PART V Medical Corps
1. Battalion Forward Aid Station
Lt. Rudolph A. Sarka, Medical Company, 7th Infantry
In December 1950 the 7th Infantry (3d Infantry Division) had one doctor in each aid station and two at each collecting station. Some divisions were critically short of doctors but we had enough because we had just arrived in Korea.
To permit the doctors to work more freely, the Medical Service Corps officers normally established battalion forward aid stations. Such an aid station was set up on a ridge west of Hamhung in December 1950.
The 1st Battalion, 7th Infantry, was withdrawing eastward from Sachang-ni toward Hamhung. When we reached the crest of the last mountain before Hamhung we were much relieved. We knew that the enemy could not cut us off from evacuation at the port. But then we were ordered to hold on this ridge.
Our infantry lines were along the forward slope, the battalion command post was four or five miles back of us, and the trains were two miles beyond that. This deployment kept our vehicles off the mountain where they might be caught if we had to pull out in a hurry.
The battalion aid station, the surgeon, and the box ambulances were with the battalion trains. The jeep ambulances were near the command post. I established the forward aid station along the road, only a few yards behind the infantry companies. The ridge was so sharp that I could be only a few yards behind the riflemen and still have both concealment and cover. At one time I requested two box ambulances, and they drove within thirty yards of the foxholes without being observed.
An enlisted medic is qualified to apply a tourniquet, to bandage wounds, and to give sedatives. In addition, as a Medical Service Corps officer, I was authorized to administer plasma and blood. I could tell when a patient needed immediate attention and could alert the doctor to be ready to treat the man when he was evacuated. I was authorized to request helicopter evacuation from my forward aid station when this service was available. My job, then, was to fill the gap between the aid man with his small kit, and the professional physician in an aid station, working with more extensive equipment. On the front lines a doctor could have done little more than I.
In any case, no one can complain that our forward aid station didn't give immediate service to the infantry. I was so close that when I needed to make a phone call, I just picked up the rifle platoon leader's sound powered phone.
2. Evacuation at Soksa-ri
Lt. Rudolph A. Sarka, Medical Company, 7th Infantry
On 19 May 1951 the 7th Infantry Regiment left Seoul and moved east to the vicinity of Ami-dong. One battalion went into a blocking position that night and the other battalions closed in assembly areas. The next day an attached platoon of the division's reconnaissance company made contact with the enemy near Soksa-ri. On the 21st all three battalions were committed in an attack.
The terrain where the 3d Battalion fought was rough. Litter evacuation of the wounded was necessary, so the battalion surgeon (Capt. Gilbert S. Campbell) and his medical assistants followed close behind the assault companies. It was impossible to bring the aid-station equipment forward, and Captain Campbell worked with the supplies from his aid kit. The battalion aid station, manned only by two medics, was three miles to the rear.
Normally, litter jeeps from our medical company collecting station pick up their patients at the battalion aid station. In this operation, however, the litter jeeps passed the aid station and came up the road to a point only fifty yards from the base of the mountain on which the 3d Battalion was fighting. Between the road and the mountain were four channels of the Soksa River. The main channel gave the litter bearers a great deal of trouble because the stream was fast-flowing, waist-deep, and had large boulders in the stream bed.
A man wounded on the firing line was immediately treated by Captain Campbell. Then he was carried down the mountain by a five-man litter team led by an American or ROK soldier and using four Korean bearers. The trip took an hour and a half.
Once the patient reached the jeep evacuation point his bandages were checked and adjusted, and his general condition observed. Seriously wounded were loaded two to a jeep; lightly wounded were often loaded seven to a vehicle -- one in the front seat, four in the back, two on the hood.
The jeeps bypassed the battalion aid station and took the patients to the advanced clearing station. Here the seriously wounded were evacuated by helicopter and the others by box ambulance.
Although this arrangement departed from the normal evacuation procedure, it worked well.
3. Helicopter Evacuation
Lt. Martin Blumenson, in Special Problems in the Korean Conflict, published by Eighth Army headquarters. (Based on interviews of Col. Thomas N. , Surgeon, Eighth Army; Lt.Col. Arne D. Smith, Medical Section, Eighth Army; Major Sydney L. Fouts, Liaison Rescue Officer to Fifth Air Force; Capt. M. A. Mecca, Rescue Controller, Fifth Air Force; Capt. James E. Childers, 8193d Helicopter Unit.)
In the past, the tendency has been to move surgery as close to the patient as possible. In Korea this was undesirable because of the fluid tactical situation, the limited highway net, the rough roads, and the mountainous terrain. If they used helicopter evacuation, the hospitals could stay longer in each location and allow four or five days of postoperative care for a patient before further evacuation.
