Battle Casualties and Medical Statistics
Evacuation of Patients From Overseas
EVACUEE REPORT CARD
Information on evacuees becomes necessary whenever their numbers arelarge. This information is needed to plan for hospitalization in the UnitedStates, as well as for evaluating evacuation policies, and evacuees. DuringWorld War II, more than one-half million evacuees were, admitted, with50,000 received in the peak month. Army regulations (12) in effectat that time contained standby provisions for submission of evacuee reportcards (MED-75) by hospitals in the United States which received evacueesfor definitive treatment. When the number of evacuees decreased markedlyafter World War II, submission of the report card was discontinued. Withthe outbreak of hostilities, in Korea and consequent increased demandson available hospital capacities in the Far East Command and in the UnitedStates, the requirement for submitting the evacuee report card was reinstitutedin September 1950.
Accordingly, a record was prepared on each evacuee patient from overseasadmitted to a hospital in continental United States beginning in September1950. The evacuee report card was prepared by the first hospital in theUnited States to which the evacuee patient was admitted initially for definitivetreatment. Hospitals were required to
Table 63-All evacuees received in continentalUnited States, by area of origin and category of personnel, 2 September1950-31 December 1953
Area of origin | Category of personnel | |||
Total | Army | Air Force | Civilian and other1 | |
All areas | 55,382 | 52,613 | 1,458 | 1,311 |
North America | 1,752 | 1,345 | 261 | 146 |
Latin America | 718 | 637 | 31 | 50 |
Europe | 10,141 | 9,499 | 217 | 426 |
Pacific | 1,820 | 1,487 | 234 | 99 |
Japan-Korea | 39,568 | 38,515 | 516 | 537 |
Africa and Near East | 43 | 16 | 13 | 14 |
Not specified and miscellaneous | 2 1,340 | 1,115 | 186 | 39 |
1 Includes a few U.S. Navy patients.
2 Includes some cases originating at sea.
prepare the card. within 7 days of the date of admission and forwardit to the Army Surgeon General at the end of the following report week.
These data cover 55,382 evacuee patients received in the United Statesduring the period 2 September 1950-31 December 1953. The inclusivenessof this period encompasses the complete duration of the Korean War, July1950-July 1953. Since evacuees were received from other overseas areasas well as from, Japan-Korea, total counts are given in table 63 by categoryof personnel and by area of origin. Approximately 95 percent (52,613) ofthe 55,382 evacuee patients were U.S. Army personnel, of whom 73 percent(38,515) were evacuated from Japan-Korea. The mode of transportation wasspecified as being ship or plane, or both, for 55,163 evacuee patients.For U.S. Army personnel, the number was 52,424, of whom 38,347 were fromJapan-Korea. The percentage distributions by mode of transportation arepresented in table 64.
Table 64.- Percentage distribution, bymode of transportation of personnel, all evacuees received in United States,2 September 1950-31 December 1953
Type of personnel | Mode of transportation | ||
Air | Water | Air and Water | |
All personnel, all areas | 93.2 | 6.6 | 0.2 |
Army personnel, all areas | 93.4 | 6.3 | 0.3 |
Japan-Korea | 95.4 | 4.3 | 0.3 |
All other areas | 88.2 | 11.7 | 0.1 |
EVACUATION POLICY AND DAYS BEFORE EVACUATION
Aside from any limitations which might be dictated by the conditionof the patient or by the availability of transport, one of the chief determinantsfor defining parametric values of the order of magnitude of evacuees isthe length of the evacuation policy. At the beginning of the war, the evacua-
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tion policy was 21 days for hospitals in Korea and 120 days for hospitalsin Japan. By September 1950, the evacuation policy for Japan was reducedto 60 days and, for a short period, to 30 days, returning to 120 days inOctober 1950. Because of the Chinese Communist intervention and the resultinginflux of casualties from Korea, the evacuation policy was again loweredto 60 days in December 1950 until 19 January 1951, when it returned to120 days and remained at that level throughout the war. In Korea, duringthe early period of heavy casualties, evacuation was determined, to a largeextent, by the availability of beds and the number of wounded being received.Subsequently, the evacuation policy was increased to 30 days and, later,to 60 days. The evacuation policy for all other overseas areas was 120days.
The evacuee patients received in the United States from 2 September1950 to 31 December 1953 spent, on the average, 35 days in overseas medicalfacilities before evacuation as did U.S. Army personnel from all overseasareas. U.S. Army personnel originating from Japan-Korea, however, averagedabout 32 days, slightly less than the overall average for all patientsfrom all overseas areas, but markedly lower than the 42 days averaged byU.S. Army personnel from all other overseas areas, excluding Japan-Korea.These differences reflect the influence of the early days of the KoreanWar, when large numbers of wounded created a heavy pressure on the availablebed capacity in Japan. It was necessary, in the last quarter of 1950 andin the first months of 1951, to evacuate many of the less seriously woundedPatients with minor wounds to make room for the more seriously woundednontransportable cases. Consequently, a higher proportion of the less seriouslywounded was evacuated rapidly upon entering the chain of evacuation andthe number of days elapsed before evacuation was low, averaging 17 to 19days for patients received from Japan-Korea in September and October 1950and not exceeding 30 days until April 1951.
