in Canadian medical journals for civilian volunteers.

"It's been a thrill," says soft-spoken general surgeon Dr. Vivian McAlister from London, Ont. "The quality of care is identical and the organization is fantastic. I think the civilian practice has a lot to learn from the way the military can handle these situations."

"We frequently cancel patients at home and declare we are unable to look after other patients and their care will have to be postponed -- this never happens here"

Winnipeg radiologist Dr. Daniel Lindsay is on his second rotation at the hospital.

"I think the Canadian military thought outside the box," he said, "and I think they were very creative and they took a huge risk on people like myself coming over here."

Lindsay was one of the first civilian specialists to work with the military medical services in Kandahar.

"We have this view of soldiers as if they are not human and they are some kind of machine. There is a tremendous amount of humanity here and a big part of what is happening here, isn't just looking after the troops out there, a big part is looking after the Afghans."

When injured coalition soldiers come to the hospital, for the most part they only stay a day or two until they are transferred from Kandahar to care facilities elsewhere or at home. But the Afghans, security services, and civilians stay longer.

"This is a clean hospital for a dust bowl in the desert," says orthopedic surgeon Dr. Dave Puskas from Thunder Bay, Ont.

But it's not the kind of environment where patients would want to stay if they had another option for surgery, he said.

A specialist at repairing bones, Puskas is no stranger to trauma injuries, car accidents, fights, or falls but even he is learning new terminology in Afghanistan.

"I heard this phrase recently -- biologic shrapnel, so shrapnel meaning a secondary missile, but another person's body part. That was something new to me," he says.

On the table in the operating room is an injured Afghan army soldier. Puskas will repair a wound to the man's left arm and he will help Dr. Steve Bureau, an oral surgeon from Calgary, repair a terrible wound to the man's lower jaw, the result of a Taliban bullet.

"One centimetre deeper, one centimetre lower, and we wouldn't be operating, that's for sure," Puskas tells CTV News as he gowns up.

Bureau is the only one of five civilian specialists on rotation at this time, who has served in the military. He was a dentist in the Armed Forces until 1996. He left for private practice and became an oral surgeon about eight years ago.

"I got an email through the Canadian Association of Oral surgeons that the Armed Forces was looking," he says.

So he called an old military colleague and was in.

There seems to be a brief, quiet pause in all the activity on the trauma floor. But then U.S. army doctor Aaron Saguil informs the medical teams that new casualties are on the way.

"We have to get out of our comfort zone," he says, "We have to be very creative and not be afraid to tackle something a little different."

Bureau replaces the Afghan soldier's shattered jaw with a metal plate. Two days later the soldier will leave, a little sore, but on the mend, and most importantly -- alive.

Curtains are drawn on one of the trauma bays where hospital staff had tried to save the life of one of the afghan police, but his injuries were too severe and he would not recover.

Cool book about Aussie medics.

Medic: Saving Lives - From Dunkirk to Afghanistan

AUTHOR: JOHN NICHOL,  TONY RENNELL

Their job is to put themselves in the heart of danger – to run into battle to rescue the wounded and to risk their own lives to try and save the dying. Doctors, nurses, medics and stretcher bearers go where the bullets are thickest, through bomb alleys and mine fields, ducking mortars and rockets, wherever someone is hit and the shout goes up – 'Medic! We need a medic over here!' War at its rawest is their domain, an ugly place of shattered bodies, severed limbs, broken heads and death.

This is the story of those brave men – and, increasingly in this day and age, women – who go to war armed with bandages not bombs, scalpels not swords, and put saving life above taking life. Many have died in the process, the ultimate sacrifice for others. But wherever the cry of 'Medic!' is heard, it will be answered. From the beaches of Dunkirk to the desert towns of Afghanistan, there can be no nobler cause.

