CHAPTER XXIV
Providing the Means forEvacuation by Air
Experiences of World War II firmly established airtransportation as an acceptable if not preferable method of evacuation, not onlywithin theaters but also from overseas areas to the zone of interior and fromone point to another within the latter. Because of insatiable demands from allquarters for aircraft, the movement of patients by plane, even more than bysurface vessels, had to be fitted in with the transportation of troops andcargo. In theaters this problem was often solved by informal arrangementsbetween local surgeons and air force commanders. In the zone of interioragreement was reached only after a debate over whether special planes would beprovided for evacuation alone or whether all transport planes would have a dualpurpose-the transportation of troops and cargo in one direction and ofpatients in the other. The Medical Department wanted special ambulance planesfor use in all areas-combat zones, communications zones, and the zone ofinterior. AAF headquarters, on the other hand, insisted upon maximum use of allplanes and therefore adopted a policy of using aircraft with other primarymissions for evacuation also. Thereafter, the Medical Department and the ArmyAir Forces collaborated in arrangements for the adaptation of transport planesto the evacuation mission.
Aircraft
Prewar Plans for Airplane Ambulances
Before the war, plans for the procurement and use of airplaneambulances were nebulous. Perhaps one reason was that there was no tradition ofusing special planes in wartime for evacuation only. With the development of airtransportation during World War I and the years that followed, surgeons ofvarious airfields had experimented with the development and use of smallairplane ambulances.1 Repeatedly in the1930's The Surgeon General had requested the procurement of at least sevenairplane ambulances for the movement of patients in the United States duringpeacetime and for experiments upon which plans for their use in wartime could bebased. In each instance, because of difficulty encountered in securingsufficient funds for the procurement of requisite planes for training and fordefense of the United States, the General
1David N. W. Grant, "Airplane Ambulance Evacuation," The Military Surgeon, vol. 88, No. 3 (1941), pp. 238-43.
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Staff, on the advice of the Chief of the Air Corps, haddisapproved The Surgeon General's requests.2Instead, a policy established as early as 1931 continued in effect.Special airplane ambulances were not normally provided, but regular transportplanes were fitted with litter-holding brackets to enable them to move patientsfrom one hospital to another. In exceptional cases only, training centers werepermitted to convert small planes into airplane ambulances for crash-rescue work(that is, the rapid removal of persons from airplane accidents to hospitals oftheir home stations).3
During 1940 opinion among medical officials as to the needfor airplane ambulances in wartime crystallized. Experience of the Germans inair evacuation during the Polish campaign, an account of which appeared in the ArmyMedical Bulletin,4 perhapscontributed to this development. The chief of the Medical Division of the Officeof the Chief of the Air Corps, the surgeon of GHQ Air Force, and The SurgeonGeneral agreed that two types of planes would be needed-small planes for thetransportation of one or two casualties from medical stations in divisionalareas to hospitals farther in the rear, and large planes for the removal ofgreater numbers of patients from evacuation hospitals to general hospitals incommunications zones or the zone of interior. They agreed also that such planesshould be set aside exclusively for air evacuation and should be under thecontrol of theater headquarters.5 TheChief of the Air Corps and the General Staff implied approval of thesepropositions, and the latter on 5 September 1940 directed the Chief of the AirCorps to maintain plans for converting standard transport airplanes and suitablesingle-engine airplanes to ambulance use.6
This directive uncovered an important problem. While theprocurement of large ambulance planes was expected to be relatively simple,since either civilian or military transports could be readily converted by theinstallation of litter racks, the procurement of small airplane ambulancespromised to be considerably more difficult. In September 1940 the Chief of theAir Corps stated that no small planes suitable for conversion were eitheravailable or anticipated for procurement. The General Staff then verballymodified its directive, relieving the Air Corps of responsibility formaintaining plans for the wartime conversion of single-engine airplanes.7Soon afterward, when the Gulf
2(1) Memo, ACofS G-4 WDGS for CofSA, 8 Jun 32, sub: Aircraft for Amb Serv. HRS: G-4/29413. (2) Ltr, SG to TAG, 7 Nov 33, same sub, with 3 inds. AAF: 452.1 (Amb Planes). (3) Memo, ACofS G-4 WDGS for CofSA, 22 Nov 33, same sub. HRS: G-4/29413. (4) Ltr, SG to TAG, 5 Sep 34, same sub, with 3 inds. AAF: 452.1 (Amb Planes). (5) Memo, ACofS G-4 WDGS for CofSA, 17 Sep 34, same sub. HRS: G-4/29413.
3(1) 2d ind, CofAC to Chief Mat Div AC Wright Fld, 5 Dec 31, on Ltr, Maj Robert [E. M.] Goolrick, AC to CofAC thru Chief Mat Div Wright Fld, 23 Oct 31, sub: Amb Airplanes. AAF: 452.1 (Amb Planes). (2) Memo, Chief Med Sec OCofAC for SG, 25 Jan 38. SG: 451.8-1.
4(1) Ltr, SG to CofAC, 5 Apr 40, sub: Airplane Casualty Evac in the German-Polish War. SG: 580.1. (2) Army Medical Bulletin, No.53 (July 1940), pp. 1-10.
5(1) Ltr, Surg GHQ AF to Chief Med Div OCofAC, 20 Jun 40. SG: 320.3-1. (2) Memo, Chief Med Div OCofAC for SG, 21 Jun 40. Same file. (3) Ltr, SG to TAG, 11 Jul 40, sub: Air Corps Med Trans Group. AG: 320.2 Med (7-11-40).
6(1) 2d ind, CofAC to TAG, 24 Jul 40, on Ltr, SG to TAG, 11 Jul 40, sub: Air Corps Med Trans Group. (2) Memo, ACofS G-3 WDGS for CofSA, 7 Aug 40, sub: Air Amb Serv. (3) Memo, TAG to CofAC, 5 Sep 40, same sub. All in AG: 320.2 Med (7-11-40).
7(1) R&R Sheet Comment 1, Exec OCofAC to Tng and Oprs, Plans and Mat Divs OCofAC, in turn, 9 Sep 40, sub: Air Amb Serv. AAF: 452.1-B (Amb Planes). (2) R&R Sheet Comment 3, Plans Div OCofAC to Mat Div OCofAC thru Exec, 17 Sep 40, same sub. Same file.
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Coast Air Corps Training Center requested procurement ofsingle-engine airplane ambulances for peacetime crash-rescue work, the Chief ofthe Air Corps disapproved the purchase of airplanes exclusively for ambulanceservice, but stated, strangely enough, that small planes already in servicemight be converted into ambulances.8 A subsequent investigationconfirmed his earlier opinion that light planes in service were not suitable forconversion. Some were too old; others were too small; and still others hadopenings that were too small to admit litters and were incapable of enlargementwithout weakening the fuselages of planes.9 Early in 1941, therefore,the Chief of the Air Corps permitted the conversion into ambulances of threesmall planes of a new type just being procured-0-49s-provided this actiondid not seriously delay the assignment of planes to observation squadrons.10By July 1941 it was reported that each of these had been converted to carry onelitter patient and a medical attendant, in addition to the pilot, and had beenassigned to training centers.11
Meanwhile the Surgeon General's Office and the MedicalDivision of the Office of the Chief of the Air Corps had been making plans forthe use of airplane ambulances in both forward and rear areas of combat zones.During 1940 and 1941, as will be seen later, they developed a table oforganization for units that would evacuate patients in airplane ambulances andrequested the publication of information about such units in a MedicalDepartment field manual. They also devoted attention to the problem ofdeveloping a small plane suitable for use in front-line areas. From the timewhen the National Research Council suggested in October 1940 that an Autogiromight solve this problem, the Surgeon General's Office maintained a steadycorrespondence with the company producing such planes. In September 1941representatives of that Office and of the Medical Division of the Office of theChief of the Air Corps witnessed a demonstration of an Autogiro and discussedwith company officials the characteristics desired in a front-line airplaneambulance.12 By the latter part of November the company producing Autogirossubmitted drawings for an ambulance. The Air Corps Materiel Division agreed thatthis type of plane, if successfully developed, would be useful in forward areas,but believed that the one proposed would be unsuccessful because of its weight.It recommended, therefore, that further action on the question of an ambulanceAutogiro be suspended until after completion and testing of others beingdeveloped for Air Corps tactical missions.13
8(1) R&R Sheet Comment 6, Mat Div OCofAC to Med Div OCofAC, 3 Dec 40, sub: Air Amb Serv. (2) R&R Sheet Comment 7, Med Div to Mat Div, 16 Dec 40, same sub. (3) R&R Sheet Comment 10, Plans Div OCofAC to Exec, OCofAC, 31 Dec 40, same sub, with approval by CofAC. All in AAF: 452.1-B (Amb Planes).