Another factor which contributed to the lower elapsed time before evacuationfrom Japan-Korea is the possibility that the duration of hospital stay,before the decision to evacuate the patient, may have been considerablylower for wounded patients than for patients hospitalized for disease conditions.Since all wounded patients originated in Korea, this factor, in itself,would diminish the time spent before evacuation for patients from Korea.
Figure 10 shows that, after April 1951, the average days elapsed beforeevacuation from Japan-Korea exceeded the average for the entire period,except for the months of September, October, and November 1951. As woundedadmission rates declined and bed capacities in Japan were built up, sufficientcapacity was on hand to return the less seriously wounded in Japan andreturn them to duty without draining away manpower through evacuation.Once the usual criteria for evacuation could be applied, the average durationbefore evacuation rose. For example, the average before evacuation was19.6 days in 1950, 30.8 days in 1951, 39.1 days in 1952, and 46.4 daysin 1953.
TYPE OF SPECIALIZED TREATMENT REQUIRED
The type of specialized treatment required for evacuee patients in hospitalsof definitive treatment in the United States is shown. in table 65 forall evacuees received and in tables 66 and 67, in more detail, by categoryof admission, for U.S. Army evacuee patients. The three largest categoriesof specialized treatment were general surgery, general medicine, and neuropsychiatry.Excluding cases with type of specialized treatment not specified, approximately36 percent of all evacuee cases from all overseas areas required generalsurgery. When amputations, hand surgery, neurosurgery, ophthalmologic surgery,orthopedic surgery, plastic and maxillofacial surgery, thoracic surgery,and vascular surgery are included, the percentage of cases requiring surgeryincreased to 59 percent, a condition to be expected considering the highproportion of wounded-in-action cases included. Cases requiring neuropsychiatriccare comprised 11 percent of all evacuee cases with slightly more thanhalf of the cases requiring closed ward care.
The cause of admission, whether for disease, nonbattle injury, or woundedin action, determines markedly the type of specialized treatment required.The more detailed data, as previously noted, are presented in tables 66and 67 for U.S. Army evacuee patients by category of admissions. The formertable is in terms of numbers of cases; the latter is in terms of percentagesof type of specialized treatment required by category of admissions. Thislatter distribution provides, in effect, a probability table of the expectedtype of specialized treatment likely to be required among a given
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Figure 10.- Average number of days elapsedbefore evacuation from Japan-Korea, U.S. Army personnel, 2 September 1950-31December 1953.
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Table 65.- All evacuees received in UnitedStates by specialized treatment required and category of personnel, 2 September1950-31 December 1953
Specialized treatment required | Category of personnel | ||||
Total | Army | Air Force | Civilian | Other | |
Total | 55,382 | 52,613 | 1,458 | 1,203 | 108 |
Amputations | 1,238 | 1,194 | 23 | 20 | 1 |
Arthritis | 961 | 896 | 62 | 3 | -- |
Blindness | 47 | 44 | -- | 2 | 1 |
Cold injury | 714 | 713 | 1 | -- | -- |
Deafness | 718 | 661 | 56 | 1 | -- |
Deep X-ray therapy | 5 | 4 | -- | 1 | -- |
Dermatology | 534 | 487 | 39 | 8 | -- |
General medicine | 9,771 | 9,166 | 321 | 276 | 8 |
General Surgery | 19,282 | 18,742 | 226 | 246 | 68 |
Hand surgery | 61 | 58 | 2 | 1 | -- |
Hepatic-metabolic | 191 | 172 | 11 | 8 | -- |
Neurology | 1,089 | 1,005 | 61 | 23 | -- |
Neuropsychiatry | 5,999 | 5,426 | 285 | 282 | 6 |
Closed ward, NP | 3,321 | 2,954 | 185 | 178 | 4 |
Open ward, NP | 2,678 | 2,472 | 100 | 104 | 2 |
Neurosurgery | 3,458 | 3,343 | 64 | 35 | 16 |
Neurosyphilis | 16 | 15 | 1 | -- | -- |
Obstetrics and gynecology | 215 | 186 | -- | 29 | -- |
Ophthalmological surgery | 1,847 | 1,784 | 34 | 23 | 6 |
Orthopedic surgery | 4,893 | 4,776 | 47 | 70 | -- |
Plastic and maxillofacial surgery | 216 | 212 | 1 | 3 | -- |
Radium therapy | 1 | 1 | -- | -- | -- |
Thoracic surgery | 119 | 114 | 2 | 2 | 1 |
Tropical disease | 11 | 11 | -- | -- | -- |
Tuberculosis | 1,549 | 1,320 | 145 | 84 | -- |
Vascular surgery | 212 | 192 | 13 | 7 | -- |
Not specified | 2,235 | 2,091 | 64 | 79 | 1 |
Table 66.- U.S. Army evacuees receivedin United States by specialized treatment required and category of personnel,2 September 1950-31 December 1953