World-class new training will prepare Canadian soldiers for Afghanistan

World-class new training will prepare Canadian soldiers for Afghanistan

By Bob Bergen

It’s not every day that you can use the words “state of the art” and “Canada’s forces” in the same sentence, but remarkable new computerized army training equipment used for the first time at CFB Wainwright, Alberta, allows just that. Known as Weapons Effects Simulation or by its acronym WES, the complex array of lasers, sensors, global positioning systems, radio transmitters and computers gives the Canadian military among the world’s most sophisticated training capability.

The Canadian Forces demonstrated how the system works to a group of four Calgary-area academics during a trip last week to the new Canadian Manoeuvre Training Centre at Wainwright. The $132-million WES system has been in trials for two years. This was the first time it has been used on exercise.

Barbed wire is coiled around the guarded entrance to a replica of Afghanistan’s camp Nathan Smith during Exercise Maple Guardian at CFB Wainwright in Wainwright, Alta. on June 10, 2009.  Photo by Ryan Jackson/Edmonton Journal

Here is how it works. Each soldier wears an array of 10 detectors on his or her body and another four on his or her helmet that registers laser simulated fire emitted from rifles, machine guns, tank cannons, mines, artillery, grenades, improvised explosive devices and chemical contaminants. If a detector is struck by a laser, the system’s computer in each soldier’s tactical vest assesses whether he or she has been killed, mortally injured or slightly wounded. It tells wounded individuals where they have been injured, their comrades the emergency first aid required and how long the wounded will live unless they get medical treatment. 

The WES system also shows commanders monitoring giant screens where each and every soldier, vehicle or weapon is on the entire 640-square kilometer Wainwright training area. It monitors their movements and reveals in near-real time every shot fired, who fired it, who has been hit and who is a “friendly” force or not. As a result, commanders can look a soldier straight in the eye and say: “You fired five rounds and, on the third round, you killed a villager.” 


The thinking behind such precise training is that it is better to get it wrong in Wainwright and learn from it, than to get it wrong in Afghanistan. Moreover, the actions of an engagement – or for an entire battle if need be – can be played back so commanders can assess the strengths and weaknesses of every action with unprecedented clarity.

In this 2007 file photo at CFB Wainwright in Wainwright, Alta., commanders from the Provincial Reconstruction Team (PRT) meet in a 'village' with Afghan community leaders to rehearse for encounters that might take place in Afghanistan.

Star

 It addition, individual unit actions like a raid on a building are recorded with video cameras which allow ever-more precise after-action reviews of the soldiers’ performance. That precision is what the WES system brought to commanders and 80 Nova Scotia reservists on exercise at the manoeuvre training centre since late June. Later this fall, the same group of reservists will return to Wainwright and join up with the 2nd Royal Canadian Regiment Battle Group to train for a deployment to Afghanistan in early 2007. When they do, each and every member of the 2RCR battle group of about 1,200 that will include a 300- member provincial reconstruction team, a Royal Canadian Dragoon amourerd squadron, assorted engineers, artillerymen, command and support elements will be equipped with the new WES training equipment. 


Altogether, there will be 2,300 individual “player units” which will enable the tracking of soldiers, vehicles, weapons, weapons systems and personnel. Other countries have similar systems: the Americans were the first, followed by the British and the Australians. But, Canada’s system is the most modern and the best in the world. 

On top of that, it was absolutely amazing for a long-time visitor to Camp Wainwright to see what the Forces have done with the training centre in an effort to replicate the environment Canadian troops will find in Afghanistan thanks to Canadians who have already been there. 


In the past, when soldiers training to fight in built up areas they had only one cinder-block building to either assault or defend, they now have near exact replicas of Afghan villages, markets, farm complexes, towns, and caves. And, they will have 150 people dressed and acting like locals to deal with. In the replicated abandoned town of Spin Boldak in the south that borders on Pakistan, the soldiers mustlearn to deal with insurgents moving back and forth across the border just like they would in theatre. They will have to deal with refugees and Imams and a police chief who cannot speak English. 

This will force the soldiers to deal with translators, because there is an art to carrying on business with a translator. To make the training even more life like, the Forces will bring in college journalism students from Calgary and Edmonton who will receive course credits for spending extended periods covering the training and reporting on what went right and what went wrong. 


