CHAPTER I
The Early Years
The small outpost in the Vietnamese delta stood a vigilant watch. Forthe past twenty-four hours guerrilla soldiers had harassed its defenderswith occasional mortar rounds and small arms fire. A radio call for helphad brought fighter-bombers and a spotter plane to try to dislodge theenemy from foxholes and bunkers they had built during the night. But neitherthe aerial observer nor the men in the outpost could detect the Communistsoldiers in their concealed positions. At dawn the outpost commander calledoff his alert and reduced the number of perimeter guards. Then he led apatrol out to survey the area. No sooner had they left their defenses thanthe enemy opened fire. Two of the soldiers fell, badly wounded, and therest scrambled back to the safety of their perimeter, dragging their casualtieswith them.
While the medical corpsmen treated the wounded, a radio telephone operatorcalled their headquarters to the east at Gia Lam. There, when the requestfor medical evacuation came in, the duty pilot ran to his waiting helicopterand in minutes was airborne. His operations officer had told him that thepickup zone was insecure and that gunships would cover him. Since therewere few helicopter ambulances in the theater, this flight would be a longone: forty-five minutes each way. After taking off, the pilots radioedthe gunships and confirmed the time and place of rendezvous. On his maphe traced his route, out across the paddied landscape, broken only by anoccasional village, hamlet, or barbed wire camp.
Five minutes from the beseiged outpost the flight leader of the gunshipteam radioed the air ambulance that they had him in sight and were closingon him. While the ambulance pilot planned his approach, the gunships madestrafing runs over the outpost to keep the enemy down. The outpost commandermarked his pickup zone with a smoke grenade, and the ambulance pilot circleddown to it from high overhead. As soon as he landed he shouted at the groundtroops to load the wounded before a mortar hit him. Once the patients weresecured, the pilot sped out of the area and headed toward Lanessan Hospital,radioing ahead to report his estimated time of arrival. Litter bearersfrom the hospital waited to rush the casualties into the emergency roomas soon as the helicopter touched down.
4
The area where this mission took place was the Red River Delta in northernVietnam. Gia Lam was the airfield serving Hanoi from across the DoumerBridge spanning the Red River. The defenders of the outpost were the Frenchin the early 1950s.1 By the end of 1953 the French in Indochinawere using eighteen medical evacuation helicopters. From April 1950 throughearly 1954 French air ambulances evacuated about five thousand casualties.
In these same years the U.S. Army, which had used a few helicoptersfor medical evacuation at the end of World War II, employed helicopterambulances on a larger scale, transporting some 17,700 U.S. casualtiesof the Korean War. Several years later in the Vietnam War it used helicopterambulances to move almost 900,000 U.S. and allied sick and wounded. Theaeromedical evacuation techniques developed in these wars opened a newera in the treatment of emergency patients. With their ability to landon almost any terrain, helicopters can save precious minutes that oftenmean the difference between life and death. Today many civilian medicaland disaster relief agencies rely on helicopter ambulances. For the pastthirty years the U.S. Army has played a leading role in the developmentof this new technology.
Early Medical Evacuation
Although surgeons often accompanied the professional armies of the eighteenthcentury, the large citizen armies of the early nineteenth century, whosebattles often produced massive casualties, demanded and received the firsteffective systems of medical evacuation. Two of the officers of NapoleonBonaparte, the Barons Dominique Jean Larrey and Pierre Francois Percy,designed light, well-sprung carriages for swift evacuation of the wounded.Napoleon saw that each of his divisions received an ambulance corps ofabout 170 men, headed by a chief surgeon and equipped with the new horse-drawncarriages. Other continental powers quickly adapted the French system totheir own needs, but the British and American armies lagged a full halfcentury in learning the medical lessons of the Napoleonic era.
In the Seminole War of 1835-42 in Florida, the U.S. Army Medical Departmentexperimented with horse-drawn ambulances and recommended their adoptionby the Army. But the Department apparently got no response. A few yearslater experiments were resumed, and a four-wheeled ambulance proved successfulin the West. But by the outbreak of the Civil War in April 1861 the Armyhad ac-
1This incident is related by Valerie André,a French Air Force medical pilot who flew in Indochina, in her article"L'Hélicoptére sanitaire en Indochine," L'Officierde Réserve, vol. 2 (1954), pp. 30-31.
5
quired more two-wheeled than four-wheeled ambulances, and even thesewere in short supply. In 1862 and 1863 scarce ambulances, poorly trainedstretcher bearers, and unruly ambulance drivers greatly hindered the MedicalDepartment's efforts to care for the wounded. Ambulances were so scarcethat after the first major battle of the war at Bull Run (21 July 1861)many of the 1,000 Union wounded depended on friends and relatives to pickthem up in a family carriage. Many more simply straggled the twenty-fivemiles back to Washington on foot. Three days after the battle hundredsof wounded still lay where they had fallen. The stretcher bearers consistedalmost entirely of members of military bands who had been assigned theduty. As one historian noted, "...scrubbing blood-soaked floors andtables, disposing of dirty scabby bandages and carrying bleeding, shell-shockedsoldiers had nothing to do with music, accordingly the impressed musiciansfled the scene."
At the second battle of Bull Run (29 August 1862) the large number ofcivilian drifters hired by the Quartermaster Corps to drive the ambulancessimply fled the scene at the first few shots. The Surgeon General quicklyrounded up about two hundred more vehicles from the streets of Washingtonand accepted civilian volunteer drivers, who proved to be worse than thefirst lot. Many broke into the medicine cabinets on the ambulances, drankthe liquor supply, then disappeared. Those who made their way to Bull Runwere found stealing blankets and other provisions, and some even took torifling the pockets of the dead and dying.
