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ACCESS TO CARE
Domestic Assistance under Civilian Coordination, 1945-1976
The Second World War curtailed U.S. Army medical as well as other types of disaster assistance- though some soldiers participated in it least one flood relief operation during the war. After the end of the conflict, military aid efforts resumed, but in the late forties and early fifties the federal government reorganized its procedures for rendering assistance. The changes influenced the role of Army medical personnel in civilian relief, although medical matters had not prompted them.1
To some extent, the new methods and organizations were designed to provide coordination and planning to reduce the problems that had characterized the interwar years. But in addition, they followed from the gradual transformation of nineteenth century attitudes toward disasters and government aid to communities stricken by them. Americans by the 1950's considered disasters natural phenomena rather than supernatural messages. Scientists had, for the most part, explained their causes, and social scientists had even begun to study how human beings behaved during them. Years of government assistance in individual disasters had left a heritage of federal involvement, and many people thought aid should be made automatic. In the postwar years, Congress responded with laws approving continuing federal disaster assistance and creating a civilian bureaucracy to coordinate it.2
The laws delegated responsibility for foreign and for domestic operations to different agencies, and to some extent the Army's procedures for
1For records of the wartime operation, see,
box 3149, 400.38, Record Group 407, NA.
rendering both became distinct as well. Futhermore, the two types of relief missions developed in such different fashion after the war as to merit separate discussion. Army medical assistance abroad, discussed in the next chapter, increased in the postwar period. Domestic assistance, on the other hand, continued at the restricted level of the late thirties, or possibly even declined.
The Texas City Explosion
Before all the administrative changes began, however, personnel from the Army Medical Department became involved in another large-scale relief effort. On the morning of 16 April 1947, longshoremen at the port of Texas City, Texas, discovered fire aboard the ship Grand Camp docked there and loaded with ammonium nitrate. Few people considered the fire a serious danger, attempts to extinguish it proceeded perfunctorily, and no one bothered to evacuate the area or disperse the crowds that gathered to watch the excitement. The fire fighters did not realize the danger of the highly volatile cargo until 0912 hours, when the Grand Camp exploded, atomizing two sight-seeing planes flying over it. Flaming metal fragments, some as large as 60 tons, were thrown up to
2,500 feet. Where they fell, these missiles ignited warehouse and fuel storage tanks on, shore. Almost instantly the entire dock area erupted in flames. Many dockhands and onlookers died immediately; others sustained injuries from the blast or the projectiles.3
Lt. Col. John P. Horan, commander at neighboring Fort Crockett, heard the, explosion and saw the smoke; he immediately phoned the sheriff and offered his post's services. When the sheriff accepted, Horan at once alerted the entire garrison. Within fifteen minutes Army ambulances and crews had begun the rescue and evacuation effort. Horan realized, however, that Texas City would need even more assistance. Early that morning he requested help from Fourth Army Headquarters. Because of the requirements the Army adopted in the later 1930's, the, command had a disaster plan, which it implemented at once. Commanding General Jonathan A Wainwright assumed direction of the relief effort and that afternoon arrived in Texas City with several of his staff officers. Wainwright personally inspected the destruction and left Brig. Gen. Josef Sheetz in
3Elizabeth L. Wheaton, comp., Texas City Remembers (San Antonio: Naylor Co., 1948); Adolph A. Hoehling, Disaster: Major American Catastrophes (New York: Hawthorn Books, 1973), pp. 114-30, Virginia Blocker and T.G. Blocker, "The Texas City Disaster A Survey of 3,000 Casualties," American Journal of Surgery 78 (1949): 756-71.
charge of the Army's operation, with all the resources of Fourth Army available to him.4
Lt. Col. Irvine H. Marshall, a medical officer from the Fourth Army surgeon's office, initially directed medical aspects of the relief effort. To assist him, Fourth Army ordered 36 doctors, 40 nurses, a medical administrator, and the 32d Medical Battalion- all from posts in San Antonio- to report to Texas City without delay. It also sent all expendable medicines from its own stocks and requested the St. Louis Medical Depot to ship additional items. By midnight all the extra personnel and the first of the supplies had arrived at Fort Crockett.
Some of the personnel, started work, at once in the Fort Crockett Station Hospital. The facility had been inactive at the time of the explosion, but shortly after the blast Lt. Col. Eugene H. Mitchell, a military science teacher at a Galveston high school, volunteered to help reopen it. With the assistance of Army wives, a medical sergeant, and fifty Red Cross volunteers, he quickly had the hospital in operation. By 2100 hours it had admitted fifty-eight civilians, though the majority of casualties had been sent to local hospitals. That night Colonel Marshall toured those institutions and assigned the remainder of the Army's doctors and nurses from San Antonio to them. He placed the 32d Battalion on standby at Fort Crockett. Soon it, too, was called into service.