This is great news for the next rotation of troops into Afghanistan because the next time the government trots out the old argument that Canadian troops are well equipped and well-trained for their mission, it will actually mean it.

Training in CFB Wainwright

Bob Bergen, Ph.D., is a Research Fellow with the Canadian Defence & Foreign Affairs Institute (CDFAI) in Calgary. The opinions expressed in this document are those of the author and not necessarily those of CDFAI, its Board of Directors, Advisory Council, Fellows or donors. Bergen’s column appears bi-weekly.

Learn more about the CDFAI and its research on the Internet at www.cdfai.org

Amputees in Action

Its good to see the UK forces using these types of training tools but it could be said that we borrowed many ideas from the US forces and now the UK practises the way we do.

The prospect of serving in Afghanistan is daunting for any soldier - and the Ministry of Defence needs to ensure its troops are as battle-ready as possible.

So when 3,500 soldiers from the 4th Mechanised Brigade underwent a two-week training exercise two months before flying to Helmand Province, the MoD went to great lengths to provide a realistic environment. 

To do this, they enlisted the help of Amputees in Action, an agency specialising in supplying amputees as extras for the film and television industries.

Amputees in Action extra Darren Swift waits for his horrific injuries to be treated by soldiers training before being deployed to Afghanistan

One such extra was Darren Swift, 45, who lost both his legs in an explosion while he was serving in Northern Ireland in the early 90s.

Double leg amputee Swift, who has previously appeared in movies including Gladiator and TV series Band of Brothers, was made up to look like an injured soldier in the exercise on Wiltshire's Salisbury Plain today.

He said: 'As a company, and as an individual, we are really proud to be part of it. It's work for us but it's an honour to be part of something to help these guys improve their skills prior to deployment to Afghanistan.'

Soldiers on the military exercise find a fellow soldier injured on Salisbury Plain, Wiltshire

Troops from the 4th Mechanized Brigade then drag the injured soldier to safety

In total, Amputees in Action provided six actors for the exercise - five men and one woman.

With the aid of prosthetics and fake blood, Swift, appeared to have been severely injured in an explosion. 

The horrific injuries included his legs appearing to have been severed above the knee, with the surrounding skin hanging from the exposed bone, and blood-soaked tourniquets around his thighs. 

Soldiers from the 4th Mechanized Brigade will deploy to Afghanistan in April

The Medical Emergency Response Team (MERT) show how they would help a soldier injured in the line of duty

As the soldiers fined-tuned their craft through the exercise, the spokesman for the Chief of Defence Staff played down concerns that casualties in the conflict in Afghanistan had now matched those of the Falklands.

Speaking in Salisbury, before the brigade deploys to Helmand in April, Major General Gordon Messenger said: 'I think we have to be wary of comparing those two conflicts.

'They are very different in nature and very different in duration.

'The Falklands lasted for three months and we have been in Afghanistan for eight-and-a-half years.

'But the fact remains that 255 servicemen have lost their lives in the Afghanistan campaign. 

'Each of those is a blow and our thoughts are with those who have lost loved ones.'

Soldiers involved in the training exercise were also tested as they performed an evacuation of casualties by a Chinook helicopter and a mobile patrol.

Royal Marine Commandos from 40 Commando, based in Taunton, chat and relax with soldiers from the Afghan National Army (ANA) during today's exercise

Read more: http://www.dailymail.co.uk/news/article-1249722/Ministry-Defence-enlist-help-amputees-make-military-training-exercise-realistic-possible.html#ixzz1T4q0JFHs

Steve Austin step aside.... Billy is in the room.

Corporal Billy Kerr and his wife Tracy

Corporal Billy Kerr is the prime example of someone who should not live.... and yet he does and does well.   

Blown up... double above the knee and missing an arm below the elbow....

He is an example of what the military medicine system calls "poly trauma".

