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Appendix E

APPENDIX E

Evacuation by Landing Ship, Tank, From the Normandy Beaches

D. P. Hall, M.D.

Operation OVERLOAD, destined to break the power of Nazi Germany, was directly dependent on landing craft which could transport a grand total of 20,111 vehicles and 176,475 men on an amphibious assault against the shores of Normandy. The LST (landing ship, tank) was said to be the most important instrument of war in the European theater. Sir Winston Churchill once observed: "The destinies of two great empires seemed to be tied up by L.S.T.'s."

On 10 May 1944, U.S. Army hospitals in the United Kingdom received orders from Headquarters, ETOUSA, to send selected enlisted technicians and medical officers capable of performing surgery of trauma to designated channel ports in England for a period of training in the handling of casualties on LST's from the invasion beaches back to English Channel ports.

The LST was the only available craft suitable for the dual role of evacuating large numbers of casualties from the invasion beaches and carrying supplies from the United Kingdom to the Normandy coast. It was wisely decided to equip LST's so that they might carry from 150 to 200 litter and hundreds of ambulatory patients from France back to England. For the actual assault phase of OVERLORD, it was decided to staff a given number of LST's with competent operating surgeons and surgical technicians provided by the Army.

All of the selected army personnel were sent to U.S. Army hospitals on the Channel coast of England to be thoroughly indoctrinated as to their various responsibilities before and during the invasion. The following tasks were specifically stressed for the surgeons: (1) Perform such third-echelon surgical treatment as was practicable, consisting in the main of lifesaving surgery and early debridement of mangled and traumatic injuries; (2) act as surgical consultants to the LST crew. For planning purposes a load of 200 litter casualties was considered to be maximum for an LST. Medical materiel, therefore, was supplied to each LST on this basis. Each LST was provided two standard surgical kits consisting of all surgical instruments that might be used for general traumatic surgery and a medical technician's kit for each technician. In addition, a special surgical outfit which consisted of instruments that might be needed in abdominal or thoracic surgery was issued to each army surgeon. Eight beach bags were provided which contained sufficient battle dressings, morphine, sulfanilamide, and splints to care adequately for the maximum number of wounded. Ten pints of whole blood, biologicals, plaster of paris, dextrose solutions, chemical warfare ointment, and 12 units of plasma were placed on board to be carried on the first trip of an LST to the beachhead. Automatic replenishment of expendable items was to be provided on the return of LST's to the English coast.

During the preparatory phase of organization and training on the Channel coast of England, Lt. Col. (later Col.) Robert M. Zollinger, MC, Senior Consultant in General Surgery for the ETO, visited all training groups and gave wise counsel as to emergencies that might arise and directed the final preparations. Credit for the idea of using rubberized cloth (Batiste) in the place of sterile drapes should go to Colonel Zollinger. This material could be easily cut to any desired dimension and sterilized by boiling for 15 minutes. It proved to be quite an innovation in the more speedy draping and handling of wounds.


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On 3 June 1944, all U.S. Army surgical teams were transported to different ports along the English Channel and placed upon waiting LST's. Aboard the LST, each medical officer oriented himself and saw to it that the operating theater, which had been built at the rear of the tank deck, was in order. He also made sure that medical supplies were dispersed at different stations on the LST so that if one source of supply should be destroyed in battle others might be available.

On 4 June, the LST's, with overhead barrage balloons and loaded with combat soldiers, tanks, and vehicles, put out into the English Channel. There was, however, such a heavy gale that, when they made their rendezvous, orders were received to return to port and wait for 24 hours.

On 5 June, the LST's in convoy made for open Channel to become an integral part of the greatest armada in history. There were 9,000 ships and landing craft protected by 702 warships and 25 minesweeper flotillas. Some were destined for Omaha Beach; others, for Utah Beach. Those carrying British and Canadian personnel were routed to Juno, Gold, and Sword beaches.

On 6 June, D-day, almost all LST's were within easy reach of the Normandy coast. Most of them had beached by D+½, and a few were beached later on D+2 day. Disgorging their cargo of combat soldiers, tanks, and vehicles, they were made ready for receiving casualties.

