MEDICAL SUPPORT OF THE U.S. ARMY INVIETNAM, 1965-1970
CHAPTER I
The Medical Command Structure
Formal U.S. military assistance to the Republic of Vietnam may be traced tothe signing of the Pentalateral Agreement in 1950, a multinational MutualDefense Assistance Treaty for Indochina. The American contribution to thedefense of the Southeast Asian sovereignties was nominal for several yearsthereafter, as reflected by the fact that at no time during the next decade didU.S. military personnel in Vietnam number more than 1,000. Most of the U.S.support effort took the form of materiel and supplies, distributed to the SouthVietnamese government through MAAGV (Military Assistance Advisory Group,Vietnam), a small logistics and training organization. However, in November1961, mounting support by North Vietnam of guerrilla activities in the South ledPresident John F. Kennedy to conclude that, if the South Vietnamese democracywere to be preserved, a much larger commitment of U.S. military personnel insupport of the RVNAF (Republic of Vietnam Armed Forces) would be required.
The consequences of the President's decision were immediately manifest. Bythe end of 1961, the number of U.S. military personnel in Vietnam hadquadrupled. Slightly more than 4,000 men were assigned as military advisers tothe RVNAF, to staff officers at MAAGV headquarters, or to a rapidly increasingnumber of support units. With the arrival of additional Special Forces andlogistical detachments in the first 2 in months of 1962, the magnitude of theU.S. military role in Vietnam became clear. To provide centralized command andcontrol for these growing combat advisory and support forces, USMACV (U.S.Military Assistance Command, Vietnam), a joint command under CINCPAC (Commanderin Chief, Pacific), was officially established on 8 February 1962. Named as thefirst COMUSMACV (Commander, U.S. Military Assistance Command, Vietnam) wasLieutenant General Paul D. Harkins, whose grade was indicative of the strengthof the expanding American commitment.
Closely related to the buildup of American combat, combat advisory, andsupport forces was the development of the U.S. medical service structure inVietnam. Based on anticipated troop lists, initial medical support requirementswere set in December 1961, shortly after President Kennedy's decision toincrease the level of American support to the RVNAF. These requirements includedone field hospital of 100-bed
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capacity, with four attached medical detachments to provide specialty carebut to be totally dependent on the hospital for administration and logistics,and one helicopter ambulance detachment to provide evacuation capability to thetreatment facility.
Over-all planning and guidance for the deployment of all incoming unitsbecame the responsibility of CINCPAC under the direction of the Joint Chiefs ofStaff and the Department of Defense. Logistical support responsibility wassubsequently isolated and delegated to USARYIS (U.S. Army, Ryukyu Islands), asubordinate command of USARPAC (U.S. Army, Pacific). Logistical support of themedical units committed to Vietnam would become a major responsibility of theUSARYIS surgeon's headquarters.
Medical Service During the Advisory Years
The field hospital recommended for deployment in December 1961 was to becomeoperational in April of the following year. In the interim, however, arrivingArmy units, primarily transportation companies, could not be left without anyform of medical service. During January and February 1962, three small medicaldetachments, each attached to a transportation company, disembarked in SouthVietnam. Each provided, on air area basis, limited dispensary and generalmedical care for the units to which they were attached, as well as for allother U.S. personnel in their area.
To co-ordinate logistical and administrative support for the increasingnumber of U.S. Army personnel and units, USARYIS Support Group (Provisional) wasestablished. On 24 February 1962, its medical section, comprised of one plansand operations officer and a chief clerk, both temporarily reassigned from themedical section of the 9th Logistical Command in Thailand, initiated medicalactivities in Vietnam. Through March, the medical section concentrated onassessing the capabilities of Army medical units in Vietnam, recommending toUSARPAC through USARYIS headquarters that preventive medicine and veterinaryfood inspection detachments be sent from the United States to the theater ofoperations. Those requirements were subsequently corroborated by Major GeneralAchilles L. Tynes, MC, USARPAC chief surgeon, and Colonel Thomas P. Caito, MSC,chief of his plans and operations division during a prolonged visit both made toSoutheast Asia between 30 March and 1 May 1962.
However, the medical section would not see the fruition of its efforts as astaff office of the USARYIS Support Group (Provisional) headquarters. On 1 April1962, the temporary USARYIS Support Group was redesignated USASGV (U.S. ArmySupport Group, Vietnam), and placed under the command and control of GeneralHarkins as
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COMUSMACV. The mission of the USASGV medical section was now clarified: toadvise the USASGV commander and his staff on matters pertaining to the medical,dental, and veterinary services of the command, and to supervise all technicalaspects of those services.
Less than 3 weeks later, on 18 April 1962, the 8th Field Hospital becameoperational at Nha Trang, assuming responsibility for the hospitalization of allauthorized U.S. military personnel, dependents, and civilians living orstationed in Vietnam. A second responsibility allotted the 8th Field Hospitalwas that it act as a central medical supply point for all Army medical units inVietnam, a duty for which the facility was ill-prepared and grosslyunderstaffed.
Concurrently, the hospital commander, Lieutenant Colonel Carl A. Fischer, MC,became also the USASGV surgeon, staff adviser to the Commanding Officer, USASGV,on all Army medical activities in Vietnam. (Chart 1) As surgeon, ColonelFischer also headed the USASGV medical section, now expanded to include oneMedical Service Corps officer acting as chief of section and two enlisted men.Physically separated by some 200 miles from USASGV headquarters, Colonel Fischermade frequent trips from Nha Trang to Saigon to insure that all necessary actionrequired of his medical section was accomplished. In addition, he had to utilizeclerical personnel assigned to the 8th Field Hospital in performing those dutiesrequired of him as USASGV surgeon. Both arrangements proved unsatisfactory,prompting Colonel Fischer to request a change in the table of distribution basedon AR 40-1; a change which, if approved, would have placed a full-time surgeonin USASGV headquarters. He further reported that, as of 31 December 1962, one ofthe major problems he faced as hospital commander was that of insufficientpersonnel in his headquarters section, leading to the absence of a"cohesive, balanced organization to accomplish the administrative andlogistics burdens of attached units."