Over the course of the war, however, the Union system markedly improved,thanks to the efforts of Maj. Jonathan Letterman, Medical Director of theArmy of the Potomac. Letterman recommended sweeping reforms in the ambulancesystem and the creation of an orderly group of medical clearing stationsto the immediate rear of each battlefront. The mission of the ambulanceswas to bring all casualties to the clearing stations as rapidly as possible.The station would then sort the casualties, a process known as triage.As soon as possible the surgeons went to work on the serious casualtieswhom they deemed savable and sent them to hospitals in the rear. The mostseriously wounded were often set aside, many to die before they reachedthe operating table. The lightly wounded were treated later and retainednear the front. Two goals suffused Letterman's new system: to reduce thetime between wounding and lifesaving (definitive) surgery, and to evacuatea casualty no farther to the rear than his wounds demanded. This wouldresult in a hierarchy of medical services, a chain of evacuation that carrieda patient to more specialized care the farther he moved from the front.
On 2 August 1862 Maj. Gen. George B. McClellan ordered that Letterman'splan be placed into effect in the Army of the Potomac. Ambulances wereto be used only for the transport of sick or wounded soldiers. Stretcher-bearersand hospital stewards were to wear distinc-
6
tive insignia on their uniforms. Ambulances were to move at the headof all wagon trains, not the rear. Only medical corpsmen were to be allowedto remove the wounded from the battlefield. Although ambulances, horses,and harnesses were to be under division control, all ambulance driverswere to be under Medical Department control, trained for their work, andnot allowed to assume other duties such as assisting surgeons in the fieldhospitals. They were also expected to be of proven good character. In March1864 President Lincoln approved a congressional act creating a uniformedAmbulance Corps, based on Letterman's plan, for the entire Army of theUnited States. Although the Ambulance Corps was disbanded at the end ofthe war, it had served remarkably well when it was needed. The MedicalDepartment during the war had never overcome serious problems in the supplyof medicine and the construction of field hospitals. But its numerous horse-drawnambulances had effectively removed the wounded from the battlefields, evenduring the massive conflict at Gettysburg.
In the Spanish-American War and World War I, the U.S. Army had to relearnmany of the medical lessons of the Civil War. By World War I ground evacuationof casualties could be accomplished by motor-driven ambulances, but theincreased speed was offset to some degree by limited road access to thewidely dispersed front lines in France and the Low Countries. World WarsI and II showed that automotive transport, while effective for backhaulsfrom clearing stations to field hospitals and evacuation hospitals, wasof limited value in evacuating casualties from the spot where they fell.
Early Aeromedical Evacuation
The first aeromedical evacuation occurred in the Franco-Prussian Warof 1870-71. During the German siege of Paris, observation balloons flewout of the city with many bags of mail, a few high-ranking officials, and160 casualties. Thirty-three years later at Kitty Hawk, North Carolina,Wilbur and Orville Wright proved that manned, engine-powered flight inheavier-than-air craft was actually possible. In 1908 the War Departmentawarded a contract to the Wright Brothers for the Army's first airplane,and in July 1909 accepted their product.
Two enterprising Army officers quickly noted the medical potential ofsuch aircraft. At Pensacola, Florida, in the autumn of 1909, Capt. GeorgeH. R. Gosman, Medical Corps, and Lt. Albert L. Rhoades, Coast ArtilleryCorps, used their own money to construct a strange-looking craft in whichthe pilot, who was also to be a doctor, sat beside the patient. On itsfirst powered flight the plane crashed into a tree. Lacking the funds tocontinue the project, Captain Gosman
7
went to Washington to seek money from the War Department. He told oneconference: "I clearly see that thousands of hours and ultimatelythousands of patients would be saved through use of airplanes in air evacuation."But his audience thought the idea impractical. In May 1912 other militaryaviators recommended the use of air ambulances to the Secretary of War,but the War Department still thought airplanes unsuitable for such a mission.During World War I Army Aviation grew steadily, but its planes served asair ambulances only sporadically.
As they had with ground ambulances, the French pioneered the use ofairplanes as ambulances. During maneuvers in 1912 an airplane helped stretcherparties on the ground locate simulated casualties. The French then designeda monoplane with a box-like structure under its fuselage for moving casualtiesto field hospitals. In October 1913 a French military officer reported,"We shall revolutionize war surgery if the aeroplane can be adoptedas a means of transport for the wounded." During World War I the Frenchdid occasionally move the wounded by airplane, especially in November 1915during the retreat of the Serbian Army from a combined German, Austrian,and Bulgarian attack in Albania. Although the type of aircraft used inAlbania was adequate in this isolated emergency, it was hardly fit forroutine use on the Western Front.
For the rest of the war the French Army gave little attention to aeromedicalevacuation; they had too many casualties and too few aircraft to be concernedwith it. But one French military surgeon, Dr. Eugene Chassaing, managedto keep the idea alive. When he first asked for money to build air ambulances,one officer responded, "Are there not enough dead in France todaywithout killing the wounded in airplanes?" Despite such criticism,Chassaing acquired an old Dorland A.R. II fighter and designed a side openingthat allowed two stretchers to be carried in the empty space of the fuselagebehind the pilot. After several test flights of the craft, he was permittedto place six such aircraft into operation. In April 1918 two of these planeshelped in the evacuations from Flanders, but the fighting grew so intensethere that French higher authorities would not sanction continued use ofthe planes. Late in 1918 Dr. Chassaing received permission to convert sixty-fourairplanes in Morocco into air ambulances, and all were used in that countryin France's war against Riffian and Berber tribesmen in the Atlas mountains.The French experimented with air ambulances throughout the interwar period.
