U.S. Army Medical Department, Office of Medical History
Skip Navigation, go to content

HISTORY OF THE OFFICE OF MEDICAL HISTORY

AMEDD BIOGRAPHIES

AMEDD CORPS HISTORY

BOOKS AND DOCUMENTS

HISTORICAL ART WORK & IMAGES

MEDICAL MEMOIRS

AMEDD MEDAL OF HONOR RECIPIENTS External Link, Opens in New Window

ORGANIZATIONAL HISTORIES

THE SURGEONS GENERAL

ANNUAL REPORTS OF THE SURGEON GENERAL

AMEDD UNIT PATCHES AND LINEAGE

THE AMEDD HISTORIAN NEWSLETTER

"We Were Ready": Health Services Support in the Normandy Campaign

Operation Overlord

“We Were Ready”:

Health Services Support in the Normandy Campaign
by

Donald E. Hall
LTC, Medical Service Corps,
US Army


November 1993

An earlier version of this paper was presented at the Conference of Army Historians
Alexandria, Virginia
in June 1992
  The views expressed in this paper are those of the author and do not reflect the official policy or position of the Department of Defense or the US Government.


1

The health services support1 provided by the Army Medical Department in support of the Normandy landings was the most difficult and complex single operation ever undertaken by the Department. Although other operations would see more medical personnel involved, or more casualties treated, the challenge of moving an entire health services support structure across the English Channel and establishing it in France was not one to be taken lightly by the Department. I will be limiting my discussion of the tactical portions of the medical support operations to those occurring in support of the V US Corps on OMAHA beach. Although this is only roughly half of the medical support effort, it was the beach which had the greater problems being established, and so, also had a more difficult time establishing its medical support structure.

Planning for the operation had been ongoing for years prior to 6 June 1944. The first medical planner sent to England by the Army was then Colonel Paul R. Hawley, who arrived there in 1941, prior to the entrance of the United States in the war.2 When war came, Hawley stayed on, and from that position eventually rose to the rank of Major General arid the position of theater surgeon for the European Theater of Operations. From this position he oversaw and coordinated the plans of the First United States Army and its surgeon, Colonel John A. Rogers, as well as those of the Services of Supply. A unique individual, Hawley had, in addition to his MD, a Doctorate in Public Health from the Johns Hopkins School of


2

Medicine and had completed the Army War College.3  In addition to ensuring that the plans of these two organizations, one with the mission of treating and evacuating casualties in France and the other with receiving and treating them upon their arrival in the United Kingdom, Hawley also had the job of coordinating the movement of patients with the United States Navy and the Army Air Forces, both of whom were critical in ensuring that patients were safely and efficiently moved from the continent back to England, and without whose cooperation the Army plans would be doomed to failure. Fortunately, the Navy and Army Air Force planners also understood this, and together, Hawley and his team developed a detailed plan for the initial treatment, cross-channel evacuation, and final disposition of casualties in the United Kingdom.

Hawley was originally given the mission to plan for a cross channel attack shortly after the landings in North Africa. At that time, he felt, it would have been impossible to support a U.S. attack, as virtually all U.S. medical support, save for that organic to the divisions which had remained in the United Kingdom had deployed to North Africa. In an emergency, he said, he could probably support the attack if provided medical support from the British. 4 Fortunately, the Allies decided against a cross channel attack in 1943, and Hawley had an additional year to receive, evaluate, and train medical units for the landings in Normandy.

Hawley and his staff were extremely concerned with the training of medical units for


3

the invasion. In addition to specialized training in the operation itself, staffs concentrated on training their enlisted personnel in medical skills and in operation of their facilities in the field. Additionally, as the number of patients in England was well short of the number needed to keep medical staffs occupied, Hawley and his staff created a European version of the Medical Field Service School, providing officers with additional training in military medicine.5  They also arranged for staffs to rotate into hospitals which were actively treating patients, held medical conferences to discuss the latest medical and surgical techniques, and established journal clubs throughout the country.6

Hawley and the Navy realized early on that the expected number of casualties, coupled with the lack of a functional port in the beachhead area, meant that the primary means of sea evacuation, at least early on, would by the use of Landing Ships Tank (LSTs). Since the only medical facility on an LST was a small sick bay located down a steep ladder from the main tank deck, arrangements were made to have a small medical section built in a caged in area at the back of the tank deck, and litter brackets were mounted in the bulkheads to allow the transport of more patients--up to 145 patients on litters, and even higher numbers of patients if they were ambulatory.7 Although LSTs had been converted into hospitals in both the Southwest Pacific and in the Mediterranean, where they were beached and essentially used as a small field or evacuation hospital, during this landing they would only be used for patient