By the end of December, the number of detachments offering area medicalcoverage for U.S. forces, all obtaining their medical supplies through the 8thField Hospital, had doubled. (Map 1) An even greater strain on theresources of that facility was created by attached units: two medicallaboratories, three specialized surgical detachments, one segmented helicopterambulance detachment, one dental detachment, one veterinary detachment, and oneengineer detachment. While the veterinary detachment was headquartered inSaigon, all other units were totally dependent on the 8th Field Hospital foradministration and logistics. The dual problems thus engendered-medical staffstoo small to handle the administrative tasks demanded of them, and the physicalseparation of the USASGV surgeon from his medical section-would continue toplague the commanding officer of the 8th Field Hospital and his successorsduring the next 3 years.
6-7
CHART 1-MEDICAL COMMAND AND STAFF STRUCTURE, U.S. ARMY,VIETNAM, 24 FEBRUARY
1962-1 APRIL 1965
8
Although the opening of a Navy dispensary in Saigon in 1963 removed thatcity, as well as III and IV CTZ's (corps tactical zones) to the south, from thehospitalization responsibilities of the 8th Field Hospital, increasing numbersof casualties more than offset that relief. In the same year, USASGV was againredesignated, becoming USASCV (U.S. Army Support Command, Vietnam). Now removedfrom his direct command, General Harkins as COMUSMACV retained operationalcontrol over the lower headquarters. As the senior Army officer in Vietnam,however, he remained the Army component commander, while the Commanding General,USASCV, became deputy Army component commander. No benefits accrued to theUSASCV medical section, however, and it remained understaffed and physicallyseparated from the commanding officer of the 8th Field Hospital.
The Army medical structure in Vietnam remained essentially unchanged in 1964.The USASCV surgeon's medical section increased by one enlisted man; and while adental surgeon, preventive medicine officer, and veterinarian were added to hisstaff, they too served in dual capacities and could contribute little to areduction in the medical section's workload.
NOTES TO CHART 1
aBefore the arrival of the 8th Field Hospital,administrative and logistical support for all Army medical units in Vietnam hadbeen coordinated through the Office of the Surgeon, Headquarters, United StatesMilitary Assistance Command, Vietnam.
bUSASCV was the acronym for the Army component headquarters inVietnam from March 1963 through June 1965. Before 1963, that headquarters hadbeen known as the USARYIS Support Group (Provisional) and, after 1 April 1962,as USASGV (United States Army Support Group, Vietnam).
cThe staff structure of the Office of the Surgeon, Headquarters,MACV, as of 31 December 1964.
dThe staff structure of the USASCV Medical Section as of 31 December1964.
eThe principal duty of the USASCV Dental Surgeon was CommandingOfficer, 36th Medical Detachment (Dental Service), the command and controlelement for dental units.
fThe principal duty of the USASCV Veterinary Officer was CommandingOfficer, 4th Medical Detachment (Veterinary Food Inspection), the command andcontrol element for veterinary units.
gThe principal duty of the USASCV Preventive Medicine Officer wasCommanding Officer, 20th Preventive Medicine Unit, the command and controlelement for preventive medicine units.
hThe principal duty of the USASCV Surgeon was Commanding Officer, 8thField Hospital, the senior medical organization and highest level headquartersfor all nondivisional medical units in Vietnam.
iThe plans and operations officer acting as chief of section, as wellas the enlisted personnel under him, had originally constituted the MedicalSection of the 9th Logistical Command, Thailand, whence they had been reassignedfor temporary duty to South Vietnam.
Sources: (1) Medical Activities Report, Office of theSurgeon, Headquarters, Military Assistance Command, Vietnam, 1964. (2) ArmyMedical Service Activities Report, Medical Section, United States Army SupportCommand, Vietnam, 1964. (3) Army Medical Service Activities Report, Office ofthe Surgeon, Headquarters, United States Army, Vietnam, 1965.
9
Map 1 - Command and Staff Relationships During the Years ofMilitary Commitment: 1965-67
Two American destroyers were attacked by North Vietnamese PT-boats on 2 and 4August 1964, prompting the Gulf of Tonkin resolution. That action taken byCongress would lead to the direct commitment of the first major U.S. combatunits in Vietnam. It would thrust General William C. Westmoreland, who hadreplaced General Harkins as
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COMUSMACV shortly after the consolidation of MAAGV and USMACV headquarters inJune 1964, into a position of international prominence; and it would be he whowould supervise the massive buildup of U.S. forces in Vietnam over the next 4years.
Medical Command Versus Logistical Command
As early as 1962, General Harkins had recognized the need for a centralizedlogistics organization in support of U.S. forces in South Vietnam. Again in1964, COMUSMACV had recommended that a logistical command be promptly introducedin-country. Later in the year, the organization of that command was authorized,with responsibility for over-all joint logistical planning to reside in USMACVheadquarters. The decision stipulated that support should be conducted on anarea basis for all common supply and service activities, which in practice meantthat the Army was to provide common-item support within II, III, and IV CTZ,plus any portion of I Corps in which major Army forces were deployed.
The doctrinal framework which justified the creation of a logistical commandin Vietnam was COSTAR II, the second of two studies on combat service supportof the Army. One of the outgrowths of the study was the directive that, when afield army was constituted, all logistical support was to be provided by FASCOM,a field army support command. Nondivisional medical service was placed under theArmy support command.
