CHAPTER IV
Hospitalization and Evacuation
The peculiar nature of counterinsurgency operations in Vietnam requiredmodification of the usual concepts of hospital usage in a combat area. There wasno "front" in the tradition of World War II. The Amy checkered thecountryside with base camps. Although any one of these might become abattlefield, the base camp was relatively secure unless it was under attack.Semipermanent, air-conditioned, fully equipped hospitals were constructed at anumber of these camps. In contrast to World War II and the Korean War, thehospital did not follow the advancing army in direct support of tacticaloperations. All Army hospitals in Vietnam, including the MUST (Medical Unit,Self-contained, Transportable) units, were fixed installations with area supportmissions. Since there was no secure road network in the combat area of Vietnam,surface evacuation of the wounded was almost impossible. Use of the fiveseparate companies and five detachments of ground ambulances sent to Vietnam waslimited largely to such functions at base camps as transportation between thelanding strip and the hospital or the routine transfer of patients betweenneighboring hospitals when roads were secure. Air evacuation of the injuredbecame routine.
Getting the casualty and the physician together as soon as possible is thekeystone of the practice of combat medicine. The helicopter achieved this goalas never before. Of equal importance was that the Medical Department was gettingthe two together in a hospital environment equipped to meet almost anysituation. The degree of sophistication of medical equipment and facilitieseverywhere in Vietnam permitted Army physicians to make full use of theirtraining and capability. As a result, the care that was available in Armyhospitals in Vietnam was far better than any that had ever been generallyavailable for combat support. The technical development of the helicopterambulance, a primitive version of which had been used to a limited extent in theKorean War, the growth of a solid body of doctrine on air evacuationprocedures, and the skill, ingenuity, and courage of the aircraft crewmen andmedical aidmen who put theory into practice in a hostile and dangerousenvironment made possible the hospitalization and evacuation system that evolvedin Vietnam. The system worked effectively because it was compatible with thecharacteristics of warfare in that country.
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Hospitalization
Until April 1965, the 8th Field Hospital at Nha Trang with a 100-bed capacitywas the only U.S. Army hospital in Vietnam. Housed in fixed semipermanentquarters, the 8th Field was fitted with a combination of field and"stateside" equipment and operated in a manner similar to a stationhospital. Attached to it were four medical detachments which provided specialtycare but were totally dependent on the hospital for administrative andlogistical support.
In October 1963, the Navy opened a dispensary in Saigon which removed thatcity, as well as III and IV CTZ's to the south, from the hospitalizationresponsibility of the 8th Field Hospital. It remained responsible only for thelarge area encompassed by II CTZ.
Because of the limited number of Army hospital beds in Vietnam to supportthe buildup of U.S. combat forces in 1965, a variable 15- to 30- day evacuationpolicy was established by the Surgeon, USMACV. By mid-1966, the number of bedshad increased sufficiently to permit a change to a 30-day policy. Patients whocould be treated and returned to duty within 30 days were retained in Vietnam;patients requiring hospitalization for a longer period were evacuatedout-of-country as soon as their medical condition permitted.
In the development of the medical troop list, the length of the evacuationpolicy did not weigh as heavily as the patient treatment capability requiredin-country. Among the factors which affected the normal book planning ofallocations were the lack of data on the number and types of foreseeablecasualties in counterinsurgency operations, the insecure ground lines ofcommunication, and the wide separation of secure base areas. No single factorhad as great an influence in determining the number of hospital beds required asthe policy approved by USMACV to keep 40 percent of the operational bedsavailable to support unexpected surges in the casualty flow resulting fromhostile actions. The occupancy rate exceeded 60 percent on two occasions: duringMay 1967 when it briefly approached 67 percent, and for a 24-hour period duringthe Tet Offensive in February 1968, when it again increased to more than 65percent.
Between April 1965 when the 3d Field Hospital arrived in Saigon and Decemberof that year, two surgical hospitals, two evacuation hospitals, and severalnumbered field hospital units, which were initially co-located with the 8thField Hospital in Nha Trang and the 3d Field Hospital in Saigon, were deployedto Vietnam. By the end of 1965, the total number of hospital beds in-country hadincreased to 1,627.
Throughout 1965, separate clearing companies were at times usedinterchangeably with hospitals. Augmented by specialty teams, platoons
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of these companies often preceded or supplanted hospitals, providing limitedcare within an area until more adequately staffed and equipped units arrived.Field-army-level clearing units were also used to augment hospitals and provideadditional bed space. Dispensaries sometimes supplemented the resources of majorhospitals and at other times provided outpatient service in remote areas.
The deployment of additional hospitals to Vietnam continued throughout 1966and 1967. During 1966 and 1967, four surgical hospitals, six evacuationhospitals, and another hospital unit of a field hospital arrived in-country. The6th Convalescent Center was established at Cam Ranh Bay.