On arrival off Normandy, excitement and tenseness was everywhere very apparent because of going into the battle area under the constant bombardment of the French shore by friendly combat ships with 4-inch to 16-inch naval guns, followed by flashes from the German shore batteries all along the coastline. The first night on the beach was indeed revealing. Some of the LST's had opened antiaircraft fire on German planes against orders for the night. This fire immediately brought about rapid retaliation by the German air raiders, who dropped phosphorous and magnesium bombs along the beach. When the enemy planes ceased their attack at daybreak, many casualties were found on the beach, and the work was cut out for the surgical teams. On Omaha Beach most of the casualties were from the 1st and 29th Infantry Divisions of the U.S. V Corps. Those received and treated at Utah Beach were from the 82d and 101st Airborne Divisions, U.S. VII Corps.

On D+½ and D+2 days, LST's began to receive casualties in larger numbers on the beaches, and routine surgical treatment, such as control of hemorrhage and shock by plasma and whole blood transfusions, was instituted. Fractures were immobilized with splints of plaster of paris. Pain was eliminated by morphine and, when necessary, by ether or Pentothal sodium (thiopental sodium). Infection was combated by the use of sulfanilamide and penicillin; tetanus toxoid and gas antitoxin were given. In any case where there was obstruction of the airway, a tracheotomy was done.

Definitive surgery was done only as a lifesaving measure with careful consideration in favor of conservatism, due thought being given to the possible time interval before definitive treatment could be provided at U.S. Army hospitals on the English coast. Definitive surgery was done in severe chest and abdominal wounds, traumatic injuries of the buttocks, and compound fractures of the extremities with damage to the main blood supply.

Triage became a very important duty of each army surgeon on the beach, as sorting was a necessity in the proper handling and treatment of the casualties. This triage was done so that, upon arrival of casualties from France at the English shore, pertinent information was at hand and available to medical units receiving the evacuated casualties. The wounded were divided into ambulatory and litter cases. The litter cases were further divided into transportable and nontransportable patients. Casualties were classified as transportable when it was considered that they could safely tolerate overland transportation, after debarkation in England, before requiring surgical attention. All those who would require immediate surgical attention and, or, early surgical intervention upon reaching the English shore were classified nontransportable.


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An EMT (Army Emergency Medical Tag) was used on all wounded. On the back of this tag, a supplemental record was kept, for use in the event the patient should require definitive surgery. A brief indication of the type of wound, such as head, chest, or abdomen, was placed on the EMT.

Some of the wounded transferred from the Normandy beaches to LST's had received first aid treatment but had lain on the beach for 12 hours in the clothes in which they were wounded. Most wounds were covered by a shell dressing, and few had received any other medication except morphine. Many were dehydrated and anxious because of loss of sleep. Supportive treatment in crossing the Channel to the English hards and quays required much time. Several chest and abdominal wounds necessitated operation. But, by far the greater number were compound fractures requiring immobilization and wounds of soft tissues-including the buttocks-requiring debridement. Because of associated rectal wounds, several colostomies were done on casualties with wounds of the buttocks.

A few German casualties were received. All these prisoners had been poorly treated and dressed, but none had received tetanus antitoxin. Most of their wounds had not been debrided but only packed with petrolatum-impregnated gauze to prevent hemorrhage. Unfortunately, the petrolatum-impregnated gauze became a plug and not a drain. The result was a grossly contaminated wound with an occasional gas gangrene infection. All these wounds were debrided, cleansed, and dressed, and the prisoner patients were given tetanus and gas antitoxin, plus sulfanilamide, en route to England.

Of the wounded received on LST's, the relative regional frequency of their injuries was estimated to be: Extremities, 50 percent; abdominal, 12 percent; thoracic, 9 percent; thoracoabdominal, 1.5 percent; and all other, 27.5 percent.

Many of the LST's caring for casualties made three or four crossings of the English Channel, after which time the Allied invasion forces had gained a good beachhead on the Normandy coast, and airstrips were quickly laid down from which wounded could be evacuated by air to England. Evacuation hospitals and field hospitals were set up at nearly the same time as the airstrips, thus ending the need for LST's as casualty carriers. As a consequence of mission accomplished, all army personnel were ordered back to their respective hospitals.

The army surgeons and technicians who participated in the LST evacuation operations during the Normandy invasion deserve the highest commendation for outstanding courage and devotion to duty under fire. Remember, many had been civilians only a few months before. The writer is sure that the aid, comfort, and lifesaving services given by the relatively few men who made up the surgical staff on the LST's deserve much credit for the reduced mortality and morbidity rate attained among American wounded during the invasion of Normandy.

The Normandy countryside is now green and peaceful. The townfolk of Sainte Mère-Église are free to stroll along Omaha or Utah Beach, but one wonders if they remember the beached LST's, one of the vanguards of their freedom and the refuge of the wounded Yank.

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