CASUALTY EVACUATION

LOOKING BACK

"Digger" James

Service Details

Major General W B 'Digger' James AO MBE MC OStJ graduated from RMC inDecember 1951. He served with 1RAR in 1952, was seriously wounded, evacuated home andspent 14 months in hospital. He transferred to the RAAC, and served as Adjutant at theArmoured School for two years, followed by a year as Adjutant of the 12/16 Hunter RiverLancers at Muswellbrook. Resigning in 1956, he proceeded to complete a medical course atSydney University, graduating in December 1963. After hospital residency, he rejoined theArmy as a medical officer in the RAAMC. He retired in 1985 after a variety of postings inAustralia and abroad, as Director General Army Health Services.

He served in South Vietnam for a year, 1968-69, as Commander of 8 Field Ambulance andSenior Medical Officer of 1ATF in Nui Dat, and later in 1971 headed a British StJohn's Ambulance medical relief team, at the conclusion of the Biafran Civil War, inNigeria. Following retirement, he was appointed Queensland Director of Visy Board, aposition he still holds.

Greatly involved in veteran affairs, he was elected National President of the Returned& Services League of Australia in 1993.

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My involvement in the Korean War was short and swift. After some seven months ofregimental life in Australia as a junior platoon commander in 2 Battalion RAR, then theRAR Depot Battalion (4RAR), I was posted to Japan in September 1952 to await being calledforward as a reinforcement to a battalion in Korea. On 30 October I arrived in Korea tojoin A Company 1RAR commanded by major David Thomson MC who sent me to take over commandof 2 Platoon, then commanded by a magnificent soldier, Sergeant L S (Squizzy) Taylor MM. Iwas wounded on my second patrol in front of Hill 355 on the 7th of November 1952.

In later years, whilst serving in the RAAMC, I was very concerned to ensure that careof the sick and injured on the battlefield was understood; of high quality and given highpriority. As history has so often revealed, war is won ultimately on the ground. Mythoughts and passion on this truism recently compelled me to put to paper my experience of1952 in casualty evacuation as an example of teaching lessons learned in war and so thatit may be recalled in "Korea Remembered", as a tribute to the magnificentsoldiers who served with me..

In his epic textbook "Organisation, Strategy and Tactics of the Army MedicalServices in War", published just 60 years ago, Colonel T B Nicholls RAMC wrote fromhis experiences on the Western Front in World War I, but with a prophetic eye on thelooming war clouds that were soon to burst into World War II. Many of his pithystatements, I believe, are timeless and bear repeating.

Firstly:

In regard to the fundamental purpose of the medical services in War he wrote:

"The medical service is neither autonomous nor independent - it exists to serve the rest of the Army and must conform with, and be subordinate itself to, the general plans of the Army".

The aim of an army will always be clear and concise. It may be to defeat the enemy, itmay be to withdraw from an area, or it may be to capture a particular feature. Whateverthe aim, the Medical Services, in Nicholls words, simply "exist to serve".

Secondly:

Nicholls wrote:

"It has often been said that those who can produce a last 100,000 men will win a war. If the Medical Service is inefficient, or is deprived of anything necessary to enable it to function properly, this last 100,000 will be in hospital and NOT on the battlefield, where their presence might turn the scale."

Thirdly:

Nicholls stated:

"The finest surgeon, however, is powerless unless his patient and his materials can be brought to him ... the success of the treatment of our wounded depends to a large degree upon efficient and rapid movement of the cases."

and went on to say:

"The other secret of success is rapid evacuation. All through the chain of medical units from the Front to the Base, the wounded man is kept the very minimum of time to attend to his wounds, and then he is moved on, and kept moving until he reaches either the Base or Home. Some, of course, are too ill to be moved, and these may have to be retained."

The reason for rapid evacuation is twofold, says Nicholls,

Firstly, it is very bad for morale if troops see wounded men lying about in largenumbers; and,

Secondly, unless Medical Units are cleared, they lose their mobility, and alsocannot deal with a fresh influx if wounded that might come in quite unexpectedly."

Lastly he stated:

"An efficient medical service is a great conservator of manpower, as, by its insistence on the principles and practice of hygiene, it keeps the troops healthy and avoids wastage from sickness. It is a great incentive to good morale, as they know that, if they are wounded, they will be well looked after."

