EXTENT OF MEDICO-MILITARY OPERATIONS
Army Battle Casualties
It developed that Army hospital and medical facilities for the Dominican stabilization operation were far in excess of what was needed to care for military casualties alone. During the period from April 1965 to September 1966, 14 U.S. Army personnel were killed in action and 148 were wounded, three of whom later died as a result of their wounds. Of the 68 combat casualties who required hospitalization, most had received wounds from small-arms fire and only a few from fragmentation devices. Based on hospitalized wounded for which data are available, 21 percent were wounded in the head or neck, 29 percent in the trunk, and 50 percent in the extremities.
The problem soon became one of having people on hand who had too little to do. It was generally agreed, however, that it was far better to have too much too soon than too little too late. The problem of having too many people on hand was eventually solved by redeployment.
Aid stations were located in the center of the city, and the medical companies of the 307th Medical Battalion rotated in and out of the area of greatest activity, providing medical service on an area basis. Casualties could be in battalion aid stations within a few minutes after they were hit, in clearing stations, if indicated, a short time later, or instead--as often developed--in the field hospital in less than a half hour.10During the June flareup, most casualties were taken directly to
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the field hospital and admitted in less than a half hour (appendix B).11
Evacuation Policies and Procedures
A 15-day evacuation policy (changed later to 30 days)12was instituted in the Dominican Republic, but this was very flexible, especially during the early days of the operation. At the outset there was some difference of opinion in the command about where patients who had to be evacuated should be sent for care. This problem was completely solved, however, when the Air Force was given evacuation responsibility and its Casualty Staging Facility at San Isidro became the Medical Regulating Authority for the area.
In the first few days of fighting there was some confusion at lower levels, and a few Army patients even bypassed Army medical channels and were mistakenly evacuated by the Air Force Casualty Staging Facility. The ailments of the soldiers in some of these cases were minor--sometimes little more than severe colds. But the Air Force handling of air evacuation as a rule was highly efficient and speedy, and won high praise from the XVIII Airborne Corps Surgeon, the 82d Airborne Division Surgeon, and other Army Medical Service officers who had contact with the facility. Air Force liaison personnel who worked directly with the Army could, by using radios, have aircraft available for emergency medical evacuations within minutes.
Most casualties requiring extensive treatment were flown to Pope Air Force Base and then transported by ambulance in a matter of minutes to Womack Army Hospital, Fort Bragg, for hospitalization. Patients with fractures were air evacuated immediately after the affected bone was stabilized. When indicated, patients were flown to specialized care facilities, such as the burn facility at Brooke Army Medical Center, Fort Sam Houston. Casualties requiring immediate surgery beyond the capability of the 15th Field Hospital were evacuated either to Ramey Air Force Base or Rodriguez Army Hospital in San Juan, Puerto Rico.
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A special evacuation policy on individuals bitten by animals had to be promulgated early in the operation. There had been no rabies control programs in the Dominican Republic for more than five years, and since the Army lacked impounding facilities and adequate laboratory capability, rabies vaccine and antitoxin was indicated for all persons bitten. Therefore, for some weeks, individuals who had been bitten were evacuated to their home stations for completion of treatment. Later, a pound was constructed for the confinement of animals, and personnel who had been bitten were retained in the area for treatment. This concern for animal bites proved largely precautionary, however, since the only animal shown to have rabies by laboratory examination was a mongoose which had been impounded for biting an airman at San Isidro.
The Army`s lack of denture repair and spectacle replacement facilities in the Dominican area increased evacuation loads. The 15th Field Hospital lacked optical and denture repair facilities. The Force Surgeon, LTC McCaleb, pointed out that such teams are needed even in small short term operations because personnel "can be relied on either by accident or by design to break or lose dentures or spectacles, particularly if repair facilities are not readily available, and replacement necessitates evacuation from the objective area.."13
Many individuals arrived in the Dominican Republic without two pairs of spectacles as required. Few of those who subsequently lost or broke their glasses could produce a copy of their spectacle prescription, so it was necessary in many cases to send people to Puerto Rico for refraction or to write to home stations and have health records searched for prescriptions before replacement spectacles could be ordered.14
Men who lost or broke their dentures had to be returned to Fort Bragg where repair and replacement facilities were available.15Some hanky-panky was proved or suspected in a few cases involving the loss of glasses or dentures, such as in the case of a sergeant who accidentally ran over his dental plate with a truck.
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Nonbattle Medical Problems
Nonbattle military casualties developed in a predictable manner. The XVIII Corps Surgeon reported that shots had hardly stopped ringing from the first fire-fight engaged in by U.S. troopers when a soldier reported on sick call for treatment of fingers he had mashed moving an air conditioner. Gastrointestinal problems and even a case of gout showed up in a relatively short time. But the medical problem taking the greatest toll was venereal disease.
Injuries.--Medical personnel in the Dominican Republic treated the same types of injuries common at any military post in the United States. After the fighting had settled down, soldiers could rent cars or motorbikes in Santo Domingo, and this led to a rash of vehicle accidents.
The sea presented a more unusual hazard. Most of the shoreline in the Santo Domingo area is an undercut volcanic cliff with a drop of 10 to 20 feet to the sea. Individuals who fell into the sea found it difficult to climb out and more than one soldier drowned as a result. Also, the surf is often quite rough and there is a significant undertow. This was also thought to have contributed to the drowning of one or two individuals who swam in unsupervised beach areas.