4

transport, and so had much more austere facilities. While the theater G-4 had agreed to the installation of the medical area, he neglected to tell his movement planning section, which nearly scuttled the invasion, as the installation of the medical section effectively meant that one less truck could be carried on each ship.8 When the number of round trips each of the LSTs was scheduled to make in the early days of the invasion, the single truck per ship quickly added up, especially when shipping was already tight. To ensure that proper care would be provided to casualties on the return trip, each LST was provided with a detachment of two Medical Corps officers and thirty corpsmen to provide in-route care on the return trip.9 When the Navy fell short of the number of personnel needed to staff the ships, Hawley turned to the hospitals of Patton's Third United States Army, which would not be in operation during the time period when personnel were most needed on the LSTs, for the additional manpower. 10

There was one area of additional concern for Hawley and his subordinates, and that was in the area of property exchange. Since the Civil War, Army medical units had exchanged property along with patients, to ensure that forward units were not depleted of high demand supplies, primarily litters and blankets. The Navy and Army Air Forces, however, did not use the same system. The Navy agreed, however, for this operation they would carry packages of supplies on the first 100 LSTs which sailed for the continent which would be left on the beach for recovery by Army personnel, and after those 100 ships had sailed would


5

carry enough litters and blankets on each LST to allow for litter and blanket exchange with Army units on the beach, which by then would be calm enough to allow an orderly exchange. These supplies would provide some 30,000 litters, as well as blankets, splints, dressings, and plasma during the early hours and days of the operation.11

Of special concern was ensuring the reception, onward movement, and definitive treatment of casualties when they arrived in the United Kingdom. Hawley realized early on in the planning process that it would be impossible to find locations for all of the required hospitals near the ports, so he came up with a different plan. Confident that he would have ambulance trains in numbers sufficient to transport casualties from the ports to hospitals located in the interior of England, Hawley turned to the British authorities to locate his hospitals inland, along the major railways. To receive the patients as they arrived from France, Hawley again turned to the Third U.S. Army, using its medical units to supplement those of the Services of Supply to provide initial treatment when the patients arrived, and to transport them to the railheads.12 Many of those same units had been used as the troops were embarking to provide medical support in the staging areas only days before the casualties began to arrive. By the time the Third Army units were needed to deploy, the casualty flow had begun to slow, freeing the units up for deployment and also providing them with additional experience treating battle casualties prior to their arrival on the continent. In all, the Service of Supply had nearly 10,000 beds available in the immediate area of the ports and another 18,000 further inland to provide definitive treatment for the patients.13


6

Medical support on the continent was a complex and evolving process. Landing with the initial assault companies were the companies' combat medics, followed shortly thereafter by the battalion aid stations. About two hours later, if all went according to plan, would come the regimental aid stations and the collecting company from the division medical battalion which supported that regiment. As the separate regimental beachheads consolidated into a divisional beachhead, a clearing company from the engineer special brigade supporting the landing would arrive and begin receiving casualties from the division collecting companies. This allowed the clearing company of the division's medical battalion to move directly inland and establish itself, rather than setting up on the beach and then moving again a short time later. Finally, the hospitals, collecto-clearing companies, ambulance companies, and other units of the corps and field army's medical support system arrived and became operational. The Navy had the responsibility of providing all medical care up to the high water mark on the beach, and for receiving patients from the Army, although the Army was also responsible for the loading of the ships. 14  While at first any returning LST would take patients aboard, once the beachhead became organized the beachmaster would specify certain transports for the reception and transport of casualties back to England. 15

Once the actual landings began, things immediately began to go wrong. Units were landed on the wrong portions of the beach, and in many cases either lost their equipment or had it destroyed. Still other units found their landings delayed by hours or even days.16 The


7

exploits of the Headquarters and Headquarters Detachment of the 61st Medical Battalion, a nondivisional medical battalion headquarters attached to the 5th Engineer Special Brigade, is perhaps typical of the events on D-Day. Landing at about 1300 on beach Easy Red, the advance party for the headquarters consisted of six officers and twelve enlisted men. After the landing on Easy Red, they were to make their way overland to beach Fox Green. As they were a headquarters, they landed with no medical supplies, simply the office supplies and equipment which they would need to perform their administrative mission. Almost immediately, they found that the enemy fire was of such an intensity as to prevent their travel to Fox Green, while the wounded on the beach, seeing the red cross armbands they all wore, began to cry for help Using the supplies they found on the beachhead, principally the first aid dressings of the dead, they began to provide what aid they could, including dragging the wounded out of the rising tide. Their efforts, as were those of many medics on the beachhead, was complicated by the fact that many of our soldiers, with the typical feelings of immortality felt by all young men, had thrown away their individual first aid packets and used the pouch to hold cigarettes, candy, or other items. For the day's exploits, the men of the detachment received nine Bronze Stars and the Presidential Unit Citation while suffering two officers and two enlisted killed in action.17