The buildup of medical units was completed in 1968 with the arrival of onesurgical hospital, three evacuation hospitals, and additional field hospitalunits, as well as 11 Reserve and National Guard medical units. The 312thEvacuation Hospital, the largest Reserve medical unit sent to Vietnam, arrivedin September 1968, and occupied a facility the 2d Surgical Hospital had operatedat Chu Lai. By December 1968, there were 5,283 Army hospital beds in Vietnam atfacilities located throughout the four corps tactical zones. (Map 2)
With the exception of the 2d Surgical Hospital which moved from An Khe to ChuLai on 8 May 1967 to support Task Force OREGON, the movement of hospitals wasminimal before 1968. The problems encountered by the 22d Surgical Hospital inits move from Da Nang to Phu Bai were illustrative of the difficulties of movingmedical facilities in the Vietnamese environment. The hospital was moved by LST(landing ship, tank) from Saigon to Da Nang. Enemy activity closed the roadbetween Da Nang and Phu Bai, stranding the unit for several days while itawaited air transportation. The number of sorties required to complete themovement resulted in an even further delay.
The policy which called for minimal movement of hospitals was modifiedsomewhat in 1968 and, to a greater extent, in 1969. The 22d Surgical Hospitaland other medical units were sent to Phu Bai. The 18th Surgical Hospital wasmoved to Quang Tri, to Camp Evans, and back to Quang Tri. The 17th FieldHospital departed Saigon to operate in An Khe. The 27th Surgical Hospital wassent to Chu Lai after it came in-country, while the 95th Evacuation Hospitalfunctioned in two different parts of Da Nang. The 29th Evacuation Hospital wasestablished at Binh Thuy to support operations in the Delta, but was laterdeactivated and its facilities taken over by the 3d Surgical Hospital after ithad moved from Dong Tam. The 91st Evacuation Hospital went to Chu Lai after theunit had built a facility near Tuy Hoa. The 85th Evacuation Hospital departedQui Nhon for Phu Bai.
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Among other moves, the 2d Surgical Hospital remained temporarily at Chu Lai,then selected personnel deployed to Phu Bai to operate a 100-bed U.S. Armyhospital (provisional) in facilities previously operated by the Marines. Theprovisional hospital was opened to retain the real estate and provide continuedmedical coverage in Phu Bai until a larger hospital could be constructed. Whenthe 85th Evacuation Hospital took over in Phu Bai, the 2d Surgical Hospitalmoved to Lai Khe.
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To a certain extent these moves were made to support increased Army combatactivity in I CTZ and elsewhere, but they were not in support of tacticaloperations in the tradition of World War II and the Korean War. Except for theinterim use of MUST equipment or existent buildings, the moves were made intosemipermanent construction and were far more deliberate and complicated than themovement of tent-housed hospitals in previous conflicts. To a far greater extentshifts in 1968 and 1969 were the result of the deactivation of units and theconsolidation of areas of support.
Construction
The construction of a modern hospital is a lengthy and complicated process.Line officers, medical staff planners, and hospital commanders soon found thatmany time-consuming, frustrating problems had to be resolved before constructioncould start.
Real estate was generally acquired in large sections for military use andthen parceled out to the units needing it. Negotiations for a hospital site wereoften protracted. For example, the need for an evacuation hospital in the Pleikuarea was recognized long before the area was secure enough to permitconstruction. Meanwhile, the original allocation of land for this use had beenlost, and new negotiations were opened with the commander of the Vietnamese IICorps and the U.S. Air Force. It was some time before an agreement for suitableland was again reached and the contractor could begin work on the 71stEvacuation Hospital.
Hospitals were built in a wide variety of configurations, and constructionwas accomplished in almost as many ways as there were hospitals. Somestructures, for example, the 91st Evacuation Hospital at Tuy Hoa, were builtalmost entirely by medical personnel with some technical advice from the Corpsof Engineers. Some were started by contractors and finished by the Corps ofEngineers. Medical personnel did some phase of the construction work inalmost all the hospitals, but some work by contractors or engineers was neededin almost all cases to put in wiring, electrical fixtures, and heavy equipment.
In October 1965, the USARV surgeon and engineer established a policy forspace utilization and prepared guidelines to govern hospital construction. Thispolicy was disseminated in a USARV regulation which stated that patient wards,operating suites, and X-ray facilities were to be located in air-conditionedsemipermanent structures. The use of these structures for medical purposes wasto take precedence over that for troop billets, recreational areas, andadministrative sections.
The improvement of existing medical facilities as well as the construction ofnew units continued to receive much attention during 1966 and 1967. Strictcontrols were placed on construction, and the position
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of base development co-ordinator was established at USARV headquarters. Thebase development co-ordinator was to evaluate the condition of hospitals andother medical treatment facilities, determine construction requirements,establish priorities, and limit or stop construction projects if duplication ofeffort was disclosed. Hospital construction was assigned a priority second onlyto the requirements of tactical units and communication centers.
