Annual Report the Surgeon General United States Army Fiscal Year 1960
ORGANIZATION OF FORCES
Control of Medical Support Operations
Changes were made during the fiscal year in the basic operational and organizational concept for administrative and logistic support of the Army in the field. Justification of these actions has been based principallyon the contention that the radically increased requirements for dispersion of of forces and emphasis on independent operations on a battlefielddominated by the threat of nuclear attack dictated a requirement for a horizontal logistic support organization. This concept envisions employment of combinations of composite technical service units of fixed internal organization which would provide the complete spread of functions required for direct or general support of a type tactical command (for example, division or corps). Command of these units would be exercised by a series of administrative support headquarters designed to operate at a major command (for example, field army) level.
Concurrently with the development of this command organizational pattern, concepts of staff organization have changed. The director
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staff concept of organization was approved for logistic command headquarters and published in FM (Field Manual) 54-1, The Logistical Command, dated July 1959. This revised concept envisioned a fully integrated staff element whose mission would be to direct the several logistic functions performed by the subordinate units. It was implemented as the ADSOC (Administrative Support Operations Center) in the final draft of FM 54-1, which, although represented as an implementation of doctrine approved in the Theater Army Study, departed from the study's concept in this respect.
The Surgeon General strongly protested the inclusion of the revised concept of ADSOC in FM 54-1. His objection was based primarily on combat experience which generally has demonstrated that, regardless of formally prescribed organizations, the surgeon has been delegated authority by his commander to direct the command's medical support operations. The Surgeon General contended that the potential of modern warfare to produce a far greater medical workload during a much diminished timespan than has pertained previously dictates a need for an even more clearly defined and unencumbered channel of control from the surgeon to the command's medical units. Recognizing the fact that AMEDS personnel and equipment required to meet these peak workloads, which could appear with little or no warning anywhere in the theater of operations, could not be furnished continuously throughout the theater army's organization, The Surgeon General proposed centralized and absolute control by the command surgeon as the key factor in guaranteeing optimum responsiveness in fast-changing requirement and effective application of the relatively austere austere medical support means organic to each command.
Field Manual 54-1, as published in July 1959, established the principle that theater AMEDS operations are intersectional and interzonal in character. This major change represents a tacit recognitionof a basic concept for which The Surgeon General has long soughtapproval in official Department of the Army doctrine.
Changes Affecting Tables of Organization and Equipment
Problems related to TOE (tables of organization and equipment) actions during fiscal year 1960 were a continuation of those encountered during the previous fiscal year. In general, these resulted from Department of the Army restrictions imposed on personnel strength ceilings, grade structure, and equipment.
Currently, no increase in grade structure will be approved for non-professional personnel in TOE unless there is an increase in responsibilities and functions shown in the revision when compared to the
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existing table. Increases in grade for professional personnel have been obtained by justifying the increase of the basis of expanded military and civilian training requirements.
In attempting to get relief from strength and grade ceilings, The Surgeon General was advised by DCSLOG that while blanket relief couldnot be given, individual cases would be considered on their merit. Using this as a base point, The Surgeon General requested USCONARC to seek an exception in order to obtain an increase in the evacuation capability of the nondivisional ambulance company (TOE8-317). Considerable difficulty was encountered because the overall strength of the unit would be increased from 85 to 97. Following a lengthy justification, including a demonstration that the same evacuation capability inherent in 6 of the 85-men companies could be obtained by utilization of 5 of the 97-men companies with a savings of 25 overhead administrative personnel, The Surgeon General was finally successful in obtaining approval of the new nondivisional ambulance company.
The equipment austerity policy established by DCSOPS is that there will be no additions or increases of major items of equipment unless such increases are fully justified through support of an expanded combat or support capability. The policy further states that existing allowances should be restudied to determine which major items can be decreased in quantity or eliminated entirely. In compliance with this policy, The Surgeon General has been required to justify not only increases in major items of equipment but also existing major items.
Medical Air Ambulance Company
The Army Medical Service took another stride forward in its program to modernize medical units in accordance with the present concepts of future warfare when the Department of the Army approved the establishment of the first medical air ambulance company under TOE 8-137D. The complete activation of the new company, originally planned for June 1960, was delayed until several of the unit components returned from Chile, where they were flown late in May to assist the Chilean Government in providing disaster relief to the victims of earthquakes, volcanic eruptions, and tidal waves.