In the rush to rescue as many people as possible, little had been done to extinguish the flames along the dock. Late, in the afternoon, fire broke out on a second ship carrying ammonium nitrate, the High Flyer. Attempts that night to tow it out to sea failed, and workers noticed the same orange smoke that preceded the explosion of the Grand Camp. Forewarned this time, they quickly evacuated the area. Shortly after midnight the High Flyer exploded with an intensity equal to the first blast and reignited fires along the waterfront. Officials at Fort Crockett sent doctors from the station hospital and ambulances from the 32d Battalion to evacuate any new victims. Fortunately, the late hour and prior warning held casualties to a minimum, and by 0900 hours the ambulances returned, their services unneeded.
4Unless otherwise cited, account based on J.R. Sheetz, "Disaster Relief Activities by Military Personnel during the Texas City Disaster," 5 May 47; Statement by John P. Horan filed with Sheetz Rpt; Ltr, Lewis C. Beebe to War Department, 16 May 47: Memo for MG Kirk by Robert P. Williams, 23 Apt 47. All in 370.1 (Texas City), Record Group 407, NA. Wheaton, Texas City, passim, but especially pp. 6, 32-33, 46-48; Reynolds, "Disaster Services," pp. 317-46; American National Red Cross, A Preliminary Report on the Texas City Explosion (St. Louis: American National Red Cross, 1947), pp. 20-22; William H. Witt "The Army's Coming," Army Information Digest 3 (Mar 48): 14-18.
Even without additional victims, casualties still taxed available health care facilities. The blast killed 513 people almost at once; another 50 died after hospitalization. Between 2,000 and 3,000 people were treated for injuries that did not require hospital care, and 150 serious cases were sent to Houston hospitals. That still left 836 patients to be cared for in three local civilian hospitals and the Fort Crockett facility. Staffed by the clearing company of the 32d Battalion after the first day, the station hospital treated a total of 121 patients during the emergency, although its patient census fluctuated between 40 and 60. With the approval of Col. Prentice L. Moore, who relieved Marshall as head of medical operations on the l7th, the Army continued to detail surgeons and nurses to the overburdened civilian facilities. In addition to the hospital work, Army doctors and first aid learns periodically visited Camp Baldwin, a refugee center ten miles from Texas City. They provided routine care for its residents and identified several cases of infectious diseases-mumps, chicken pox, possibly whooping cough-but no serious health threat developed.5
An outbreak of gas gangrene in Texas City itself was reported, however, and on the l7th a specialist from Brooke Army Medical Center investigated but confirmed only one case. When rumors of more persisted, the Army's Surgeon General sent two surgical consultants, one a civilian and the other an Army medical officer, to conduct another study. The two experts confirmed nine cases but still pronounced previous reports exaggerated. With no serious gas gangrene outbreak or problems with infectious diseases, the necessity for Army medical support in Texas City quickly passed. By the 19th, requests from civilian hospitals for surgical services had ended, and some Army personnel began returning to their stations. On the 22nd the Army transferred the remaining patients in the station hospital to civilian facilities and closed it. By that time all but a few of the Army's medical personnel had gone home.
Creation of a Federal Relief Bureaucracy
Army medical missions like that in Texas City, which had been unusual in the interwar years, became more so after the war as military involvement declined and the trend toward greater centralization and increased civilian control continued. In the late thirties Congress had
5Statistics from Blocker and Blocker, "Survey of Casualties," p. 759; and Sheetz Rpt, Inclosure 13, p. 6. See also David Minard, John H. Killough, and Bernard Zimmerman, "Medical Aspects of the Texas City Disaster with Special Reference to the Effects of Air Blast," project NM 0111015, Report No. 4, Naval Medical Research Institute, 1948.
passed laws providing for loans to victims of certain disasters, and in 1941 it enacted a measure authorizing the Army Corps of Engineers to conduct rescue operations and entergency repairs during floods, Three years later, in legislation with important implications for the Army Medical Department's role, Congress placed the Public Health, Service (PHS) in charge of assisting states during health emergencies. This law gave legal authority to the increased PHS activity that had begun during the twenties and thirties and recognized the reduced participation of Army medical personnel.6
None of these acts, however, authorized automatic relief or created a civilian agency to coordinate federal assistance. A major step in that direction occurred in July 1947 when Congress enacted Public Law 233, the Surplus Property Law, which authorized the president to initiate federal, disaster relief without specific funding or approval from Congress, The law, allowed him to transfer surplus property held by the War Assets Administrator to the Federal Works Administrator, who could then transfer it to any state, or local government in a distressed area,. The administrator could donate medicines or other expendable items, loan nonexpendable supplies, and pay shipping costs. The statute permitted the Federal Works Administrator to use officers of other federal agencies when necessary to fulfill his mission and directed all departments to cooperate with him.7
Although precedent-setting, the Surplus Property Law did not mark a dramatic change in policy. After World War I a similar distribution of war surplus property had occurred without benefit of law. Furthermore, the program obviously had a limited life span- roughly until surplus stocks were depleted- at which time either a return to the prewar ad hoc system or another program would have to replace it. The law did, however, further reduce Army involvement by delegating the responsibility for distributing surplus property to a civilian agency.