9Memo, Fld Serv Sec Mat Div Wright Fld for Tec Exec Mat Div Wright Fld, 17 Jan 41, sub: Info . . . Regarding Amb Airplanes. AAF: 452.1-B (Amb Planes).
10(1) R&R Sheet Comment 1, Mat Div OCofAC to Exec OCofAC, 23 Feb 41, Comment 3, Tng and Oprs Div OCofAC to Exec OCofAC, 1 Mar 41; and Comment 4, ExecOCofAC to Mat Div OCofAC, 4 Mar 41, sub: Amb Airplanes. All in AAF: 452.1-B (Amb Planes).
11Memo, Mat Div Wright Fld for Mat Div OCofAC, 29 Jul41, sub: 0-49 Amb Airplanes. AAF: 452.1-B (Amb Planes).
12See SG: 452.-1, and Off file, Research and Dev BdSGO, "Amb Airplane."
13(1) Memo, Mat Div OCofAC for Mat Div Wright Fld, 28 Nov 41, sub: Amb Autogiro. AAF: 452.1-B (Amb Planes). (2) Memo, Mat Div Wright Fld for Mat Div OCofAC, 3 Jan 42, same sub. Same file.
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Decision Not To Provide Separate Transport Planes for Evacuation
Soon after war began, the need for air evacuation was met bythe peacetime practice of using regular transports. The first occasion requiringthe movement by air of large numbers of patients occurred in January 1942 duringconstruction of the Alcan Highway to Alaska. The second occurred in Burma inApril 1942. In both instances regular transport planes (C-47s) alreadyequipped with litter brackets were pressed into ambulance service.14
Successful evacuation by transports did not remove the desireof some military agencies for separate airplane ambulances. In July 1942 theAlaska Defense Command asked for a large airplane ambulance, and was supportedin its request by the Western Defense Command. The next month The Surgeon General requested an airplaneambulance for use in transporting patients from the Newfoundland Base Command tothe United States. These requests produced a confirmation-in view of thewartime demand for planes for other purposes-of the existing policy of notproviding special planes for ambulance service only, but of equipping alltransports with litter brackets so they might be used for evacuation as well asfor normal missions.15
AAF headquarters encountered some difficulty in theobservance of this policy.
14Frederick R. Guilford and Burton J. Soboroff,"Air Evacuation: An Historical Review," Journal of AviationMedicine, Vol. 18 (December, 1947), pp. 601-16.
15(1) Ltr, CG Alaska Def Comd to CG Western Def Comd, 14 Jul 42, sub: Aircraft Amb for Alaska, with 2 inds. AG: 452 (7-14-42). (2) Ltr, CG Eastern Def Comd to CG AAF, 31 Jul 42, sub: Air Amb Evac of Pnts from Newfoundland Base Comd, with 4 inds. SG: 705.-1 (Newfoundland)F.
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INTERIOR OF C-46 TRANSPORT PLANE, equipped with webbing strap litter supports.
Litter brackets were not always installed in transportairplanes, particularly in new types developed to meet wartime needs. In August1942 the Air Service Command stated that C-53 transport planes were beingprocured without litter supports and that the makers of these planes consideredit impossible, because of difficulty in obtaining parts for litter racks forC-47s, to install them in C-53s before January 1943. The commanding general,Army Air Forces, then directed the Materiel Command to review its transportprocurement program to assure the installation of litter supports in planes during their manufactureand to provide for their installation in all C-53s purchased without them.16Several months later the Air Transport Command requested that litter supports beprovided by manufacturers for all C-46s. Expressing irritation with failure toequip transport planes with litter supports, the AAF Directorate ofMilitary
161st ind, Chief Fld Serv Air Serv Comd AAF to CG Air Serv Cornd AAF, 4 Aug 42, and 3d ind, CG AAF to CG Mat Comd AAF, 21 Aug 42, on Ltr, Chief Overseas Div Air Serv Comd AAF to Chief Fld Serv Air Serv Comd AAF, 20 Jul 42, sub: Litter Racks for C-53 Airplanes. AAF: 370.05 (Evac).
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INTERIOR OF C-54 TRANSPORT PLANE equipped with metal litter supports.
Requirements called upon the Materiel Command for a report.In reply that Command summarized the situation. All C-47s were completelyequipped with litter supports during production. While a shortage of criticalmaterials had prevented installation in the first twenty-four C-46s delivered,all others would come equipped. Beginning in December 1942, all C-53s would beprovided with litter brackets by manufacturers. Meanwhile, the Air Forces wouldinstall them in 200 planes of that type already delivered. Beginning in January1943, supports for ten litters would be placed in each C-60. Finally, all new types of transports would be equipped with litter supportswhen deliveries began.17
Small Planes for Ambulance Service at Training Centers
The question of the assignment to training centers of small ambulance planesfor rescue work was raised again when the
17R&R Sheet Comment 1, CG ATC to Mil Reqmts Dir AAF, 26 Oct 42; Comment 2, Mil Reqmts Dir AAF to Mat Comd AAF, 2 Nov 42; and Comment 3, Mat Comd AAF to Mil Reqmts Dir AAF, 5 Nov 42, sub: Removable Insulation and Litter Supports for C-46 Airplanes. AAF: 370.05 (Evac).
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Southeast Air Corps Training Center requested in May 1942 theassignment of one each to its flying training schools. While the AAF Directorateof Military Requirements observed a policy of neither developing nor altering anairplane so as to provide an additional type, it was willing that planes ofother types be used to carry patients. It therefore directed the AAF MaterielCommand on 18 June 1942 to examine all small transport and liaison planes beingprocured in order to determine which could be readily adapted, with leastmodification, to carry litters.18
The Materiel Command reported in August 1942 that smallplanes most suitable for adaptation to ambulance service were the AT-7 and theC-64. The Air Forces had 127 of the former on hand, and 300 C-64s were beingprocured. Either could be modified to carry at least two litters and a medicalattendant, in addition to the pilot. They would be more suitable than theO-49s (L-1s) already converted, because the latter required more extensivemodification and carried only one litter and a medical attendant, in addition tothe pilot. The Materiel Command therefore requested authority to have a localsubdepot modify one AT-7 and to have a manufacturer modify one C-64 inproduction, in order to determine which would be preferable as an ambulance.19
This recommendation was considered by AAF headquarters, alongwith a request of the Flying Training Command for assignment to the Gulf Coast,West Coast, and Southeast Air Force Training Centers of sixty-two smallambulance planes and of thirteen larger planes of greater cruising range, suchas C-60s.20 On 20 August 1942 the Assistant Chief of Air Staff forTraining, A-3, announced that all small planes being procured were earmarked for othermissions.21 AT-7s were in such demand for the navigation trainingprogram that C-60s were being modified to supplement them. All C-64s beingprocured were to be used in communications work, pilot dispersal, and lightcargo movement. Consequently it was decided not to modify AT-7s, but to havemanufacturers equip all C-64s, beginning in January 1943, with brackets forthree litters. Since none of the latter were assigned to the Flying TrainingCommand, the commanding general, Army Air Forces announced on 8 November 1942that it would have to meet its requirement for airplane ambulances by havinglitter supports installed in planes already on hand.22
The issue of airplane ambulances in the United States came upagain on 12 January 1943 when the Air Surgeon proposed the assignment of L-1Bs-liaisonplanes
18Ltr, CG Southeast AC Tng Ctr to CG Flying Tng Comd AAF, 7May 42, sub: Amb Airplanes, with 5th ind, Dir Mil Reqmts AAF to CG Mat Comd AAF,18 Jun 42. AAF: 452.-1 (Amb Planes).