This multiple trauma is supposed to be rare but in reality for the wounded soldiers of all nations its common.  Bombs are not surgical in their strikes they blow up with incredible force.... and the anti government forces want to see big bangs for their bucks.

It goes beyond overkill.

They can not match us on the battlefield so they have taken the cowards way out and fight with IED's suicide bombers and remote controlled bombs....

In reality all these wounded should be dead.....

We are not.

Because of Tactical Combat Casualty Care that teaches such things as tourniquets on every bleed.....

Because of rapid transport that no longer includes ground transport but helicopters and makes the two hour drive through a hostile environment only 20 minutes in a large (usually) American chopper.

Because of a hospital that is so good that it is considered the best in the world at what it does.

Because of a commitment to keep our wounded at a place called Landsthul Germany and not move the patients for just political or national reasons.

Because of rehabilitation hospitals in Ottawa, Edmonton and Quebec city.

Because of fellow soldiers willing to help and talk to the wounded and their families.

Because DND stepped up and has helped wounded soldiers and their families.

Now its Veteran Affairs Canada's turn to step up.

Also remember that it was not one person wounded that day his family was mortally wounded as well.

OTTAWA—Cpl. Billy Kerr has a burning sensation in his heel and on the last two toes on his right foot.

“I look down and I want to scratch them,” he says. “I feel it.”

He can’t scratch them. He doesn’t have heels. Or toes. On the morning of Oct. 15, 2008, he stepped inside a mud compound in Afghanistan shortly before noon and a bomb ripped off his legs above the knee and his left arm a few inches below his elbow.

Kerr, Canada’s only triple amputee to return from Afghanistan, remembers everything about that day.

His left leg hanging by sinews. The sense — wrong as it turned out — that the damage wasn’t so bad to his right leg. Seeing his watch continue to tick on his gloved hand, which was severed from his body.

Now he gazes down at the metal and plastic contraptions that stand in for his legs and arm and prays the staggeringly powerful 175-milligram patches of fentanyl — a drug far more potent than morphine that he uses each day — will dull the pain. The nerves in his three stumps have excruciatingly wrapped around the splintered fragments of bone in his body.

This pain is the war that Kerr, a 43-year-old reservist from Sudbury, Ont., will never win. The sensations mock him morning, noon and night and they steal his sleep, though he rarely mentions it.

Instead he focuses on the battles at hand, which are as foreign to the standout athlete and former bartender as the dusty Kandahar landscape is to most Canadians. He does this with the help of his second-in-command, wife Tracy.

“Whatever he needs, I’m his gofer. I’m his two legs and his arm,” says Tracy Kerr, who quit her waitress job at a Sudbury restaurant to care for her husband.

Tracy drives him to endless appointments with doctors, military officials and therapists. She fills out mountains of paperwork. She claims expenses for trips to rehab in Ottawa and for housing modifications.

Then she waits. Often months pass before the money comes in and she can pay off their credit cards.

One $852 cheque reimbursing her for six weeks of lost wages after Kerr’s injury only arrived this year, 20 months after she submitted her initial application.

Another payout for the cost of transporting her vehicle and clothes from Sudbury to Ottawa, where she lived during Kerr’s 18-month hospital stay, only came through a few weeks ago.

“You assume that if they’re going to come back like this, then boom, they’re going to have everything all set up,” she says. “But they didn’t.”

When he first considered joining the military, an 18-year-old Billy Kerr was talked out of it by a girl. The second time around two girls were behind his decision to enlist as a reserve in theIrish Regiment of Canada, his daughters Zoe and Abbie, who are now 10 and 7, respectively. It was 2003 and Kerr was 36.

“I wanted to do something more than just being a bartender,” he says. “I wanted something where my kids could be proud of what their father was doing.”

He was in the reserves until November 2005, when he was accepted for a tour in Afghanistan. He got six months of training — but nothing could truly prepare him for combat.

Every day his all-reserve team drove convoys through Kandahar province. Every night they slept inside the safety of the coalition base, Kandahar Airfield.