Under these provisions, the federal government rendered assistance in thirty-two disasters. Surplus stocks quickly dwindled, and Congress twice revitalized the program with supplementary appropriations. Many people advocated new legislation that would offer a permanent solution to the disaster relief problem, and those who administered the law perceived
6Congressional Record, 81st Cong., 2d
sess., 1950, pp. 11901-2; Office of Emergency Preparedness, Report to
the Congress: Disaster Preparedness (Washington: GPO, 1972), 1:168;
L.E. Burney, "Public Health Problems in Major Disasters," Annals
of the American Academy of Political and Social Science 309 (1957):
a need- as the Army had in the thirties- for more coordination in relief efforts. Gen. Philip Fleming, Federal Works Administrator, complained that in a relief operation "with so many public and private agencies converging on a panic-stricken area, they are bound to get into each other's way and that confusion is certain to result in wasteful duplication of effort and failure to accomplish some necessary measures."8
Some congressional advocates of disaster relief realized the need for both continued funding and closer cooperation among federal agencies. After three years of discussions, in 1950 Congress passed a comprehensive Federal Disaster Act with three stated goals: to furnish "an orderly and continuing means" of federal assistance to state and local governments "in carrying out their responsibilities to alleviate suffering and damage resulting from major disasters"; to provide for the repair of essential public facilities; and to foster the, development of state and local organizations to cope with disasters. To accomplish these goals the law authorized federal agencies to lend personnel, supplies, facilities, and other resources to state and local governments and approved the distribution of federal medicines, food, and other consumable supplies through the American National Red Cross. It also allowed using federal personnel for saving lives and property, clearing debris, and making emergency repairs to public facilities. Authority to mobilize federal aid was given to the president, but the law instructed him to designate an existing office to coordinate relief rather than create a new agency.9
Although in many ways a dramatic assumption of federal responsibility, the Federal Disaster Act of 1950 did incorporate much of the traditional response to disasters, In its stated purpose of aiding states and the Red Cross to render relief, it continued the heritage of local control and voluntarism. In granting authority to act to the president, it simply legalized what had been customary practice since the 1880's. Nevertheless the statute made the federal response automatic rather than dependent on the whims of Congress, and for the first time it provided for an agency with authority to coordinate all federal relief efforts. To that extent the
8Quote from "Gen. Philip Fleming Seeks
Coordination in Disaster Relief," Eastern Underwriter 49 (20
Aug 48): 1. On developments in this period, see also Report to Congress:
Disaster Preparedness, 1:168; Subcommittee on Natural Disaster Relief,
p. 4; Hearings before the Committee on Public Works, House of Representatives,
81st Congress, 2d Session on HR 8396, HR 8461, HR 8420, HR 8390, and HR
8435, Bills to Authorize Federal Assistance to States and Local Government
in Major Disasters (Washington: GPO, 1950) pp. 81-82; Val Peterson,
"Co-ordinating and Extending Federal Assistance," Annals of
the American Academy of Political and Social Science 309 (1957): 53.
law substantially altered the means of rendering federal assistance and set a strong precedent for increased federal involvement.
At the same time Congress had considered the disaster act, it had debated a civil defense bill, and most officials expected one agency to administer both programs. But President Harry S. Truman decided that the fledgling Federal Civil Defense Administration (FCDA) had enough responsibility and assigned the disaster work to the Housing and Home Finance Agency (HHFA). Then in 1952 Truman transferred the disaster relief function to FCDA. In 1958 the FCDA- still responsible for disaster relief- merged with another agency to form the Office of Defense and Civilian Mobilization (ODCM), but three years later ODCM split, with the Office of Emergency Planning (OEP) assuming responsibility for disaster relief.10
The Army had at first been ambivalent about civilian control of disaster relief, but by 1950 its officials welcomed the new law and agency. The Army really did not have the resources to coordinate federal assistance itself, and reorganization eased some of the problems that had complicated its disaster relief function during the interwar years. Funding for each mission no longer depended on special congressional action, and the law provided for Red Cross reimbursement of the Army for the transfer of supplies if the president did not declare a major disaster. If he did, the Red Cross received expendable equipment free of charge and accepted responsibility to return nonexpendable items, but the Army's costs were refunded by the president from disaster relief funds.11
On the question of the Army's authority to approve and conduct relief operations, Army regulations were slow to recognize the new civilian relief organization's responsibility. In the early 1950's AR 500-60 made no mention of it and delegated relief responsibility to the continental Army commanders- a policy similar to the earlier practice of relying on the corps area commands (which no longer existed). In 1956 a revised AR 500-60 first incorporated the principle of civilian coordination with sections defining the FCDA's role. That same year, a Department of
10Shifts between agencies and the rationale
for them can be followed in Report to Congress: Disaster Preparedness,
1: 168; Peterson, "Coordinating Assistance," p. 58; Lyon G. Tyler,
Jr., "Civil Defense the Impact of the Planning Years, 1945- 1950"
(Ph.D. diss., Duke University, 1967), p. 291; Executive Order 10427, 16
Jan 53; Edward A. McDermott. "Emergency Planning," Military
Review 44 (Feb 64): 19-28; Executive Order 10773, 1 Jul 58, Executive
Order 11051, 27 Sep 62.