Specialized treatment required | Type of admission | |||
Total | Disease | Nonbattle | Wounded | |
Total evacuees | 52,613 | 25,684 | 7,464 | 19,465 |
Amputations | 1,194 | 8 | 171 | 1,015 |
Arthritis | 896 | 889 | 5 | 2 |
Blindness | 44 | 14 | 5 | 25 |
Cold injury | 713 | 22 | 673 | 18 |
Deafness | 661 | 622 | 14 | 25 |
Deep X-ray therapy | 4 | 4 | -- | -- |
Dermatology | 487 | 483 | 2 | 2 |
General medicine | 9,166 | 8,443 | 267 | 456 |
General Surgery | 18,742 | 3,647 | 3,354 | 11,741 |
Hand surgery | 58 | 7 | 33 | 18 |
Hepatic-metabolic | 172 | 166 | 6 | -- |
Neurology | 1,005 | 899 | 43 | 63 |
Neuropsychiatry | 5,426 | 5,313 | 73 | 40 |
Closed ward, NP | 2,954 | 2,877 | 53 | 24 |
Open ward, NP | 2,472 | 2,436 | 20 | 16 |
Neurosurgery | 3,343 | 660 | 417 | 2,266 |
Neurosyphilis | 15 | 14 | -- | 1 |
Obstetrics and gynecology | 186 | 186 | -- | -- |
Ophthalmological surgery | 1,784 | 868 | 162 | 754 |
Orthopedic surgery | 4,776 | 1,086 | 1,910 | 1,780 |
Plastic and maxillofacial surgery | 212 | 13 | 60 | 139 |
Radium therapy | 1 | 1 | -- | -- |
Thoracic surgery | 114 | 12 | 8 | 94 |
Tropical disease | 11 | 11 | -- | -- |
Tuberculosis | 1,320 | 1,308 | 5 | 7 |
Vascular surgery | 192 | 177 | 3 | 12 |
Not specified | 2,091 | 831 | 253 | 1,007 |
hundred evacuees by category of admission, when the "not specified"cases were excluded.
The variation in type of specialized treatment required according tocategory of admission is readily apparent from table 67. Of each 100 woundedevacuees, approximately 64 required general surgery, and about 97 requiredsome type of surgery. Among each 100 Army nonbattle injury evacuees, 47required general surgery and 85 required some type of surgery. But, amongeach 100 disease evacuees, only 15 required general surgery, and only 26required some type of surgery.
Roughly, 9 percent of the nonbattle injury evacuees required specializedtreatment for cold injury, largely frostbite. Of each 100 disease cases,21 were evacuated to the United States to receive specialized treatmentfor neuropsychiatric conditions.
The wounded evacuees reported its requiring certain types of specializedtreatment for disease conditions, such as arthritis (two cases), neurosyphilis(one case), general medicine (456 cases), neuropsychiatry (40 cases), dermatology(two cases), and tuberculosis (seven cases), presumably represented caseshospitalized for wounds and for disease concomitantly, with the diseasecondition being reported as the primary cause of evacuation although
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Table 67.- Percent distribution of U.S.Army evacuees, by specialized treatment required and type of admission,2 September 1950-31 December1953
Specialized treatment required | Type of admission | |||
Total | Disease | Nonbattle injury | Wounds | |
| Number of evacuees | |||
Total | 52.613 | 25.684 | 7.464 | 19.465 |
Specialized treatment. not specified | 2.091 | 831 | 253 | 1.007 |
Specialized treatment. known | 50.522 | 24.853 | 7.211 | 18.458 |
| Percent distribution by specialized treatment | |||
Total specialized treatment known | 100.00 | 100.00 | 100.00 | 100.00 |
Amputations | 2.36 | 0.03 | 2.37 | 5.50 |
Arthritis | 1.77 | 3.58 | 0.07 | 0.01 |
Blindness | 0.09 | 0.06 | 0.07 | 0.13 |
Cold injury | 1.41 | 0.09 | 9.33 | 0.10 |
Deafness | 1.31 | 2.50 | 0.19 | 0.13 |
Deep X-ray therapy | 0.01 | 0.02 | -- | -- |
Dermatology | 0.96 | 1.94 | 0.03 | 0.01 |
General medicine | 18.15 | 33.97 | 3.70 | 2.47 |
General surgery | 37.10 | 14.67 | 46.52 | 63.61 |
Hand surgery | 0.11 | 0. 03 | 0.46 | 0.10 |
Hepatic-metabolic | 0.34 | 0.67 | 0.08 | -- |
Neurology | 1.99 | 3.62 | 0.60 | 0.34 |
Neuropsychiatry | 10.74 | 21.38 | 1.01 | 0.22 |
Closed ward, NP | 5.85 | 11.58 | 0.73 | 0.13 |
Open ward, NP | 4.80 | 9.80 | 0.28 | 0.09 |
Neurosurgery | 6.62 | 2.66 | 5.78 | 12.28 |
Neurosyphilis | 0.03 | 0.06 | -- | 0.01 |
Obstetrics and gynecology | 0.37 | 0.75 | -- | -- |
Ophthalmological surgery | 3.53 | 3.49 | 2.25 | 4.08 |
Orthopedic surgery | 9.45 | 4.37 | 26.49 | 9.64 |
Plastic and maxillofacial surgery | 0.42 | 0.05 | 0.83 | 0.75 |
Radium therapy | 0.00 | 0.00 | -- | -- |
Thoracic surgery | 0.23 | 0.05 | 0.11 | 0.51 |
Tropical disease | 0.02 | 0.04 | -- | -- |
Tuberculosis | 2.61 | 5.26 | 0.07 | 0.04 |
Vascular surgery | 0.38 | 0.71 | 0.04 | 0.07 |
the case was classified as a battle casualty on the basis of the primarycause of admission. The same comment is applicable to the 18 woundedcases reported as requiring specialized treatment for cold injury.