I consider the words of T B Nicholls are as sound today as they were when written allthose many years ago.

I write here in general terms on the 'Evacuation Chain' in war, and in sodoing, try to pick out valuable lessons from history, and, if I may, relate some personalanecdotes in regard to 'Evacuation'. Many authors of military medicine, andindeed, in all official military histories I have studied, always point out twofundamental axioms of war surgery that seem to always require repeating to the nextgeneration of military medical men, and these are:

Firstly:

High velocity gunshot wounds are very different from all other wounds. Tissue and structure damage is related to the imparted Kinetic Energy of the missile - half mass times the velocity squared. IT IS the 'squaring' of velocity that is the significant feature. As an Armalite bullet, for example, travels at about 1000 ft/sec. This means when squared, energy is 1,000,000 units times the mass.

 

Secondly:

Casualties must be evacuated for both their best care, and moreover to allow the forward medical unit to continue to support the battle.

Let me quote the British Army 1962 publication, 'A Field Surgery Pocket Book ofthe RAMC" which in this regard is still most relevant.

"A surgeon with extensive experience of civilian surgery may make costly mistakes under field conditions. His new and strange circumstances may cause him to forget basic surgical principles. Unorthodox individual techniques, which may have worked well in civilian practice, in war conditions may jeopardise the patient's chances of survival. Patients cannot remain under an individual surgeon's personal care in the forward area, but must, after prompt stabilisation, be evacuated at once. He will then come under another doctor. For this reason, surgery, in general, must be as simple and standardised as practicable."

In my own case, on the battlefield in Korea - November 1952 - I was wounded leading a12 man infantry patrol to capture an enemy held outpost. As a consequence, I rapidlybecame interested in war surgery and casualty evacuation.

In the midst of the final assault on the small enemy objective, I stood on a landmineand was blown up. One of my men was killed instantly and three others wounded. My injurieswere serious, including traumatic amputation of my left leg below knee, multiplecomplicated compound fractures of my right leg and foot, and Gun Shot Wound's to myhands, arms and head. Following the explosion, I, with my wounded men, had the classicevacuation and subsequent restoration to good health. Let me detail some of the relevantpoints in the medical care and evacuation process that occurred to me.

As is normal with a small patrol, we did not have a medic, so we each applied basicfirst aid to each other. I applied a tourniquet (bootlace from right foot boot lying nearme) to my left amputation using a gold propelling pencil (a gift from my fiancee Barbara,who later became my wife). A stretcher party was called for by radio, and as only onestretcher was available, there was some delay in getting the three stretcher cases back tobase. Being last to be picked up, it was some ninety minutes before I reached the forwardcompany position and from there taken by a jeep fitted with a stretcher frame to thebattalion regimental aid post (RAP).

Here I was given my first attention by way of formal first aid and resuscitation by thecontrolling of pain and haemorrhage, ensuring a good airway and circulation. Despite lossof blood, adequate intravenous fluids in those days was not available at the RAP. All ofthis occurred in winter and it was snowing throughout the time. I was very cold but wasmade comfortable with blankets and the warmth of a fire at the RAP. It was here that muchof my infantry equipment was removed, but I remained on the same stretcher for the nextphase of the evacuation.

The next phase was via a road ambulance of the 60th Indian Field Ambulance to the US8055 MASH - a distance of perhaps some 15 kms over rather bumpy roads. I remember beingvery thirsty and the very attentive Indian medics provided me with a beautiful cold drinkof water - now I know that shock had set in. The MASH was exactly as you have seen on theTV series, only the Unit Number was changed for the series.

The care in the MASH was superb - X-rays and immediate stabilisation surgery undertakento control haemorrhage and immobilise fractures. 'Hot Lips' was not inattendance (at least I don't remember her!) They saved my life for which I shallalways be grateful. One silly incident was that I had developed a pain in my back duringthe ambulance trip with the Indian Field Ambulance and complained to the doctors in theMASH. Still on my stretcher, an X-ray soon detected the problem - one of my hand grenades(fully primed) was under my back. I think I heard the shout "Get Radar!" - infact, as it was a 36M grenade, unknown to the US medical personnel, I made it safe.