19(1) Rpt, AAF Mat Ctr Wright Fld, 10 Aug 42, sub: Selectionand Modification of Small Aircraft for Amb Serv. (2) R&R Sheet Comment 1,Mat Comd AAF to War Orgn and Mvmt Dir AAF, 16 Aug 42, sub: Amb Airplanes. Bothin AAF: 452.-1 (Amb Planes).
20Ltr, CG Flying Tng Comd AAF to CG AAF, 5 Aug 42,sub: Amb Airplanes. AAF: 452.-1 (Amb Planes).
21R&R Sheet Comment 5, AC of Air Staff for Tng A-3 to War Orgn and Mvmt Dir AAF and Indiv Tng Dir AAF, 20 Aug 42, sub: Amb Planes. AAF: 452.-1-B (Amb Planes).
22(1) Interoffice Memo, Capt John P. Marshall Mat Comd AAF to Col Seesums, 19 Aug 42, sub: Amb Airplanes. (2) R&R Sheet Comment 3, Indiv Tng Dir AAF to War Orgn and Mvmt Dir AAF, 5 Oct 42; Comment 7, Indiv Tng Dir AAF to Mat Comd AAF, 22 Oct 42; Comment 10, War Orgn and Mvmt Dir AAF to Idiv Tng Dir AAF, 2 Nov 42, same sub. (3) Memo, CG AAF for CG Flying Tng Comd AAF, 8 Nov 42, same sub. All in AAF: 452.1 (Amb Planes).
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modified by manufacturers to carry one litter and one medicalattendant, in addition to the pilot-to meet a need expressed by the Second AirForce. Soon afterward the Flying Training Command renewed its attempt to getairplane ambulances. By this time-the spring of 1943-training programs,such as the glider towing program, were being curtailed and small liaison planes(L-1s) formerly used were no longer needed. As a result, some of them wereassigned for ambulance service to the Second Air Force, and the Flying TrainingCommand was permitted to modify about 100 liaison-type planes to meet its needs.23Soon afterward the AAF Requirements Division announced officially a policywhich it had formerly observed without publicity. When a training station neededa special airplane to be held always in readiness purely as an ambulanceairplane, its requirement would be treated as a special one and would be met bythe conversion of a suitable available plane. Such conversions were to be heldto a minimum and were to be made only when specifically approved by AAFheadquarters.24
The Question of Airplane Ambulances for Use in CombatZones
After the war began, the Air Surgeon and The Surgeon Generalcontinued to plan for the use of small airplane ambulances in combat zones.Their problem in this instance was twofold: (1) to find a suitable plane and (2)to get it delivered in appropriate numbers for use by evacuation units.
Various types of planes were considered. It was agreed that asuccessful one would have to accommodate at least two litters and a medicalattendant, in addition to its pilot, and would have to be able to go in and out of smallfields over tops of trees and other obstructions. Before the war, as mentionedabove, The Surgeon General had thought that an Autogiro might be developed withthese characteristics. In May 1942 an aircraft corporation submitted photographsof a small airplane ambulance which it had developed.25 Both TheSurgeon General and the Air Surgeon proposed that it be studied anddemonstrated, even though it could accommodate only a pilot and one patient,26but after consultation with the AAF Directorate of Military Requirements theMateriel Command informed the company that the Army had no use for such a plane.It stated that litter bearers were the most effective means for removingcasualties from battlefields with rough terrain; that even if the terrain weresuitable for landing, a plane was too vulnerable a target to risk in advancedareas; and, finally, that any plane that lacked room for a medical attendant wasunsatisfactory.27 Somewhat later, in June, another manufacturerdemonstrated to representatives
23(1) R&R Sheet Comment 1, Air Surg to Mil Reqmts Dir AAF, 12 Jan 43, and Comment 3, War Orgn and Mvmt Dir AAF to Air Surg, 16 Mar 43, sub: Airplane Amb (L-1A). AAF: 452.1 (Amb Planes). (2) Routing Slip, [Lt Col] C. W. G[lanz], Mil Reqmts Dir AAF to Col M[ervin] E. Gross, 15 May 43. AAF: 370.05-A (Evac).
24AAF Mil Reqmts Policy No. 41, 25 May 43, sub: Amb Airplanes-Provisions for Evac Wounded by CargoAirplanes. AAF: 370.05-A (Evac).
25Ltr, Aeronca Aircraft Corp to Hon John J. McCloy, AsstSecWar, 20 Apr 42, with incl. SG: 452.1. A similar letter to the Commanding General, Army Air Forces is on file in AAF: 452.1-B (Amb Planes).
26(1) Ltr, SG to Hon John J. McCloy, Asst SecWar, 5 May 42. (2) Memo, Col David N. W. Grant, Air Surg for Col H[oward] T. Wickert, SGO, 11 May 42. Both in SG: 452.1.
27Ltr, Lt Col F. I. Ordway, Jr, AC, Asst Exec MatComd to Aeronca Aircraft Corp, 5 May 42. AAF: 452.1-B (Amb Planes).
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of the Air Surgeon and The Surgeon General a small planewhich he had converted into an ambulance. It was likewise consideredunsatisfactory because it also had room for only one patient and a pilot.28Meanwhile, the Air Forces had begun the investigation, already mentioned, ofsmall transport and liaison planes which training centers might adapt toambulance use. Apparently the Air Surgeon believed that this might result indiscovery of an existing plane that could be used in combat zones as well as inthe zone of interior.29
Despite uncertainty about the availability of a suitableplane for use in forward areas, the Air Surgeon continued to plan in thoseterms. One method of getting approval for his plans was to have airplaneambulances considered as organic equipment of evacuation units. One could assumethat upon activation of such units, planes authorized for them would be madeavailable. When the Air Surgeon revised the table of organization for airevacuation units during 1942, he included twenty small planes along with anequal number of flight officers in the table for the air evacuation squadron,light.30 This table was approved by certain sections of the Air Staffand by the Chief of Air Staff, and one air evacuation squadron, light, wasactivated on 11 November 1942.31 When the matter of providing planes for it cameup, the Directorate of Military Requirements objected. Not having been consultedin advance, it had made no plans for supplying evacuation units with eitherplanes or pilots. It insisted that litter bearers and automobile ambulancescould best move patients from divisional medical stations to rear areas, forpick-up by transport planes. It maintained, therefore, that squadrons equippedwith small planes, or "puddle jumpers," were not required and should not be provided.32 Thecommanding general, Army Air Forces, supported Military Requirements, and itsposition was subsequently announced as policy in May 1943.33
Consideration of Helicopters for Air Evacuation
Announcement of this policy did not quash the hopes of many,including the Air Surgeon, The Surgeon General, and Army Ground Forcesheadquarters,34 that a suitable plane for evacuating patients fromfront-line areas might be found and its use approved. Late in 1942 a civiliandoctor in Virginia had pressed upon the War Department the possibility of using
28(1) Ltr, SG to Piper Aircraft Corp, 5 Jun 42. SG: 452.-1. (2) Memo by Lt Col Thomas N. Page, MC, SGO, 7 Nov42, sub: Air Evac of Pnts. HD: 370.05.
29Memo by Lt Col Thomas N. Page, MC, SGO, 7 Nov 42,sub: Air Evac and Air Trans of Med Sups and Pers. HD: 580.1 Air Evac.