The juxtaposition of two events (the decision of the joint Chiefs of Staff toestablish a centralized logistical command in Vietnam and the Gulf of Tonkinaftermath) made it only a matter of time before the U.S. Army would assumeresponsibility in South Vietnam for the distribution of supply items common toall military services, as well as for those used only by the Army,
On 1 April 1965, Headquarters, 1st Logistical Command, a field army supportcommand and control element, was activated. In accordance with the policy ofcentralized logistical direction, four geographic support areas (roughlycorresponding to CTZ's) were directly subordinated to that command. The 8thField Hospital was removed from the direct command of USASCV headquarters andsubordinated to the 1st Logistical Command. As senior medical officer inVietnam, the hospital commander, Lieutenant Colonel (later Colonel) James W.Blunt, MC, now assumed a third hat: 1st Logistical Command surgeon and directorof the command's medical section.
When Colonel Blunt activated the 1st Logistical Command medical section on 1April, he was made responsible for providing the commander and his staff withnecessary assistance and advice on all aspects of non-
11
divisional medical support, to include veterinary and dental service, andmedical supply. That proved an impossible task, since he remained both USASCVsurgeon and commanding officer of the 8th Field Hospital. Colonel Blunt'sdilemma was partially resolved with the interim appointment of a more juniorMedical Corps officer, Major (later Lieutenant Colonel) Stuart A. Chamblin, Jr.,as the 1st Logistical Command surgeon on 12 May. However, far more importantchanges in the structure of the Army medical service in Vietnam were imminentand would, for a time, reduce if not eliminate the problems faced by precedingcommanding officers of the field hospital.
Consistent with current concepts, the USARPAC chief surgeon noted in his 1965Annual Medical Activities Report: "Medical Service is an Army or area wideservice and, as such, all medical support capability should be consolidatedunder one Medical Command." Prompting that statement were the recognizedcriticality of professional medical personnel, the unique characteristics ofmedical supply and maintenance, the constant demand for strong and effectivepreventive medicine and veterinary food inspection programs, and therequirement for medical support to be immediately responsive to the needs of thecommander. A field hospital was completely unsuitable as a control element for amedical command encompassing units scattered through three CTZ's. Consequently,the 58th Medical Battalion was assigned to the 1st Logistical Command on 29 May,assuming command and control over nondivisional Army medical units in Vietnam.The battalion's commanding officer, Lieutenant Colonel (later Colonel) Edward S.Bres, Jr., MC, was simultaneously appointed 1st Logistical Command surgeon anddirector of its small organic medical planning staff.
With the appointment of Colonel Bres as 1st Logistical Command surgeon, thecommanding officer of the 8th Field Hospital once again wore only two hats.However, the need for a full-time surgeon in the Army component headquarters hadnot diminished, but rather had become more pressing. The Department of the Armyfinally concurred in the oft-repeated demands of earlier USASCV surgeons, and on29 June, authorized a table of distribution change adding a full-time surgeon,an administrative officer, and an additional enlisted man to the USASCV medicalsection. Ten days later, Lieutenant Colonel (later Colonel) Ralph E. Conant, MC,became the USASCV surgeon. Assigned no duties other than surgeon, he retainedthat post when USASCV was redesignated USARV (U.S. Army, Vietnam), on 20 July1965.
The scope of the medical advisory effort at the field army level increasedwith the establishment of USARV as the highest command and control headquartersfor all U.S. Army units in Vietnam. Reorganized in structure and expanded insize, the USASCV medical section was renamed the Office of the Surgeon,Headquarters, USARV. Staff super-
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vision of a medical service supporting Army logistical operations had ceasedto be a responsibility of the medical section when the 1st Logistical Command'smedical section was activated. But on 20 July, that loss was more than offsetwith the assumption of staff responsibility for the health services of theentire Army medical structure in Vietnam, including unit, division, and armylevel medical service. Specifically, the USARV surgeon was given the mission ofplanning all USARV medical service, to be correlated at USARV headquarters withtroop concentrations, logistical support areas, and the concept of tacticaloperations, Additional duties included preparing and co-ordinating broad medicalpolicies, recommending assignments for medical personnel within USARV,maintaining medical records and statistics, and furnishing professionalconsultants to the command.
In the meantime, the 1st Logistical Command surgeon was co-ordinating thedeployment and day-to-day operations of nondivisional medical units in Vietnam,units increasing in numbers from 11 in April to 60 by early fall, Just as the8th Field Hospital had earlier proved inadequate as a command and controlelement, so now was Headquarters, 58th Medical Battalion, too small to handlethe increasing volume of logistical, administrative, and support functionsdemanded by subordinate headquarters. On 18 August, Lieutenant Colonel Conantwas replaced as USARV surgeon by Colonel Samuel C. Gallup, MC. On 25 October,the recently promoted Colonel Conant in turn replaced Colonel Bres as 1stLogistical Command surgeon. The reason for the replacement of Colonel Bres wassoon apparent, for with the activation of the 43d Medical Group on 1 November,the 58th Medical Battalion ceased to be the senior army level medical unit inVietnam. (Chart 2) Colonel Conant was the commanding officer of thatmedical group.
Although a subordinate medical headquarters, the 58th Medical Battalioncontinued to exercise major command and control responsibilities through 17March 1966. The 43d Medical Group assumed the nondivisional medical servicemission in II CTZ, and also exercised command and operational control over allnondivisional medical maintenance, laboratory, and helicopter units in Vietnam.The 58th Medical Battalion remained the command and control element fornondivisional units in III and IV CTZ's, and for all preventive medicine,dental, and veterinary units, until the 68th Medical Group became operational on18 March 1966.