The classification by type of specialized treatment, however, does notprovide a count of the number of cases of certain categories of considerablespecial interest; namely, the amputees, the paraplegics , the blind, andthe deaf. Some cases of blindness are included under the category blindness,"but some might be classed elsewhere; for example, in a case where a penetratingwound resulted in loss of an eye and also in some brain damage, the specializedtreatment might be classified as "neurosurgery" rather than "blindness."Likewise, amputees ordinarily would be reported by specialized treatmentas "amputations," but some small number might have been includedelsewhere; for example, as general surgery cases. This is also true ofthe evacuees suffering from deafness. Paraplegics cannot be separatelyidentified by consideration of specialized treatment alone.
Because of the difficulty in identifying certain of these groups fromany distribution by type of specialized treatment, cases that fall intothese particular categories must be identified separately, taking intoaccount the actual diagnoses and operations reported. Among the 52,613U.S. Army evacuees reported to The Surgeon General for the period 2 September1950-31 December 1953 were 1,354 major amputations of one or more of theupper and lower extremities, 111 hemiplegics, 247 paraplegics, 178 blindnessinvolving both eyes, 1,325 blindness involving one eye only, 314 deafnessinvolving both ears, and 299 deafness involving one ear only (154 of thesecases also had defective hearing in the other ear). These disabilitiestotaled 3,828 and involved somewhat less than 3,800 individual patients.
Nearly all of these cases originated in Japan-Korea; for example, 1,306amputations, 98 hemiplegics, and 227 paraplegics were evacuated from theFar East Command (Japan-Korea). With respect to blindness, 1,253 of thecases involving one eye and 161 of those involving both eyes were evacueesfrom Japan-Korea. Unlike the other disabling conditions, it substantialproportion of the evacuees with deafness originated in areas other thanJapan and Korea, although 193 of the 314 evacuees with deafness involvingboth ears, and 161 of the 209 involving one ear originated in Japan andKorea. Of the 161 cases of deafness, 67 also had defective hearing in theother ear. A total of 3,399 disabilities of those special categories werereported for almost the same number of individual patients evacuated fromJapan and Korea.
CATEGORY OF ADMISSION
For U.S. Army evacuee cases, table 68 shows the respective categoryof admission (disease, nonbattle injury, and wounded) for all overseasareas, for Japan-Korea, and for all other overseas areas excluding Japan-Korea.Disease cases accounted for 49 percent, nonbattle injury for 14 percent,and
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Table 68.- U.S. Army evacuees, by prioroperation overseas, category of admission, and overseas areas, 2 September1950-31 December 1953
Category of admission and prior operation | Number of evacuees | Percent | |||||||||||||||
Evacuees with prior operation in each category of admission | Evacuees in each category of admission | ||||||||||||||||
All overseas areas | Japan-Korea | All other overseas areas | All overseas areas | Japan- Korea | All other overseas areas | All overseas areas | Japan-Korea | All other overseas areas | |||||||||
Total | 52,613 | 38,515 | 14,098 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | ||||||||
With prior operation | 18,925 | 17,459 | 1,466 | 36.0 | 45.3 | 10.4 | -- | -- | -- | ||||||||
Without prior operation | 33,688 | 21,056 | 12,632 | 64.0 | 54.7 | 89.6 | -- | -- | -- | ||||||||
Disease, total | 25,684 | 13,077 | 12,607 | 100.0 | 100.0 | 100.0 | 48.8 | 34.0 | 84.4 | ||||||||
With prior operation | 1,529 | 789 | 740 | 6.0 | 6.0 | 5.9 | -- | -- | -- | ||||||||
Without prior operation | 24,155 | 12,288 | 11,867 | 94.0 | 94.0 | 94.1 | -- | -- | -- | ||||||||
Nonbattle injury, total | 7,464 | 5,974 | 1,490 | 100.0 | 100.0 | 100.0 | 14.2 | 15.5 | 10.6 | ||||||||
With prior operation | 4,061 | 3,335 | 726 | 54.4 | 55.8 | 48.7 | -- | -- | -- | ||||||||
Without prior operation | 3,403 | 2,639 | 764 | 45.6 | 44.2 | 51.3 | -- | -- | -- | ||||||||
Wounded in action, total | 19,465 | 19,465 | -- | 100.0 | 100.0 | -- | 37.0 | 50.5 | 0.0 | ||||||||
With prior operation | 13,335 | 13,335 | -- | 68.5 | 68.5 | -- | -- | -- | -- | ||||||||
Without prior Operation | 61130 | 61130 | -- | 31's | 31.5 | -- | -- | -- | -- | ||||||||
wounded in action for 37 percent of all Army evacuees for all areascombined.