30(1) R&R Sheet Comment 1, Air Surg to War Orgn andMvmt Dir AAF, 15 Sep 42, sub: Air Evac, with incl. AAF: 370.03. (2) Rpt of Mtg, ATC,13 Oct 42, sub: Air Evac of Wounded. AAF: 370.05 (Evac).
31(1) R&R Sheet Comment 3, Ground-Air Support MilReqmts Dir AAF to Mil Reqmts Dir AAF, 24 Nov 42, sub: Conversion of Airplanes toEvac Wounded. AAF: 370.05 (Evac). (2) Hubert A. Coleman, Organization andAdministration, AAF Medical Services in the Zone of the Interior (1948), p. 689.
32(1) R&R Sheet Comment 4, Dir Mil Reqmts AAF to AC of Air Staff for Tng, A-3, 31 Oct 42, sub: Conv of Liaison Type Airplanes. AAF: 370.05 (Evac). (2) R&R Sheet Comment 3, Ground-Air Support Mil Reqmts Dir AAF to Mil Reqmts Dir AAF, 24 Nov 42, sub: Conv of Airplanes to Evac Wounded. Same file.
33(1) R&R Sheet Comment 1, C of Air Staff to Dir Mil Reqmts AAF, 12 Nov 42, sub: Conv of Airplanes to Evac Wounded. AAF: 370.05 (Evac). (2) Mil Reqmts Policy No. 41, 25 May 43, sub: Amb Airplanes-Provisions for Evac Wounded by Cargo Airplanes. AAF: 370.05-A (Evac).
34For the Army Ground Forces' viewpoint, see: 10th ind, CG AGF to CG ASF, 20 Nov 43, on Ltr, Dept of Air Tng Fld Artillery Sch to CG ASF thru Repl and Sch Comd AGF, 7 Sep 43, sub: Air Evac by Light Airplane. AAF: 452.-1 (Amb Planes).
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helicopters in front-line medical service.35 Boththe Air Surgeon and The Surgeon General quickly adopted the idea as a solutionto the problem of evacuating patients by air from inaccessible areas in combatzones and called upon the AAF Materiel Command for information in thisconnection.36 The Command reported early in 1943 that it had beentesting helicopters for a period of eight months. Although it had begun theprocurement of several types, none of them were expected to be delivered beforethe middle of 1943. The Command had already given preliminary consideration tothe use of helicopters for evacuation and was requiring that they be fitted forthe external attachment of "capsules" suitable for carrying litterpatients. It was anticipated that this would enable each XR-5 and R-5helicopter to carry four litter patients and each XR-6 to carry two. Incollaboration with the Aero Medical Research Laboratory, the Materiel Commandwas studying the possibility of modifying XR-5 and XR-6 helicopters so theymight carry four and two litters respectively within their fuselages, ratherthan in externally attached capsules. Meanwhile, it expected that an XR-5helicopter, with capsules attached, would be ready for testing by September 1943and that additional ones could be procured, after their use as ambulances hadbeen approved, in from ten to eighteen months.37
Progress in the general helicopter program was apparently notas rapid as had been expected. In the winter of 1943-44 the Air Forces had onhand only eight or nine serviceable helicopters and expected that few more wouldbe delivered before the latter half of 1944.38 The development of an ambulancehelicopter had also lagged. Believing that patients should not be transported in capsules beyond the reach of medicalattendants except in emergencies, the Air Surgeon succeeded in having a"requirement" established early in March 1944 for a helicopter thatcould accommodate at least four litter patients and an attendant within itsfuselage. In conformity with established policy, the AAF Requirements Divisiondirected that any helicopter developed to meet this requirement should besuitable for basic use as a cargo plane and should be equipped for carryinglitters only if this did not interfere with such use.39 The AirSurgeon also apparently requested the procurement of 150 helicopters for use byhis proposed air evacuation squadrons but he reconsidered the matter afterdiscussion with the AAF Requirements Division. In view of the shortage ofhelicopters of all types and the lack of one that could transport patientswithin its fuselage, he agreed in March 1944 not to organize helicopterevacuation squadrons but instead to use
35(1) Ltr, Dr Huston St. Clair to Maj Gen W[ilhelm] D. Styer, CofS SOS, 23 Nov 42. Off file, Research and Dev Bd SGO, "AmbAirplanes." (2) Ltr, same to Col G[ustave] E. Ledfors, Air Surg Off, 7 Dec42. AAF: 452.1 (Helicopters). (3) Ltr, Mr. G. H. Dorr, Spec Asst to SecWar toCol W[ood] S. Woolford, Air Surg Off, 31 Dec 42. Same file.
36(1) Ltr, SG to Chief Engr Div Wright Fld, 21 Dec 42, sub: Helicopter Dev. AAF: 452.1 (Helicopters). (2) Memo, Air Surg for Mat Comd Wright Fld, [22 Dec 42], same sub. AAF: 452.1 (Amb Planes).
37(1) Memo, Mat Comd AAF for SG, 16 Jan 43, sub:Helicopter Dev-Util as Air Amb. (2) Memo, Mat Comd AAF for Air Surg, 3 Mar 43,sub: Helicopter Dev for Air Amb Serv. Both in AAF: 452.1 (Helicopters).
38(1) Memo, CG AAF for ACofS G-3 WDGS, [12 Dec 43], sub: Status of AAF Helicopter Program. (2) Ltr, CG AAF to CG Tng Comd AAF, 20 Jan 44, sub: Availability of Helicopter Aircraft. Both in AAF: 452.1 (Helicopters).
39(1) Ltr, Mat Div AAF to Mat Comd Wright Fld, 3 Mar 44, sub: Dev of Large Type Helicopters. (2) R&R Sheet Comment 2, Oprs, Commitments, and Reqmts Div AAF to Air Surg, 23 Mar 44, sub: Status of Helicopters. Both in AAF: 452.1 (Helicopters).
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LOADING A PATIENT ON AN L-5 PLANE
for emergency evacuation helicopters ordinarily employedotherwise.40 Soon afterward he stated that it was AAF policy to useC-64 and L-5 airplanes equipped to carry litters for the evacuation ofpatients singly or in small numbers.41 Meanwhile, the generalhelicopter program continued, and toward the end of the war there wereindications that some might soon be modified to carry patients within theirfuselages and that they would be available in sufficient numbers for assignmentto overseas commands.42
Relaxation of the Policy Limiting the Use of Special Planesfor Evacuation
Despite AAF policy against the use of airplanes exclusivelyfor evacuation, assignment of additional transport planes to supply enough"lift" for evacuation in addition to normal operations became anaccepted practice in the zone of interior
40R&R Sheet Comment 1, Air Surg to Oprs,Commitments, and Reqmts Div AAF, 4 Mar 44, and Comment 2, Oprs, Commitments, andReqmts Div AAF to Air Surg, 7 Mar 44, sub: Use of Helicopters for Air Evac. AAF:452.1 (Helicopters).
415th ind, CG AAF (Air Surg) to CG Air Serv Comd, 24 May44, on Memo, 2d Lt William R. Kee, AC for Air Surg, thru Channels, 17 Apr 44,sub: Evac of Wounded by Air. AAF: 370.05 (Evac). Also see The Air Surgeon's Bulletin, vol. I, No. 8 (1944), p. 19 and vol. I, No. 9 (1944), p.16.
42(1) R&R Sheet Comment 1, Reqmts Div AAF to Mat Div AAF, 31 May 45, sub: Litter Capsules for Helicopters. (2) Ltr AG 320.3 (11 Apr 45) OB-I-AFRTH,TAG to CG ETO, 5 May 45, sub: AAF Helicopter Program. Both in AAF: 452.1 (Helicopters).