Defense directive established channels for liaison between its officials and those of the civilian agency but reaffirmed that the Army was to be the department's primary source of domestic aid. Within the Army, responsibility for providing assistance remained with the continental Army commands, though under the direction and supervision of, the Continental Army Command (CONARC) after its creation in 1955.12
Even with the newly established channels for requesting and administering relief, the revised AR 500-60 still retained the clause carried by its predecessors, allowing aid without prior appeal from the coordinating agency when "local resources" were "clearly inadequate" or the "overruling demands of humanity" compelled it. The clause remained through repeated changes in the regulation, though in later years the phrasing-reflecting the increasing bureaucratization of relief was changed to "imminent seriousness" and still later to "imminently serious condition."13
Medical Relief Missions of the Fifties and Sixties
In the 1950's an "imminently serious condition" did not arise very often, and the Army rarely undertook relief on its own authority. Although the civilian bureaucracy did request Army's assistance occasionally, it rarely summoned members of the Army Medical Department. Both the Red Cross and the Public Health Service had been designated by law to render assistance, and their roles had been reaffirmed in the Federal Disaster Act of 1950. In addition, two other agencies assumed an increasing share of the medical burden. In the late thirties the Army had advocated reliance on the National Guard in disasters, and state units increased their relief activities, after the Second World War. Local civil defense organizations created after 1950 because of fears of nuclear war also rendered aid in local natural disasters, even though civil defense and disaster relief were not always coordinated by the same agency on the federal level. Together,
12On Department of Defense policy, see DOD
Directive 3025.1, "Responsibilities for Civil Defense and Other Domestic
Emergencies," 14 Jul 56; DOD Directive 3025.1, "Employment of
Military Resources in Natural Disaster Emergencies within the United States,
Its Territories, and Possessions," 18 Nov 65. DOD Directive 3025.1,
"Responsibilities for Civil Defense and Related Programs," 24
Jan 52, the first of this series, set policy for civil defense and other
emergencies but did not mention disaster relief. On changing Amy regulations,
see AR 500-60, "Emergency Employment of Army Resources: Disaster Relief,"
1 Oct 52; AR 500-60, change 2, "Emergency Employment of Army Resources:
Disaster Relief," 29 Feb 56, AR 500-60, "Emergency Employment
of Army Resources: Disaster Relief,"10 Jul 59.
the Red Cross, Public Health Service, National Guard, and local civil defense organizations were usually capable of meeting emergency medical needs in domestic disasters. Hence the civilian relief bureaucracy rarely had to request Regular Army assistance.14
The Army Medical Department did, however, have resources and capabilities for one type of assistance, helicopter support, that the civilian agencies lacked. The Army received many requests for the dispatch of helicopters, and the rotary-wing aircraft proved most versatile in relief operations. They served not only as air ambulances but could also fly rescue, reconnaissance, and supply missions. The Army had begun development of the, helicopter before World War II; a few served as air ambulances during that conflict but only proved themselves fully in the Korean War. Though Air Force helicopters had participated in domestic relief operations as early as 1949, it was only after Korea that Army helicopters became active in disaster assistance missions. When Army craft did participate, they were not, of course, always from medical units since other Army organizations had them, too. But when air ambulance units did participate, they not only evacuated patients but also performed other relief tasks. Two missions flown by Army medical aviators during the 1950's illustrated the versatility of helicopter ambulances in disaster situations.15
One of the earliest domestic missions involving Army helicopter ambulances occurred in June and July of 1954 when the Rio Grande and its tributaries flooded much of the area along the Mexican border between Langtry and Laredo, Texas. Operating out of Laughlin Air Force Base, Air Force and Navy craft with two H-25's and nine H-13's from the Army's Medical Field Service School and two ambulance detachments at Fort Sam Houston, Texas, participated. Shortly after their arrival on the
14Demonstrating statistically the, increase
in National Guard medical participation is almost impossible since, accurate
statistics are unavailable and even numbers for all missions are difficult
to find. However, between 1947 and 1953, guard units aided in 194 disasters.
See Bennett M. Rich and Philip H. Burch, Jr., "The Changing Role of
the National Guard," American Political Science Review 50 (1956):
704, Reports of the Militia Bureau, with incomplete statistics, for the
interwar years show nowhere near that many missions, in an equivalent period.
