Operation OVERLOAD, destined to break thepower of Nazi Germany, was directly dependent on landing craft which could transport agrand total of 20,111 vehicles and 176,475 men on an amphibious assault against the shores ofNormandy. The LST (landing ship, tank) was said to bethe most important instrument of war in the European theater. Sir WinstonChurchill once observed: "The destinies of two great empires seemed tobe tied up by L.S.T.'s."
On 10 May 1944, U.S. Army hospitals in the UnitedKingdomreceived orders from Headquarters, ETOUSA, to send selected enlisted techniciansand medical officers capable of performing surgery of trauma todesignated channel ports in England for a period of training in the handlingof casualties on LST's from the invasion beaches back to English Channelports.
The LST was the only available craft suitable for the dualrole of evacuating large numbers of casualties from the invasion beaches andcarrying supplies from the United Kingdom to the Normandy coast. It was wiselydecided to equip LST's so that they might carry from 150 to 200 litter andhundreds of ambulatory patients from France back to England. For the actualassault phase of OVERLORD, it was decided to staff a given number of LST'swith competent operating surgeons and surgical technicians provided by theArmy.
All of the selected army personnel were sent to U.S. Armyhospitals on the Channel coast of England to be thoroughly indoctrinated as totheir various responsibilities before and during the invasion. The followingtasks were specifically stressed for the surgeons: (1) Perform suchthird-echelon surgical treatment as was practicable, consisting in the main oflifesaving surgery and early debridement of mangled and traumatic injuries; (2)act as surgical consultants to the LST crew. For planning purposes a load of200 litter casualties was considered to be maximum for an LST. Medicalmateriel, therefore, was supplied to each LST on this basis. Each LST wasprovided two standard surgical kits consisting of all surgical instrumentsthat might be used for general traumatic surgery and a medical technician'skit for each technician. In addition, a special surgical outfit which consistedof instruments that might be needed in abdominal or thoracic surgery was issuedto each army surgeon. Eight beach bags were provided which containedsufficient battle dressings, morphine, sulfanilamide, and splints to careadequately for the maximum number of wounded. Ten pints of whole blood,biologicals, plaster of paris, dextrose solutions, chemical warfare ointment,and 12 units of plasma were placed on board to be carried on the first trip ofan LST to the beachhead. Automatic replenishment of expendable items was to beprovided on the return of LST's to the English coast.
During the preparatory phase of organization and training onthe Channel coast of England, Lt. Col. (later Col.) Robert M. Zollinger, MC,Senior Consultant in General Surgery for the ETO, visited all training groupsand gave wise counsel as to emergencies that might arise and directed thefinal preparations. Credit for the idea of using rubberized cloth (Batiste) inthe place of sterile drapes should go to Colonel Zollinger. This material couldbe easily cut to any desired dimension and sterilized by boiling for 15 minutes.It proved to be quite an innovation in the more speedy draping and handling ofwounds.
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On 3 June 1944, all U.S. Army surgical teams weretransported to different ports along the English Channel and placed upon waiting LST's. Aboard the LST, eachmedical officer oriented himself and saw to it that the operating theater, which had been built at the rear of thetank deck, was in order. He also made sure that medical supplies were dispersed at different stations on the LST so that if one source of supplyshould be destroyed in battle others might be available.
On 4 June, the LST's, with overhead barrage balloons andloaded with combat soldiers, tanks, and vehicles, put out into the EnglishChannel. There was, however, such a heavy gale that, when they made theirrendezvous, orders were received to return to port and wait for 24 hours.
On 5 June, the LST's in convoy made for open Channel tobecome an integral part of the greatest armada in history. There were 9,000ships and landing craft protected by 702 warships and 25 minesweeperflotillas. Some were destined for Omaha Beach; others, for Utah Beach. Thosecarrying British and Canadian personnel were routed to Juno, Gold, and Swordbeaches.
On 6 June, D-day, almost all LST's were within easy reachof the Normandy coast. Most of them had beached by D+?, and a few were beached later on D+2 day. Disgorging their cargo of combat soldiers,tanks, and vehicles, they were made ready for receiving casualties.
On arrival off Normandy, excitement and tensenesswas everywhere very apparent because of going into the battle area under theconstant bombardment of the French shore by friendly combat ships with4-inch to 16-inch naval guns, followed by flashes from the German shorebatteries all along the coastline. The first night on the beach was indeedrevealing. Some of the LST's had opened antiaircraft fire on German planesagainst orders for the night. This fire immediately brought about rapidretaliation by the German air raiders, who dropped phosphorous and magnesiumbombs along the beach. When the enemy planes ceased their attack at daybreak,many casualties were found on the beach, and the work was cut out for thesurgical teams. On Omaha Beach most of the casualties were from the 1st and29th Infantry Divisions of the U.S. V Corps. Those received and treated at UtahBeach were from the 82d and 101st Airborne Divisions, U.S. VII Corps.