By the end of World War I the U.S. Army had also begun to reexamineits position on air ambulances. In 1920 the Army built and flew its firstaircraft designed as an air ambulance, the DeHavilland DH-4A, which hadspace for a pilot, two litter patients, and a medical attendant. In 1924the Army let its first contracts for air ambulances,
8
and in the next few years it occasionally used its air ambulances toprovide disaster relief to the civilian community. In April 1927, aftera tornado struck the small town of Rocksprings, Texas, the Army sent eighteenDH-4 observation planes, two Douglass transports, and a Cox-Klemin XA-1air ambulance. These planes flew in physicians and supplies to treat 200injured citizens, some of whom the Cox-Klemin then flew out to more sophisticatedmedical care in San Antonio.
The decade after the war also saw the development of rotary-wing aircraft.In December 1928 the United States received from France its first sampleof a rotary-wing aircraft-the autogiro, which used one motor-driven propellerfor forward motion and another wind-driven propeller for vertical lift.By 1933 one U.S. manufacturer had designed an autogiro ambulance to carrya pilot and three patients, two recumbent in wire basket (Stokes) litters,and one sitting. In the December 1933 issue of the Military Surgeon,Lt. Col. G. P. Lawrence foresaw the military uses of this air ambulance.Since the autogiro could not hover, rough terrain, forests, and swampswould still require ground evacuation of casualties. But autogiros workingfrom nearby landing areas could backhaul the casualties to medical stations.The advantages seemed indisputable:
Autogiros, not being limited by roads, would find morefrequent opportunities to open advanced landing posts than would motorambulances. They could maneuver and dodge behind cover so as to make hitsby enemy artillery quite improbable. At night they could potter aroundin the dark, undisturbed by aimed enemy fire, until they accurately locatedthe landing place, outlined by ordinary electric flash lights in the handsof the collecting company, and then land so gently that the exact estimationof altitude would be immaterial.
In 1936 the Medical Field Service School at Carlisle Barracks, Pennsylvania,tested the medical evacuation abilities of the autogiro Though the resultswere promising, the Army's budgetary problems prevented funding a rotary-wingmedical evacuation unit.
World War II brought the first widespread use of fixed-wing aircraftfor military medical evacuation. In May 1942 the Army Medical Service activatedthe first U.S. aeromedical evacuation unit, the 38th Medical Air AmbulanceSquadron, stationed at Fort Benning, Georgia. The war also stimulated furtherresearch on rotary-wing aircraft, both in Germany and the United States.Although Allied bombing raids destroyed the factories that the Germansintended to use for helicopter production, research and development inthe United States proceeded apace. On 20 April 1942 Igor Sikorsky stageda successful flight demonstration of his helicopter. By March 1943 theArmy had ordered thirty-four Sikorsky helicopters, fifteen for the U. S.Army Air Forces, fifteen for the British, and four for the U.S. Navy. Theseand
9
later versions of the Sikorsky could be quickly converted to air ambulanceuse by attaching litters to the sides of the aircraft.
Tests at the Army Materiel Center in the summer of 1943 suggested thatthe helicopter could be an effective air ambulance. On 13 August 1943 theArmy Surgeon stated that he intended to fill the need for a complete airevacuation service in combat zones by employing helicopters, regardlessof terrain features, as the only means of evacuation from front lines toadvanced airdomes. Further successful tests of the litter-bearing helicopterin November 1943 supported his decision. But helicopters were not yet abundant,and the Surgeon's plan came to nothing.
The helicopter nevertheless managed to prove its value as a device forrescue and medical evacuation from forward combat areas. In late April1944, Lt. Carter Harman, one of the first Army Air Forces pilots trainedin helicopters at the Sikorsky plant in Bridgeport, Connecticut, flew forthe 1st Air Commando Force, U.S. Army Air Forces, in India. On 23 Aprilhe took one of his unit's new litter-bearing Sikorskys to pick up a strandedparty with casualties about twenty-five kilometers west of Mawlu, Burma.When he returned to India he had flown the U.S. Army's first helicoptermedical evacuation (medevac) mission. Soon helicopters became an item inhigh demand. Maj. Gen. George E. Stratemeyer, commander of the EasternAir Command, requested six of them for the rescue of five of his pilotswho had crashed in inaccessible areas and for similar rescue missions.In the spring of 1945 helicopters evacuated the sick and wounded of the112th Regimental Combat Team and the 38th Infantry-Division from remotemountain sites on the island of Luzon in the Philippines.
Most evacuation from the front lines in World War II, however, was byconventional ground ambulance. The Army Medical Service did improve itsservices, greatly reducing the mortality rates from those of World WarI. New drugs, such as penicillin and the sulfonamides, and the stationingof major surgical facilities close to the front line, saved hundreds ofthousands of lives. Airplanes evacuated over 1.5 million casualties, farmore than in World War I, but this role was largely limited to transportingcasualties from frontline hospitals to restorative and recuperative hospitalsin the rear, rather than from the site of wounding to life-saving surgicalcare. At the end of the war Army aeromedical evacuation still lacked acoherent system of regulations and a standing organizational base. Beforeit could acquire these, Army aviation would have to survive the upheavalattending the creation of the United States Air Force.