The Third Auxiliary Surgical Group had similar experiences. Given the mission of


8

providing forward surgical teams to units of the V Corps and the Engineer Special Brigade, the “Third Aux” was supposed to help stabilize severely wounded patients on the beachhead so that they would, hopefully, survive the trip across the channel without further intervention in route. Unfortunately, they, too, lost most of their supplies and equipment in the landing and were also reduced to the role of Aidmen on the beach.18 For their actions that day, the men of the “Third Aux” would be awarded two Silver Stars, eight Purple Hearts, and a number of Bronze Stars, in addition to the Presidential Unit Citation.19

One of the most important factors which allowed the medics to improvise on the beach was the large amount of medical supplies which the Navy LSTs had left on the beach, in accordance with the plan. Unfortunately, the squad of the 1st Medical Depot Company which was to have gathered the supplies and established a central medical supply dump with them had been delayed in landing by an entire day. Once ashore, they found that the sites which had been selected for the establishment of their dump sites had not yet been secured, and it was not until D+3 that they were finally able to move to their assigned sites and place the medical supply dumps in operation. 20

The first hospital scheduled to become operational ashore was the 51st Field Hospital, a 400 bed facility. Originally scheduled to land on D+2, the personnel of the hospital did


9

indeed land on D+2, but it was not until another day had passed that their equipment, which had sailed on another ship, arrived. It was not until D+5 that the hospital opened its first 100 bed unit, and the facility was not fully operational until D+6, when its nurses were finally allowed to land and all three of its hospital units became operational. As the three hospital units of the hospital were operating in different areas on the beachhead, they had a total. operating capacity of 300 beds.21 Similar delays in both landing and becoming operational were observed by all of the hospitals landing on OMAHA, in many cases because the personnel of the hospital landed a day or more before their equipment, which in many cases was on a different ship than the personnel.22

During its first five days in operation, the hospital admitted 636 patients and performed 356 operations, an average of more than 71 surgical procedures a day. Despite their heavy workload, they managed to keep their overall death rate at 4 percent, and their. postoperative death rate at just over three percent.23

One system which did work better than expected was the air evacuation system. Originally scheduled to become operational on D+14, the first airfield to become operational did so on 10 June--fourteen days ahead of schedule. 24 Almost immediately the Army Air Forces began transporting casualties on planes which had just left supplies or equipment in France, and by the end of the month had moved nearly five percent of all patients transported


10

to England.25 As the beachhead expanded and more and more airfield became operational, a greater and greater reliance was placed on air evacuation, and eventually most of the patients transported from France to England would move by air.26 By the 16th of June, ten days after the landings had begun, the evolution of the health services support system in support of the V US Corps, and indeed, the entire First United States Army, was progressing well. Admissions, defined at the time as “admitted to any medical treatment facility on an excused from duty basis, whether or not they were subsequently admitted to a hospital,” averaged about twelve to thirteen hundred a day for the First Army throughout the period from D to D+10, although there are quite obvious peaks in the data corresponding to periods of greater combat activity. Although deaths due to combat related injury were more frequent than deaths due to nonbattle causes during World War II, admissions for combat related injuries were less than for disease or nonbattle injury--just the opposite of what occurred during the landings, as might be expected. The incidence of combat stress injuries remained low in the early parts of the battle, but began to climb as time passed.27

By the end of the month, the system was even larger. By 30 June the medical personnel in the First U.S. Army numbered some 30,760--the equivalent of nearly two divisions.28 What, then, did their patients look like? Of the patients being admitted, 72.4 percent were wounded, 19.9 percent were suffering from some sort of disease, and 7.7 percent


11

were suffering from a nonbattle injury.29 If a casualty survived his injury long enough to enter the medical treatment system, his chances of surviving were excellent--the death rate ran at only 2.5 percent, which compares favorably to the 1.5 percent died in hospital rate experienced by the Medical Department in the Republic of Vietnam over twenty five years later.30 Of those who lived, only 14 percent would be returned to duty from a First Army treatment facility, the other 83.5 percent being evacuated out of the Army area.31

One reason for the high success rate may be due to the types of injuries encountered. Most of the injuries seen in medical treatment facilities--nearly two thirds of them--were in the extremities, while only about 1.3 percent were due to multiple injuries.32 I should issue a caveat here, however, these statistics are based on the medical records of patients admitted to treatment facilities, so soldiers whose injuries were severe enough to cause them to die before reaching a treatment facility may, and probably did, have more severe wounds.