Of course, one has to assume that the number of medical missions within
the overall figures remains constant. No good overview of civil defense
medical assistance in natural disasters exists, but for indications of
what was happening, see William L. Wilson, "Medical Plans for Civil
Defense and Disaster," American Practitioner and Digest of Treatment
2 (1951): 151-62; and a series of articles on disaster medicine in
California Medicine 93 (1960): 69-98.
scene, the Army helicopter ambulances evacuated the passengers of a train stranded near Langtry. Later they transported medical supplies, food, and mail to isolated cities along the border and maintained a communications link between United States and Mexican relief officials by flying messages between Laughlin and the roof of a hotel in Nuevo Laredo. Ten days after they reported, all of the helicopters except one H-25 had returned to station. In this craft Capt. Joseph L. Bowler, a veteran of air evacuations in Korea, continued to fly food, milk, and Red Cross supplies to isolated spots on both sides of the border.16
Five years after the Texas floods, the 57th Medical Detachment (Helicopter Ambulance) at Fort Meade, Maryland, undertook a very different type of relief mission. On 27 January 1959, three of the unit's H-19 helicopters with a demolition team from the 19th Engineer Battalion flew to Meadville, Pennsylvania, where an ice jam in a nearby creek threatened to renew flooding in an area, already hard-hit. That afternoon the crews conducted air reconnaissance of the jam, and blasting operations began shortly thereafter. The crews of the H-19's flew demolition experts to inaccessible areas on the ice and dropped 540-pound loads of TNT for their use. By 9 February the jam had been blasted loose, and the helicopters returned to Fort Meade.17
Despite continued minor and occasional missions, the early sixties saw little relief work by Army medical personnel. In 1964, however, a calamity severe enough to tax civilian resources compelled renewed Army medical assistance. On 27 March 1964 a massive earthquake struck south-central Alaska, triggering tidal waves along the coast. The quake damaged military facilities in the area; patients from the post hospital at Elmendorf Air force Base near Anchorage had to be transferred to a temporary facility the Army's 64th Field Hospital from nearby Fort Richardson helped operate. But despite their own problems, military units in Alaska answered pleas for help from their civilian neighbors.18
16"Copters Aid Flood Victims in Stricken
Del Rio Region," American Helicopter 36 (Aug 54): 16 "Brooke
AMC 'Chopper' Continues Mercy Flights," unidentified clipping; Ltr,
John R. Russell to CO, Brooke Army Medical Center, 16 Jul 54. Both in CMH
Since power service had been disrupted, the night of the quake troops at Fort Richardson worked by candlelight to establish a logistical center. The soldiers manned phones and poured Army supplies into the civilian relief effort. During the remainder of the emergency, requests for supplies or assistance generally came from civil defense officials to Alaskan Command (ALCOM). ALCOM passed them on to the U.S. Army, Alaska (USARAL), which sent them to the logistical brigade or to the office best equipped to fill the request. Bassett Army Hospital at Fort Wainwright coordinated all Army medical assistance. That aid primarily supplemented civilian health care efforts and went mostly to the cities of Anchorage and Valdez.
On the night of the quake, Anchorage police requested and received two Army ambulances staffed by four aidmen and stocked with emergency equipment. The next day the aidmen participated with other soldiers and local policemen in a search of all buildings in the downtown area. The Army also loaned equipment and personnel to local civilian hospitals. Late the first night Fort Richardson sent a generator to Presbyterian Hospital and cots, blankets, and pure water to Providence Hospital. During the next few days, two Army doctors worked at Providence, and, twenty Army technicians helped care for additional patients transferred there from a, psychiatric institute damaged by the quake. Since Presbyterian Hospital had sustained damage too extensive to continue its services, authorities evacuated its patients to other civilian facilities. Before it reopened, Army troops helped clean and prepare it to receive patients, and during the first four days of its renewed operations Fort Richardson did its laundry.
The Army also furnished public health assistance in Anchorage. Because the quake broke water and sewage lines, polluting the city's water supply, Anchorage health officials asked the Army for water trailers. The Army provided and staffed them, and for a time these water distribution Points furnished the only potable water in many areas. They were phased out as public officials restored water service, but an Army preventive, medicine officer and two technicians continuously monitored the city's water supply during the process. In addition, a USARAL veterinarian inspected food outlets in the anchorage area to prevent public health problems from that source.
Battered both by the quake and the subsequent tidal wave, the small coastal town of Valdez experienced greater devastation than Anchorage
and did not have so well organized a civil defense force to help it recover. Since more help was needed from the Army, Fort Wainwright dispatched relief troops late on the night of the quake. Because of bad weather, the advance party, which included an Army surgeon, did not arrive until the next morning. Its members immediately examined the extensive damage, consulted with local officials, and decided to evacuate most of the population.