They ran more than 200 convoy missions during that deployment; 16 times they hit roadside bombs. One friend’s face was seriously burned when a suicide bomber blew up his car next to their convoy. But Kerr was hooked. He felt like he was making a difference in the world.

“The day I got back from my first tour, I told (Tracy) I wanted to go back.”

He saw a perfect opportunity when Warrant Officer Gaetan Roberge, a tough-as-nails mentor at the regiment, told him about a chance to train Afghan police in Kandahar. Kerr had been thinking of joining the Sudbury police force.

Kerr arrived back in Afghanistan in September 2008. Home was a 30-square-metre police station in the middle of the violent Panjwaii district. Their task was to teach proper procedures to a notoriously corrupt and abusive national police force.

Cpl Billy Kerr

“We went out on patrols. So if you went out east, it was a cool patrol. You didn’t have to worry about too much. You didn’t have to bring out extra ammo. You could go out and talk to the villagers. We gave out candies and pencils and pens.

“When you went out to the west, everybody was turning away. Nobody wants to talk to you. They’re always looking down or walking away from you when you’re going through.”

Force Protection Unit members Cpl. Jason Walter, Cpl. Lee Willcocks, Cpl. Billy Kerr, Cpl. John Makela

On Oct. 15, Kerr headed west as part of a large patrol expecting trouble. There was a small skirmish early on with enemy fighters, but the bulk of the work involved searching villages and clearing compounds of hidden weapons.

By 11:30 a.m. there was one final compound to be cleared. By twos, the soldiers entered the building. The fifth and sixth through the doorway were Kerr and his sergeant. Kerr made sure to step on the bootprints of those who had already entered, as he had been trained.

His boot hit the ground and the blast hit his body, making him think the bomb was detonated by a cellphone or other remote device. Then the Taliban ambush began. And the Canadian medics went to work on the latest casualty of the Afghan war.

For two weeks in October, Kerr is in Ottawa training to get his license to drive a modified car. He is frustrated. He feels he is being treated like a 16-year-old boy, not a 43-year-old war veteran. He and Tracy arrive in their black Chevrolet Blazer. Dogs Boomer and Hunter, their constant companions, whimper in the back.

The passenger door pops open and Kerr swings out his prosthetic legs. He heaves himself off the seat with his only functioning limb and shifts his weight gingerly onto his legs.

They are his 16th set of prosthetic legs in less than two years — more than most amputees will go through in a lifetime. At first, he was healing quickly and the scar tissue in his legs shrank fast, necessitating an ever-slimmer, better-fitting leg. Then, a year ago, the growth of the nerve-wrapped bone fragments made it too difficult to stand for more than a few seconds, never mind walk.

The real Six million dollar man

At the back of the truck, Tracy hoists a 135-kilogram electric wheelchair with a motorized lift. She rolls it behind him, putting an end to his brief struggle and wincing pain. He reverses the steps to get into the driving instructor’s car.

In the driver’s seat, he wraps his prosthetic hand around a lever that controls the gas and brakes and heads off on the highways and side streets. Behind the wheel, nobody can tell the damage that has been done to his body.

This is what he wants. It is why he puts his legs on even to wheel to the corner store, although he won’t be able to walk on them until after another surgery to remove the splintered bone growth.

It’s also what he’ll never have, and he is reminded of it constantly.

Kerr took his daughters swimming at a hotel pool in Sudbury two months after his injury. Five or six families were frolicking in the water. They disappeared within five minutes of his arrival. Any doubt that this was a coincidence disappeared when it happened a second time at a public pool.

Military friends have also disappeared. They see in his savaged body a reminder of their own mortality. Kerr knows this because he felt the same horror the first time he saw a soldier walk past him on two prosthetic legs at CFB Petawawa.

“Soldiers looked at him and they’re thinking, that could be you,” he says. “Guys don’t want to think about that.”

Now the roles are reversed. Kerr played hockey. He was on three baseball teams. These days he can no longer stomach watching others do what he can’t.

