Lanning’s account of a conversation between him and a pilot was perhaps not atypical: "I held [the wounded and delirious Staff Sgt.] Blyman with one arm and reached for the handset to talk to the medevac pilot with the other.

‘Listen,’ I said, ‘I need a hook and a cable.’

"’What’s the situation?’ he asked.

"I told him we were receiving sporadic fire, knowing ahead of time what his reaction would be. ‘No way,’ he answered. ‘I can’t hover that long under fire.’

"’Listen,’ I said again, ‘we’ve got a man hit in the knee. He’s gone crazy. I’ve got to get him out of here now! We’ll put down all the supporting fire we can.’

"The pilot must have heard the urgency in my voice, because after a slight pause he said, ‘Okay. Pop smoke. Let’s give it a try.’"

In that instance, the dustoff chopper did receive some hits. But the extraction was successful and the members of the medevac team were recommended for medals.

It was essential for medevac helicopters to drop their extraction hooks at safe sites, or more normally they would need to find a viable and secure LZ–which was often even more difficult in overgrown jungle terrain, in marginal weather or close to the enemy. The quickest way to lose a helicopter was to land it under heavy close-range fire. So it was understood, as Philip Caputo memorably remarked, that "happiness is a cold landing zone." The dustoff pilots became renowned for their courage in placing themselves and their ships in harm’s way, but there was always a fine line to be drawn between an acceptable risk and a suicidal one.

Quite apart from enemy action, even the basic physical and administrative preconditions for a medevac mission were often daunting. Such problems persisted from the start to the finish of the war. In War Zone D during July 1965, General John J. Tolson recalled that 173rd Airborne Brigade members "found that they had to go to unusual lengths to clear new landing zones for medical evacuation." One company of the 1st Battalion (Airborne), 503rd Infantry, tried to clear an LZ with 100 pounds of C-4 explosives, but the GIs could make little impression on the trees. In July 1969, the 1st Battalion, 3rd Infantry, accidentally dropped a massive mahogany tree across its LZ, and the men needed a whole day to clear it away. Then again in Laos, in March 1972, according to Tolson, "even single-ship re-supply and medical evacuation missions had to be planned and conducted as a complete combat operation. This entailed a separate fire plan, allocation of escorting armed helicopters, and contingency plans for securing downed crews and aircraft." Such operations were by no means easy or instant, as might casually be assumed by the armchair strategist.

The sheer complexity of organizing many of the dustoff missions leads us on to the final price that had to be paid for them, which was surely by far the most serious and costly of all. In a nutshell, medevac often distorted the tactical shape of battles, because it was normally given priority over every other type of mission. As F.J. West put it in Small Unit Action in Vietnam, care for the wounded, and even retrieving the bodies of the dead, became a mission "more sacred than life itself." Strict attention to these considerations became elevated into a vital point of honor, as well as a precondition for high morale both among soldiers in the field and (albeit less directly) among the civilian population back home.

Both the in-country comrades in arms and the Stateside relatives of conscripted teenagers had to be reassured that the United States would do everything possible to rescue its soldiers if they should be injured or in danger of falling into enemy hands. And the men also needed reassurance that, if the very worst befell them, their bodies would not simply be left to rot in a suppurating alien jungle. This approach was excellent in itself and in many ways supremely humane. However, the requirements of medevac frequently changed the planned evolution of battles, or even led to new engagements that had not been planned at all. It became a force that worked strongly against the freedom of tacticians to organize tactics.

The need to search for a viable LZ for helicopter medevac often distracted the unit fighting on the ground (which had by definition just suffered one or more injuries) from pursuing its battle against the enemy in front. There are numerous examples of this in eyewitness narratives. In essence, what often happened was that an infantry company would advance, come under fire, lose a few men, and then start looking for and securing a suitable LZ somewhere close to–or embarrassingly often, rather far from–its immediate rear.

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