Despite the fact that the First Army had begun to evacuate casualties by air on D+4, the preponderance of patients still moved by sea during the month of June--in excess of 95 percent of them. Although the reports do not indicate where they went, we may assume that the 0.1 percent of casualties evacuated by land were probably transported to the British Army.33

It is said that the First Corollary to Murphy's law regarding combat operations is that


12

“No operations plan survives first contact with the enemy,” and this was certainly the case with the medical support of the landings at OMAHA beach. Yet despite the problems--the loss of equipment, the heavy casualties in the medics landing with the first wave, and the general disorganization on the beachhead--the medics were able to do their job, and do it well. And this, in large part, is due to the prior planning and continuous training which the units which took part in the landings participated in. For, in the words of Major General Hawley, “they were ready”.34


   
FOOTNOTES

        1 I use the term health services support here in its Medical Department usage, which is more encompassing than the term medical support.

        2 Major General Paul R. Hawley, Chief Surgeon, European Theater of Operations.  Interview conducted by MG Alvin L. Gorby, COL John B. Coates, Jr., and Dr. Charles M. Wiltse, 16 and 18 January 1962. Original in the files of the US Army Military History Institute, Carlisle Barracks, Pennsylvania.

        3 Roderick M. Engert, “A Concise Biography of Major General Paul R. Hawley.” This biography was prepared by the Army Medical Department Historical Unit in March 1968. Original in the Paul R. Hawley Papers, US Army Military History Institute, Carlisle Barracks, Pennsylvania.

        4 Hawley Interview.

        5 Graham A. Cosmas and Albert E. Cowdrey,  Medical Service in the European Theater of Operations (Washington, DC: USGPO, 1992), pp. 132-35.
        
        6 Hawley Interview.

        7 George B. Dowling,  Special Report to the Chief of the Bureau of Medicine and Surgery. U. S. Navy of United States Naval Medical Service in the Invasion of Normandy. 6 June 1944 (Washington, DC: USGPO, 1945), pp. 4-5.

        8 Hawley Interview.

        9 Dowling, pp. 6-7.

        10 Third United States Army, After Action Report, Third U. S. Army, 1 August 1944-9 May 1945 (Regensburg, Germany: Third US Army, 1945), Med 2.

        11 Dowling, pp. 10-14.

        12 Cosmas and Cowdrey, pp. 196-200, and AAR Third Army, Med 2.

        13 Cosmas and Cowdrey, p. 199.

        14 Dowling, D-5 thru D-13.

        15 Dowling, A-2 thru A-12.

        16 For a listing of actual landing dates, see First U.S. Army, "Annex No. 21 to Report of Operations, First US Army, Period 6 June 1944-1 August 1944."  Original in the National Archives and Records Administration (NARA) II, College Park, MD, Record Group (RG) 112 (Records of the Surgeon General (Army), 1917- ), entry 54A, box number 335,  pp.5-13. For a listing of scheduled landing dates see:  First United States Army, Report of Operations, 20 October 1943-1 August 1944 (Paris, France: First United States Army, 1944), Medical Annex, pp. 60-61.

        17 61st Medical Battalion, "Annual Report of the 61st Medical Battalion Activities [1944]." Original in NARA II, RG 112 (Records of Army Medical Department), entry HUMEDS (Historical Unit, Medical Service), box number ????

        18 Clifford L. Graves,  Front Line Surgeons: A History of the Third Auxiliary Surgical Group (San Diego, CA: Frye & Smith, Ltd., 1950), pp. 125-76.

        19 Graves, pp. 329-36.  The “Third Aux” continues its service today. On 15 March 1991, the unit was redesignated the 3d Medical Command and activated in Riyadh, Saudi Arabia.  It is currently stationed at Fort McPherson, Georgia.

        20 "Chronological Report, 1st Section, Advance Depot Platoon, First Medical Depot Company, from 18 January 1944 to 21 June 1944 inclusive." Original in NARA II, RG  338, entry HUMEDS, box 185, pp. 3-5.

        21 51st Field Hospital, "Annual Report to the Surgeon General for the Year 1944 including the Previously Unreported Period 10 Sep 43 to 31 Dec 43."  Original in NARA II,  RG 338, entry HUMEDS, box number 70, pp. 6-8.