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during the later war years. This practice began in January1944, when three C-47s were temporarily used to move 661 patients from StarkGeneral Hospital to other hospitals in the zone of interior. Several monthslater the Air Transport Command temporarily assigned twelve C-47s to itsFerrying Division for a similar "special operation." These operationswere so successful that, after the Ferrying Division was made responsible forair evacuation in the zone of interior in May 1944, twelve planes werepermanently assigned to that mission. They could, of course, be used for thetransportation of other persons and of cargo when not carrying patients. Thenext month twelve additional C-47s were assigned to provide planes forevacuation. As the number of patients arriving from theaters increased and thecalls for air evacuation became more frequent, the number of transport planesassigned to the Ferrying Division for evacuation operations grew until itreached forty-nine by September 1944.43
As patients continued to be evacuated from theaters to thezone of interior in regular transport planes, efforts were made during 1944 and1945 to increase the number of patients they carried. The increase wasaccomplished in two ways. One was the installation of newly developedwebbing-strap litter supports. More patients could be accommodated in planesusing these supports than in those equipped with metal-type supports. In thesummer of 1944 the Air Forces installed webbing-strap litter supports in C-54salready in use and provided for their installation in others during production.44Another method of increasing the use of airplanes for evacuation was to modifythe system of determining the number of patients theaters would evacuate by air.In the spring of 1944, it will be recalled, the Air TransportCommand authorized theaters to ignore the old system of priorities for airtransportation and determine locally the proportion of space on returningtransport planes that would be reserved for patients.45
Medical Flight Attendants
Early Plans for Medical Personnel for Air Evacuation
Since plans for air evacuation during the period before thewar and well into its first year were tentative only, plans for units to beemployed in such operations were of necessity also uncertain. In the prewaryears The Surgeon General and the Medical Division of the Air Corps collaboratedin the development of an organization-sometimes called a task force-thatwould be used exclusively for the evacuation of patients from forward to rearareas of theaters of operations and perhaps to the zone of interior. While therewere differences of opinion on some points-such as the name of theorganization, the number of subordinate units it should have, and the amount ofpersonnel
43(1) Organizational History of the Ferrying Division,June 20, 1942 to August 1, 1944, pp. 271-78. ATC: Hist Div. (2) Initial Medical History (11 February 1943to 30 June 1944), Headquarters Ferrying Division, Air Transport Command. HD: TAS.(3) Quarterly Medical History, Headquarters Ferrying Division, Air TransportCommand, 1 July-30 September 1944. HD: TAS. (4) Memo, Air Surg for SG, 27 Jul 44. SG: 580. (5) Memo, Comdt Sch of Air Evac for CG AAF, 16Feb 44, sub: Air Evac. AAF: 370.05 (Evac). (6) The Air Surgeon's Bulletin, vol.I, No. 4 (1944), pp. 10-11.
44(1) 1st ind, CG ATC to ACofS OPD WDGS thru CG AAF, 15 May 44, on unknown basic Ltr. OPD: 580.81. (2) The Air Surgeon's Bulletin, vol. I, No. 7 (1944), p. 17.
45See above, p. 340.
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required for each unit-there was general agreement on majorissues. An air ambulance organization should be composed of both Air Corps andmedical personnel, the former to maintain and operate ambulance airplanes andthe latter to care for patients. This organization should operate under thecontrol of theater headquarters, augmenting surface evacuation, and shouldperhaps be assigned on the basis of one unit per field army. Medical officersand enlisted men of the organization would not only serve as attendants topatients during flights but would also operate medical stations at largeairfields, fifteen to fifty miles from the front, and at small emergency landingfields, two to ten miles from the front. They would collect and transportpatients by motor ambulances to such stations, care for them as they awaited airevacuation, and load them on planes for transportation to the rear.46
Several tables of organization for an air evacuation unitwere developed through the collaboration of the Surgeon, GHQ Air Force; theMedical Division of the Air Corps; and the Surgeon General's Office. Onesubmitted in July 1940 was disapproved by the General Staff because airplaneambulances were included as organic elements of medical rather than Air Corpsunits of the evacuation organization.47 Another, submitted by TheSurgeon General in October 1940, apparently remained in the G-3 Division ofthe General Staff without action until the late summer of 1941. It was thenrevised and resubmitted for approval in November.48 It was publishedshortly afterward as the table of organization for a medical air ambulancesquadron. This squadron was to be a companion unit for an Air Corps transportgroup composed of a headquarters squadron, a flight squadron, light, equipped witheighteen single-engine liaison planes for front-line evacuation, and two flightsquadrons, heavy, each equipped with twelve two-engine transport planes forintra-theater evacuation. The medical squadron was to consist of a headquarterssection, a single-engine transport ambulance section, and two two-enginetransport ambulance sections. It was to have 45 Medical Department officers, nonurses, and 218 enlisted men. One unit of this type, the 38th Medical AirAmbulance Squadron, was activated at reduced strength as a test unit in May1942.49
After AAF was charged with responsibility for air evacuationin the summer of 1942, the Air Surgeon's Office developed a new plan for an air evacuation unit,called an air evacuation group. This group was to be composed of a headquarters
46(1) Ltr, SG to TAG, 11 Jul 40, sub: AC Med TransGroup. AG: 320.2 Med (7-11-40). (2) Memo, Chief Med Div OCofAC for SG, 3 Oct40. SG: 320.3-1. (3) 2d ind, SG to TAG, 18 Mar 41, on Ltr, Dir DeptExtension Courses MFSS to SG thru Comdt MFSS, 31 Jan 41, sub: FM 8-5, MobileUnits of MD. AG: 300.7 (1-31-41) FM 8-5. (4) David N. W. Grant,"Airplane Ambulance Evacuation," The Military Surgeon, vol. 88,No. 3 (1941), pp. 238-43. (5) FM 8-5, Mobile Units of MD, 12 Jan 42, pp.157-69.
47(1) Ltr, Surg GHQ AF to Chief Med Div OCofAC, 20 Jun 40. SG: 320.3-1. (2) Memo, Chief Med Div OCofAC for SG, 21 Jun 40. Same file. (3) Ltr, SG to TAG, 11 Jul 40, sub: AC Med Trans Group. AG: 320.3 Med (7-11-40). (4) Memo, ACofS G-3 WDGS for CofSA, 7 Aug 40, sub: Air Amb Serv. Same file. (5) Memo, TAG to SG, 5 Sep 40, same sub. Same file.
48(1) Ltr, SG to TAG, 29 Oct 40, sub: New T/O Med Bn,Airplane Amb, with 3 inds. (2) DF G-3/42108, ACofS G-3 WDGS to CofAAF, 15 Augand 27 Oct 41, same sub. (3) R&R Sheet Comment 1, C of Air Staff AAF toCofAC (Med Div), 7 Nov 41, same sub. All in AAF: 320.3 L-1. (4) DF, C of AirStaff to TAG, 19 Nov 41, sub: T/O for Med Airplane Amb Sq. AG: 320.2 (11-19-41).
49(1) T/O 8-455, 19 Nov 41, Med Air Amb Sq. (2) Guilfordand Soboroff, op. cit.
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squadron; an air evacuation squadron, light; and three airevacuation squadrons, heavy. While it was anticipated that the heavy squadronswould consist of medical personnel only and would use planes of either troopcarrier or air transport commands, the light squadron was to have twenty smallplanes and twenty pilots assigned as organic elements. The light squadron was toconsist of only enlisted men and officers, but the heavy squadron was to havenurses also. The entire group was to have 49 Medical Department officers, 20 AirCorps officers, 78 nurses, and 458 enlisted men. It was anticipated that airevacuation groups would be assigned as the situation required to air forces,theaters, defense commands, task forces, or field armies.50 The AirStaff having approved the plan for this organization, the I Troop CarrierCommand activated such a unit in October 1942, using initially officers and mentransferred from the 38th Medical Air Ambulance Squadron. This unit-the 349thAir Evacuation Group-at first consisted of a headquarters squadron and oneheavy squadron. In November, when a light squadron and two additional heavysquadrons were activated and assigned to it, the 349th Air Evacuation Group wasgiven the mission of training personnel for air evacuation operations.51Meanwhile, as already explained, the Air Staff had decided that transport planeswould not be earmarked for evacuation only and that small ambulance airplaneswould not be provided for use in forward areas. This decision cut short the lifeof the squadrons just activated because it destroyed the basic conceptunderlying their formation.