The construction of dispensaries and dental clinics was given a lowerpriority. Adequate control had been established over the construction ofarmy-level (separate) dispensaries, general dispensaries, and dental clinics,but control over the construction of unit dispensaries was initially inadequate.Some units constructed elaborate facilities, often located adjacent to anotherdispensary or hospital. Controlling these actions was difficult because of themaze of channels through which requests for construction were forwarded andapproved. After appointment of the base development co-ordinator, these wastefuland uneconomical practices were greatly reduced.
Climate and weather created special problems in site selection andpreparation. Buildings flooded during the monsoon rains, requiring extensivedike building and ditch digging to preclude a recurrence. Roads had to behard-surfaced to be passable during the wet season. Grounds had to be seededwith grass to keep the dust down during the dry season.
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Heavy-duty construction equipment itself had to be specially prepared towithstand the dust, mud, humidity, and intense heat.
Electrical power was limited in the cities and lacking in the countryside.Generators were installed to provide the vast quantities of current needed forlighting, air-conditioning units, and the electrically powered equipment of amodern hospital. Water was equally limited. Wells were dug or water piped in tofurnish the running water needed for bathing, laundry, sterilization ofequipment, and operation of flush toilets. Equipment was installed to make thewater potable.
Through the concerted effort of contractors, the Corps of Engineers, andmedical personnel, these handicaps were overcome and a series of superbhospitals capable of providing the finest care in every branch of medicine andsurgery was established in Vietnam. After returning from Vietnam in 1968,General Collins commented, "Our hospitals in Vietnam are not evacuationhospitals, surgical hospitals, or field hospitals. They are more than that andconsequently require sophisticated equipment . . . . We are all interested inproviding the best care possible. At present we have some items of equipment inVietnam that equal what you have at Walter Reed."
Special Units
MUST-equipped surgical hospitals were operated for several years in Vietnamwith mixed success. These units consisted of three basic elements, each of whichcould be airlifted and dispatched by truck or helicopter. The expandablesurgical element was a self-contained, rigid-panel shelter with accordion sides.The air-inflatable ward element was a double-walled fabric shelter providing afree-space area for ward facilities. The utility element or power packagecontained a multifuel gas turbine engine which supplied electric power forair-conditioning, refrigeration, air heating and circulation, water heating andpumping, air pressure for the inflatable elements, and compressed air orsuction. In addition, other expandables were used for central materiel supply,laboratory, X-ray, pharmacy, dental, and kitchen facilities.
By 20 October 1966, personnel and MUST equipment of the 45th SurgicalHospital had all arrived in-country. Work was begun on ground preparation andconstruction of quarters and a mess a few miles west of Tay Ninh. The utilitypacks and operating rooms and central materiel expandables had been moved nextto the site when it was hit by mortars on 4 November and its commander, MajorGary P. Wratten, MC, was killed.
Two days later the hospital was ordered to become operational as soon aspossible to support Operation ATTLEBORO, then in progress northeast of Tay Ninh.An emergency surgical capability and a 20-
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45th Surgical Hospital at TayNinh, 1967
patient holding capacity was completed on 8 November. The rest of thehospital was ready to open on 11 November when three more mortar attacks delayedoperations until 13 November, when the hospital received its first casualties.
Lieutenant Colonel (later Colonel) Thomas G. Nelson, MC, MUST professionalconsultant to The Surgeon General, reported in 1967 that, during the earlyperiod of its operation, the 45th Surgical Hospital operated as a true forwardsurgical hospital; that is, patients were not held for followup surgery orprolonged treatment.
Commenting on the relationship between helicopter evacuation and theemployment of a forward surgical hospital, he continued:
As was true of other hospitals in Vietnam, patients weremoved directly from the battlefield either to a clearing station or a nearbyhospital. . . . Most patients arrived at the hospital within 10 minutes ofpickup, and some of these were in such critical condition, usually from internalbleeding or respiratory problems, that further evacuation even by helicopterwould likely have been fatal. . . .
Patients were moved from the helicopter pad directly into thepreoperative and resuscitation shelter where they were met by the surgical teamon-call and the registrar section to initiate resuscitation and medical records.Patients were nearly always admitted in groups of from three to ten, andsurgical priorities were established as blood administration and otherstabilizing measures were employed and X-ray and laboratory determinationsobtained.
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The performance of the 45th Surgical Hospital led to the accelerateddeployment of MUST equipment for three additional surgical hospitals in 1967:the 3d, 18th, and 22d. In 1968, the 95th Evacuation Hospital was temporarilysupplemented with some MUST equipment until the construction of a fixedfacility was completed. The 2d Surgical Hospital arrived in Vietnam in 1965 andhad a long history of distinguished service before becoming the last unit to beequipped with MUST in January 1969. Meanwhile the Marine Corps was also usingMUST equipment.