Command by the Medical Brigade
In December 1965, Lieutenant General Leonard D. Heaton, The Surgeon General,and General Westmoreland decided to send a medical brigade to Vietnam. Agreementhad not been reached, however, on the
13
level at which the brigade should be assigned. A month earlier, The SurgeonGeneral visited Southeast Asia and, at that time, had concluded that the medical brigade should be made a major subordinate command of USARVheadquarters, just as were the aviation and military police brigades and theengineer command. Shortly thereafter, Colonel (later Major General) SpurgeonNeel, MC, USMACV surgeon, had prepared a memorandum for General Westmorelandrecommending that the medical brigade could most effectively support Armypersonnel in Vietnam if placed under the direct supervision of the USARVsurgeon. Pointing out that medical service is an integrated functionconsisting of treatment, evacuation, and supply, Colonel Neel maintained thatoptimal medical service could only be, achieved if directed solely byprofessional medical personnel. The interposition of an intermediate, nonmedicalheadquarters between responsible commanders and their medical resources couldonly reduce the quality of medical care available to troops. During the sameinterval, the USARPAC chief surgeon, Brigadier General (later Major General)Byron L. Steger, MC, had visited Vietnam and strongly recommended the release ofmedical service from logistical command and control.
The designated commanding officer of the medical brigade, Colonel (laterMajor General) James A. Wier, MC, nonetheless found that, upon his arrival inJanuary, no decision as to the placement of his command had been made. Under theCOSTAR II concept, medical service was visualized as a logistical service and,as such, belonged under FASCOM, the 1st Logistical Command. The FASCOMcommanding general, Major General Charles W. Eifler, was unconvinced of the needfor a medical brigade, preferring instead that medical groups be placed underthe operational control of the commanding officers of each of his three areasupport commands. In that manner, General Eifler believed, all logisticalsupport would be more responsive to the needs of the commanders of the twoField Force headquarters, and the mission of FASCOM best accomplished.
Since existing doctrine lent support to the position of General Eifler,Colonel Wier was made director of Medical Service and Supply on the GeneralStaff of the FASCOM commanding general on 26 January 1966. Colonel Conant, whohad previously occupied that position, was to remain 1st Logistical Commandsurgeon until the arrival of the medical brigade. In a March briefing attendedby Major General (later Lieutenant General) John Norton, Deputy CommandingGeneral, USARV, and General Eifler, Colonel Wier made a final attempt to havethe medical brigade assigned directly to USARV headquarters, but to no avail. Hesucceeded only in persuading all concerned that the senior medical officer inVietnam should be the USARV surgeon at the Army com-
14-15
CHART 2-MEDICAL COMMAND AND STAFF STRUCTURE, U.S. ARMY,VIETNAM, 1 NOVEMBER 1965-17 FEBRUARY 1966
16
ponent headquarters rather than the commanding officer of the medicalbrigade.
Thus, when the advance party of the 44th Medical Brigade, activated at FortSam Houston, Tex., on New Year's Day 1966, arrived in Vietnam on 18 March, itwas assigned to the 1st Logistical Command. A Medical Brigade (Provisional) wasestablished, consolidating in a single element command and controlresponsibility for medical units not organic to divisions and separate brigades-responsibilities formerly divided between the 43d and 68th MedicalGroups. As director of the
NOTES TO CHART 2
aAs is indicated above, the 58th Medical Battalion,senior Army-level medical unit in Vietnam from 30 May 1965 to 31 October 1965,retained considerable command and control jurisdiction after the 43d MedicalGroup became operational, although it was technically a subordinate unit ofthat group.
bThe 406th Mobile Medical Laboratory, based in Japan, was reorganizedon 24 September 1963 to include a mobile laboratory unit attached to USASGV.Envisioned as a Pacific Command-wide laboratory service for all U.S. militarymedical facilities, the 406th Mobile Medical Laboratory replaced and absorbedthe personnel and equipment of the 7th Medical Laboratory, previously operativein Vietnam. Throughout the Vietnam conflict, the 406th Mobile Medical Laboratoryremained under the command of USARJ (United States Army, Japan). While operatingin Vietnam, however, it was attached to and operationally controlled by variousin-country medical headquarters.
cOperational control of the 36th Medical Detachment (Dental Service),4th Medical Detachment (Veterinary Food Inspection), and 20th PreventiveMedicine Unit was retained by the 1st Logistical Command Surgeon.
dThe staff structure of the Office of the Surgeon, Headquarters, MACV,as of 31 December 1965. The consolidation of MAAGV and MACV Headquarters led toan expansion in the functions of the Office of the Surgeon, and culminated inthe staff organization depicted above. The MACV Surgeon's Office changed littlein subsequent years. Throughout the Vietnam conflict, Army medical staffs andheadquarters were directed to co-ordinate their activities with the MACVSurgeon's Office, although the latter was not an element in the command andcontrol chain for Army medical Units.
eThe staff structure of the USARV Surgeon's Office as of 31 December1965. The organizational structure was patterned after the reorganized USASCVMedical Section of 9-20 July 1965.
fOn 1 November 1965, a full-time USARV Dental Surgeon, with noadditional duties, was appointed. The commanding officer of the 36th Medical Detachment,who had previously performed that, advisory function as an additional duty,continued to wear a second hat as the 1st Logistical Command Dental Surgeon.
gThe commanding officer of the 4th Medical Detachment was alsoVeterinary Staff Officer in the Office of the Surgeon, USARV Headquarters, untilthat advisory function was delegated to lower headquarters, the 44th MedicalBrigade, in 1966.
hThrough 20 November 1965, the commanding officer of the 20thPreventive Medicine Unit served also as Preventive Medicine Officer on the staffof the USARV Surgeon. Thereafter, that position constituted a full-timeassignment.
iThe staff structure of the 1st Logistical Command MedicalDirectorate as of 31 December 1965. Emerging duplication in medical stafffunctions is reflected in the similarity between the organizations of the USARVSurgeon's Office and the Medical Directorate.
jBefore 26 January 1966, the Medical Director was also the 1stLogistical Command Surgeon. Both were additional duties performed by thecommanding officer of the 43d Medical Group, who retained his second position as1st Logistical Command Surgeon following the appointment of a full-time MedicalDirector on 26 January.