The National Security Act of 1947 established the United States AirForce as a separate military arm and at the same time stripped the Armyof most of its aircraft, leaving it only about two hundred light planesand helicopters. The general mission of Army aviation was
10
limited to furthering ground combat operations in forward areas of thebattlefield, a mission that fortunately encompassed responsibility foremergency aeromedical evacuation from the front. However, when the KoreanWar opened three years later, the Army Medical Service still had no helicopterambulance units.
The Korean War
The Korean War resulted in a rapid, new buildup of American militaryforces, which had been precipitously reduced after World War II. This wasno less true for the Army Medical Service than for other U.S. militaryagencies. At first, in July 1950, only a single evacuation hospital andone Mobile Army Surgical Hospital (MASH) supported all U.S. forces in Korea.By the end of the year these medical resources had grown to four mobilesurgical hospitals, three field hospitals, two 500-bed station hospitals,one evacuation hospital, and the Swedish Red Cross Hospital near Pusan.The medical buildup was timely, for between 7 July and 31 December 1950United Nations forces suffered nearly 62,000 casualties. Medical supportexpanded even further in 1951.
The Korean War resulted in the first systematic use of helicopters forevacuation of casualties from the battlefield. The rugged, often mountainousterrain and the poor, insecure road network in wartime Korea made overlandmovement extremely difficult. Transport of wounded and injured ground troopsfrom the front line rearward by litter bearers or jeep ambulances seriouslyaggravated the patient's condition, caused deepened shock, and often producedfatal complications just before the war broke out Lt. Gen. Walton Walker,the Eighth U.S. Army, Korea (EUSAK) commander, told his senior surgeonthat in event of hostilities he wanted mobile surgical hospitals placedas close to the front lines as possible. During the war the mobile surgicalhospitals, stationed from five to forty kilometers behind the front, servedas the main destination of ground and air ambulances bringing casualtiesfrom clearing stations at the front. Most of the casualties arrived inground ambulances, but 10 to 20 percent were brought by helicopters. TheAir Force and Navy also used helicopters for medical evacuation, but theArmy's helicopter ambulance detachments carried the great majority of thewars helicopter evacuees.
The Air Force, however, pioneered the use of helicopter ambulances inKorea. In July 1950, just after the war broke out Helicopter DetachmentF of the Air Force's Third Air Rescue Squadron began to receive requestsfor evacuation of forward Army casualties in areas inaccessible to groundvehicles. Col. Chauncey E. Dovell, the Eighth Army Surgeon, arranged atest of the Third Air Rescue Squadron's H-5 helicopters in the courtyardof the Taequ
11
Teachers' College. On 3 August he and Capt. Oscar N. Tibbetts, the squadron'scommander, met at the college and examined one of the H-5's. A Stokes litterfit into the compartment of the H-5 very well, but the handles of the standardArmy litter had to be cut off. With two patients and Colonel Dovell onboard, the H-5 lifted off, easily cleared the surrounding telephone polesand buildings, and returned for a perfect landing. Colonel Dovell askedto see a long flight, so the pilot flew him and the two patients out tothe 8054th Evacuation Hospital at Pusan, 100 kilometers away. On 10 August,at Colonel Dovell's request, Lt. Gen. Earle E. Partridge, commander ofthe Fifth Air Force, authorized the use of these and other Air Force helicoptersfor frontline evacuations. The Air Force continued to evacuate the Army'sfrontline casualties until the end of the year, allowing the Army timeto organize and ship to Korea its own helicopter detachments.
Late in the year the Army deployed four helicopter detachments to Korea.These units, each authorized four H-13 Sioux helicopters, contained nomedical personnel, but were under the operational control of the EUSAKSurgeon. Each was attached to a separate mobile surgical hospital, witha primary mission of aeromedical evacuation. The crewmembers drew theirrations and quarters from the MASH, and their aircraft parts and servicefrom wherever they could be found. The 2d Helicopter Detachment becameoperational on 1 January 1951; the 3d, later in January; and the 4th, inMarch. The 1st Helicopter Detachment, which arrived in February, neverbecame operational because commanders transferred all of its aircraft toother nonmedical units. At the height of the Korean conflict the threeoperational helicopter detachments controlled only eleven aircraft. Butby the end of the war they had evacuated about 17,700 casualties, supplementedby a considerable number of medevac missions performed by nonmedical helicoptersorganic to division light air sections and helicopters of Army cargo transportationcompanies. Marine and Air Force helicopters had also made a sizable numberof frontline evacuations.
The independence and therefore the value of the air ambulance unitsincreased after the introduction of detailed standard operating procedures.Typical of those adopted by the detachments was the list that Lt. Col.Carl T. Dubuy, commander of the 1st Mobile Army Surgical Hospital, drewup in early February 1951. Evacuation requests were to be made only forpatients with serious wounds, or where surface transport would seriouslyworsen a casualty's injuries. The helicopters would be used strictly formedical evacuation and reconnaissance, and would not be used for command,administrative, or tactical missions. Each request for a helicopter wasto include a clear and careful reading of the coordinates of the pickupsite. The ground commander was to try to find the lowest pickup site around
12
to ease the strain on the minimally powered H-13 helicopters that performedthe bulk of medical evacuations in Korea. A request was not to be madefor a landing zone subject to hostile fire; if trouble did develop, themen on the ground were to wave off the helicopter. Dubuy recommended theuse of colored panels to form a cross to mark the pickup site, and he alsofavored some indicator of wind direction and velocity, such as grass fire.He suggested that if the helicopter flew past the pickup zone without recognizingit, the soldiers on the ground should fire flares or smoke grenades toattract the pilot attention. (The aircraft had no radios.) Colonel Dubuysent these recommended procedures to the commanding general of the 7thInfantry Division, which the 1st Mobile Army Surgical Hospital then supported,but the division afforded the list only a haphazard distribution.