Helicopter evacuation in Korea evolved out of circumstances. A detachment of the ad Air Rescue Squadron, whose mission was to retrieve downed pilots, began to receive occasional requests from Army units to evacuate wounded from mountainous positions. Whenever its helicopters were not busy, the detachment responded. During the rapid advance of the ground troops in the fall of 1950, the helicopters were especially helpful in speeding evacuation over the lengthened routes.
In January 1951 three Army helicopter detachments arrived in Korea with the mission of evacuating seriously wounded from the front lines. Each detachment consisted of 4 helicopters, 4 pilots, and 4 mechanics. Two detachments were equipped with Bell H-13 helicopters; one had Hiller H-23s. Each craft carried only a pilot and was equipped with two baskets or pods for litter patients. Under exceptionally good flight conditions, one walking patient could be carried at the same time.
The Eighth Army surgeon placed the first two detachments to arrive under the control of the IX Corps surgeon. Since IX Corps was in the center of Korea, the helicopters were also able to serve the other corps.
The first problem that arose was the necessity of teaching the helicopter pilots what their aircraft could do in front-line evacuation. The pilots could learn only by trial and error.
The ground forces then had to learn the limitations of helicopter evacuation. In the popular conception, helicopters landed on mountain peaks, lifted straight up into the air, and operated in all types of weather. It was necessary to understand that helicopters could not fly at night, operate in bad weather, or land on sloping terrain. They needed takeoff space; they could not fly in heavy winds; they had limitations of range and altitude. They also had less lifting power in the thin, warm air of summer.
Ground troops had to understand the importance of reporting accurate coordinates to locate the patient. They had to be taught the necessity of marking the landing site with panels and of using colored smoke grenades to indicate proper location and wind direction.
Combat elements sometimes requested helicopter evacuation as a convenience. By the fall of 1951, ground units had learned to request a helicopter only for cases involving head, chest, and abdominal wounds, multiple fractures, and great loss of blood. Even then, evacuation was available only if an ambulance could not reach the patient, if a rough ambulance ride would seriously injure him, or if it was necessary to get him to a medical installation quickly. As a working premise, the local surgeon decided whether the patient needed helicopter evacuation and the helicopter detachment commander decided whether the helicopters could reach the patient.
Ground forces generally did not realize the extreme vulnerability of helicopters. Their lack of speed and inability to fly at high altitude increased the hazard of enemy ground fire. Furthermore, helicopters were extremely sensitive to damage. Lack of the gliding characteristics of a conventional plane and the increased problem of pilot control meant that almost any damage from enemy fire was fatal to the craft. Pilots did not wear parachutes because of the danger of falling into the blades if they jumped from a disabled craft. When an area was under enemy observation the patient had to be prepared for quick loading.
Because there was always a shortage of helicopters in Korea, Eighth Army ordered that these craft not be used on missions involving danger from enemy action. This did not prevent pilots from evacuating patients from units surrounded by the enemy; nor did it prevent the evacuation of casualties sustained by patrols operating forward of friendly front lines.
The first two Army helicopter detachments to arrive in Korea were attached to the 8076th Mobile Army Surgical Hospital (MASH). At that time IX Corps headquarters was at Chungju; the hospital was forty miles to the rear. This arrangement left long distances between the helicopters and the combat lines. It then decided to dispatch the helicopters from corps headquarters. Later, all the helicopters moved into the division areas. Normally, one helicopter was stationed at each division clearing station. From there it was but a few miles to the front lines.
Certain expedients adapted the helicopters for evacuation. Plastic bags were used to keep the patients warm. Flexible tubes were fitted from the engine to heat the patients in flight. Covers for the pods were devised to keep the wind off their faces. The fact that the patients in the pods could not receive medical care while in flight remained one of the serious limitations of the helicopter, even though a mechanical device permitted them to be given plasma. The limitation on medical care and the short fuel-range of the craft make it necessary to keep helicopter flights short.
Helicopters in Korea had evacuated eight thousand casualties by 1 November 1951. Many of these men would not have survived without this transportation. The smooth ride and the rapid arrival at a clearing station or hospital possibly caused a lower rate of shock fatalities than in World War II. The treatment of head injuries was expedited because helicopters carried patients swiftly to neurosurgical teams.
The presence of helicopters in Korea helped morale. Although much experimentation in the use of helicopters for evacuation remains to be done, this "ambulance of the air" has proved its usefulness in the Korean conflict.
4. Optical Treatment in the Field
Capt. Daniel B. Sullivan, 24th Medical Battalion. (Interview by Lt. Martin Blumenson, 3d Historical Detachment.)
Before May 1951 there was no medical officer in the 24th Infantry Division qualified to do refracting and no equipment for adequate eye examination. Men needing glasses were evacuated through medical channels, often as far as Taegu and Pusan. This wasted a great deal of time and sometimes caused individuals to be permanently lost to the division because they were returned to duty through replacement channels.