With the decision to consider air evacuation as a secondarymission of planes engaged in general transport service, a different kind of organization was needed. The Air Surgeontherefore developed a smaller unit, the Medical Air Evacuation TransportSquadron (MAETS), whose table of organization was issued in advance form at theend of November 1942 and was published in regular format in February 1943. Thisunit had no personnel for the movement of patients in motor ambulances or theoperation of medical stations at loading points. It consisted of a headquartersand four evacuation flights, each made up of six flight teams. A commandingofficer, a chief nurse, an administrative officer, and 29 enlisted men comprisedthe headquarters. Each flight, headed by a flight surgeon, consisted of 6 flightnurses and 8 enlisted men, of whom 6 were surgical technicians. Flight teams,made up of one nurse and one technician, could be placed on transport planes asneeded.52 In December 1942 members of the three heavy air evacuationsquadrons already activated were used to form six medical air evacuationtransport squadrons. The next month the light air evacuation squadron wasdisbanded and its personnel was absorbed by the 349th Air Evacuation Group.Subsequently, during 1943 and 1944, additional MAETS were organized, trained,and sent overseas.53
50(1) Coleman, op. cit., pp. 685-87, 703.(2) R&R Sheet Comment 1, Air Surg to Dir War Orgn and Mvmt AAF, 15 Sep 42, with incl. AAF: 370.03. (3) Rpt, Mins ofMtg, ATC, 13 Oct 42, Air Evac of Wounded. AAF: 370.05.
51(1) Medical History, I Troop Carrier Command From 30April 1942 to 31 December 1944. HD: TAS (2) Coleman, op. cit., p. 689.(3) Guilford and Soboroff, op. cit.
52(1) An Rpt, FY 1943, Oprs Div Air Surg Off. DAF: SGOHist Br. (2) T/O 8-447, Med Air Evac Trans Sq, 15 Feb 43.
53(1) Guilford and Soboroff, op. cit. (2) UnitCards, 801st thru 831st Med Air Evac Trans Sqs, filed in Orgn and Directory Sec Oprs Br Admin Servs Div AGO.
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School of Air Evacuation
Charging the 349th Air Evacuation Group with the mission oftraining personnel for air evacuation operations indicated recognition by theAir Surgeon of the need for specialized training for such work. Despite the factthat it was not to be used in the theaters of operations as originallyanticipated, the 349th continued in existence as a training school until June1943. At that time the Air Forces established a School of Air Evacuation atBowman Field, Kentucky. This school operated under the Troop Carrier Commanduntil August 1944. Then, after a short period of operation directly under AAFheadquarters, it was merged in October 1944 with the School of Aviation Medicineat Randolph Field, Texas. During the period from June 1943 through September 1945it trained in air evacuation duties 109 medical officers, 1,331 nurses, and 837 enlisted men.54
Method of Controlling and Supplying Flight Attendants
Teams of one nurse and one Medical Department technician perplane continued in use throughout the war. As air evacuation operations withinthe United States began to assume significant proportions early in 1944, ATCheadquarters announced in April that additional nurses trained in air evacuationwould be assigned to ATC hospitals and would be used, along with enlistedtechnicians qualified to assist them, to form flight teams for planestransporting patients between hospitals in the United States.55 Whenthe Ferrying Division took over domestic air evacuation soon afterward, itacquired flight surgeons, flight nurses, and enlisted technicians as part of its bulk allotment of MedicalDepartment personnel for use in air evacuation only.56 Forevacuation within theaters of operations and for flights between theaters andthe zone of interior, flight teams were supplied by medical air evacuationtransport squadrons. The table of organization for these squadrons was revisedin July 1944, reducing the number of enlisted men in squadron headquarters fromtwenty-nine to twenty-four. Personnel in the squadron's four flights, each ofwhich contained six flight teams, remained unchanged, but the rank of nurses wasraised.57 Squadrons used for intra-theater evacuation were attachedto troop carrier commands or to Air Transport Command divisions in theaters.Those for evacuation from theaters to the zone of interior were assigned to ATCwings until the end of 1944. Gradually thereafter the squadrons assigned to ATCwings were disbanded and flight teams used to accompany patients from theatersto the United States were grouped under the 830th Medical Air EvacuationSquadron Headquarters, organized in the office of the ATC surgeon in Washingtonin November 1944. By the end of the year this squadron consisted of 44 flights;by April 1945 the number had been increased to 56; and by July, to 78. Thiscentralization of administrative and
54(1) Coleman, op. cit., pp. 691ff. (2) Guilford andSoboroff, op. cit. (3) An Rpt, FY 1943, Oprs Div Air Surg Off. DAF: SGOHist Br. (4) AAF Reg 20-22, 22 Jul 43.
55ATC Memo 25-6, 29 Apr 44, sub: Med Air Evac. AAF:370.05.
56(1) Organizational History of the Ferrying Division,June 20, 1942 to August 1, 1944. ATC: Hist Div. (2) Quarterly Medical History,Headquarters Ferrying Division, Air Transport Command, 1 July-30 September1944. HD: TAS.
57(1) T/O&E 8-447, 19 Jul 44. (2) DF, CG AAF toACofS G-3 WDGS, 8 Jul 44, sub: T/O&E 8-447, Med Air Evac Sq. AG: 320.3(2 Jun 44) (1).
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operational control resulted in a saving of overheadpersonnel and permitted the rapid reassignment of flight teams to areas wherethey were needed most. It also permitted the establishment of a procedure in thespring of 1945 which enabled each flight team to accompany patients to theUnited States. Formerly, flight teams located along ATC routes had flown fromtheir home stations to stations en route and then had returned to home stations.58
The economy of men made possible by air evacuation was amajor factor in enabling the War Department to meet the demands for large-scaletransportation of patients in 1944 and 1945 with the limited number ofattendants at its disposal. Early in 1944, when there was concern in Washingtonlest there be not only insufficient shipping but also insufficient personnel tomove the patient load anticipated for the latter half of the year, the SurgeonGeneral's Office and ASF headquarters asked for an increase in air evacuationfrom theaters as a means of saving manpower.59 The saving waspossible, for one reason, because air evacuation was so much faster than surfaceevacuation that patients required the care of only nurses and enlistedtechnicians. Moreover, for such short periods, fewer attendants per patient wereneeded. The saving of personnel can be illustrated by comparing the number ofattendants required for a trip by hospital ship with the number required for thesame trip by planes that did not stop to change medical attendants or to givepatients treatment at hospitals en route. In such a case, the transportation of500 patients by hospital ship required eight doctors, eight other officers,thirty-four nurses, and 135 enlisted men. To transport a similar number ofpatients by air in one continuous flight required seventeen planes (assuming that each carried thirty patients) with seventeenteams consisting of one nurse and one technician each, or a total of thirty-fourpersons, together with the personnel rounding out the flights to which theseteams were attached-three doctors and six enlisted men. The economy is morestrikingly realized if man-days are compared. For example, the transportation of500 patients across the Atlantic by hospital ship normally requiredapproximately seven days and therefore used about 1,295 man-days of medicalattendance, while the same evacuation could be accomplished by airplane withinfrom one to two days, depending upon whether or not an overnight stop was madein Newfoundland, and required from forty-three to eighty-six man-days only.60
Efforts To Supply Appropriate Equipment for Air Evacuation
Confirmation as policy during 1942 of the peacetime practiceof using operational planes instead of special airplane ambulances for theevacuation of patients required the development of special equipment that couldbe used easily and quickly to adapt cargo and transport planes to theirsecondary mission-the
58(1) Guilford and Soboroff, op. cit. (2) Historyof the Medical Department, Air Transport Command, 1 January 1945-31 March 1946. HD: TAS. (3) AAF Manual 25-0-1, Flight Surgs Ref File, 1 Nov 45. HD: 321 (AAF).
