PART FOUR
EVACUATION
TO AND IN THE ZONE OF INTERIOR
Introduction
The evacuation of patients from theaters of operations to thezone of interior and from one point to another in the United States was anintricate operation, involving not only the transportation but also the care enroute of patients suffering from all kinds of diseases and injuries. It wascomplicated by many factors, among them the means employed. Various types oftransportation facilities were used-motor vehicles, trains, ships, andairplanes. Each of these had subtypes. For example, both hospital and transportships returned patients from theaters. Various kinds of personnel, civilian andmilitary, were employed to operate transportation facilities and care forpatients aboard them-doctors, nurses, technicians, pilots, and many others.Moreover, equipment and supplies needed to care for patients in transit wereextensive and sundry, ranging from aspirins to operating tables. To some degreepersonnel and equipment required were governed by transportation facilitiesemployed, because hospital ships, for instance, needed more elaborate equipmentand larger staffs than did airplanes.
Evacuation was further complicated by its interrelationshipwith plans, policies, and procedures for hospitalization. For example, thedivision of general hospital beds between the theaters and the zone of interiorwas determined by-among other factors-the evacuation facilities expected tobe available. On the other hand, the number of beds supplied to theatersinfluenced the number of patients to be transferred to the zone of interior, andhence the transportation facilities that would be required. Successful operationof the specialized hospital system in the United States and observance of apolicy of hospitalizing patients as near their homes as possible depended uponthe evacuation system.1
To co-ordinate evacuation with hospitalization and to use allavailable means-transportation facilities, personnel, and equipment-in such away that large numbers of patients would be moved as safely and expeditiously aspossible required a highly organized operational system. Its development andconduct were complicated not only by the divers means employed but also by thedistances traversed and the agencies involved. Patients traveling by land, air,and sea from hospitals in theaters of operations to those in the zone ofinterior were the responsibility of successive military agencies. Among themwere the bases and headquarters of theaters of operations; the Air TransportCommand with its overseas wings; the Transportation Corps with its ports ofembarkation and debarkation in the United States; the Offices of the Chief ofTransportation, The Surgeon General, and the Air Surgeon; service and aircommands in the United States; and the headquarters of both the Air and ServiceForces.
Involvement of so many agencies made it important to definetheir respective areas of responsibility-particularly after
1Interrelationships between hospitalization and the policies and processes of evacuation have been discussed at various points in preceding chapters and will be referred to again from time to time.
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the War Department reorganization in March 1942. Onrecommendation of SOS headquarters, this was done for major agencies thefollowing June. The commanding general, Army Air Forces, was charged withdevelopment and operation of air evacuation. Commanders of theaters ofoperations and of major commands in the United States were declared responsiblefor the movement of patients within their own commands. The commanding general,Services of Supply, was charged with evacuating patients from all major commands-those overseas as well as in the United States-and of co-ordinatingall plans of such commands for the evacuation of sick and wounded to bedelivered to his control.2 To assisthim in this function, various responsibilities (which will be discussed later)were assigned to the Chief of Transportation, The Surgeon General, and port andcorps area commanders. In the early part of the war their activities wereclosely supervised and coordinated by the SOS Hospitalization and EvacuationBranch.
Beginning in 1943 a series of events transferred that Branch'sresponsibility and authority for evacuation to The Surgeon General and the Chiefof Transportation. Early that year, it will be recalled, ASF (formerly SOS)headquarters began to return to The Surgeon General some of the functions it hadassumed earlier in hospitalization and evacuation operations. Some of theofficers of its Hospitalization and Evacuation Branch were transferred to theSurgeon General's Office after the Branch was reduced in status to a sectionof another branch in ASF headquarters. One of them was Lt. Col. John C.Fitzpatrick, who had been active in sea evacuation operations while in ASFheadquarters. Soon afterward, The Surgeon General and the Chief ofTransportation decided that the latter would need constant technical advice fromthe Medical Department on matters of evacuation that concerned him and that theformer would need a means of exercising technical supervision over evacuationoperations. Accordingly The Surgeon General in June 1943 assigned ColonelFitzpatrick as his liaison officer with the Chief of Transportation, who gavehim office space for a Transportation Liaison Unit. In this capacity ColonelFitzpatrick assisted the Chief of Transportation in estimating evacuationrequirements and in planning and supervising the transportation of patients bywater and rail.
In the spring of 1944, in anticipation of the patient loadexpected as a result of aggressive combat operations, the unit headed by ColonelFitzpatrick was increased in size and given additional authority andresponsibilities. In May, it will be recalled, The Surgeon General removed theEvacuation Branch from his Hospital Division and merged it with theTransportation Liaison Unit to form a Medical Regulating Unit. This stepcombined the function of regulating the flow of patients from ports to hospitalsof definitive treatment with that of providing for their transportation. Thusone office, representing The Surgeon General and belonging to his OperationsService but located in and working as a part of the Movements Division of theOffice of the Chief of Transportation, assumed responsibility in the latter halfof the war for supervising all evacuation operations ex-
2(1) Ltr AG 704 (6-17-42) MB-D-TS-M, TAG to CGs AGF, AAF, SOS, et al., 18 Jun 42, sub: WD Hosp and Evac Policy. (2) Ltr SPOPM 322.15, CG SOS to CGs and COs of CAs, PEs, Gen Hosps, and SG, 18 Jun 42, sub: Opr Plans for Mil Hosp and Evac. Both in AG: 704(6-17-42).