In January 1951 all four pilots of the 2d Helicopter Detachment tookpart in a mission that, although it violated the precept that helicopterswould not be flown within range of enemy weapons, saved several lives.On the morning of 13 January, Capt. Albert C. Sebourn of the 2d Detachmentreceived an urgent request for air evacuation from a unit at a schoolhousesurrounded by a large Chinese Communist force near Choksong-ni. The unitwas a Special Activities Group (SAG), an elite, battalion-size organizationof airborne and ranger-qualified soldiers. Their only defensive perimeterwas the border of the one acre schoolyard. A MASH doctor had been askingfor a ride in a helicopter. Sebourn put him in the right seat and thenflew to the coordinates of the request. After landing in the schoolyard,Sebourn shut down the helicopter. As soon as he and the doctor climbedout, a mortar round landed near the right side of the helicopter, damagingit but not injuring anyone. Both men ran into the schoolhouse, where thecommander of the SAG unit explained that he had numerous casualties andwanted the helicopter to bring in ammunition on its return flights fromthe hospital. When Sebourn tried to restart his aircraft, he found thatthe battery was dead; he and the doctor stayed at the school overnight.
When Sebourn did not return to the 2d Detachment's base after severalhours, Capt. Joseph W. Hely checked back through Eighth Army channels.The request had been quite old when the 2d Detachment received it: it hadbeen routed through Tokyo. Eighth Army asked Hely whether he would flyammunition out to the beleaguered force, and he assented. With ammunitionin both his aircraft's litter pods, he tried to fly out, but heavy snowfallmade him postpone the flight until the weather improved. Next morning,when he reached the area, he noticed tracers from enemy machine guns tryingto shoot him down. He spiraled down into the schoolyard, unloaded the ammunition,gave the battery in Sebourn's helicopter a boost, and then
13
loaded two patients in his own craft. He spiraled out to escape theenemy fire again and Sebourn followed him.
Later that day two other 2d Detachment pilots joined Hely in two moreflights to the schoolyard, carrying food and ammunition to the SAG unitand casualties back to the hospital. Enemy ground fire harassed each entryand exit at the schoolyard. On leaving the school for the last time justbefore darkness, Hely radioed an Air Force fighter and marked the perimeterfor its strike. The next morning the 2d Detachment made a final evacuationfrom the schoolyard before the SAG unit withdrew. Captains Hely and Sebournwon Distinguished Flying Crosses for their work.
The communications net used to route and obtain approval of a groundcommander's request for such a medevac mission was, laborious at best,especially early in the war. The request usually originated at a casualtycollecting station in the field or at a battalion aid station. Then itwas relayed by radio or telephone to the division surgeon, then to thecorps surgeon, and finally to the Eighth Army Surgeon, who decided if themission was valid. If he approved, the approval passed back down the ladderto the helicopter detachment attached to the hospital supporting the corpsarea. This process often delayed a mission for hours, and sometimes itled to a cancellation because the casualty had already died. Some procedures,though, helped speed the response time of the helicopters. Stationing amobile surgical hospital and its helicopter detachment close to the frontline, usually some ten to forty kilometers behind it, reduced the responsetime. Eventually the Eighth Army Surgeon ceded mission approval authorityto the corps surgeons, who had direct communications with the mobile surgicalhospitals, thereby eliminating one level in the three-tiered approval structure.
To improve the communications and speed the response, the helicopterdetachments began the practice of siting their aircraft in the field atclearing stations near the tactical headquarters just behind the frontlines. These one-aircraft field standbys ensured ready and rapid transportationof the critically wounded to mobile surgical hospitals. But this solutionproduced another problem. Since the helicopters themselves carried no radios,an aircraft that was field-sited with a combat unit that had a poor radiolinkup with other combat units in the Corps zone could not respond rapidlyto sudden fighting in other areas. The absence of radios in the aircraftalso precluded any air-ground communication and made necessary the useof smoke signals and hand gestures to ensure the safe completion of a mission.In the first months of the war not even the detachment headquarters hadradios. When available, they helped immensely by freeing the detachmentsfrom their dependence on Army switchboards and landlines.
Several times division commanders tried to obtain the assignment
14
of helicopters to specific combat units for evacuation missions (directsupport). For instance, the 3d Infantry Division, with an indorsement fromI Corps, requested its own air ambulance; I Corps wanted to give each divisionits own air ambulance. But EUSAK headquarters denied the request becausethere were not enough helicopters to provide such individualized coverage,and the current area and standby coverage was working adequately.