Hepatitis.--By June a number of soldiers had come down with hepatitis, and as incidence began to follow a rising curvel6the Medical Service became concerned. Almost all the individuals affected by the disease were stationed in the American corridor through Santo Domingo. In that area the temptation to use water from other than approved sources and to buy food and drink from street vendors was great. Since it was impossible to relate the outbreak epidemiologically to any particular military facility or mess hall, it was assumed that the occurrence of the disease resulted from the general exposure of the troops to the city`s environment. The use of gamma globulin immunization seemed indicated, was tried,l7and proved successful, for only an occasional rare case was found following immunization.
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Gastrointestinal diseases.--Environmental impediments and pressing operational activities of the first few weeks of Army involvement in Santo Domingo contributed to a poor state of sanitation within the military establishment. Negligence, ignorance, and resentment over harangues on the dangers of disease-breeding filth were evident in many units, but the city itself was the worst enemy. Rock-hard volcanic subsoil drastically slowed the digging of adequate latrines and garbage sumps. In addition, the presence of myriads of flies, the accumulation of garbage everywhere during the fighting, and an existing diarrhea epidemic among the infants in the city made a serious outbreak of gastrointestinal disease almost inevitable.
But contrary to experience of the past, good fortune in the form of accurate daily medical reports prevailed, and no serious outbreak occurred among the troops.
The slack produced by the failure of most units to provide required field sanitation teams was largely taken up by the 714th Preventive Medicine Detachment. During the first 2 months of the operation, the unit was swamped by requests to do the actual spadework in providing sanitation for individual units, while continuing to perform its many legitimate functions. Then from 28 June to 2 August, personnel of the 714th conducted a series of 6-hour field sanitation courses three times a week for representatives of individual units. All units of company or battery size were requested to place two men on orders to function as a field sanitation team and to attend the 714th`s course of instruction. In all, 114 personnel successfully completed the course, which outlined the responsibilities of a unit sanitation team, taught the team how to procure and use authorized equipment, and familiarized them with the capabilities of the 714th.18The field sanitation problem grew smaller with each passing week, partly because of enlightened unit effort, partly because of planned deployment.
All 82d Airborne Division medical units, including battalion aid stations, were required to report daily on all cases of gastrointestinal disease or complaints, including suspected cases of infectious hepatitis. The Division Surgeon`s Office conducted inspections in areas where a potential outbreak was suspected. In addition, several medical bulletins outlining health hazards were published by the Division early in the operation.
During the Dominican operation there were a number of mild diarrheas scattered throughout the command, but these could usually be traced to poor mess sanitation. Mess kit washing facilities were inadequate, water was
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not hot enough, or troops were not careful in washing utensils. Diarrhea outbreaks were halted when command interest in mess sanitation was stimulated. Such measures, plus cleanup programs in the city and vector control activities, kept gastrointestinal disease to a minimum.
Venereal diseases.--Prophylactics were not available during the first weeks. Troops were briefed on the high incidence of venereal disease, its lasting nature, the dangers in "no sweat" pills, and the importance of reporting on sick call if venereal disease were contracted. All houses of prostitution, when they became known, were put off-limits, and troops were generally restricted in their movements. The movements of female Dominicans could not be so easily restricted, however. Incidence of venereal diseases among U.S. troops in the Dominican Republic jumped in May to a point far higher than normal stateside levels.l9Lectures by surgeons, chaplains, and commanders seemed to be totally ineffective, and the situation was aggravated in time, by an increase in spare time. The U.S. Army, Dominican Republic, reported an initial rate for venereal disease of 369 per thousand per annum for May 1965. Rates for the following three months were lower: on the order of 211, 190, and 234. The rate for September rose to 380 per thousand and was the peak for 1965. Thereafter the rate declined steadily for the remainder of the year. In January 1966, the rate rose precipitously to 593 per thousand per annum, the highest rate for the entire operation. The rate was 567 in February, 410 in March, and declined steadily to its lowest point for the entire operation at 123in August 1966. The annual rate for the 18 days in September was 232 per thousand, the next lowest for the year and the fifth lowest for the operation. These were mostly cases of gonorrhea, but there were 118 cases of syphilis in 1965 and 81 cases in 1966, totaling 199 for the entire operation.20
Commanders were directed that men were not to be punished for having venereal disease, and unit surgeons were reminded that personnel treated for venereal disease were not to be reported. The reasoning for this policy was disseminated to commanders on 22 May (appendix C). Unit surgeons were to maintain lists of treated personnel for follow up studies after the personnel returned to CONUS. (For overall redeployment physical evaluation policies, see appendix D.)
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Before the end of the year, the IAPF Surgeon, CPT Francis A. Sunseri, MC, and CPT Joseph D. Goldstrich, MC, a preventive medicine officer in the USFORDOMREP Surgeon`s office, worked out a reporting procedure for tracing the sources of venereal disease, which involved the cooperation of the civilian health services of North Carolina and the Dominican Republic, as well as the Army Medical Service. Some infected women were traced through this program, but no reduction in venereal disease rates among soldiers in the Dominican Republic was noted. To the contrary, rates which were declining at the end of the year rose precipitously in January and February1966.
Psychiatric Problems
A total of 33 cases of psychotic and psychoneurotic conditions occurred among U.S. Army troops in the Dominican Republic. However, most of these did not occur under conditions of fire, but when there were heavy restrictions on activities and a "great deal of uncertainty as to who and where the enemy was.21 The 82d Airborne Division psychiatrist, CPT William H. Goodson, Jr., MC, reported that he saw only one patient with combat exhaustion. Life-threatening situations and physical deprivation in the Dominican Republic operation "were never sustained enough to give rise to the conditions known to precipitate classical cases of combat exhaustion."22 (The psychiatrist`s complete report appears in appendix E.)