Early in 1951 the Eighth Army surgeon recommended that refracting be done in the division medical battalions. The 24th Medical Battalion (24th Infantry Division) received a trial lens set, but there was no other equipment.
In April 1951, the commanding officer of the Clearing Company (Major Samuel Rothermel) determined to implement Eighth Army's recommendation. He sent Capt. Daniel B. Sullivan to the 4th Field Hospital at Taegu for a refresher course in refracting. All medical officers know the theory of refracting, and the refresher course provided a review of theory and a chance to develop skill in practice.
Returning to the battalion with eye charts, eye drops, and a retina-scope obtained from the 4th Field Hospital, Captain Sullivan arranged for space for an optical shop, and then trained an enlisted assistant. Units were told of the new service and on 9 May optical examinations began.
Each refraction took only a few minutes. If glasses were needed the prescription was recorded in the soldier's immunization record (his Form 66-1) and in the records of the medical battalion. The soldier was sent to the 8076th MASH, where his prescription for glasses was filled immediately. The hospital maintained a stock of lenses and ground special ones when needed. The entire process took less than a day.
Whenever the division went into reserve, the 6th Army Mobile Optical Unit, operating from an optical van, moved into the medical battalion's area and filled a prescription for glasses within a matter of minutes. It was not unusual for a soldier to have his eyes examined and be fitted with glasses within an hour.
After the optical section began its work, the enlisted assistant gained enough training and experience to do the refracting himself. Examination of the eyes for pathology remained the duty of a medical officer, however.
From 9 May to 16 September, 897 men were examined and 768 had glasses prescribed and fitted. Only 34 -- those with pathology or needing other treatment -- had to be evacuated. These figures include not just men of the 24th Division, but soldiers of the 7th Division, Eighth Army and its corps units, as well as British Commonwealth units.
The saving of man-hours within the 24th Division has been tremendous. The increase in speed has led to an increase in the number of soldiers seeking treatment and, therefore, to an improvement in health and morale.
5. Dental Treatment in the Field
Major Peter M. Margetis, Dental Surgeon, 24th Infantry Division. (Interview by Lt. Martin Blumenson, 3d Historical Detachment.)
The division dental surgeon has authority to distribute his dental officers as he wishes. Each division is authorized 18 dentists, but in January 1951 the 24th Division had only 15 -- enough for combat, but not enough for garrison duty. When Major Peter M. Margetis arrived at the 24th Medical Battalion, all of the 24th Division's dentists were on duty at a central clinic except one at division rear and another at the advanced clearing station.
Major Margetis saw no advantage in keeping the dentists centralized away from the troops. A man needing dental treatment might have to spend a whole day traveling from his unit to the dental clinic. Under this system of distribution, only one thousand dental operations (fillings, extractions, and prosthetic work) were performed each month.
Major Margetis distributed the dental officers one to each regiment, division headquarters forward, division headquarters rear; two each to the replacement company and division artillery; and three each to the clearing company and the medical battalion (including the division dental surgeon).
Each dental officer has an enlisted assistant and a No. 60 dental chest. The chest is only slightly larger than a foot locker, but it contains a folding dental chair, electric motor, instruments, lights, trays, and medications. Mobility is no problem and definitive dental treatment can be performed.
Although it had been the practice to send all impaction cases to rear medical installations (usually the 8076th MASH), Major Margetis insisted that all such work be done by the division's dental officers. Only four patients were evacuated as dental cases (gunshot wounds are considered medical cases) in six months.
As a result of the new distribution of dental officers, dental operations increased from 1,000 to 8,000 a month. More dental work has been accomplished and less time has been lost by soldiers seeking dental work.
6. Changing the Mission
Capt. John M. McGuire, 1st Mobile Army Surgical Hospital
Early in November 1950 the 1st MASH landed at Iwon, on the northeast coast of Korea, and moved inland to Pukchon. Here we worked for thirty days attached to the 7th Infantry Division. This month was unlike any other period for us. Our hospital "followed the book" in both organization and operation at Pukchon.
We were set up in a two-story school building which we shared with the 7th Medical Battalion. Although the 7th Division had infantry regiments near the Yalu River and Changjin Reservoir, relatively few casualties were evacuated to Pukchon. The 7th Medical Battalion was able to receive and care for the nonsurgical casualties. This allowed the 1st MASH to limit its admissions to patients requiring surgery. During November we received a total of 171 surgical cases and were successful in treating them without a single death. We gave each case maximum attention.
At Pukchon, although we were more than a hundred miles from many of the units we were serving, only two patients -- both extremely serious cases -- were air-evacuated to us. Shortage of airfields near the infantry regiments was the major reason for limiting air evacuation.