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cept the movement of patients by air. The Air Forces Medical RegulatingService in the Air Surgeon's Office controlled the transfer of patientsbetween AAF hospitals and supervised air evacuation operations. Collaboratingclosely with the ASF Medical Regulating Unit, the Air Regulating Office followedthe pattern of the ASF office both in its development and in its procedures.3
In contrast with wartime operations, evacuation of patients from overseasareas and within the United States in peacetime had been a small-scale affair.The few troops who were in overseas areas were not engaged in combat activities;and therefore the number of patients who needed to be returned to the UnitedStates for hospital care was not large. General hospitals in this country werelocated in relation to troop density and served on a regional basis to treatcomplicated cases of all types rather than on a specialized basis to treat fewtypes of cases from wide areas; and therefore the movement of patients fromstation to general hospitals was also a relatively simple procedure.
The primary means of transporting patients from overseas areas was by trooptransports. No hospital ships were available, and the movement of patients byair was still in the experimental stage. Transports delivering troops andsupplies at overseas ports took aboard patients for return trips and transportsurgeons cared for them in ships' hospitals or in ships' quarters.4Before arrival in the United States, transport surgeons radioed to portsof debarkation lists of patients aboard, with their diagnoses and proposeddispositions. Ports receiving such information arranged with the corps area(later called service command) in which they were located for the transportationof patients being evacuated. Upon arrival of transports, port commanders issuedorders transferring patients to general hospitals in which ports had bed creditsand then informed The Surgeon General of the number received and of thehospitals to which they had been transferred. The New York Port, for example,had bed credits in both Tilton and Lovell General Hospitals and transferredpatients within the limit of its allotments to these hospitals. Because thenearest meant an ambulance trip of more than two hours, the port occasionallykept in its station hospital for short periods of time patients who needed restbefore further travel. Personnel both for transports and for the debarkation ofpatients was supplied by ports from their bulk personnel allotments or wasborrowed from corps areas.5
Within the United States patients were moved from ports to hospitals, or fromone hospital to another, by ambulance, by trains, and by airplanes. Ambulancesavailable to all hospitals were used, as hospital commanders directed, for shorttrips. Accommodations for patients aboard regularly scheduled passenger trainswere
3(1) Ltr, SG to CG ASF thru CofT, 17 Apr 43, sub: Coord Med Serv for PE, with 2 inds. HD: Wilson files, "Book IV, 16 Mar 43-17 Jun 43." (2) ASF Cir 147, 19 May 44. (3) WD Cir 140, 11 Apr 44. (4) AAF Reg 25-17, 7 Feb and 6 Jun 44. (5) An Rpt, FY 1944 and 45, Oprs Serv SGO. HD. (6) An Rpt, FY 1944, Oprs Div Off Air Surg. HD. (7) Ltr, Dr. Richard L. Meiling to Col Calvin H. Goddard, 30 Jun 52. HD: 314 (Correspondence on MS) XI.
4Reports of transport surgeons, required as a part of each voyage report by AR 30-1150, 19 September 1941, were submitted through port surgeons to Army Transport Service. For surgeon's reports see files SG: 721.5, QM or TC: 569.1 under name of Army transport.
5(1) AR 40-1025, 12 Oct 40. (2) WD Cir 120, 21 Jun 41. (3) An Rpt, NYPE, 1943, contains an account of activities before 1943. HD.
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arranged by corps area officers with local agents of carriersinvolved. Normally, transfers were made without reference to such higherauthority as the Surgeon General's Office, because station hospitals, corpsarea surgeons, and port commanders had general hospital beds set aside for theiruse by the bed-credit system.6 Someairfields and air training centers converted airplanes available to them intoairplane ambulances and used them to transfer patients from scenes of crashes tonear-by hospitals or, in some instances, from one hospital to another. Whenairplane ambulances were not available, medical personnel on duty with the AirCorps made local and informal arrangements with Air Corps operations officersfor the transportation of patients in operational planes.7Such an informal system worked well enough as long as the number ofpatients to be evacuated was small and the distances they were to be moved wereshort, but it was not easily adaptable to the movement of large numbers ofpatients over long distances. The way this system was transformed will bediscussed later. It will be helpful, though, to consider first the magnitude ofoperations that made necessary such a transformation.
6An Rpts, Lovell and Tilton Gen Hosps, 1941. HD.
7(1) Ltr, Walter Reed Gen Hosp to SG, 11 Jan 41, sub: Airplane Trans of Pnts, with inds. SG: 580.-1 (Walter Reed GH)K. (2) Ltr, Hq West Coast ACTC to CofAC, 15 Aug 41, sub: Air Amb, with inds. AAF: 452.-1B (Amb Planes).