All of the wounded evacuees, of course, originated from Japan-Korea;of each 100 U.S. Army evacuees from the Far East Command, 51 were woundedcases, 34 were disease cases, and 16 were nonbattle injury cases.
As one should expect, the flow of wounded evacuees fluctuated with thetactical situation. This may be seen graphically from the data includedin figures 11 and 12. The greatest number of wounded evacuees were receivedin September and October 1950 and again in December 1950 at the time ofthe Chinese Communist Intervention (fig. 11). During the first 2 months,three of each four evacuees received in the United States were woundedpatients. In December 1950, one of each two evacuees received was wounded.Throughout most of 1951, the majority of all evacuees received from Japan-Koreawere wounded. Nonbattle evacuees exceeded battle evacuees in January andFebruary 1951, when the number of nonbattle injury evacuees included increasednumbers of cold injury cases.
Reflecting the start of truce talks in July 1951, the proportion ofwounded evacuees dropped in August and September, but even in these months,such cases comprised about 40 percent of all Army evacuees from Japan-Korea(fig. 12). The number of wounded evacuees rose precipitously during October1951 at the time of the U.N. offensive to secure Line JAMESTOWN on thewestern front.
The situation was reversed throughout the first 6 months of 1952, whenthe number of wounded evacuees dropped each month to a low of 94 in June1952. The predominant cause of evacuation was then related to nonbattlecauses and the number of wounded evacuees was as low as 21 percent androse no higher than 40 percent in the first, 9 months of 1952. In October1952, the Chinese Communists launched their largest attack of the yearon the western and central fronts, increasing the proportion of woundedevacuees to 52 percent in the last quarter of 1952. During the first 6mouths of 1953, wounded evacuees never exceeded 40 percent. However, theirnumber increased to 48 percent in July and reached a peak at 58 percentin August, reflecting the last two enemy offensives in June and July 1953,before the signing of the Armistice agreement at Panmunjom.
SURGICAL OPERATIONS PERFORMED OVERSEAS
Data On the number of surgical operations performed overseas beforeevacuation are also presented, in table 68. Operations as defined for thepurposes included, here do, not include all surgical procedures, such asdebridement of wounds and transfusions. They do, however, include mostother major and minor surgery. An operation was recorded, even though onlyone step of the operation (as in the ease of a surgical amputation) mayhave been performed overseas.
Approximately 18,925 Army evacuees required surgical operation overseasbefore evacuation to
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Figure 11.- Number of U.S. Army evacueesreceived in United States from Japan-Korea, monthly by cause of evacuation,2 September 1950-31 December 1953.
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Figure 12.- Percentages of battle evacueesreceived in United States compared with percentage of battle admissionsin Korea, 2 September 1950-31 December 1953.
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U.S. hospitals of definitive treatment. This total represents an impressiveoverseas surgical workload since approximately 36 percent of all Army evacueesfrom all overseas areas required some surgical procedures before evacuation.In Japan-Korea, 45 percent of all evacuees were subjected to some surgicalprocedure before evacuation from overseas as contrasted with 10 percentrequiring prior operation Overseas among evacuees originating in all overseasareas other than Japan-Korea.
The high proportion of operations performed in Japan-Korea reflectsthe influence of the wounded evacuees who originated from this area. Theproportions of disease cases requiring operation before evacuation in Japan-Koreaand in all other overseas areas are notably consistent. The proportionsrequiring operation for nonbattle injury, however, are markedly higherfor Japan-Korea. Of 19,465 wounded evacuees, 13,335 (69 percent) requiredsome surgical procedure before evacuation to the United States.
CAUSATIVE AGENTS
Analysis of the 19,465 evacuee cards for wounded cases by causativeagent (table 69) shows that, as in World War II, explosives and fragmentationweapons accounted for more than half the cases; in this instance, 59 percent.
However, this proportion for wounded evacuees is somewhat smaller thanthe 66 percent shown in table 40 for all nonfatal wounds of both WorldWar II and the Korean War.