Many other problems in this new system proved intractable. The mostserious came from the constant need to repair the helicopter. The sluggishnessof the Air Force, the Army's aviation procurement agency, in meeting Armyaviation's supply needs created a backlog of requests for helicopter partsand components. just as American industry at the start of World War IIwas unable to fill all the Army's requests for airplanes, so at the startof the Korean War it was not geared for helicopter production. The finetolerances required because of the many rotating and revolving parts ina helicopter, and the limited commercial potential for the craft, madeAmerican aircraft manufacturers reluctant to devote their resources tosuch a chancy investment. When production did increase, a serious problemarose in transporting the vast quantities of war materiel from the Statesto Korea. All of these problems adversely affected the supply of spareparts, fuel, and even aircraft. By late 1952 the eleven air ambulance helicoptersin Korea had to compete with about 635 other Army nonmedical helicoptersfor whatever resources the American aircraft industry could provide.
Parts shortages in the field accounted for the loss of much valuableflying time in all Army aviation units in Korea, more so than any otherproblem. In a three month period in 1952 the 8193d Army Unit lost aboutone-third of its potential aircraft days because of parts shortages. Thisresulted in lives lost because the unit was unable to respond to all evacuationrequests. The 8193d commander, Capt. Emil R. Day, requested that a fifthhelicopter be assigned to each of the MASH helicopter detachments, butthis was not done. In allocating parts the Air Force favored its own fightersand bombers over the Army helicopters. Supply personnel in the States seemedto have little awareness of the cost in human life of returning supplyrequests for editorial changes, explanations of excess requirements, and"proper" item descriptions. Harry S. Pack, in an evaluation ofthe problems of helicopter evacuation in Korea, aptly criticized the supportsystem:
The basic concept of the employment of the helicopterin the Army... is its increased speed over other forms of transport currentlyin use in the movement of personnel and materiel. Therefore, it is onlylogical that the entire helicopter program, including maintenance and supplyprocedures, should follow the same philosophy of speed and mobility toensure receiving maximum value from the helicopter.
15
The focal point of these supply problems was the Bell Aircraft Corporation's H-13 Sioux helicopter, which performed almost all aeromedical evacuationsin Korea. Powered by a Franklin engine, it sported a large plexiglass bubbleover the top and front of the cockpit. It could transport a pilot and onepassenger, and two patients on external litters. Although Bell Aircraftsent some of its test pilots to Korea to help the Army pilots obtain maximumperformance from the H-13, the aircraft simply had not been designed formedical evacuations in mountainous terrain. The H-13's standard fuel capacitycould not keep the aircraft aloft the two or more hours that many evacuationflights took. The pilots had to either fuel at the pickup site or carryextra fuel in five-gallon cans. The cans could be carried in the cockpitor, more safely, strapped to the litter pods and left at the pickup site.Also, since the battery in the H-13 was not powerful enough to guaranteerestarting the aircraft without a boost, the pilots often practiced "hotrefueling" in the field. Although dangerous, the practice seemed saferthan being unable to restart the aircraft near the front line.
Because the H-13D's the pilots flew had no instrument or cockpit lightsand no gyroscopic attitude indicators, most evacuation missions took placein daylight. But extreme emergencies sometimes prompted the pilots to completea night mission by flying with a flashlight held between their legs toilluminate the flight instruments. The expedient barely worked, becausethe bouncing, flickering beam of the flashlight often produced a blindingglare.
When the first Army aeromedical unit in Korea, the 2d Helicopter Detachment,arrived at the end of 1950 and put its equipment in working order, it stillcould not declare itself operational, because the H-13D's lacked litterplatforms, attaching points on the helicopters, or even litters. The unitquickly received permission to fit platforms on the skid assemblies sothat litters could be mounted on either side of the fuselage. When theEUSAK Aviation Section failed to obtain litters for the detachment, itscommander, Captain Sebourn, turned to the Navy hospital ship in the InchonHarbor. The Navy people gave him eight of their metal, basket-like Stokeslitters. The detachment then had to find covers for them to protect thepatients from the elements and secure them to the pod. Lt. Joseph L. Bowlertook the litters to Taegu, found some heavy steel wire, and then had awelder at a maintenance company fashion a lid with a plexiglass windowthat could be attached to the litter, enclosing the patient's upper body.Next, both the lid and the litter were covered with aircraft fabric andseveral coats of dope. This laborious process required repeated paintingand drying in the cold, sleet, and snow of the Korean winter.
The improvised pods and litters proved far from ideal. Loading and unloadingthe patient was an awkward process, since he had to be taken from the standardArmy field litter, lifted onto a blanket, and then placed
16
into the Stokes litter. Some patients with certain types of casts, splintsand dressings could not be moved by helicopter at all because of the confinedspace of the Stokes litter. The pilots and mechanics improvised heatingfor the inside of these litters by fabricating manifold shrouds and ductingwarm air off the manifolds into the litters. Even so, the patients hadto be covered with mountain sleeping bags or plastic bags. If the manifoldheat were used on one litter only, excess warm air escaped near the hoseconnection; but if heat were turned on both litters, there was not enoughfor either. The problem partly stemmed from the plastic cover; it lay directlyon the patient and did not allow the heat to circulate properly So thedetachments worked with a maintenance company and a Bell Aircraft technicalrepresentative, constructing a three-quarter length cover of fabric-coveredtubing that could be joined to the original head cover. It served as awindbreak and gave space for the heat to circulate over the patient's lowerbody. In July 1951 a new litter mount, manufactured by Bell Aircraft forthe H-13, reached Korea. These greatly improved mounts accommodated a standardArmy field litter, eliminating the need to transfer a patient to a Stokeslitter before placing him in the pod. Unfortunately the covers that Bellmanufactured for the new mount were usually torn up by the slipstream afterjust thirty days of use. The detachments improvised a canvas cover frompup tent shelter halves; when used with the zipper and snaps from the Bellcover, it proved far superior to the original in that it had a long servicelife and kept water from seeping through onto the patient. The men of thedetachments used their own money and Korean labor to produce an ample supplyof covers.