All medical facilities were vulnerable to enemy attack. On 4 and 11 November1966, the 45th Surgical Hospital was subjected to mortar attacks. The 3dSurgical Hospital underwent a 15-minute mortar barrage on 24 July 1967, withdirect hits on the bachelor officers' quarters and the MUST maintenance hut.Near misses caused extensive damage to practically all inflatable elements. Nopatients were wounded, although 18 members of the hospital staff received minorwounds. During 1968, the 3d Surgical Hospital underwent 13 attacks whichresulted in damage to the hospital area. On 5 and 6 March the hospital sufferedextensive damage from mortar and recoilless rifle fire. The headquarters andchapel were completely flattened; the dental clinic, X-ray, laboratory, medicallibrary, medical supply building, and nurses' quarters were all damaged. Theintensive care ward and postoperative ward were heavily damaged or destroyed.During this 2-day period, no patients were wounded, although three staffmembers received minor fragment wounds. Repairs were completed quickly and thehospital remained operational throughout.
Until mid-1968, most field-army-level medical facilities, including MUSTunits, were not mobile. The 45th and 3d Surgical Hospitals remained stationaryafter the initial emplacement of MUST equipment. Billets, messhalls, and storageareas were constructed to support the units. Revetments were raised around allinflatable MUST components to make them less vulnerable during attacks.Difficulties in relocating the 18th and 22d Surgical Hospitals earlier in 1968demonstrated the need to retain mobility. Thus, late in 1968, the USARV surgeoninstituted a policy that two MUST surgical hospitals would retain all equipmentnecessary to be completely mobile and that drills would be held frequently tokeep hospital personnel trained to displace, move, and emplace their hospitalsrapidly. The 2d and 18th Surgical Hospitals were designated as"mobile" MUST's.
While MUST equipment was an important addition to the inventory of MedicalDepartment assets, it was not used in accordance with doctrine. Its"transportable" attribute was not exploited. Because hospitalssupported operations from fixed locations, emphasis was placed on the
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selection of a hospital site in a reasonably secure area. Proximity totactical operations was a consideration only in the sense that the hospital hadto be within reasonable air-evacuation time and distance. Hospitals had to bemoved only when major tactical forces shifted to open new areas of operations,such as, for example, the large-scale buildup of U.S. Army forces in I CTZduring 1968. MUST equipment was a link in such hospital relocations. Pending theconstruction of fixed facilities in new areas, MUST hospitals provided thecontrolled environment and the other resources needed for high-quality patientcare. As air-conditioned fixed hospitals were completed, the need for MUSTequipment diminished. In late 1969, the MUST equipment was withdrawn from the3d, 18th, and 22d Surgical Hospitals, leaving only two hospitals so equipped.The 3d and 18th Surgical Hospitals were re-established in semipermanentfacilities and the 22d Surgical Hospital redeployed to the continental UnitedStates. The 2d and 45th Hospitals were closed out in 1970.
The convalescent center. During the visit of The Surgeon General,Lieutenant General Leonard D. Heaton, to Vietnam in early November 1965, GeneralWestmoreland strongly recommended that a convalescent center be established inVietnam as soon as possible. Malaria was increasing among U.S. forces, and toomany patients suffering from malaria or hepatitis were being evacuated out ofthe country because they could not be hospitalized and returned to duty withinthe USARV 30-day evacuation policy. General Heaton accepted this recommendationand directed that a convalescent center be established.
The 6th Convalescent Center was activated on 29 November 1965, deployed toVietnam during March and April 1966, and received its first patients on 15 May.The center was located at Cam Ranh Bay, adjacent to the South China Sea. Itsmission was to provide convalescent care for medical and surgical patients,including combat wounded. After a year of operation, approximately 7,500patients had been admitted to the center from all areas of the country. Thepatient census averaged more than a thousand a month, with malaria constituting50 to 65 percent of all admissions. Other admissions included hepatitis patientsand those requiring longer periods of postoperative care than 30 days.Approximately 96 percent of all admissions were returned to duty-during anaverage month, the equivalent of one to two battalions.
Prisoner-of-war hospitalization. During 1965, POW (prisoner-of-war)patients captured by U.S. forces were treated in U.S., medical facilities in thearea where they were apprehended. Because of an increase in the number ofprisoners, this policy was changed in early 1966. Special medical facilities forthe care of prisoners of war, operated by two clearing companies, wereconstructed at Long Binh and Phu Thanh (near Qui Nhon). Initial major surgeryand postoperative care continued to be
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provided by an Army hospital before the POW patient was moved to a clearingfacility. This system created a number of problems. It reduced the number ofbeds available for U.S. soldiers, mixed prisoners of war U.S. patients, andrequired a large number of guards. To alleviate these problems, both clearingfacilities were expanded by semipermanent construction into 250-bed hospitalswith complete surgical resources.
During 1968, the POW patient load increased from an average of 250 toapproximately 400. After several Reserve and National Guard hospitals arrived inOctober, the 74th Field Hospital assumed the POW mission of the 50th ClearingCompany at Long Binh, and the 311th Field Hospital replaced the 542d ClearingCompany at Phu Thanh.