59Memo, CG ASF for ACofS OPD WDGS, 26 Apr 44,sub: Air Evac from ETO and NATO. HRS: ASF Planning Div Program Br file,"Hosp and Evac, vol. 3."
60This paragraph is based upon a comparison of thetables of organization of hospital ship complements and medical air evacuationtransport squadrons and upon comments by Brig Gen. Albert H. Schwichtenberg on afirst draft of this chapter. Also see Journal of the American MedicalAssociation, Vol. 141, No. 8 (1949), pp. 540-41.
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evacuation of patients. Early in 1942 the Air Forces began touse Douglas removable metal-type litter racks, which had already been designedfor this purpose, to enable large cargo planes such as the C-47s to carryeighteen litter patients.61 These racks had importantdisadvantages. Their detachable parts frequently were lost or damaged instowage, and replacements had to be stocked at various fields. Furthermore, itwas discovered in the fall of 1942 that standard racks did not accommodate alltypes of American litters currently in use in combat theaters. The MaterielCenter at Wright Field (Ohio) therefore undertook a series of experiments, andby the early part of 1944 it developed litter supports made of webbing straps.62They were superior to Douglas metal-type racks in many ways. The racks hadto be disassembled after each evacuation mission and stowed in floorcompartments while two sets of webbing straps could be spaced and anchoredpermanently along the roof and side walls of the interiors of planes. Douglasracks weighed nearly 200 pounds in comparison with 110 pounds for webbing-strapsupports. Metal supports would accommodate only eighteen litter patients incertain aircraft, but webbing straps would hold twenty-four. Preparation ofplanes for evacuation with webbing-strap supports could be accomplished in sixto eight minutes, a fraction of the time needed to assemble and installmetal-type racks. In March 1944, therefore, the use of metal-type racks wascurtailed and airplane production was modified to require the installation ofthe new supports.63 The Air Forces later issued technical orders toguide those engaged in air evacuation operations in the use of webbing-strapsupports in C-47, C-47A, C-46, C-64, and C-54 airplanes.64
Litters were important items because they served aspatients' beds during flights. Before the war the Air Corps had used a metallitter, based upon the best features of the Navy's Stokes litter. It wasnoninflammable, easy to disinfect, and could be carried, with a patient strappedin, in either a horizontal or a vertical position, but it was costly, bulky,heavy, and difficult to carry.65 At the beginning of the war,therefore, the Air Corps substituted for it aluminum-pole litters which had beendeveloped in 1937 especially for Air Corps use. In 1942 growing shortages ofaluminum stimulated development of a straight carbon-steel-pole litter. Apotential steel shortage in turn brought about the development early in 1943 ofboth straight and double-folding laminated-wood-pole litters. The latter couldbe collapsed into a smaller space than others, and it soon came to be generallyregarded as the best of Medical Department folding litters and ideal for AirForces use.66
When aluminum and steel again became available in the summerof 1943, the
61David N. W. Grant, "A Review of Air EvacuationOperations in 1943," The Air Surgeon's Bulletin, vol. I, No. 4(1944), p. 1.
62Tec Instruction 1255, Hq Mat Comd AAF Hq to Tec ExecMat Ctr, Wright Fld, Ohio, 9 Sep 42, sub: Correction of Standard Type Litter Support Now BeingInstalled in Army Trans Aircraft. AAF: 452.1-B (Amb Planes).
63D. M. Clark, "Litter Support Installations for theC-47 Airplane," The Air Surgeon's Bulletin, vol. I, No. 4(1944), p. 10.
64AAF Tec Orders 00-75-1 (1 Jul 44); 00-75-2 (30 Nov 44); 00-75-3 (5 Jan 44); 00-75-4 (15 Jan 44); Air Evac Technique of Loading Pnts in C-47 and C-47A, C-46, C-64, and C-54 Airplanes respectively. AAF: AF Admin Ref Br, Air AG.
65John B. Johnson, Jr., and Graves H. Wilson, A Historyof Wartime Research and Development of Medical Field Equipment (1946), pp.1-245.
66Sup Plan 16, Procurement Div SGO, 20 Oct 43, sub:Litters. Off file, Sup Div SGO, 400.114/3815 (Litter, Steel, Folding).
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Air Forces shifted procurement back to straight steel-poleand folding aluminum-pole litters. Those issued were unpopular-the formerbecause of its weight and the latter because it did not fold up well in fielduse.67 The folding laminated-wood-pole litter continued to bepreferred until February 1944. At that time the Air Forces recommended thatstraight aluminum-pole litters be procured for the remainder of the war. Thischange was due not so much to dissatisfaction with the special folding litter asto basic changes in aircraft construction. By the early part of 1944 doors andinternal capacities of cargo and transport planes had been so enlarged thatdifficulties formerly encountered in loading, unloading, and stowing litterswere no longer problems in air evacuation. Thus the litter which had beendesigned originally for Air Force use was supplanted, in Air Force procurement,by the standard Ground Force litter. In the summer of 1945, general preferencefor straight aluminum-pole and folding laminated-wood-pole litters wassanctioned by keeping only these two types classified as standard.68
Supplies and equipment for the care of patients during flightsimilarly had to be specially designed and selected because weight and spacewere important factors in air movements. At the beginning of the war, twomedical chests had been developed for the Air Corps as Medical Department items.A flight service chest, standardized before and improved during the war, wasfurnished each air evacuation transport squadron. An airplane ambulance chest,developed by the Air Corps and a plastics corporation in St. Louis, Mo., forissue to each flight team, was lighter and contained a minimum of supplies andequipment to care for the immediate needs of patients.69The latter type ofchest appears to have been satisfactory only for trips requiring six to ninehours. For shorter trips, like those in the North African campaign, the chestwas too large and frequently was not used at all if a nurse had to providemedical care unassisted. For longer ones, medical evacuation personnelconsidered the chest too small for efficient use.70 Variation in distancesbetween theaters and the zone of interior and in the types of patients evacuatedwas so great that standardization of a chest for universal use was impractical.Therefore, improvisations of cabinet-type containers for long trips and thedevelopment of experimental kits for short trips continued to the end of thewar.71
The provision of adequate oxygen equipment and improvement offacilities to control and restrain psychotic patients were other problems theAir Forces faced. The availability of oxygen was essential to minimizephysiological changes due to the altitude at which flight was maintained. TheAir Forces developed and issued a portable continuous-flow therapeutic-oxygenkit to be used for both air evacuation and air and sea rescue. Beginning in thesummer of 1944, each air evacuation team received four of these kits to augmentthe
67See n. 66.
68Johnson and Wilson, op. cit., p. 45.
69(1) See documents in Off files, Sup Div SGO, 400.112/2642 (Chest, Flt Serv, Empty), and 400.114/3023 (Chest, Amb, Airplane, Empty). (2) T/E 8-447, 30 Nov 42. (3) Ltr, SG to CG SOS, 14 Jan 43, sub: Airplane Amb Chest, with 5 inds. SG: 428.
70(1) Weekly Staff Rpts, Staff Mtgs ASO, 13 Sep 43. HD: TAS. (2) Daily Rpt, Sup Div ASO, 3 Oct 44. HD: TAS.
71(1) An Rpt, Sup Div ASO, FY 1944. HD: TAS. (2) Daily Rpt,Sup Div ASO, 3 May 45. Same file. (3) Andres G. Oliver and Hampton C. Robinson,Jr., "Domestic Air Transportation of Patients," The Air Surgeon'sBulletin, vol. II, No. 11 (1945), p. 401.