Shell fragments of unspecified explosive projectile shells alone accountedfor approximately one-fourth of all wounded evacuees. The specified explosiveprojectile shells, (artillery, mortar, and bazooka) caused another 17 percentof the casualties, so that the two categories combined, specified and unspecifiedexplosive projectile shells, were the causative agents for roughly 41 percentof the battle casualties evacuated. This compares to explosive projectileshells of 58 percent for the overall World War II distribution of nonfatalwounds and 51 percent overall for Korea. Other types of explosives and,fragmentation weapons accounted for 18 percent (the balance for this group),including grenades (6 percent) and land mines (5 percent) for wounded evacueepatients. A similar distribution for all nonfatal wounds, for World WarII, was 9 percent for the balance, including 2.5 percent for grenades
Table 69.- U.S. Army wounded evacueesreceived in United States, by causative agent, 2 September 1950-31 December1953
Causative agent | Battle injury and wound | ||||
Number | Percent | ||||
Total all agents | 19,465 | 100.0 | |||
Small arms weapons (subtotal) | (6,460) | (33.2) | |||
Rifle bullet | 934 | 4.8 | |||
Machinegun bullet | 602 | 3.1 | |||
Other or unspecified small arms bullet | 4,924 | 25.3 | |||
Explosives and fragmentation weapons (subtotal) | (11,559) | (59.3) | |||
Rifle artillery | 18 | 0.1 | |||
Other specified projectile explosives, mortar, bazooka, etc. | 3,357 | 17.2 | |||
Explosive projectile shells, unspecified | 4,734 | 24.3 | |||
Bombs or other air-launched explosive missiles | 19 | 0.1 | |||
Land mine | 899 | 4.6 | |||
Grenade | 1,232 | 6.3 | |||
Other or unspecified explosion or fragment | 1,300 | 6.7 | |||
Parachute jump and aircraft accidents | 29 | 0.1 | |||
Land transport vehicles | 184 | 0.9 | |||
Incendiaries and other chemical warfare agents | 52 | 0.3 | |||
Direct, or indirect intended effects of other instrumentalities of war | 341 | 1.8 | |||
Use of own instrumentalities of war | 640 | 3.3 | |||
Falls or jumps | 128 | 0.7 | |||
Machinery, tools, objects, etc. | 35 | 0.2 | |||
Miscellaneous, other, or unspecified agents | 37 | 0.2 | |||
and 3.4 percent for land mines. For Korea, the remaining distributionfor fragmentation weapons was 15 percent, of which 9.0 percent was grenadesand 3.5 percent was land mines.
The proportion of battle wounds caused by small arms weapons among theevacuees is considerably higher than the 20 percent experienced in WorldWar II, and even surpassed the 27 percent for small arms included in theoverall distribution of nonfatal wounds for the U.S. Army, Korea. Thisdifference, however, reflects partly the comparative lack of enemy aerialactivity in support of enemy ground troops; thus, bombs, or other air-launchedexplosives, were not so significant a factor as a cause of casualties amongU.S. Army personnel during the Korean War.
Another and more decisive factor for differences between the World WarII and the Korean War small arms totals is the relative weight from evacueesincurring wounds in the earlier fighting in Korea; that is, before thebuildup of Communist artillery.
Also of some interest is the fact that only 0.3 percent sustained burnsfrom incendiaries and other chemical warfare agents serious enough to requireevacuation. It is entirely probable that some battle casualty evacueeswhose primary diagnoses involved
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Table 70.- Number and percent of U.S.Army wounded evacuees, by type of traumatism, 2 September 1950-31 December1953
Type of traumatism | Number | Percent |
Total | 19,465 | 100.0 |
Fracture, compound | 9,687 | 49.8 |
Fracture, other, or not elsewhere clarified | 956 | 4.9 |
Wounds | 6,868 | 35.3 |
Amputation, traumatic | 708 | 3.6 |
Burns | 85 | 0.4 |
Concussion | 77 | 0.4 |
Other or unspecified | 1,084 | 5.6 |
any of the other types of causative agent also sustained burns. Theseadditional diagnoses and causative agents are not, of course, includedwith these data. However, an indication that burns are not a major factormay be derived from the fact that only 0.4 percent of the total traumatismsamong wounded evacuees were evacuated because of burns.
Another item of interest in table 69 on causative agents is the proportion(3.3 percent) wbo were evacuated because of wounds caused by use of ourown instruments of war. Included in this group of causative agents areexplosions of weapons and ammunition and handling of weapons and ammunition.
TYPE OF TRAUMATISM AND ANATOMICAL LOCATION OF WOUND
Of all traumatisms among the 19,465 U.S. Army wounded, evacuees, 90percent fell into the two main categories of fractures and wounds. Compoundfractures represented approximately 50 percent of all traumatisms whilewounds of all types were about 35 percent. The distribution, by type oftraumatism is shown in, table 70.
Table 71 shows the number and percent distributions by anatomical locationof wound for U.S. Army wounded evacuees for the complete period, 2 September1950-31 December 1953, and for seven elected periods. If one compares thetwo periods before the peace talks began in July 1951 with the four periodsafter that date ending in June 1953, it will be observed that the proportionof wounds involving the head, face, and neck increased while the proportionof wounds involving the upper extremities decreased. Wounds of the trunkarea, (thorax, abdomen, pelvis, and spinal cord) and of the lower extremitiesremained relatively unchanged.
The increase in the proportion of head wounds, as previously noted inthe section on "Anatomical Location of Wounds and Tactical Operations"included in chapter three, resulted from the change in the character offighting from a mobile combat situation to defense of fortified lines.This, of course, required the individual soldier to expose his head moreoften than any other part of his body.
TIME FROM WOUNDING TO FIRST MEDICAL CARE
Table 72 presents a cumulative percentage distribution of the elapsedtime from wounding to first medical care.
This period of time is defined as extending from the time of woundingas recorded in the diagnosis space on the Emergency Medical Tag (WD AGOForm 8-26) (4) to the time shown on that same record as "hourtagged," usually the time of admission to an aid station.