        22 First U.S. Army, "Annex 21 to Report of Operations," pp. 5-9.

        23 51st Field Hospital, "Annual Report," p. 8.

        24 Mae Mills Link and Hubert A. Coleman, Medical Support of the Army Air Forces in World War II (Washington, DC: USGPO, 1955), pp. 599-601.    

        25 First U.S. Army, "Annex 21 to Report of Operations," p. 138.

        26 First U.S. Army, "Annex 21 to Report of Operations," pp. 139-140.

        27 First U.S. Army, "Annex 21 to Report of Operations," pp. 123-29.

        28 First U.S. Army, "Annex 21 to Report of Operations," p. 149.

        29 First U.S. Army, "Annex 21 to Report of Operations," p. 135.

        30 For First U.S. Army death rates, see "Annex 21 to Report of Operations," p. 135, while death rates in Vietnam are located in Spurgeon Neel, Medical Support of the U.S. Army in Vietnam, 1965-1970 (Washington, DC: USGPO, 1973), pp. 50-51.

        31 First U.S. Army, "Annex 21 to Report of Operations," p. 134.

        32 First U.S. Army, "Annex 21 to Report of Operations," p. 146.

        33 First U.S. Army, "Annex 21 to Report of Operations," pp. 139-40.

        34 Paul R. Hawley, “How Medicine in the European Theater of Operations Prepared for D-Day,” in Morris Fishbein (ed.),  Doctors at War  (New York: Dutton, 1945), pp. 195-217.


BIBLIOGRAPHY
"Chronological Report, 1st Section. Advance Depot Platoon. First Medical Depot Company, from 18 January 1944 to 21 June 1944 inclusive." Original in     NARA II, RG 338, entry HUMEDS, box number 185.

Cosmas, Graham A., and Albert E. Cowdrey. Medical Service in the European Theater of Operations (Washington, DC: USGPO, 1992).

Dowling, George B. Special Report to the Chief of the Bureau of Medicine and Surgery, U. S. Navy of United States Naval Medical Service in the Invasion of Normandy, 6 June 1944.  Washington, DC: USGPO, 1945.

Engert, Roderick M. “A Concise Biography of Major General Paul R. Hawley.” This biography was prepared by the Army Medical Department Historical Unit in March 1968. Original in the Paul R. Hawley Papers, US Army Military History Institute, Carlisle Barracks, Pennsylvania.

51st Field Hospital.  Annual Report to the Surgeon General from the 51st Field Hospital for the Year 1944, Including the Previously Unreported Period 10  Sep 43 to 31 Dec 43. Original in NARA II,  RG 338, entry HUMEDS, box number 70.

First United States Army.   "Report of Operations 20 October 1943-1 August 1944." Paris, France:  First United States Army, 1944.

  "Annex No. 21 to Report of Operations, First US Army Period 6 June 1944 - 1 August 1944." Original in the National Archives and Records Administration II (NARA II), College Park,  Maryland, Record Group (RG) 112 (Records of the Surgeon General (Army), 1917-  ), entry 54A, box number 335.

Graves, Clifford L.  Front Line Surgeons: A History of the Third Auxiliary Surgical Group. (San Diego, CA: Frye & Smith, LTD, 1950)

Hawley, Maj. Gen. Paul R. “How Medicine in the European Theater of Operations Prepared for D-Day,” in Morris Fishbein (ed.), Doctors at War (New York: Dutton, 1945).

Interview with Maj. Gen. Paul R. Hawley, Chief Surgeon, European Theater of Operations.  Interview conducted by MG Alvin L. Gorby, COL John B. Coates, Jr., and Dr. Charles M. Wiltse, 16 and 18 January 1962. Original in the files of the US Army Military History Institute, Carlisle Barracks, Pennsylvania.

Link, Mae Mills and Hubert A. Coleman. Medical Support of the Army Air Forces in World War II.  (Washington, DC: USGPO, 1955).

Neel, Spurgeon. Medical Support of the U.S. Army in Vietnam, 1965-1970. (Washington, DC:  USGPO, 1973).

Third United States Army.  "After Action Report, Third U. S. Army, 1 August 1944-9 May 1945."  Regensburg, Germany: Third US Army, 1945.

61st Medical Battalion.  "Annual Report of the 61st Medical Battalion Activities [1944]." Original in NARA II, RG 338 (Records of United States Army Commands, 1942-), entry HUMEDS (Historical Unit, Medical Service), box number 242.