When the driving lesson is finished, Kerr pulls into the hospital parking lot. Tracy and his instructor rush to open the door and help him out of the car, but a tall, ramrod-straight soldier calls them off. Kerr peers up to see the boyish grin of Gen. Walter Natynczyk, the chief of defence staff, asking whether the designer sunglasses, ballcap and scruff on his chin is some sort of homage to Joint Task Force Two, Canada’s top secret special forces unit.

Crossing paths with Kerr is chance. The head of the Canadian Forces is meeting a young combat engineer who lost two legs to a roadside bomb this summer in Afghanistan. It is a part of his job that few see, but it shows how seriously he takes the problems of amputee soldiers.

It doesn’t make it any easier to offer them a secure future.

When Kerr was first visited in hospital by the many generals controlling his future, he told them he wanted to remain in the army.

“I said, ‘I bleed green.’ Anything they wanted to hear I’d say to them to show how much I wanted to stay in.”

The regiment back in Sudbury offered him full-time work on the firing range until they realized they couldn’t actually afford to pay for a full-time position at a reserve unit.

Later Natynczyk suggested he become an officer instructing army cadets, essentially teaching kids camping and survival skills.

“I guess it sounds good in some ways, but it’s the biggest slap in the face a soldier can get. Privates don’t salute officer cadets. You’re in the army but you’re not really in the army,” Kerr says. “It’s like being a Cub Scout. I don’t want to be a Cub Scout leader.”

So he lives from one six-month military contract extension to the next, never sure when he will be passed on to the Veterans Affairs Department, where he will receive three-quarters of his corporal’s salary until the age of 65 and be called out each Remembrance Day as a reminder of the Canadian sacrifice in Afghanistan.

Despite the uncertainty, the Kerrs are getting ready for the next chapter of their lives. On Nov. 17, they are due to move into a new home on five acres of land in Chelmsford, just outside Sudbury.

The house is the brainchild of a Sudbury union president and fellow member of the Irish regiment, Derik McArthur. Three days after Kerr arrived at the hospital in Ottawa, McArthur visited and told his old friend that he was going to raise enough money to build him an accessible house. It would replace the tiny cottage they had been living in behind Tracy’s mother’s house, which was too small to modify or expand.

“At least he would never have to worry about where he’s going to live,” McArthur says. “If we can fix one thing, he’ll never have to be homeless.”

Kerr was reluctant to accept the offer. Tracy doubted it would succeed.

“I’m totally in the back of my mind going, ‘You’re not going to get that much money for one injured soldier,’ ” says Tracy.

But word got out. Before long, it seemed an entire city was involved in building a Home for a Hero, as the project was dubbed.

The local country radio station kicked in promotions and advertising. A home builder offered labour and expertise. A lumber company put up the wood. A local ad man set up and ran thewebsite. An elementary school bake sale brought in $390. Grandmothers whose husbands had died in World War II sent $20 bills. A construction company even paved an access road so people could get to the four-lane highway where McArthur had organized a fundraising walk in Kerr’s honour last fall that raised $100,000. The access road was torn up days later.

They finally broke ground on the house this summer. About $260,000 worth of financial contributions, plus supplies and services, have come from donations. The Canadian Forces is paying $200,000 to cover the costs for the wider doorways, extra square footage and special appliances that will make the house fully accessible.

What seemed an impossibility is now a reality. That reality brings security, but not enough to ease Kerr’s mind.

Along with a security system, Kerr insisted the house be built with a hidden panic room where he will store his collection of pistols, shotguns and an unused M4 rifle, the same type of weapon that he carried in Kandahar when he was injured.

With no left hand to hold his wedding ring it hangs with his dogtags on his wife's... rear view mirror.

It will also keep his family safe in the event of an emergency. It’s something he never would have considered before a bomb hidden in the ground thousands of kilometres away took his limbs and his confidence.

“I can’t defend my family and that’s a hard pill to swallow. It’s probably one of the reasons that I don’t sleep, too.”