Sources: (1) Medical Activities Report, Office of theSurgeon, Headquarters, Military Assistance Command, Vietnam, 1965. (2) ArmyMedical Service Activities Report, Office of the Surgeon, Headquarters, UnitedStates Army, Vietnam, 1965, 1966. (3) Army Medical Service Activities Report,Medical Section, Headquarters, 1st Logistical Command, 1965. (4) Army MedicalService Activities Reports, Headquarters, 43d Medical Group, 1965 and 1966. (5)Army Medical Service Activities Reports, Headquarters, 58th Medical Battalion,1965 and 1966.
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FASCOM medical section and designated commanding officer of the incomingbrigade, Colonel Wier had paved the way for the assimilation of the LogisticalCommand's medical directorate personnel and functions into the Medical Brigade(Provisional).
The medical directorate was, at that time, charged with an inclusive mission:to develop, co-ordinate, and supervise medical plans and operations, medicalsupply and maintenance policies, medical statistics and records, professionalmedical and dental activities, preventive medicine, and medical regulatingactivities for all nondivisional medical units in Vietnam. Between 18 March and 1May, when the 44th Medical Brigade became operational, the responsibility forthe accomplishment of these functions was shifted from the directorate to thebrigade. The number of personnel staffing the FASCOM medical section graduallydiminished; some transferred to the Medical Brigade (Provisional), othersrotated. By 1 May, the only personnel left in the medical directorate were thedirector and a FASCOM staff medical section consisting of two plans officers,one supply and maintenance officer, one medical noncommissioned officer, and twoenlisted men. Five months later, the medical section had withered even further,and was thereafter maintained at Headquarters, 1st Logistical Command, forliaison purposes only. During its 6-week span, the Medical Brigade (Provisional)had served as a medium for transferring direct command and control of medicalunits from the 1st Logistical Command to the 44th Medical Brigade.
From 1 May 1966 through 9 August 1967, when the most rapid buildup of U.S.combat forces took place in Vietnam, the 44th Medical Brigade remainedsubordinate to the 1st Logistical Command. As combat forces expanded, medicalunits and personnel grew proportionately; by 31 December 1966, units assigned tothe medical brigade totaled 121, while assigned personnel increased from 3,187on 1 May to 7,830 by the end of the year.
Units and individuals under the centralized control of the 44th MedicalBrigade operated on a direct support/general support basis. Those providingcountrywide or general support services, such as medical laboratories, supplydepots, and preventive medicine units, were retained under the direct command ofHeadquarters, 44th Medical Brigade. Commanders of these general supportfacilities frequently held two posts, acting as staff officers at brigadeheadquarters. They were occasionally given a third hat as well, maintaining anoffice at USARV headquarters as staff advisers to the USARV surgeon.
Other units, particularly evacuation and treatment facilities, provided areaor direct support, and as such would be subordinated to one of the medicalgroups. Groups were in turn assigned geographic areas of responsibilityapproximately equivalent to doctrinal Army corps areas,
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and attached to one of three area support commands of the 1st LogisticalCommand for administration and logistics. Thus, when the 55th Medical Groupbecame operational in June 1966, it was attached to the Qui Nhon Area SupportCommand, assuming control over nondivisional medical units in II CTZ North. The43d Medical Group, previously responsible for medical service throughout II CTZ,retained that wider responsibility only for air evacuation. For all otheraspects of nondivisional medical care, the 43d Medical Group was responsibleonly for II CTZ South, supported in its mission by the Nha Trang (later Cam RanhBay) Area Support Command. Headquarters, 68th Medical Group, remained thecommand and control element for units in III and IV CTZ, and was, along withHeadquarters, 44th Medical Brigade, and all general support units, attached tothe Saigon Area Support Command for administration and logistics. (Chart 3)
In his assigned area, the group commander would act as the support commandsurgeon, providing first-echelon medical care for nondivisional andnonaviation units, plus evacuation and second-echelon medical treatment for allU.S. Army and other authorized personnel. Medical regulating within the CTZwould be controlled from his group headquarters, with all hospitalization andair ambulance units kept directly under group command. In most cases, however, aseparate medical battalion headquarters would be used as the command element forground ambulance, clearing, and dispensary units.
Had all medical command and control been vertically integrated, that systemof area medical service might have been most efficient. However, the separationof administrative and logistical support from command, in conjunction with theexistence of an intermediate, nonmedical headquarters between medicalpractitioners in the field and consultants in the USARV surgeon's office,created duplicative, overlapping, and confusing channels of communication.Administrative support was often confused with command responsibility, withactions of the former type following a communications channel from the supportcommand directly to Headquarters, 1st Logistical Command, completely bypassingHeadquarters, 44th Medical Brigade. The resultant lack of responsiveness toadministrative problems on the part of the Commanding Officer, 44th MedicalBrigade, an officer on the same command level as the commanding officers of eacharea support command, was inevitable, although difficult to explain to theCommanding General, 1st Logistical Command.
Similarly, the inability of hospital and medical group commanders toaccomplish required personnel changes in their commands limited theeffectiveness of medical service. Professional consultants assigned to the USARVsurgeon's office, following visits to treatment facilities, made recommendationsdirectly to the USARV surgeon or brigade personnel
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officer. Medical officers, on that basis, were subsequently transferred amonginstallations and support areas, frequently without the foreknowledge ofaffected hospital and medical group commanders.