All but forty-five people left. Other members of the Army rescue party, who had stopped in Gulkana when poor weather prevented them from proceeding to Valdez, prepared to receive the evacuees. After conferring with local civil defense officials, the soldiers established a hospital ward and refugee center in the gymnasium of a local high school. In addition, the Army established a checkpoint along the highway leading from Valdez where a medical team could examine evacuees for possible injury or disease. Over the next two days, Army medical personnel processed about six hundred refugees and sheltered a hundred of them in the gym.
Back in Valdez, Army medical and engineer troops labored to restore sanitary conditions. Fearing an epidemic, Army doctors inoculated all remaining residents. Dogs left behind by the evacuees posed another health problem as they began to prowl for food. Some anxious civilians suggested the Army shoot them, but realizing that most were family pets, the task. force commander detailed dogcatchers to impound them. Meanwhile cleanup operations continued, and a preventive medicine officer and an enlisted technician arrived from Fort Wainwright to conduct final sanitary surveys.
No other towns or cities in the affected area received as much medical assistance as Valdez or Anchorage, though in Seward preventive medicine specialists spent two weeks checking all sources of food and water for possible contamination. In other areas, assistance was not required, though the armed forces were ready to furnish it. Upon receiving word of the disaster, Bassett Army Hospital immediately alerted all personnel and expanded to maximum capacity but admitted no civilian casualties. A medical team from Madigan General Hospital at Fort Lewis, Washington, arrived in Anchorage on 29 March to support, the 64th Field Hospital, but the unit was not needed for civilian relief and returned to Madigan on 5 April. Two air transportable 36-bed hospitals and a 160-bed casualty staging unit flown in from Air Force bases in CONUS were never off-loaded, and two Army hospitals alerted in CONUS were never actually deployed.
Most of the Army medical personnel committed to civilian relief
completed their work, within five days. In badly damaged Valdez, Army doctors remained on duty a little longer, until 14 April, but by that time public health conditions even there had returned to normal. Throughout the area, despite massive property damage, total casualties from the quake remained low and no medical emergency developed. Consequently the need for Army medical assistance from CONUS never developed, and aid tendered by ALCOM could be quickly withdrawn.19
As had happened following earlier major relief efforts, requests for Army medical assistance increased after the Alaskan quake, as widespread publicity reminded relief officials of the Army's availability. After Hurricane Betsy in September 1965, Fourth Army dispatched ten medical officers and fifty-nine enlisted men from Fort Polk, Louisiana, to the stricken city of New Orleans. There they provided outpatient care, immunization, and ambulance services. The next year Army helicopters flew water, food, and vaccines into flooded Dell City, Texas, and sent a motor column from Fort Bliss. Though Dell City officials believed they could handle the immediate, health problems, they feared the possibility of an epidemic. At their requests, Army medical personnel established an aid station and vaccinated 2,000 residents against typhoid.20
In August 1967 the Army again provided medical assistance in Alaska when the Chena River, which borders Fort Wainwright and flows through nearby Fairbanks, rose dramatically. The rising river endangered the city's St. Joseph Hospital, perched precariously on the north bank of the Chena. On 14 August the mayor decided to evacuate, its patients and consulted military authorities at Fort Wainwright who agreed to admit them to Bassett Army Hospital on the post. Bassett's commanding officer summoned all physicians and staff for duty; they activated the reserve ward, and within three hours of notification the hospital, had admitted all sixty-one patients from St. Joseph's. Bassett became the only operational hospital in the area, receiving all civilian emergency cases during the remainder of the flood crisis.21
Only hours after the influx of patients, the Chena's waters flooded the
19"Medicine in Alaska Nearly Normal; Major
Hospitals Are Being Repaired," Medical Tribune, 20 Apr 64,
clipping in CMH files.
basement at Bassett. All available hospital personnel worked feverishly in a vain attempt to salvage, emergency equipment located there, but by morning the basement was completely underwater. Engineers installed pumps to keep down the rising water level, and strategic points throughout the hospital were sandbagged. Since the hospital had already lost power from the post's regular electrical system and the flood in the basement eliminated its emergency source, the staff placed large mobile generators, in critical areas such as the operating room, delivery suite, and X-ray and outpatient clinics. On the 17th, power from private and Air Force sources replaced the emergency generators, but the building still lacked heat, water, and sewage facilities. Loss of heat posed the most immediate danger because after three days the hospital had cooled to a dangerously low temperature. To alleviate the crisis, the staff set up electrical units and a few Herman Nelson heaters in strategic spots. Tankers brought in water from Eielson Air Force Base, and the hospital used chemical toilets.
Even though dependent on emergency or makeshift support systems most of the time, Bassett operated an efficient relief facility. It treated 172 civilians for a total of 1,135 patient days of care. Its own staff physicians handled the increased patient load, but the hospital did hire additional civilian help and borrowed Air Force nurses. The Air Force also provided Bassett with supplementary supplies. Although the emergency passed quickly, the last civilian patient was not discharged until 6 September.