During the first half of 1969, the patient load remained fairly constant.Average length of stay for wounded POW patients was 4 to 5 months, and eachhospital had a 70- to 80-percent average bed occupancy. After hospitalization,patients were transferred to POW compounds operated by the Vietnamese Army. Uponthe redeployment of the reserve hospitals to CONUS during the second half of1969, the POW hospital mission was reassigned to the 17th Field Hospital and the24th Evacuation Hospital. A decrease in combat activity reduced the averagepatient load in each hospital to approximately 100. Because the ARVN (ArmyRepublic of Vietnam) had the largest POW medical workload and the ultimateresponsibility for the prisoners' continued confinement, USARV proposed thatARVN administer the entire POW hospitalization program. U.S. Army hospitalswould continue to accept and treat prisoners of war captured in their respectivegeographic areas until their medical condition permitted transfer to an ARVNhospital. In addition, the United States agreed to assist ARVN in reducing thereconstructive and rehabilitative surgical backlog of patients in ARVNhospitals. This concept was implemented in September 1969.
Offshore Support
The patient evacuation policy for Vietnam was established as a 15-dayminimum or a 30-day optimum. Under this policy, it was possible to return toduty in Vietnam nearly 40 percent of those injured through hostile action and 70percent of other surgical patients.
Out-of-country evacuation was by aircraft to Clark Air Force Base in thePhilippines; from there evacuees were subsequently routed either to thecontinental United States, to Tripler General Hospital in Hawaii, to the U.S.Army Hospital, Ryukyu Islands, or to Japan. In the summer of 1966, directevacuation by jet aircraft of patients from Vietnam to the continental UnitedStates via one stop in Japan was inaugurated.
Patients received in the continental United States were mostly accommodatedin general hospitals nearest their homes, but some were
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regulated to class I hospitals even nearer their homes when these hospitalshad beds available and the professional capability of treating their injuries.
As the entire Republic of Vietnam had been designated a combat zone, fixedhospitals that give long-term care to patients and are normally found in acommunications zone were not present. If all the injured or sick who could notbe returned to duty in Vietnam within the established 15- to 30-day evacuationpolicy had been evacuated to the continental United States, it would havecreated a great drain of experienced manpower from the combat zone. To give thisfixed-bed capability, the equivalent of about 3? general hospitals wereestablished in Japan to receive and care for patients who could be expected toreturn to duty within 60 days.
Evacuation
In-Country
Highly mobile and widely deployed forces must have a highly mobile andflexible medical evacuation system immediately responsive to their needs. Thehelicopter ambulance provided this flexibility and responsiveness in Vietnam. Atthe peak of combat operations in 1968, aeromedical support was provided by 116air ambulances. These helicopters could transport six to nine patients at atime, depending upon the number of litter cases. Medical evacuation flightsaveraged only about 35 minutes each, a feat which often meant the differencebetween life and death for hundreds of patients. The more seriously woundedusually reached a hospital within 1 to 2 hours after they were injured. Of thewounded who reached medical facilities, about 97.5 percent survived.
The helicopter brought modern medical capabilities closer to the frontlinethan ever before. Furthermore, combined with a medical radio network, thehelicopter provided greater flexibility in regulating patients. Preliminaryevaluation of the injury and the condition of the patient was made while inflight, and the use of the radio network permitted redirecting the patient tothe nearest hospital suited to his needs. If a hospital developed a surgicalbacklog, the combination of helicopter and radio facilitated regulating patientsaccording to available operating facilities, rather than available beds. Thiscombination was the core of the Army medical management system in Vietnam.
The buildup of air ambulance units. The buildup of air ambulance unitsparalleled the commitment of U.S. combat forces to Vietnam. The first airambulance unit sent to Vietnam, the 57th Medical Detachment (HelicopterAmbulance), later nicknamed "The Originals," arrived in 1962 tosupport the 8th Field Hospital at Nha Trang. The unit was authorized five HU-1Aaircraft, which were replaced by an improved model, the "B" version,in March 1963. Initially, two aircraft were
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stationed at Qui Nhon and three in Nha Trang. As fighting increased aroundSaigon and in the Delta, the helicopters were shifted from place to place inresponse. The 82d Medical Detachment (Helicopter Ambulance) became operationalin IV CTZ (the Delta), in November 1964.
The buildup of units continued at an accelerated pace in 1965. The 283dMedical Detachment (Air Ambulance) arrived in August 1965, followed by the 498thMedical Company (Air Ambulance) in September. The 254th Medical Detachment (AirAmbulance) arrived in Vietnam before the end of the year but did not becomeoperational until February 1966 because a backlog at the port delayed thearrival of the unit's equipment. The four detachments, each authorized sixhelicopters under a new table of organization and equipment, supported III andIV CTZ's. The 498th Medical Company, which was authorized 25 aircraft, supportedII CTZ.