Duplication of Effort: Headquarters, 44th Medical Brigade, Versus theOffice of the Surgeon, Headquarters, USARV
Much, if not all of that confusion, could have been eliminated through aconcise delineation of the responsibilities of Headquarters, 44th MedicalBrigade, vis-a-vis the USARV surgeon's office. In theory, the former should havebeen responsible for the day-to-day operations of all nondivisional medicalservices in Vietnam; the latter, for long-range plans and operations. Inreality, those functions could not be so easily segregated.
In addition to those responsibilities earlier transferred from the 1stLogistical Command medical directorate to the medical brigade, the duties of thebrigade commander included all in-country communications among nondivisionalmedical units; the evaluation and dissemination of medical intelligence; andprovision for the security of all medical forces assigned to the 1st LogisticalCommand.
The mission of the USARV surgeon, originally less broad with respect to theoperations of nondivisional medical service than that of the 1st LogisticalCommand surgeon, rapidly outpaced that of the commanding officer of the 44thMedical Brigade. On 10 June 1966, Colonel Wier became USARV surgeon, and commandof the brigade was transferred to Colonel Ray L. Miller, MC. Exactly 5 monthslater, Colonel Wier received his first star. Although, when serving as brigadecommander, he had expressed the desire to reduce if not eliminate the USARVsurgeon's office, Brigadier General Wier found it necessary to double the sizeof his office staff over the next year. As U.S. Army forces and their organicmedical units expanded, so, of course, did the workload of the surgeon assignedto headquarters of the Army component. However, part of the growth in the USARVsurgeon's office was the result of an increasing volume of paperwork,principally planning, accomplished at the Army level. Much of that planning wasdemanded of General Wier by G-3, Assistant Chief of Staff for Plans andOperations, Headquarters, USARV. Because of the time lag involved, General Wierfound co-ordination with Headquarters, 44th Medical Brigade, difficult and wastherefore unwillingly forced to increase the staff of his plans and operationsdivision. Other responsibilities such as collecting and compiling medicalstatistics were added to his office during the year, and could not be delegatedto lower headquarters. Professional activities and consultants had to remain atthe Army level for, in addition to visit-
20-21
CHART 3-MEDICAL COMMAND AND STAFF STRUCTURE, U.S. ARMY,VIETNAM, 1 MAY
1966-10 AUGUST 1967
22
ing hospitals, they provided consultant services for organic medical units indivisions outside the purview of the 44th Medical Brigade.
The confusion in command and control, support, and co-ordination that ensuedwas documented in a position paper prepared by General Wier in June 1967. Notingthat the USARV surgeon was not only the senior medical officer, but was alsoassisted by the most competent medical consultants in Vietnam, General Wierargued for the placement of the 44th Medical Brigade directly underHeadquarters, USARV. To do so would make the highest level of medical skilldirectly and immediately available to all medical units; a level of skill farbeyond that available to the Commanding General, 1st Logistical Command, underthe existing organization. Advantages resulting from the removal of the medicalbrigade and subordinate units from the intermediate logistics headquarters wouldbe numerous: reinforcement of the medical service of tactical units could bemore rapidly effected, and personnel economies could be realized through therealignment of duplicative staffs in higher and lower medical headquarters andthrough the elimination of the 1st
NOTES TO CHART 3
aDeployment of medical groups as of 1 July 1966.When the 68th Medical Group became operational on 18 February 1966, it becamethe higher headquarters for, and assumed the former command and controlresponsibilities of the 58th Medical Battalion. The 55th Medical Group becameoperational on 1 July 1966, assuming control over nondivisional medical units inthe northern portion of II CTZ. The 43d Medical Group remained the command andcontrol element for units in the southern portion of II CTZ. It acted in thesame capacity for the 6th Convalescent Center, operational at Cam Ranh Bay since16 May 1966, although doctrine specified that the facility be assigned directlyto Headquarters, 44th Medical Brigade. All Medical Groups were further attachedfor administration and logistics to the headquarters of the various area supportcommands, subordinate commands of the 1st Logistical Command.
bOn 1 August 1966, Headquarters, 9th Medical Laboratory becameoperational in Saigon. Thereafter, it acted as the control element for allmedical laboratories in Vietnam, including the 406th Medical Mobile Laboratory.
cAttached for administration and logistics.
dUpon becoming operational in Saigon on 27 December 1965, the 932dMedical Detachment (AI) became the command and control element for dental unitsin Vietnam.
eThe staff structure of the USARV Surgeon's Office as of 31 December1966.
fUntil 9 March 1967, the Chief Nurse, USARV Surgeon's Office, alsoacted as Staff Nurse, Headquarters, 44th Medical Brigade. From 9 March to 27September, the latter position was occupied on a full-time basis by an ANCofficer.
gThe staff structure of the 1st Logistical Command MedicalDirectorate as of 1 October 1966.
hThe primary duty of the 1st Logistical Command Medical Director wasCommanding Officer, 44th Medical Brigade.
iThe staff structure of Headquarters, 44th Medical Brigade, as of 31December 1966. In general, the organization differed in structure from that ofthe Medical Brigade (Provisional) only in the addition of two officers to theBrigade Commander's staff: (1) The Dietary Staff Adviser; and (2) the StaffNurse.
jOn 6 June 1966, the Brigade Staff Veterinarian was appointed toadditional duty as Veterinary Consultant to the USARV Surgeon.
kThe primary duty of the 44th Medical Brigade Dental Surgeon wascommanding officer of the 932d Medical Detachment (Dental Service).
Sources: (1) Army Medical Service Activities Reports,Office of the Surgeon, Headquarters, United States Army, Vietnam, 1965, 1966,and 1967. (2) Army Medical Service Activities Report, Headquarters, 44th MedicalBrigade, 1966. (3) Interview, Brigadier General James A. Wier, MC, USARV Surgeon,and Captain Darrell G. McPherson, MSC, 17 June 1967.