Obviously Army medical resources could still be useful in emergency situations. By the late sixties, though, demand for Army medical support in civilian disaster had declined. Two Army relief missions, one in 1967 and the other in 1969, illustrated the reason why. Only two weeks after the floods in Alaska, Hurricane Beulah severely damaged Rio Grande City, Texas, and the Army dispatched a large relief force. Its medical contingent, however, found civilian resources sufficient to meet all health care needs. Army medical personnel operated a communications center and worked as sanitary teams in refugee centers. Only the task force surgeon, who conducted a health survey of the area, actually served in a professional capacity. In the second relief operation, after Hurricane Camille struck the Gulf coast in 1969, Army doctors and corpsmen did little, even though more than 1,500 soldiers took part. Army aviators- not from Medical Department units- flew 600 medical evacuation missions, and Army medical depots furnished vaccines and other supplies. Nonetheless, direct health care by Army personnel was simply unnecessary in this
relief effort as in most domestic disasters.22
Federal Reorganization and Minor Medical Missions of the Seventies
The year before Camille struck, 1968, marked the beginning of further administrative changes in the procedures by which the Army and the federal government rendered relief. Spurred by increasing demand for Regular Army assistance in quelling civil disorders, the Defense Department created the Directorate of Military Support (DOMS), Staffed primarily by Army personnel, DOMS set policy and coordinated all military assistance to civilian communities, including disaster relief. On medical matters, DOMS worked closely with Plans and Operations Division of the Office of the Surgeon General.23
Even after the creation of DOMS, the commanding general of CONARC and the continental Army commanders actually conducted disaster assistance operations. In 1972-1973 the Army adopted a new organizational structure under which the Training and Doctrine Command (TRADOC) and Forces Command (FORSCOM) replaced CONARC. Within the new structure the commanding general of FORSCOM assumed responsibility for domestic disaster assistance. He could delegate relief missions to his subordinate CONUS Army commanders or call on resources from TRADOC, the Health Services Command (created in the reorganization, HSC included all medical installations), or other DOD components. Most relief operations, though, involved FORSCOM's own units. In such cases, the FORSCOM surgeon provided his command with advice on medical relief, and the surgeon's office of the CONUS Army commands did the same for them. As before, actual control of medical resources most often remained with officers designated by the Army commander rather than the Medical Department.24
22On Beulah see Task Force Bravo, After Action
Report, Hurricane Beulah, 22 Sep- 8 Oct 67, DOMS files, WNRC. Army Medical
Service Activities, Annual Rpts, 47th Field Hospital, 1st Medical Group,
Fort Sam Houston, Tex.; 37th Medical Battalion, 1st Medical Group, Fort
Sam Houston, Tex. Both for 1967, in CMH files. On Camille, see "Hurricane
Camille: Amount of Federal Assistance, Office of Emergency Preparedness";
Memo to Director of OEP by Richard G. Stilwell, 23 Sep 69; "Hurricane
Camille, Military Disaster Relief," 22 Aug 69. Copies of all in DOMS
files, WNRC. Federal Response to Hurricane Camille, Hearings before
the Special Subcommittee on Disaster Relief of the Committee on Public
Works, U.S. Senate, 91st Congress, 2d Session (Washington: GPO, 1970).
part 1, pp. 10-11, 27-29, 104; Jimmie S. Ford, "Hurricane Camille:
4th Army Operations," U.S. Army Aviation Digest 16 (Jul 70):
18-20; D.T. Irby, Jr., "Virginia Disaster Relief," U.S. Army
Aviation Digest 16 (Jul 70): 21-23, John W. Griffin, "Operation
Camille," U.S. Army Aviation Digest 16 (Jul 70): 3-9.