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standard oxygen system available for the crew and able-bodiedpassengers.72 A rather knotty problem developed from thetransportation of psychotic patients. Since planes had no facilities forisolation, such patients constituted a potential danger to others during flight.Although the Air Transport Command returned several hundred of them from theSouthwest Pacific to the zone of interior during 1944 and 1945, it was not untilthe end of the war that the Command produced a really suitable flexiblerestraint.73
Although feeding was a normal part of pre- and post-flightcare, a serious problem in feeding patients developed when flights extended overlong periods of time. Cargo and transport planes had no facilities for cleaningor washing dishes, trays, or silverware; and their crews lacked experience inpreparing suitable meals for patients from a limited variety of available foods.By January 1944 this problem became serious and the Air Forces started a surveyto find a solution. Nevertheless, provisions for feeding patients beingevacuated from theaters continued to be little more elaborate than sandwiches,hot coffee, and cold drinks carried in thermos jugs. Patients transported in thedomestic air evacuation system, operated by the Ferrying Division of the AirTransport Command, were more fortunate. In November 1944 Wright Field begantesting and later approved for installation in planes of the Ferrying Division agalley unit containing four large cups to heat food, a container for coffee, andtwo "hot cups" for preparing chocolate, soup, and bouillon, as well asdrawers for the storage of food.74
Both patients and medical attendants complained of fatigue onlong flights, patients because of lying on litters for several hours and medical attendants because of lifting andchanging the position of patients frequently. An air mattress was thereforedeveloped by the Air Forces to fit on Army litters. It took little space instowage, weighed little, inflated easily, and could be washed with soap andwater. Authority was granted in January 1945 to issue twenty-four air mattressesto each flight team.75
Patients transported by air along both tropical and arcticroutes suffered from uncomfortable temperatures in planes when they landed forservicing. Early in 1944 the Air Forces collaborated with the QuartermasterCorps and other agencies in the development of portable air conditioners to coolplanes' interiors at stopover points. By August 1944 the Supply Division ofthe Air Surgeon's Office had issued forty-two air conditioners to the AirTransport Command for use both in the zone of interior and in overseas theaters.76In arctic areas, large heaters that could be moved up to planes on the groundwere used to warm cargo areas until planes were ready for flight.77
72(1) The Air Surgeon's Bulletin, vol. II, No. 3 (1945),pp. 78-79, and vol. II, No. 4 (1945), pp. 106-07. (2) T/O&E 8-447, C1, 11 Dec 44.
73History of the Medical Department, Air TransportCommand, 1 January 1945-31 March 1946, pp. 91-97. HD: TAS.
74(1) A mimeographed copy of a broad plan to studycertain equipment problems in connection with air evacuation of patients,developed around January 1944, may be found in AAF: 370.05 (Evac Book 2). (2)Oliver and Robinson, op. cit., pp. 400-01.
75(1) Ltr, CG AAF (Air QM) to CG ASF, 2 Jun 44, sub: Air Mattresses and Pillows. AAF: 427. (2) Rpt, Off of Air Insp (I. B. March) to Air Insp Hq AAF, 21 Aug 44, sub: Summary of Med Insp of ATC and Stas In CBI Wing. HD: TAS (ATC and Misc). (3) T/O&E 8-447, C 2, 25 Jan 45.
76(1) An Rpt, Sup Div ASO, FY 1944. HD: TAS. (2) Daily Rpt, Sup Div ASO, 29 Aug 44. Same file.
77The Air Surgeon's Bulletin, vol. II, No. 10 (1945), pp. 330-31.
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Until the fall of 1943 loading and unloading litters inhigh-door planes were accomplished manually. When air evacuation increased inthe latter part of 1943, this method was discarded generally in favor of afork-lift truck with a "litter adaptor" made from a simple woodenpallet platform used to move and store cargo. The mechanical loading andunloading of patients proved to be rapid, safe, and comfortable and was adoptedat most Air Transport Command installations throughout the world by the end ofthe year.78
The exchange of property used in air evacuation constituted adifficult problem. A patient was seldom separated from his litter and blanketsuntil he reached a hospital. When the Air Forces released patients to Ground orService Forces installations, comparable equipment seldom was returned inexchange and the Air Forces sustained a gradual loss.79 This wasparticularly important in the case of litters in the first part of the warbecause the Ground and Service Forces were using straight-pole litters while theAir Forces preferred and used folding-pole litters. The Air Surgeon and TheSurgeon General were acquainted with the problem and by the middle of 1943 beganto study means of solving it.80 A new procedure was established bydirectives issued by the Air Transport Command in April and the War Departmentin June 1944. According to it, the Air Transport Command was to furnishnecessary medical supplies for use in flight, while commanding officers ofmedical installations, through medical supply officers, were to be responsiblefor providing such equipment as litters and blankets. When a hospital requestedair transportation for a group of patients, a shipping ticket was to be preparedby its medical supply officer listing necessary litters, blankets,splints, etc. The flight nurse was to turn in the shipping list to the medicalsupply officer of the receiving hospital where it would be signed and mailed tothe originating hospital. Later, the equipment was to be turned in to a depotfor return to the theater by boat. If the originating hospital was in the zoneof interior, the equipment would be shipped directly to that hospital.81This system did not work as well as anticipated. Shipping by water was slow anddid not always return property as fast as it was used. As a result, successiveefforts were made during 1944 to increase the number of blankets and litterssupplied to air evacuation squadrons so that a pool of this equipment could beestablished overseas.82
Changes in the table of organization and equipment for airevacuation squadrons reflected both the development of special equipment for airevacuation operations and attempts to eliminate shortages of equipment intheaters of operations. The table, first published on 30 November 1942,authorized the Air Forces to issue such items as flight clothes and equipment tonurses and enlisted technicians and the Medical Department to issue blankets,litters, and flight service medical chests. As revised in June 1943, this tabledoubled the allowance of blankets, undoubtedly to
78John M. Collins, "Litter Loading Device," TheAir Surgeon's Bulletin, vol. I, No.9 (1944), p. 22.
79Diary, SOS Hosp and Evac Br (Fitzpatrick), 27 Nov 42. HD:Wilson files, "Diary."
80Johnson and Wilson, op. cit., p. 152.
81(1) ATC Memo 25-6, Air Evac, 29 Apr 44. AAF: 370.05 (Evac Book 2). (2) Ltr, TAG to CGs AAF, AGF, ASF, Theaters, Def and Base Comds, etc., 8 Jun 44, sub: Procedure for Evac of Pnts by Water or Air from Overseas Comd. AG: 704.11 (3 Jun 44).
82Memo SPMOO 400.34 (15 Nov 44), CG ASF (Lutes) for CGAAF, 20 Nov 44, sub: Change 1 to T/O&E 8-447. AG: 320.3 (2 Jun 44).
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cover shortages growing out of unsatisfactory operation ofthe property-exchange system.83 Medical supplies were to berequisitioned from medical depots operated by the Air Service Command accordingto requirements determined by the Supply Division of the Air Surgeon's Office.84A revision of the table in July 1944 authorized the Air Forces to issuefour portable oxygen assemblies per air team, and it increased the number oflitters per squadron from 432 to 576. Five months later, a further changereflected the substitution of the Air Forces' newly developedtherapeutic-oxygen kit for the portable assembly. It also authorized an increase in straightaluminum-pole litters from 576 to 1,500, and the addition of 3,732 olive drabblankets for each squadron. The increase in litters and blankets was made tocover part of the shortages of these items in the theaters. Another change inthe table, published 25 January 1945, added as Air Forces organizationalequipment 576 pneumatic mattresses per squadron.85
83T/E 8-447, 30 Nov 42, with C 1, 14 Jun 43.
84Coleman, op. cit., pp. 635-36.
85T/O&E 8-447, 19 Jul 44; C 1, 11 Dec 44; C 2, 25 Jan 45.