Even with the improved pods, the external mounting and the absence ofa medical corpsman on the aircraft produced another difficulty. Pilotsbegan to notice that many of the casualties needed transfusions beforebeing moved to a mobile surgical hospital. In cold weather an in-flighttransfusion with the fluids stored outside the aircraft risked deepeningthe patient's shock as the fluid temperature dropped. At first the pilotswould wait the thirty or forty-five minutes necessary for a transfusionbefore departing with a patient. Then Lt. Col. James M. Brown, commanderof the 8063d Mobile Surgical Hospital, devised a method for en route transfusionsof plasma or whole blood. A bottle of blood or plasma was attached to theinside wall of the cock it within reach of the pilot. Needles and plasmawould be arranged before departure, and during flight the pilot could monitorthe fluid flow through the tubes extending to the litter pods. A rubberbulb could be used to regulate pressure to the bottle. This modificationwas approved for all medical helicopters in the theater, and Bell Aircraftalso incorporated it in all its D-model aircraft.
Since the Eighth Army possessed only thirty-two H-13's by May
17
1951, use of the valuable craft had to be closely monitored and restricted.A recurring problem was that ground commanders sometimes requested helicoptersmore as a convenience than as a necessity. To prevent this, the EUSAK Surgeonon 23 June 1951 disseminated a statement that the role of helicopter evacuationwas only to provide immediate evacuation of nontransportable and criticallyill or injured patients who needed surgical or medical care not availableat forward medical facilities. This statement was given wider distributionthan had Colonel Dubuy's in February and it noticeably reduced the numberof unnecessary missions.
The detachments offered their service to all of the fighting units involvedin the United Nations effort in Korea. At first glance it seemed that thelanguage barrier would make many of these missions extremely difficult.But the lack of air-ground communications helped in this respect, for itprecluded any attempt whatsoever at oral communication between pilots andground commanders. Most pilots found that universal sign language usuallysufficed to transmit any information necessary to complete an evacuation.In September 1951 one of the pilots received a request to pick up two woundedmen from a Turkish brigade. The pilot recalled:
When I got to the spot designated I couldn't find anybody.I was circling around when a Turkish observation plane buzzed me. He ledme to a wooded area on a mountain top where the Turks had dug in. The treeswere too high to permit a landing. It looked pretty hopeless because Icouldn't communicate with them. Finally, I went in close until the rotorblades of the helicopter brushed the tops of the trees. The Turks got thepitch. They chopped down enough of the trees so that I could land on aridge. I sat down and the Chinese began tossing mortar shells at me. ButI got the two wounded Turks out.
Enemy ground resistance to air ambulances in Korea never became a severeproblem, as it did later in Vietnam. Few landing zones were subject toenemy small arms fire, but many were within range of enemy artillery andmortars. Although the pilots generally stayed out of landing zones underenemy fire, several had more than one encounter with Communist weapons.At one point early in the war a company of the 7th Infantry Division wasfighting in the area known as the Iron Triangle. In assaulting an enemy-heldslope, two of its soldiers were seriously wounded by the Chinese. A requestfor an air ambulance quickly made its way to the 4th Helicopter Detachment,stationed with the 8076th Mobile Surgical Hospital at Chunchon. CBS correspondentRobert Pierpoint was there and had received permission to fly with thedetachment. Three minutes after the call came in, a pilot and Pierpointflew north toward the pickup site. The men on the ground put out coloredpanels to mark a landing zone on a
18
nearby paddy, while others tried to bring the casualties down from thehill. Thirty minutes after the call went out, the helicopter landed atthe marked position. The pilot and Pierpoint got out. just as the litterbearers made it down the hill, Chinese mortars from across the valley openedup on the paddy. A mortar round came in, hit about thirty feet from thehelicopter tail, and sent the Americans scrambling up the hill. The companycommander called an artillery battalion 6,000 yards to the rear, and hadthem knock out the Chinese mortar positions.
The pilots, Pierpoint, and the litter bearers returned to the helicopterand loaded the casualties. Not waiting to check for damage, the pilot climbedinto the smoke-filled cockpit. He could hardly see the instruments, but,as soon as Pierpoint jumped in they made a maximum power takeoff. Theylanded at the hospital at 2120, reading their aircraft instruments witha flashlight one of the men at the paddy had given them.
In another respect, Korea was worse than Vietnam: the ambulance crewssometimes had to contend with enemy aircraft. Although the U.S. Air Forcedestroyed most of the North Korean aircraft early in the conflict, theentrance of the Chinese Communists into the war in December 1950 broughtfast and powerful enemy jet fighters to Korea. A few medical helicoptersdid encounter fire from North Korean Yak fighters, but the Americans outmaneuveredthe faster jets and escaped damage.
Apart from frontline evacuations, air ambulance detachments also flewa few other medical support missions. By the second year of the war theyroutinely transported whole blood to the mobile surgical hospitals. Thisproved valuable because the whole blood tended to break down prematurelyor clot when carried by surface vehicles over the rough Korean roads. Thefaster means of transport also allowed blood storage and refrigerationto be centralized rather than dispersed close to the front. The helicoptersbackhauled some critical patients from the mobile surgical hospitals toairstrips for further evacuation to one of the general hospitals in Japan.Sometimes they even backhauled patients to hospital ships along the coast,such as the Navy's hospital ship Consolation and the Danish Jutlandia,which were equipped for helicopter landings. Since fixed-wing cargo planesflew all casualties bound for Japan, the hospital ships remained anchoredas floating hospitals off Korea rather than act as ferries.