The medical air ambulance company consists of a headquarters and four platoons. The headquarters and one platoon of the 45th Medical Company (Air Ambulance) were to be activated at Fort Bragg. The existing TOE 8-500C (RA) medical helicopter detachments at Fort Ord and Fort George G. Meade are being reorganized as platoons of the company. A new platoon is being organized at Fort Benning, Ga.
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The company is authorized 25 utility helicopters (6 for each platoon and 1 for the company headquarters). It has the mission of providing aeromedical evacuation of selected patients, emergency movement of medical personnel and the necessary equipment and supplies to meet a critical situation, and around-the-clock emergency delivery of whole blood, biologicals, and medical supplies.
Radiological Emergency Medical Teams
The Surgeon General and the Commanding General, USCONARC, jointly reviewed and revised the instructions regarding the responsibilities for providing radiological emergency medical teams to function in the event of nuclear incidents or accidents. Under the revised policy (Change Order No. 10, dated 6 April 1960, to the USCONARC BasicPlan), each ZI army is required to organize, train, equip, and maintain one or more radiological emergency medical teams from Army resources. In order to carry out this policy, The Surgeon General has designated nine major AMEDS installations and activities to organize, train, equip, and maintain Radiological Emergency Medical Teams for augmentation of the ZI armies' capabilities. Under certain condition, these teams will have the initial responsibility for providing medical advice in case of nuclear incidents or accidents.
Ambulance Railway Trains and Convertible Bus-Type Ambulances
The Surgeon General, in coordination with the Chief of Transportation and DCSLOG, initiated studies to determine the Army's worldwide requirements for ambulance railway trains and convertible bus-type ambulances and the total numbers of these vehicles that are available. As a result of these studies, DCSLOG decided that no additional ambulance railway equipment for use in foreign countries will be procured. At the request of The Surgeon General, the Chief of Transportation has requested users of Army transportation, both in CONUS and overseas, to state their requirements for convertible buses and ambulances as a step toward achieving a more adequate distribution of the decreasing numbers of these vehicles that are available.
Tactical-Type Ambulances
A determination by USCONARC that the XM408 was not militarily acceptable left the Army Medical Service without a replacement for the current frontline ambulance M170. In seeking guidance on
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mid-range plans for tactical ambulances, The Surgeon General was advised that-
1. Continued production of the M170 frontline ambulance was considered uneconomical because of the limited requirements and the prohibitive price.
2.The ?-ton M38A1 jeep with litter brackets would be a more desirable solution to the frontline ambulance problem.
3. Procurement of the M43 series of ?-ton ambulances would continue, subject to the availability of funds.
The Surgeon General informed DCSLOG, on 25 April 1960, that he did not consider the M38A1 and M151 jeeps with litter brackets as acceptable replacements for frontline ambulances. He cited comparative costs to show that the continued procurement of the M170 frontline ambulance would be less expensive than the procurement of the modified M38A1 or the M151, since a larger number would be required to attain an equivalent patient-carrying capability. The M170 can carry three litter or six ambulatory patients while the modified jeeps have only a two-litter capability. He stated that the ?-ton utility truck, XM408, with an ambulance conversion kit, would be a suitable replacement for the M170. DCSLOG requested the Chief of Ordnance to submit recommendations for a solution to the problem.
Atropine Authorization for Theaters of Operations
Following standardization of the new automatic injection device that provides a rapid and easy method of intramuscular self-injection of atropinealkaloid when required for mass administration in the event of exposure to nerve gas agents, action was taken during the fiscal year to determine the allowances of atropine in the combat zone. Initially, it was considered desirable to have available within the theater of operations the equivalent of 12 milligrams of atropine per individual. This was later changed to 16 milligrams.
The Director of Medical Research, U.S. Chemical Research and Development Command, endorsed this plan and recommended that additional atropine in vials of 25 milliliters be made available at each aid station. His recommendation was included in the plan which was adopted and implemented.
One automatic atropine injector is to be kept in each soldier's gas mask carrier. Authorizations for the 16 milligrams have been published in TA (table of allowance) 8-100.
Authorizations of Broad-Spectrum Antibiotics
As a means of controlling infectious diseases in theaters of operations, The Surgeon General initiated action to include broad-spectrum antibiotics
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within the supply system of field medical units. He believes that it is imperative for the Army Medical Service to accumulate sufficient supplies of antibiotics to have available 25 grams for each person supported by the Service. Of this total, 10 grams should be available in the installations or units responsible for providing primary medical care. The drugs specified are tetracycline, chlortetracycline, or oxytetracycline.
To satisfy these requirements, a drug set containing these antibiotics is being developed. After standardization, authorizations will be published in TA 8-100.