During 1967, the 45th Medical Company (Air Ambulance) and four additional airambulance detachments arrived in Vietnam. The units were shifted from locationto location to provide the most effective area coverage in response to tacticaloperations. In 1968, four additional detachments were sent to Vietnam,completing the buildup of aeromedical evacuation units. One unit, the 50thMedical Detachment, which was assigned to the 101st Airborne Division inmid-1968, became the nucleus of the division's air ambulance platoon. By 1969,there were 116 field-army-level helicopter ambulances in Vietnam. These wereassigned to two companies and 11 separate detachments. (Map 3)
Air Force aeromedical evacuation support. The Army and the U.S. AirForce evacuation systems complemented each other, each carefully continuing themovement of wounded or sick until they reached a final-destination medicalfacility.
Based on experience gained in World War II and the Korean War, the U.S. AirForce initially used returning assault or cargo aircraft for casualtyevacuation. The system worked well during the early stages of the Vietnam War,because the number of sick and wounded was relatively low. As troop strengthincreased and combat operations became more intense, the system grewprogressively less satisfactory. The requirements for evacuation often coincidedwith the most urgent needs for resupply, although not always at the samelocation.
The old system was therefore abandoned in favor of a new one in whichaircraft were regularly used specifically for evacuation purposes. The 903dAeromedical Evacuation Squadron scheduled the first regular in-countryevacuation flights in 1967. By late 1969, the number of regular scheduledflights had increased to 188. The assault aircraft initially used foraeromedical evacuation were supplemented, in early 1968, by C-118 cargo aircraftspecifically modified for evacuation missions. The average
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number of patients moved increased from 5,813 per month between July 1967 andJanuary 1968, to 9,098 from March to June 1968. During the Tet Offensive inFebruary 1968, more than 10,000 patients were evacuated by the Air Force.
"Dust-off." Those Army medical evacuation helicopter unitsnot organic to divisions came to be called Dust-off, after the radio call signof
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the most famous of the early pilots, Major Charles L. Kelly, MSC, who waskilled in action on 1 July 1964. Several scores of these flying"medics" flew their unarmed helicopters into hostile areas, riskingtheir own lives to save those of others. In a 2-year period, 39 crew memberswere killed and 210 wounded in aeromedical evacuation missions.
The combination of the helicopter ambulance and a medical radio network wasthe basis of the effective medical regulating system that evolved in Vietnam.During the first phase of U.S. troop commitment to Vietnam in early 1965, therewas only one hospital in support of each CTZ and therefore no alternative tothe destination of a casualty. As the number of hospitals and the number ofcasualties increased, however, the need for a regulating system becameimperative. The first system in the III and IV CTZ's was set up with Air ForceRadar Tan Son Nhut, Paris control. Dust-off helicopters inbound called Pariscontrol which had a direct-line field telephone, "hot line" to the MRO(medical regulating office) and the 3d Field Hospital. The three major treatmentfacilities available were the 3d Field Hospital, the 93d Evacuation Hospital,and the 3d Surgical Hospital, the last named then located at Bien Hoa. The MROconfirmed or changed the destination chosen by the pilot as the medicalsituation indicated.
After Headquarters, 44th Medical Brigade, arrived in Vietnam in 1966, thebrigade MRO became responsible for all in-country regulating of patients.Medical groups controlled the movement of patients from tactical areas tohospitals within their own group areas. Further movement of patients from onegroup area to another was co-ordinated by medical group MRO's with the brigadeMRO, who maintained over-all control to insure proper usage of all medicalfacilities.
Telephone communications were abysmally poor and radio communications notmuch better during this period. When heavy fighting produced a large number ofcasualties and medical regulating was most urgently needed, operational radiotraffic was also heaviest. Moreover, since short-range radios were used,requests for evacuation had to be routed from divisional medical battalions tobackup hospitals by way of the Dust-off radio network or through the supportingfield army medical group. This cumbersome method caused delays and sometimesresulted in garbled transmissions.
On an experimental basis, the 55th Medical Group at Qui Nhon borrowedsingle-sideband long-range radios from the 498th Medical Company (AirAmbulance). Originally placed in the air ambulance company for long-rangetransmissions to its aircraft on evacuation missions, these radios had beenlittle used because of the relatively short distance of most flights and theextensive maintenance they required. Their use for medical regulating provedhighly successful, and an additional 54
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sets were ultimately acquired to expand the communications network throughoutthe medical brigade.
Medical regulating started on the battlefield. Medical groups placedregulators (senior noncommissioned officers) in areas of troop concentration orat the site of a combat operation. In co-operation with the local medical unit,the regulator radioed requests for evacuation to the supporting Dust-off unit.The transmission was monitored by the MRO at his medical group headquarters.
In the absence of a field medical regulator, a request for air evacuation wasnormally made by the medical aidman at the site of the casualty. The request,which included such information as the number of patients by type, the exactlocation by map grid co-ordinates, data on enemy movements, and the radiofrequency of the requesting unit, was transmitted over the Dust-off radionetwork to the supporting air ambulance unit. Frequently the call was receivedby an air ambulance already in flight which could be diverted from a less urgentmission. If not, a standby crew at a field site or at the unit headquartersscrambled to make the pickup.