Most detachment pilots also tried to make the life of the frontlinesoldiers as tolerable as they could. Besides medical supplies and ammunition,the pilots often took beer, ice cream, and sodas to the front. The sightof the helicopter coming in for a landing in the blistering Korean summerwith the pilot wearing only his boots, a red baseball cap, and swimmingtrunks, and then unloading these otherwise unobtainable luxuries, did muchto boost the morale of the combat soldiers.
19
Apart from yielding a great deal of practical experience, the KoreanWar furthered aeromedical evacuation by convincing the Army that the helicopterambulances deserved a permanent organization. When the war broke out, theArmy Medical Service commanded neither helicopters nor pilots, and itsleaders were not committed to furthering aeromedical evacuation. In Koreathe Eighth Army soon acquired virtually complete operational control ofthe helicopter detachments charged with a mission of medical evacuation.But the Surgeon General wanted to have the detachments made organic tothe Medical Service, to have an organization within the Office of the SurgeonGeneral capable of directing and administering the aviation resources,and to have medical personnel rather than aviators from other branchesof the Army piloting the aircraft.
The Surgeon General achieved his first goal with the publication on20 August 1952 of TO&E 8-500A, which provided for an air ambulancedetachment of seven officers, twenty-one enlisted men, and five utilityhelicopters. The first such unit was the 53d Medical Detachment (HelicopterAmbulance), activated at Brooke Army Medical Center, Fort Sam Houston,San Antonio, Texas, on 15 October 1952. In Korea, meanwhile, the ambulanceunits were transferred from the administrative command of the Eighth ArmyFlight Detachment to that of the Eighth Army Surgeon.
By the end of the war the Surgeon General also succeeded in achievinghis second goal of creating a special aviation section in his office. On30 June 1952 the Chief of Staff of the Army directed the Chairman of theMateriel Review Board to evaluate the Army helicopter program. In accordancewith the Board's recommendation, the Chief of Staff on 17 October 1952directed the assistant chiefs of staff and the various Army branch chiefsto set up their own agencies to supervise and coordinate aviation withineach office. The Surgeon General's Office was charged with coordinationof all planning, operations, personnel staffing, and supply of Army aviationused in the Medical Service. On 6 November the office established the ArmyAviation Section within the Hospitalization and Operations Branch, MedicalPlans and Operations Division. On the advice of the new section, the SurgeonGeneral recommended that "...all aircraft designed, developed, oraccepted for the Army (regardless of its intended primary use) be chosenwith a view toward potential use as air ambulances to accommodate a maximumnumber of standard litters." This advice was followed in 1955 whenthe Army held a design competition for a new multipurpose utility helicopter.The winner of the competition, the Bell Aircraft Corporation's prototypeof the UH-1 Iroquois ("Huey"), eventually became the Army's standardambulance helicopter in the Vietnam War.
During the Korean War the Surgeon General also tried to place
20
Medical Service Corps (MSC) pilots in the cockpits of the Army's airambulances.2 But he did not succeed until shortly after thearmistice in 1953. From early 1951 on, the Surgeon General had advocatedtraining some MSC officers as aviators, and in the spring of 1952 the regulationsgoverning Army aviation were amended to allow MSC personnel to become pilots.A quota of twenty-five MSC officers, mostly second lieutenants, was setfor flight training in October. None of the current MSC officers had everbeen helicopter pilots, although a few had had some aviation training.By early July, fifty-three applications for the slots had been received,but only seventeen applicants were qualified. Eight MSC officers beganflight training in October, and one washed out before graduation. The otherseven graduated on 28 February 1953. In September the Surgeon General'soffice requested and received a standing quota of ten MSC officers permonth for attendance at the Army Aviation School at Fort Sill, Oklahoma.By 1 October the Medical Service had twenty-four officer pilots and soonreceived five more by transfer from other branches. None had flown in Koreabefore the armistice in July.
After the Korean War the Surgeon General's Office applied itself toassessing the potential of helicopter ambulances in future conflicts. Inparticular, Lt. Col. Spurgeon H. Neel, Jr., in a number of medical andaviation journals, publicized and promoted the Army's air ambulances. TheKorean experience, he realized, could not serve as an infallible guideto the use of helicopters in other types of wars and different geographicalregions, but it certainly showed that helicopters had made possible atleast a modification of the first links in Letterman's chain of evacuation.A superior communications system would allow a well-equipped and well-staffedambulance to land at or near the site of the wounding, making much groundevacuation unnecessary. If the patient's condition could be stabilizedbriefly, it might prove helpful to use the speed of the helicopter to evacuatethe patient farther to the rear, to more complete medical facilities thanthose provided at a rudimentary division clearing station. Triage mightbe carried out better at a hospital than in the field. But the Korean Warand the concurrent French struggle in Indochina had afforded only limited,imperfect tests of helicopter medical evacuation. The potential was obvious,but not fully proven.
2At this time the Army Medical Service consistedof six corps: Medical, Dental, Veterinary, Army Nurse, Women's MedicalSpecialists, and the Medical Service Corps, which provided a variety ofadministrative and technical services.