On D+? and D+2 days, LST's began toreceive casualties in larger numbers on the beaches, and routine surgicaltreatment, such as control of hemorrhage and shock by plasma and whole bloodtransfusions, was instituted. Fractures were immobilized with splints ofplaster of paris. Pain was eliminated by morphine and, when necessary, byether or Pentothal sodium (thiopental sodium). Infection was combated by theuse of sulfanilamide and penicillin; tetanus toxoid and gas antitoxin weregiven. In any case where there was obstruction of the airway, a tracheotomy was done.
Definitive surgery was done only as a lifesavingmeasure with careful consideration in favor of conservatism, due thought being givento the possible time interval before definitive treatment could be provided atU.S. Army hospitals on the English coast. Definitive surgery was done in severechest and abdominal wounds, traumatic injuries of the buttocks, and compoundfractures of the extremities with damage to the main blood supply.
Triage became a very important duty of eacharmy surgeon onthe beach, as sorting was a necessity in the proper handling and treatment ofthe casualties. This triage was done so that, upon arrival of casualties fromFrance at the English shore, pertinent information was at hand and available tomedical units receiving the evacuated casualties. The wounded were dividedinto ambulatory and litter cases. The litter cases were further divided intotransportable and nontransportable patients. Casualties were classified astransportable when it was considered that they could safely tolerate overlandtransportation, after debarkation in England, before requiring surgicalattention. All those who would require immediate surgical attention and, or,early surgical intervention upon reaching the English shore were classifiednontransportable.
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An EMT (Army Emergency Medical Tag) was used on all wounded.On the back of this tag, a supplemental record was kept, for use in the eventthe patient should require definitive surgery. A brief indication of the type ofwound, such as head, chest, or abdomen, was placed on the EMT.
Some of the wounded transferred from the Normandybeaches to LST's had received first aid treatment but had lain on the beach for 12 hoursin the clothes in which they were wounded. Most wounds were covered by a shelldressing, and few had received any other medication except morphine. Many weredehydrated and anxious because of loss of sleep. Supportive treatment incrossing the Channel to the English hards and quays required much time. Severalchest and abdominal wounds necessitated operation. But, by far the greaternumber were compound fractures requiring immobilization and wounds of softtissues-including the buttocks-requiring debridement. Because ofassociated rectal wounds, several colostomies were done on casualties withwounds of the buttocks.
A few German casualties were received. All these prisonershad been poorly treated and dressed, but none had received tetanus antitoxin.Most of their wounds had not been debrided but only packed withpetrolatum-impregnated gauze to prevent hemorrhage. Unfortunately, thepetrolatum-impregnated gauze became a plug and not a drain. The result was agrossly contaminated wound with an occasional gas gangrene infection. All thesewounds were debrided, cleansed, and dressed, and the prisoner patients weregiven tetanus and gas antitoxin, plus sulfanilamide, en route to England.
Of the wounded received on LST's, the relative regionalfrequency of their injuries was estimated to be: Extremities, 50 percent;abdominal, 12 percent; thoracic, 9 percent; thoracoabdominal, 1.5 percent; andall other, 27.5 percent.
Many of the LST's caring for casualties madethree or fourcrossings of the English Channel, after which time the Allied invasionforces had gained a good beachhead on the Normandy coast, and airstrips werequickly laid down from which wounded could be evacuated by air to England.Evacuation hospitals and field hospitals were set up at nearly the same time asthe airstrips, thus ending the need for LST's as casualty carriers. As aconsequence of mission accomplished, all army personnel were ordered back totheir respective hospitals.
The army surgeons and technicians who participated in theLST evacuation operations during the Normandy invasion deserve the highestcommendation for outstanding courage and devotion to duty under fire. Remember,many had been civilians only a few months before. The writer is sure that theaid, comfort, and lifesaving services given by the relatively few men who madeup the surgical staff on the LST's deserve much credit for the reducedmortality and morbidity rate attained among American wounded during theinvasion of Normandy.
The Normandy countryside is now green and peaceful. Thetownfolk of Sainte M?re-?glise are free to stroll along Omaha or Utah Beach, butone wonders if they remember the beached LST's, one of the vanguards oftheir freedom and the refuge of the wounded Yank.
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