After our withdrawal from North Korea we moved near Kyungju. We were assigned to X Corps and our responsibilities were increased. Instead of operating as a mobile army surgical hospital -- that is, a small, sixty-bed hospital assigned to one division -- we were called upon to care for the casualties from the 1st Marine Division, the 2d and 7th Infantry Divisions, and the 187th Regimental Combat Team.
We rapidly expanded from a 60-bed to a 200-bed hospital, but our personnel increased from only 16 medical officers, 16 nurses, and 100 enlisted men, to 20 medical officers, 20 nurses, and 120 enlisted men.
The expansion of the hospital meant that our primary mission was enlarged. Instead of handling only surgical cases, we began to receive medical cases as well. Because the increased work load had not been accompanied by a corresponding increase in personnel, it occasionally became necessary for us to evacuate some patients without operating. In no case, however, did this jeopardize a patient's chance of survival or return to duty, for air and hospital-train evacuation to the next medical installation was always available.
Lt.Col. John L. Mothershead and Capt. Samuel L. Crook. (Interviews by Lt. Martin Blumenson, 3d Historical Detachment)
The primary function of a mobile army surgical hospital is to do emergency, life-saving surgery and to make the patient transportable to rear medical installations. The MASH was originally a 60-bed hospital with the mission of supporting one division. Because there were not enough evacuation hospitals in Korea, the surgical hospitals were expanded to 200-bed capacity. With the increased patient load, personnel, services, and tentage, there has been a decrease of mobility.
To improve the mobility of the 8076th MASH, the officers designed a new tent plan. Hospital tents are formed of detachable sections. Using 41 main sections and 16 end sections, the 8076th designed a unique hospital which was especially adaptable to displacement. The core of the hospital is shaped in a U. Around this basic center, tents are added and subtracted as the situation changes.
Arrangement of Tents: 8076th Mobile Army Surgical Hospital (14K)
The hospital is moved in two phases. In Phase I, the tents housing the registrar and receiving-and-holding are taken down. The laboratory, the pharmacy, and the admitting functions of receiving are moved into the preoperative ward. The tentage that has been struck is then moved to a new location with half of the personnel of preoperative, postoperative, surgical, and central supply, plus one receiving clerk. At the new location a second basic U is formed, consisting of preoperative, postoperative and surgical. Central supply functions of sterilizing instruments and dressings are carried out in the surgical tent.
At one point, therefore, there are two functioning hospitals. The hospital in the rear continues to admit patients until the forward installation is complete. When the advance unit begins to receive patients, the rear installation stops all admissions. When its patients have been evacuated, the rear unit moves up and joins the advance hospital as Phase II of the move. The tentage of Phase II is added externally to the basic U in its new location. The medical officers and enlisted men who have not yet moved come with Phase II. All nurses move with the rear element.
Moving from Chunchon to Hwachon, the 8076th relocated its installations in this manner:
19 September
0900 Capt. Samuel L. Crook left Chunchon to check several sites in the vicinity of Hwachon.
1000 Lt.Col. John L. Mothershead received final orders to move to the vicinity of Hwachon. Key personnel notified of impending move. 1200 Captain Crook notified that the move would be that day.
1300 Tentage at Chunchon began to be struck.
1330 Captain Crook notified Colonel Mothershead of new site and its location.
1530 Phase I convoy left Chunchon. 1730 Convoy arrived at Hwachon.
2230 Basic U set up at Hwachon. Ready to receive patients. 2400 Advance unit opened; rear unit closed.
20 September
0800 Patients at rear unit transferred to 629th Clearing Company, which moved into Chunchon to assume the function of evacuating patients to the Chunchon railhead and airstrip.
1300 Phase II convoy left Chunchon.
1500 Rear unit arrived at Hwachon. Basic U expanded to form complete MASH.
Several modifications have been made to equipment to adapt it for local conditions. To increase the hauling capacity of the hospital vehicles, trailer hitches were taken from abandoned trucks along the road. The hospital had Ordnance weld these hitches to a butt plate on the rear of each l-ton trailer. Each 2-1/2-ton truck now safely hauls two trailers, thereby doubling its hauling capacity.
The tents have been made warmer by the use of Air Force gasoline burning heaters which blow hot air to the tents through ducts. A sliding light system has been devised so that illumination can be moved to the best advantage in surgery. A sprinkler system has been developed to keep down dust. A food box has been developed to keep flies off food carried from the kitchen to the ward. The hospital has had no diarrhea attributable to fly contamination.
In the medical field, one of the expedients developed by the 8076th is the upright which has been welded on the bar holding the Thomas splint to the litter. This modification permits giving intravenous fluids while the patient is being moved. Because some type of holder for litters was needed to support them at a higher level than the cot, an iron-pipe tripod was improvised. This improved the hydrostatic pressure in certain types of lung surgery cases where drainage was needed.
Causes of the Korean Tragedy ... Failure of Leadership, Intelligence and Preparation