The MASH was very busy, and I had several surgical operations in the succeeding days. Irecall being given a marvellous 'smoke' by a medic in the snow, awaiting entryto the primitive 6 table operating theatre. Anaesthetists these days would shudder atthis! After some days in the MASH with further surgical stabilisation, I was evacuated tothe US 121 Evacuation Hospital in Seoul on a Hospital Train. This, I recall, was aconverted series of sleeping carriages, rather airy, short bunks and warmed usingwood-burning pot-bellied stoves. It was a comfortable three hour journey, as I remember.The 121 US Evac Hospital was in a converted school, and I was placed in the origins ofwhat we now call 'Intensive Care'. I was there for six days and needed moresurgery, as my right foot required further partial amputation due to distal ischaemia.Nursing was very poor.

The next phase of evacuation was to Japan by air. The RAAF, using converted DC3'sflew regular sorties of casualty evacuation to Iwakuni air base in Japan. It was not avery comfortable journey for we were placed three stretchers high, but Morpheus was agreat help. We stayed overnight in a glorious RAAF hospital, and then travelled by road tothe British Commonwealth General Hospital in Kure, Japan.

For the next four weeks I was given excellent care, and underwent more surgery in thisvery well equipped general hospital. Anxious to be home for Christmas, the next evacuationwas arranged. This involved a short journey by sea back to the air base in Iwakuni,over-nighting at a US hospital at the US Naval Base at Guam, and a glorious boozy stopover at Port Moresby which was put on by the Australian Army staff and families, withmusic and good cheer.

The flight to Sydney was painless and not remembered, such is the excellent analgesicqualities of alcohol. In Sydney, I was transported by ambulance to the RepatriationGeneral Hospital at Concord. I was there for 2 days, and, with considerable difficulty,gained approval to be transferred to my home state of Victoria. Australia was at peace,Christmas was 2 days away, and for the first time in my evacuation, I observed and feltthe lethargy of a peacetime service which put staff needs before patient needs. I was toldthat I would be moved to Melbourne after the Christmas holidays! I got very angry, andinsisted I should speak to Mr Bob Menzies, our PM at the time, on the subject. Suddenly aflight home was arranged. I arrived in Melbourne on Christmas Eve to my fiancee andfamily.

For the next 14 months I was managed at RGH Heidelberg in Melbourne, and returned toduty to take up the appointment as Adjutant of the Armoured School in Victoria.

The point of my story is to give a typical process of evacuation of a war casualty.This story was typical of evacuation in both World Wars, and in subsequent wars. Ithappened then, and it will happen again.

I conclude by a summary of some major points in the process of the 'EvacuationChain."

1. The wounded soldier has invariably been in the front-line for hours, usually days,at time of wounding. Although usually a very fit chap, he is dirty and he is dehydrated.

Needs: First Aid at point of wounding - self, mate or medic. Fix airway, and blood loss. Save own blood early, as this is better than transfusions later. Simple temporary immobilisation of fractures is good for both the long term healing, and is excellent to relieve pain.

Also Suggest: Fluids and antibiotics.

2. Medical care must be continuous.

3. Medical/surgical care must be simple, orthodox, and above all .....

* highest of quality of medical notes must be kept, recorded, and travel with the

patient at all times. Diagrams of wounds, procedures, investigations are essential for proper ongoing management.

4. Overfly particular casualties to specialised unit if needed and if possible.

eg. Neurosurgical, Facio/maxillary.

5. Maintain military hospitals at home for care, including rehabilitation, for return to duty.

Editors Note:

The incident referred to by "Digger", in all modesty, is better recorded inthe official history:

" One of the early 1 RAR patrols, led by Lieutenant W.B. James on the night of 7-8November, was badly blown up when it unwittingly entered an unmarked and unrecordedminefield which the Canadians had laid around an out post position. A group of enemy washeard moving nearby as James' patrol approached the outpost. When he deployed his mento ambush the Chinese, they entered the minefield. One man detonated a mine and waskilled. Four others, including James were wounded. The force of the blast took offJames' left foot and badly broke his right leg. He remained conscious and in commandof the patrol, although in great pain. He organised the evacuation of casualties,insisting he was the last to be moved, even though it was over three hours until he wasback in the battalion position. He was awarded the Military Cross."