During the years of Army reorganization, the civilian relief establishment was also undergoing change. Though the rechristening of the OEP in 1969 as the Office of Emergency Preparedness entailed no change of mission, significant new departures were on the way. Later that year Congress passed a new disaster relief law with greater provision for long-term rehabilitation, including direct financial aid to victims. In 1970 Congress passed a revised omnibus Disaster Relief Act which incorporated most of the features of its predecessors but increased aid to individuals expanded assistance to local communities for the repair of public facilities, and allowed OEP to coordinate relief by private agencies such as the Red Cross with their permission. In 1973, President Richard M. Nixon transferred relief responsibility from OEP to the Department of Housing and Urban Development, which created a new agency, the Federal Disaster Assistance Administration, to coordinate 'federal disaster aid.25
This bureaucratic shift symbolized a change in emphasis in ederal aid from relief to rehabilitation. Since 1950 all disaster acts had by implication endorsed a division of function that charged the federal government with greater responsibility for rehabilitation, and left most immediate aid to local and voluntary groups. In fact, the trend in that direction dated to the early twentieth century and was obviously related to the increasing capabilities of the Red Cross, National Guard, and civil defense organizations to render emergency assistance.26
In addition, a shift in the primary problem in disasters from mass casualties to massive property loss spurred the federal government to devote more of its resources to rehabilitation. In 1900 the Galveston hurricane killed 6,000 people and caused $30 million damage. Sixty-one years later Hurricane Camille struck the same region, killing only 46 people but destroying $400 million worth of property. Although obviously an imprecise comparison, the dramatic difference nevertheless highlighted the change that had taken place. The shift was clearly present in the Alaskan earthquake of 1964 in which casualties were few but property damage was substantial. Over the course of the twentieth century, early warning systems for tornadoes and hurricanes, evacuation planning, and
25Report to Congress: Disaster Preparedness,
1: 168-69 Executive Order 11575, 31 Dec 70; Executive Order 11725, 27 Jun
improved building techniques reduced deaths and injuries in disasters. During the same period, however, increased urbanization and greater use of marginal lands in floodplains and along the coast meant that the costs of property damage soared. In most disasters- though any loss of life was tragic- the larger problem became reconstruction, and the federal government increasingly directed its efforts toward that end.27
The shift in federal efforts affected various types of Army aid in different ways. For the Corps of Engineers, with a Civil Works Directorate able to repair community facilities, it meant increased responsibility. For the Army Medical Department, it became one more factor contributing to a decline in disaster relief activity. Medical aid never completely ceased, of course. For no matter how strong other relief agencies became, no matter what federal responsibility became, the Army still had medical resources that could be of value to distressed civilian communities. It also had a long heritage of helping civilians in emergencies, and procedures existed whereby it could be called upon to help. After 1970 the Army continued to render medical aid, but only in isolated emergencies or as a small part of a larger civilian relief effort.
The pattern of minor aid within a predominantly civilian program was more common. In 1972, for example, Tropical Storm Agnes caused tremendous destruction in the mid-Atlantic states and prompted a large relief operation. Though other agencies provided most medical care, the Army did ship supplies and furnished ambulances in Maryland and Pennsylvania. That same year, civilian agencies and West Virginia National Guard conducted relief operations after the Buffalo Creek dam burst. Four Military Service Corps sanitarians from Fort Meade, however, aided local authorities in establishing emergency procedures to safeguard public health.28
On other occasions Army medical units provided helicopter support while civilians furnished medical care. After a tornado in the small town of Salina, Kansas, on 25 September 1973, the 82d Medical Detachment (Helicopter Ambulance) received a request from the Kansas Highway, Patrol for search and rescue assistance. Over the next few days the unit flew survey missions along the track of the storm, kept civilian officials
27This argument based on Douglas C. Duey and
Howard Kunreuther, The Economics of Natural Disasters: Implications for
Federal Policy (New York: Free Press, 1969), pp. 3-5, 13-18. 44-57. See
also Hoyt Lemons, "Physical Characteristics of Disasters: Historical
and Statistical Review," Annals of the American Academy of Political
and Social Science 309 (1957): 1-14.
apprised of the damage and of new tornadoes, and resupplied local hospitals. Throughout the emergency, its commander reported, civilian resources proved "totally effective and in most cases an, excess of ambulances and medical personnel were on hand at the sites hardest hit."29
Not all medical missions in the seventies consisted only of support for civilian efforts, however. On 3 April 1974 a tornado nearly demolished the small Kentucky town of Brandenberg. Nearby Fort Knox received a request from the state police for helicopter evacuation of the injured, but bad weather conditions prevented helicopter operations. Military personnel, including the 42d Field Hospital, drove to the scene. Since Brandenberg had only two doctors and the storm had incapacitated its sole clinic, Army medical personnel cared for the injured. As soon as the weather cleared, they evacuated the more serious cases by air to Ireland General Hospital at Fort Knox and sent many less seriously injured patients by ground ambulance either to Fort Knox or to a civilian hospital in Elizabethtown, Kentucky. Residents with only minor injuries were treated in an emergency clinic set up in a local school. Within twenty-two hours, the Army had completed its mission and returned to post.30
As the Fort Knox effort demonstrated, the changes that the seventies had brought to the federal government's domestic disaster mission had not completely eliminated a role for Army medical personnel. In fact, dispersion of troops and the ubiquitous helicopter had increased the Army's potential for rapid medical relief to almost any area of the nation. On the other hand, the federal government in the years after the Second World War had created a disaster assistance establishment based upon civilian rather than military control and with primary federal responsibility for rehabilitation rather than relief. Both principles entailed a further reduction in Army Medical Department participation. Nevertheless, in certain situations- either a massive calamity that exhausted civilian resources or a less severe disaster in a small, isolated community that had few resources to begin with- Army medical units continued to be summoned for aid.
29Quote from Civilian Mission 51, Disaster
After Action Report, 73-1, 82d Medical Detachment, copy in CMH files; Joesph
L Bradley, Jr., "Twister," U.S. Army Aviation Digest 21(Jun