Table 71.- Percent distribution of U.S.Army wounded evacuees, by anatomical location of wound, 2 September 1950-31 December 1953
Time period | Anatomical location of wound | |||||
Total | Head, face, and neck | Trunk | Upper extremities | Lower extremities | General, or unspecified | |
Total period | ||||||
Total cases | 19,465 | 3,108 | 3,063 | 5,866 | 7,381 | 47 |
Percent | 100.0 | 16.0 | 15.7 | 30.1 | 38.0 | 0.2 |
September-December 1950 | 100.0 | 11.6 | 16.8 | 31.2 | 39.9 | 0.5 |
January-June 1951 | 100.0 | 14.4 | 14.1 | 33.7 | 37.6 | 0.2 |
July-December 1951 | 100.0 | 18.3 | 16.6 | 29.1 | 35.9 | 0.1 |
January-June 1952 | 100.0 | 18.1 | 16.9 | 26.7 | 38.3 | -- |
July-December 1952 | 100.0 | 20.7 | 16.8 | 28.4 | 34.0 | 0.1 |
January-June 1953 | 100.0 | 22.5 | 15.4 | 24.1 | 37.7 | 0.3 |
July-December 1953 | 100.0 | 21.3 | 11.5 | 27.3 | 39.8 | 0.1 |
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Table 72.- Army wounded evacuees, fromtime of wounding to first medical care, 2 September 1950-31 December 1953
Elapsed time (hours) | Number | Cumulative percent |
Total cases | 9,549 | -- |
0 to ½ | 2,105 | 22.0 |
½ to 1 | 1,653 | 39.3 |
1 to 2 | 1,823 | 58.4 |
2 to 3 | 1,097 | 69.9 |
3 to 4 | 704 | 77.3 |
4 to 5 | 452 | 82.0 |
5 to 6 | 306 | 85.2 |
6 to 7 | 247 | 87.8 |
7 to 8 | 184 | 89.7 |
8 to 12 | 390 | 93.8 |
12 to 18 | 255 | 96.5 |
18 to 24 | 98 | 97.5 |
The data in table 72 are based on the records of 9,549 of a total of19,465 Army wounded evacuees received in the United States on whom thetime wounded and the time first admitted to medical care were specified.The remaining 9,916, or 51 percent, of the total battle casualties receivedin the period 2 September 1950-31 December 1953 did not have one or bothof the time periods specified on their evacuee report cards.
For the cases with specified information, slightly more than 58 percentreceived medical care during the first 2 hours and slightly more than 85percent during the first 6 hours after wounding. The median number of hoursbetween the time of wounding and first, medical care was about 1½hours; that is, half of the cases for which data are available obtainedtheir first medical care within the first 1½ hours after being wounded.
TIME FROM WOUNDING TO FIRST HOSPITALIZATION
Another measure of the time elapsed from wounding to medical care isafforded by consideration of the number of days elapsed before hospitalization.Data were reported in this connection for 17,503 of the 19,465 Army, woundedevacuees received in the United States during the period 2 September 1950-31December 1953. The necessary information was not specified for 1,962 ofthe cases, or about 10 percent of the total received.
In the entire period, 55 percent, of the Army wounded evacuees werehospitalized on the same day wounded, 30 percent were hospitalized on thefirst day following, 6 percent on the second day following, and 9 percenton the third day or later (table 73).
The method by, means of which this type of information was gatheredwounded in action patients who became evacuees should be noted, however.Only the date, not the precise hour, was specified in reporting the lengthof interval between wounding and hospitalization. Thus, a patient, woundedlate in a 24-hour day during one of the frequent Communist night attacks(for example, at 2100 hours), might be admitted to hospital only 4 hoursafter wounding (at 0100); yet he would be reported as having been hospitalizedthe day following wounding, not the same day wounded.
The overall percentages for the complete period are somewhat misleading.During the first months of the Korean War particularly, the fluid tacticalsituation sometimes interfered with early hospitalization of patients.Some clearing stations were used in a role other than their conventionalone of evacuating patients to hospitals. The overall percentages for thecomplete period are, therefore, affected by heavy weighting of evacueeswounded in the first 9 months of the war (see table 74). Moreover, throughoutthe war, many patients were treated and returned to duty at echelons forwardof the surgical and evacuation hospitals, particularly at the clearingstation. Some patients temporarily held for treatment in forward installationsundoubtedly were found to require evacuation.