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Logistical Command medical directorate. Perhaps most importantly, thecentralized control of all Army medical assets in Vietnam would permit the mostefficient use of critical, scarce resources. Their optimal utilization would beassured by vesting in the senior medical officer in Vietnam, the USARV surgeon,full command and control responsibility.
With the exception of G-1, Assistant Chief of Staff for Personnel, allmembers of the USARV General Staff concurred in General Wier's proposal. Thelone demurral argued that placing the medical brigade directly under USARVheadquarters would cause the latter to become a support command, rather thanthe command and control headquarters for a true field army. General Wier's paperwas returned without action, and before the proposal could be resubmitted, hereturned to the United States, replaced as USARV surgeon by Brigadier General(later Major General) Glenn J. Collins, MC.
The effort to elevate the 44th Medical Brigade to the field-army level ofcommand did not subside, and events of the first 2 weeks of General Collins'tour as USARV surgeon were to conspire to make that effort successful. As theresult of decisions made elsewhere, space ceilings were placed on USARV in July1967, bringing about a total reevaluation of the Army medical service inVietnam. After a careful examination of the over-all Army medical supportstructure, the Office of the Surgeon concluded that spaces could be deletedfrom the division medical service. To do so, however, would make it mandatorythat the USARV surgeon have complete and direct control over all medicalresources. Otherwise, the immediate reinforcement of divisional medical unitscould not be guaranteed.
On 2 August 1967, a final realignment study including these qualificationswas presented by General Collins to the USARV General Staff. More explicit thanthe June proposal, it listed in detail both the advantages of assigning the 44thMedical Brigade directly to USARV, as well as the disadvantages of leaving thebrigade directly under the 1st Logistical Command. Two points were, for thefirst time, emphasized: the reduction in delays in medical planning and medicalstatistical reporting, and in implementing the recommendations of professionalconsultants; and the greater ease in the management of medical personnel to berealized by assigning the brigade directly to USARV headquarters.
Nondivisional Command and Staff Relationships: 1967-71
The need could no longer be denied. On 10 August 1967, the 44th MedicalBrigade was released from the 1st Logistical Command and reassigned directly toUSARV as a major subordinate unit. (Chart 4) The efforts of the last 2years were rewarded; the arguments of
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CHART 4-MEDICAL COMMAND AND STAFF STRUCTURE, U.S. ARMY,VIETNAM, 10 AUGUST
1967-1 MARCH 1970
26
General Heaton, General Steger, General Wier, General Collins, and ColonelNeel, validated. The Army medical service in Vietnam became in effect what itwould become in later years in name-a unified medical command.
The Medical Brigade as a Major Subordinate Command of USARV Headquarters
General Collins assumed the dual role of Surgeon, USARV, and CommandingGeneral, 44th Medical Brigade. Although technically excluded in the formercapacity from operational control over nondivisional medical units, he wasnonetheless able to exercise full command and control responsibilities in hisother position as brigade commander.
As USARV surgeon, General Collins and his staff were charged with fivegeneral responsibilities: to advise the USARV commander on all matters regardingthe health of the command; exercise technical supervision over all medicalactivities of the command; plan to assure the availability of adequate medicalsupport in the command; control the assignment and use of medical personnel inVietnam; and manage medical supply and maintenance functions. As applied tonondivisional medical service, these were interpreted as responsibilities formedium- and long-range planning, the development of theater-wide medicalplanning factors, and the monitoring of co-ordination between the 44th MedicalBrigade and supported units.
Meanwhile, Headquarters, 44th Medical Brigade, assumed responsibility forprograms not originally envisioned for a field medical unit, in-
NOTES TO CHART 4
aThe maximum deployment of medical groups in Vietnam, a situation existingfrom 23 October 1967, when the 67th Medical Group became operational, to the 15June 1969 deactivation of the 55th Medical Group. Originally headquartered inIII CTZ, the 67th Medical Group relocated in I CTZ early in 1968.
bThe 522d Medical Detachment (AF) became operational on 10 April 1968,assuming control over all veterinary TOE units in Vietnam.
cThe 172d Preventive Medicine Unit became operational under reduced strengthon 1 August 1968. It was not subordinated to the 20th Preventive Medicine Unit,but rather assigned directly to Headquarters, 44th Medical Brigade. Both the172d and 20th Preventive Medicine Units acted as control elements for preventivemedicine detachments in Vietnam, the former for those operative in I and II NCTZ, the latter for units in II S, III and IV CTZ.
dThe staff structure of the USARV Surgeon's Office as of 31 December 1969.
eThe staff structure of Headquarters, 44th Medical Brigade as of 31 December1968.
fThe Commanding General of the 44th Medical Brigade was also USARV Surgeon.
gThe 44th Medical Brigade Veterinary Officer was also USARVVeterinarian.
hThe 44th Medical Brigade Dietary Staff Adviser performed additional duty asDietetic Consultant in the USARV Surgeon's Office.
iThe 44th Medical Brigade Dental Surgeon was also USARV Dental Surgeon.
jThe 44th Medical Brigade Preventive Medicine Officer was also USARVPreventive Medicine Officer.
kThe 44th Medical Brigade Chief Nurse was also Chief Nurse, USARV Surgeon'sOffice.
Sources: (1) Army Medical Service Activities Reports, Office of theSurgeon, Headquarters, United States Army, Vietnam, 1965, 1967, and 1969. (2)Army Medical Service Activities Report, Headquarters, 44th Medical Brigade,1968.
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cluding an awards program, command maintenance inspections, and supervisionof special services activities. Other responsibilities of the brigade commanderand his staff were more limited than those of the USARV surgeon, includingin-country medical regulating and the short-term planning of day-to-dayoperations involving army level medical support.