After proper identification of the ground force with the casualty, theDust-off helicopter generally made a high-speed or tight-circle approach intothe area. Time spent on the ground in a normal operation was usually between 30seconds and 1 minute, depending on the number of casualties. The casualty wasgiven emergency treatment by the medical aidman on board as soon as theaircraft was out of the combat area.
The patient was flown directly to the medical treatment facility best able togive the care required. This might or might not be the one nearest the site ofinjury. The decision as to the proper destination hospital was based on severalfactors. Distance was less important than time; the objective was to reduce thetime between injury and definitive treatment to the minimum. Information basedon the preliminary in-flight evaluation of the injury and the condition of thepatient, knowledge of existing surgical backlogs, and the over-all casualtysituation were other considerations. If the aircraft commander questioned thedestination selected by the medical regulator because of his knowledge of thepatient's condition, a physician was consulted by radio while the patient wasstill in transit before the decision became final. The inbound medical aircraftcommander informed the receiving hospital by radio of his estimated time ofarrival, the nature of the casualties on board, and any special receptionarrangements that might be required. Thus, the receiving hospital was able tohave everything in order to receive casualties and begin definitive surgicalcare.
Helicopter evacuation techniques and requirements varied by geographic area,type of combat operation, and type of equipment available, and changed from yearto year as experience modified and refined pro-
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cedures. Since the air ambulance was unarmed, gunship support was requestedif the ground reported contact with the enemy in the vicinity of the pickupsite, or if the rescue was a hoist operation.
In "hot" areas, the crew of the evacuation aircraft consisted of apilot, copilot, crew chief, medical aidman, and a man armed with an automaticrifle. In quieter areas, the rifleman was left behind in favor of increasedpatient capacity. On hoist operations in mountainous and jungle terrain, beforethe more powerful "H" model aircraft was introduced, the crewconsisted only of a pilot, copilot, and hoist operator. On these missions, fuelload was also generally reduced in favor of greater lift capability. Nightmissions were quite common, often comprising 15 to 20 percent of the, totalmissions in some areas.
Helicopter rescue operations were aided by new equipment designed especiallyfor use in jungle terrain or in combat areas where it was too dangerous for ahelicopter to land. The hoist consisted of a winch and cable on a boom which wasmoved out from the aircraft when it arrived over the rescue site. At the end ofthe cable was a ring and hook to which a Stokes litter, rigid litter, or forestpenetrator could be attached. The cable could be lowered at the rate of 150 feetper minute and retracted at the rate of 120 feet per minute. The forestpenetrator, a spring-loaded device which could penetrate dense foliage, openedto provide seats on which a casualty could be strapped. It was preferred overthe litter by the crews for hoist rescues because it was less likely to becomeentangled in the trees.
Hoist operations significantly increased the danger for Dust-off crews.Hovering above the jungle or a mountain side as it lowered its cable, thehelicopter became a "sitting duck" for enemy troops in the area. In1968, 35 aircraft were hit by hostile fire while on hoist missions. The numberincreased to 39 in 1969. Nonetheless, the hoist was used extensively and togreat advantage in Vietnam. Its use permitted the rescue of 1,735 casualties in1968 and 2,516 casualties in 1969, who otherwise could not have been retrieved.
The primary mission of the Army helicopter ambulance was the in-countryaeromedical evacuation of patients. The number of patients evacuated byaeromedical evacuation helicopters rose from 13,004 in 1965, to 67,910 in 1966,to 85,804 in 1967, and peaked at 206,229 in 1969. These figures included membersof the ARVN, Vietnamese civilians, and Free World forces as well as U.S.patients. Each time a patient was moved by helicopter, the move was entered inthe tally. Thus, if a patient was taken to a surgical hospital by helicopter andlater transported from there to an evacuation hospital by helicopter, this wouldcount as two patients evacuated. Army air ambulances completed more
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than 104,112 aeromedical evacuation missions while flying approximately78,652 combat hours in 1969.
In addition to this primary mission, Army helicopters were also used totransport professional personnel, medical supplies, and blood to medicalfacilities. Supplemented by scheduled Air Force flights, and from time to timeby larger helicopters, they were also used to transport patients betweenhospitals for consultations or to free beds in areas where increased casualtieswere anticipated.
Out-of-Country
The Air Force provided all out-of-country aeromedical evacuation. Initially,out-of-country medical regulating was controlled at the FEJMRO (Far East MedicalRegulating Office) at Camp Zama, Japan, through a representative functioning atthe Office of the Surgeon, USMACV. To handle the increased volume of traffic, abranch of the FEJMRO was established in Vietnam and Major (later LieutenantColonel) Robert M. Latham, MSC, reported as Chief, FEJMRO (USMACV), in July1966. FEJMRO allotted bed space in hospitals in the Pacific area for FEJMRO (USMACV)use, and issued "bed credits" on a 24-hour basis. This information wasrelayed to Vietnam via Clark Air Force Base in the Philippines becausecommunications between Japan and Vietnam were chronically poor. Late in 1966, adirect system for transmitting information between the two offices was adopted.
