CBS News Correspondent Terry McCarthy reports Medevac pilots have been saving lives since the Korean War. But never have pilots like Air Mission Commander Russ Schuler been pushed so close to their limits as in the mountains of Afghanistan.
"Some of the flying here has been really difficult," said Schuler. "A lot of situations where you are having to make the call at the last second."
Schuler, who is based in Logar Province, south of Kabul, is used to mountains and desert. At home in Las Vegas, he flies classified narcotics missions for the Nevada National Guard.
CBS News Special Report: The Road Ahead
Special Report: Afghanistan
But with 18,000-foot peaks here higher than the unpressurized helicopters can fly, Schuler is battling the terrain every day.
"We fly up to 14,000 feet without oxygen, but it's for a limited time," said Chief Warrant Officer Schuler. "We usually fly the valleys to get through the mountains."
Major Dan Anderson flies out of San Diego - and likes to brag about scooping water from golf course water traps to douse flames in southern California's fire season. He has flown Medevac in Iraq and Afghanistan - and says the differences are stark.
"Whereas Iraq is a two dimensional fight - almost flat, very low contour," said Anderson. "Here, it is three dimensional.
The Medevac pilots do 24 hour shifts, and leave all their equipment on the helicopters so they can take off within minutes of getting a radio
This is one of the busiest Medevac units in Afghanistan. They have flown 577 missions in the last nine months, averaging more than two a day.
The most common injuries they treat are from improvised explosive devices, or IEDs. Today the Taliban are planting bombs of up to 1,000 pounds under roads, causing damage even more deadly than in Iraq.
"You can have internal injuries, external injuries, amputations with head injuries, penetrating trauma," said Specialist Anthony Della, a Medevac medic.
Because of the vast, mountainous terrain, evacuating casualties often extends beyond what doctors call the "golden hour": that crucial 60 minutes during which a traumatically-injured person has to reach a hospital before their survival chances plummet.
So medics have begun doing emergency procedures inside helicopters that would normally wait for ER doctors like Dustin Zierold.
"I think we have adapted very well, using whole blood transfusion, haemostatic agents, training of the medics to get airways and special techniques down, inside the helicopters themselves," said Dr. Zierold.
"Literally, you have had to stretch the golden hour?" asked McCarthy.
"Absolutely, absolutely," he said.
At night the helicopters fly without lights, so medics like Specialist Anthony Della have to work on patients with night vision goggles.
"You have the turns, you have the bumps, you have no space, you have no light," said Spc. Della. "It is definitely a hard environment to work in.
"I mean is it scary? Yeah. It's scary. People are trying to shoot at you, kill you," Said Della. "But it's all about the guy on the ground. They're taking the higher levels of risk. We can assume a little bit of it to make sure he goes home."
Every time they launch, Medevac teams from pilots to medics know only too well that Afghanistan is a battlefield with no margin for error, and no easy way out.
More special coverage on CBSNews.com:
Medevac Helicopter Crews Saving Lives in Afghanistan
Marines in Afghanistan: A Day in the Life
Taliban Gaining Firepower and Confidence
Battle of Wanat - Inside the Ambush
Afghanistan, 8 Years In: How We Got Here