The similarity in functions performed by these two medical staffs producedboth advantages and disadvantages. Personnel economies were realized, and thedegree of co-ordination between higher and lower headquarters enhanced, butconsiderable confusion remained as to the precise staff functions to beperformed at each level, especially with respect to operationalresponsibilities.
In addition to the surgeon/brigade commander, the dental surgeon, chiefnurse, veterinary officer, preventive medicine officer, entomologist,dietitian, and aviation staff officer sat on both staffs, eliminating severalduplicate slots. Further, personnel consultants on the USARV surgeon's staff nowhad direct access to medical treatment facilities of the brigade, contributingto improved relations between surgeons and medical commanders at all levels. Thegreater ease of co-ordination which these staffing arrangements permitted washeightened by the shift in location of brigade headquarters from Tan Son Nhut toLong Binh late in September 1967. The proximity of the two headquarters addedmaterially to the freedom of communications between the two staffs. As GeneralNeel, successor to General Collins as USARV surgeon/brigade commander,emphasized, good communications were essential to the success of army levelmedical service in Vietnam.
All forms of co-ordination between the two staffs were not enhanced by theassignment of the medical brigade directly to USARV headquarters, however. Inan attempt to delineate the proper role of S-3, Plans and Operations, the USARVOrganization and Functions Manual was amended in December 1968, and the name ofthe USARV surgeon's Plans and Operations Division changed to the Plans,Programs, and Analysis Division. That abortive attempt to more preciselydescribe the division's functions created more confusion than order, and itreverted to the original designation the following year. In short, under theexisting medical structure in Vietnam, no better description of proper stafffunctions could be made on the simple statement: the brigade staff were theoperators; the surgeon's staff, the advisers and long-range planners.
Establishment of the U.S. Army Medical Command, Vietnam
Duplicative staff functions, the last major area of deficiency in the medicalcommand and control structure in Vietnam, were eliminated in 1970 with thecreation of USAMEDCOMV (U.S. Army Medical Com-
28
mand, Vietnam) (Provisional). The previous year had been one of majorreorganization, consolidation, and realignment of 44th Medical Brigade units.Headquarters, 55th Medical Group, had been deactivated on 15 June. The 43dMedical Group then assumed command and control over all 55th Medical Group unitsin II CTZ, but was itself scheduled for deactivation in the spring of 1970. WhenHeadquarters, 43d Medical Group, was reduced to zero strength, the 67th MedicalGroup, which had become operational in October 1967 and had assumed command andcontrol over nondivisional units in I CTZ, became the command and controlelement for medical units in II CTZ as well. Throughout, the 68th Medical Groupexercised responsibility for nondivisional medical service in III and IV CTZ
Reorganization and consolidation of medical staffs proceeded in tandem withthat of field units. A review of functions performed by the USARV surgeon'soffice and the 44th Medical Brigade headquarters suggested that, if the twostaffs were combined, duplication and overlap could be eliminated. Accordingly,Brigadier General David E. Thomas, MC, USARV surgeon/brigade commander,appointed a study group to determine the feasibility of such a move. A loneadmonition guided their study: that the prospective consolidation of staffs andfunctions result in no loss in the efficiency of medical service in Vietnam.
A basic organization and function for the unified medical command wasderived from the finding of the study group. The 44th Medical Brigade would beeliminated, with all command and control responsibilities absorbed by themedical command. The USARV surgeon would assume the role of Commanding General,USAMEDCOMV. Similarly, the Deputy Commander, USAMEDCOMV, would serve as theUSARV deputy surgeon. Manpower spaces would be eliminated in the offices of theUSAMEDCOMV dental surgeon and veterinarian, officers who had formerly maintainedstaffs in both medical headquarters. In total, the study revealed that manpowercould be reduced by 17 percent with no loss in functional efficiency through theproposed consolidation of medical staffs. Based on these projected results, thestudy further recommended that, in the future, the dual function concept of thesurgeon as commander of the major surbordinate medical unit be retained, andconsidered on all levels as a method of reducing manpower requirements andachieving the best utilization of all scarce medical resources.
On 1 March 1970, Headquarters, 44th Medical Brigade, was consolidated withthe USARV surgeon's office, forming the USAMEDCOMV (Provisional). (Chart 5)That command continues to provide field-army-level medical service throughoutVietnam. Most of the co-ordination and logistics problems associated with theArmy medical structure in Vietnam have been eliminated, and benefits have beenachieved through a
29-30
CHART 5-MEDICAL COMMAND AND STAFFSTRUCTURE, U.S. ARMY, VIETNAM, 1 MARCH 1970
31
reorganization that has resulted in a medical command structure curiouslysimilar to that which prevailed before the buildup of U.S. combat forces.Duplication of efforts in the functional areas of command, including dental andveterinary control, administration, and plans and operations, has beeneliminated. Manpower requirements have been reduced without degrading theefficiency of medical operations. More importantly, the responsiveness andflexibility of the command to changes in medical support requirements haveimproved, perhaps the ultimate test of the value of Army medical service in thetheater of operations.
NOTES TO CHART 5
aThe deployment of Medical Groups in Vietnam has continued despite thereduction of zero personnel strength and equipment status of the 43d MedicalGroup on 7 February 1970.
bSupport areas in Vietnam are now referred to as Military Regions (MR)rather than Corps Tactical Zones (CTZ). The geographic regions thus specifiedare similar to, although not identical with, the CTZ's of earlier years.
cThe staff structure of Headquarters, Medical Command (Provisional) as of 1March 1970.
Sources: (1) Army Medical Service Activities Reports, Office of theSurgeon, Headquarters, United States Army, Vietnam, 1965 and 1969. (2)Operational Report, Lessons Learned of the United States Army Medical Command,Vietnam (Provisional) for Period Ending 30 April 1970, Headquarters, UnitedStates Army Medical Command, Vietnam (Provisional), 15 May 1970.