The procedures for regulating out-of-country evacuations were furtherimproved in November 1967. Under these new procedures, medical group regulatingofficers submitted consolidated requests for evacuation to the medical brigadeMRO who then sent a single request to FEJMRO (USMACV). In turn, informationconcerning destination hospitals was sent back down the line. The new systemenabled hospitals in Vietnam to follow up on patients and permitted medicalfacilities to close out clinical records. It also provided information morepromptly on the total number of evacuees to casualty staging facilities, theMilitary Airlift Command, and offshore hospitals. Routine calls were handledwithin a 36-hour period, and urgent evacuation requests were processed within anhour if an aircraft was available.
Since substantial U.S. forces were committed to Vietnam in 1965, the relativecontinuity of combat was as much a factor in building up
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patient loads as was the severity of fighting. Under such conditions, patientevacuation was therefore accelerated to provide for contingencies. The 9thAeromedical Evacuation Squadron, for example, increased its flight schedule fromtwo weekly departures from Tan Son Nhut to daily flights with additional sitesfor departure at Da Nang and Qui Nhon. The number of evacuations out-of-countryincreased from 10,164 in 1965 to 35,916 in 1969. (Table 8)
TABLE 8.-TOTAL NUMBER OF PATIENTS EVACUATED FROM VIETNAM,U.S. ARMY, BY MONTH, 1965-69
| Month | 1965 | 1966 | 1967 | 1968 | 1969 |
January | 164 | 832 | 1,469 | 2,417 | 3,224 |
February | 227 | 1,330 | 1,851 | 3,576 | 3,099 |
March | 226 | 1,062 | 2,178 | 2,471 | 4,166 |
April | 252 | 853 | 1,780 | 2,782 | 3,210 |
May | 300 | 1,298 | 2,367 | 3,952 | 4,334 |
June | 480 | 1,256 | 2,072 | 2,701 | 3,951 |
July | 471 | 766 | 1,595 | 2,569 | 2,879 |
August | 821 | 957 | 1,521 | 2,700 | 3,308 |
September | 999 | 942 | 1,431 | 3,401 | 2,187 |
October | 1,978 | 983 | 1,851 | 2,856 | 1,890 |
November | 2,361 | 1,331 | 2,435 | 2,790 | 1,789 |
December | 1,885 | 996 | 2,152 | 3,176 | 1,879 |
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Source: Army Medical Service Activities Report, MACV,1965; Army Medical Service Activities Reports, 44th Medical Brigade, 1966, 1967,1968, 1969.
Initially, out-of-country evacuation was by aircraft to Clark Air Force Base;from there evacuees were routed either to the continental United States; toTripler General Hospital in Hawaii, to the U.S. Army Hospital, Ryukyu Islands,or to Japan. In the summer of 1966, to reduce the drain of experienced manpowerfrom the combat zone, the equivalent of about 3? general hospitals wasestablished in Japan to receive and care for patients who could be returned toduty within a 60-day period. C-141 Starlifter jets, which were used to transporttroops to Vietnam, were quickly reconfigured to evacuate patients to Japan. TheC-141 could carry 80 litter, 121 ambulatory, or a combination of 36 litter and54 ambulatory patients. After a 6-hour flight to Japan where those patients to beretained disembarked, patients bound for the continental United States boardedand the aircraft continued either to Andrews Air Force Base, Washington, D.C.(18 hours via Elmendorf Air Force Base, Alaska) or to Travis Air Force Base,Calif., by a direct 10-hour flight.
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Throughout the chain of evacuation, the well-being of the patient was ofoverriding concern. At all points along the chain, a qualified flight surgeonwas on hand to determine if the evacuation should be continued. If necessary, aphysician accompanied a severely wounded or critically ill patient. At alltimes, the finest medical care was given to the wounded or sick soldier as heprogressed through the aeromedical evacuation system.
Reduction and Reorganization
The de-escalation of combat activities in Vietnam during 1969 and 1970 wasparalleled by a reduction in the number of hospitals and air ambulance units.During 1969, three Reserve hospitals returned to the continental United States.The 7th and 22d Surgical Hospitals and the 29th and 36th Evacuation Hospitalswere inactivated. The number of beds in operation decreased from 5,189 to 3,473by the end of the year. During 1970, the 8th Field, the 2d Surgical, the 45thSurgical, and the 12th Evacuation Hospitals were redeployed or inactivated. (Map4) The 254th Medical Detachment (Helicopter Ambulance) was inactivated inNovember.
A new structure for administering the medical units still in-country wasauthorized. Early in 1970, outlying dispensaries and clinics were placed underthe command and control of the hospital in the closest geographic proximity.This change resulted in the inactivation of the headquarters elements of twomedical battalions. The two medical battalions in-country were reorganized andgiven command and control of all medical evacuation helicopter, field ambulance,and bus ambulance resources. One medical evacuation battalion was assigned toeach of the two medical groups that remained in Vietnam.
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