Table 73.- Percent of U.S. Army evacueeswounded, reaching surgical and evacuation hospitals within a specifiednumber of days after wounding, July 1950-August 1953
Month wounded | Same day wounded | First day after day wounded | Second day after day wounded | Third day after day wounded |
July 1950-August 1953 | 54.9 | 30.1 | 6.2 | 8.8 |
July-December 1950 | 34.3 | 32.8 | 12.4 | 20.5 |
January-June 1951 | 51.5 | 35.6 | 5.8 | 7.1 |
July-December 1951 | 65.9 | 29.5 | 2.5 | 2.1 |
January-June 1952 | 76.4 | 18.4 | 2.8 | 2.4 |
July-December 1952 | 71.6 | 24.3 | 2.8 | 1.3 |
January-June 1953 | 73.2 | 24.2 | 2.1 | 0.5 |
July-December 1953 | 73.2 | 22.6 | 2.2 | 2.0 |
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Table 74.- Cumulative percentage reachingsurgical or evacuation hospitals after day wounded, Army wounded in actionevacuees by month wounded, July 1950-August 1953
Month of wounding | Number of evacuees | Percentage reaching surgical or evacuation hospitals within specified number of days | |||
Same day wounded | First day after day wounded | Second day after day wounded | Third day or later after day wounded | ||
Total | 17,503 | 55 | 85 | 91 | 100 |
1950 | |||||
July | 100 | 26 | 52 | 64 | 100 |
August | 730 | 35 | 64 | 75 | 100 |
September | 2,673 | 33 | 64 | 77 | 100 |
October | 271 | 45 | 82 | 90 | 100 |
November | 1,130 | 33 | 71 | 84 | 100 |
December | 369 | 45 | 74 | 87 | 100 |
1951 | |||||
January | 484 | 38 | 82 | 93 | 100 |
February | 1,075 | 40 | 79 | 87 | 100 |
March | 703 | 54 | 90 | 96 | 100 |
April | 717 | 60 | 93 | 96 | 100 |
May | 753 | 55 | 89 | 92 | 100 |
June | 603 | 66 | 94 | 97 | 100 |
July | 237 | 67 | 96 | 97 | 100 |
August | 377 | 57 | 93 | 96 | 100 |
September | 998 | 60 | 93 | 97 | 100 |
October | 1,277 | 68 | 97 | 99 | 100 |
November | 294 | 79 | 96 | 98 | 100 |
December | 181 | 79 | 98 | 99 | 100 |
1952 | |||||
January | 161 | 83 | 97 | 99 | 100 |
February | 84 | 79 | 96 | 96 | 100 |
March | 102 | 74 | 96 | 99 | 100 |
April | 146 | 68 | 92 | 97 | 100 |
May | 100 | 65 | 81 | 90 | 100 |
June | 313 | 81 | 98 | 99 | 100 |
July | 262 | 71 | 98 | 99 | 100 |
August | 221 | 78 | 99 | 100 | 100 |
September | 339 | 78 | 96 | 98 | 100 |
October | 643 | 66 | 94 | 99 | 100 |
November | 241 | 70 | 96 | 98 | 100 |
December | 131 | 79 | 100 | 100 | 100 |
1953 | |||||
January | 119 | 85 | 97 | 100 | 100 |
February | 142 | 73 | 100 | 100 | 100 |
March | 218 | 64 | 96 | 99 | 100 |
April | 207 | 78 | 96 | 99 | 100 |
May | 179 | 74 | 98 | 99 | 100 |
June | 366 | 72 | 98 | 99 | 100 |
July | 554 | 73 | 96 | 98 | 100 |
August | 3 | 67 | 100 | 100 | 100 |
If time from wounding to first hospitalization is considered in intervalsof 6-month periods, as in table 73, a considerably different picture ispresented. For example, the percent hospitalized on the same day woundedrose from 34 percent for July-December 1950 to 76 percent in January-June1952. Thereafter, the percent hospitalized the same day remained constantat about 72 to 73 percent.
The monthly fluctuations in the percentage of wounded in action caseshospitalized within specified numbers of days are shown in table 74. Thepercentages shown are cumulative within any 1 month, reading from leftto right.
It will be noted that, beginning in April 1951, the percentage of woundedin action evacuees hospitalized on the day wounded at all times was at,or above, the average of 55 percent shown for the complete period.
Similarly, except for May 1952, the cumulative percentage hospitalizedon the day wounded and
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the first day following wounding, from March 1951 on, exceeded, theaverage of 85 percent for the complete period. An explanation of the dropin the percentage hospitalized in May 1952 is not discernible; the numberof cases involved, however, is small, and the percentage may only be indicativeof chance variation.
The changed character of the war is, of course, reflected in the increasingproportion hospitalized on the day wounded and the day following. By March1951, the United Nations Forces were again established north of the 38thParallel. The campaign was becoming less a war movement and more fixedpositional type warfare prevailed. Conditions were, therefore, more favorableto the rapid recovery and evacuation of wounded to forward hospitals.
In addition, the use of helicopters for evacuation of the seriouslywounded in need of immediate surgical treatment markedly affected the percentageof those hospitalized on the day wounded or on the day following.
In September and October 1951 during heavy fighting for possession of"Heartbreak Ridge" and the, "Punchbowl," and the majoroffensive in October 1951 to secure Line JAMESTOWN, 93 percent and 97 percent,respectively, of all the wounded during these 2 months were hospitalizedon the same day they were wounded or on the following day.
Furthermore, during August and September 1952 when bitter battles wagedfor "Old Baldy," "T-Bone," and "Bunker Hill,"and during the following month of October 1952 when the Chinese Communistslaunched a major attack on the western and central fronts, the percentageof wounded hospitalized on the same day or the day following wounding was99 percent during August, 96 percent during September, and 94 percent duringOctober. During 1953, these percentages ranged from 96 to 100 percent forwounded hospitalized on the same day or the day following.
