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Chapter XX

Contents

CHAPTER XX

Development of Procedures for Evacuation from Theaters to the Zone of Interior

Before the patient load (described in the last chapter) could be transferred from theaters to general hospitals in the United States, policies and procedures to govern the entire operation had to be developed. Those established early in the war remained effective with minor modifications to its end.

Procedures for Sea Evacuation

SOS directives charged ports of embarkation, operating directly under the Chief of Transportation, with responsibility for the evacuation of patients from overseas areas to which they supplied war materiel. A basic prerequisite to the discharge of this responsibility was information about the kind and number of patients to be evacuated. Accordingly, in August 1942 SOS headquarters announced that patients would be classified for transportation purposes as mental, hospital, or troop class.1 The next month these classes were increased to four by splitting the hospital class in two: hospital litter and hospital ambulant. Mental, or Class I, patients were those who required security accommodations aboard ships or trains to prevent them from injuring or destroying themselves. Hospital litter, or Class II, patients were those whose physical condition required them to remain in bed and be cared for entirely by others. Hospital ambulant, or Class III, patients were those who required medical care and service, even though they did not have to remain in bed at all times. Troop class, or Class IV, patients were those who needed little medical care en route and were able to care for themselves even in emergencies.2

In 1944 subdivisions were established for Class I, or mental patients. They were actually of three groups: those who were seriously disturbed and needed locked-ward accommodations in hospitals as well as on ships; those who were borderline cases and might or might not require locked-ward care on land but did require it aboard ships; and those who were only mildly disturbed and did not need to be

1Memo,CG SOS (init by Lt Col J[ohn] C. Fitzpatrick) for SG, 21 Aug 42, sub: Est of Reqmt for Sea Evac. SG: 560.-2.
2Ltr SPOPH 322.15, CG SOS to CGs and COs of SvCs and PEs and to SG, 15 Sep 42, sub: Mil Hosp and Evaš Oprs. AG: 370.05.


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placed under restraint in any event. Patients of the last type suffered from being quartered with the more serious mental cases and, if placed in locked wards, took up space needed for the latter. Yet, under existing regulations and classifications, transport surgeons and medical officers in charge of patients on hospital ships often treated all mental patients alike, regardless of the degree of their disability. To remedy this situation the War Department in June 1944 broke the classification for mental patients (Class I) into three parts-Class I A, Class I B, and Class I C-to conform with the three groupings just stated.3 The Chief of Transportation then ordered hospital ship commanders and transport surgeons not to place Class I C patients in restrictive quarters but to evacuate them instead in accommodations used for troop class (Class IV) patients.4

To furnish ports in the United States with information about the number of patients of each type to be returned to the zone of interior, SOS headquarters in September 1942 devised a system of reports of "essential information concerning evacuation of sick and wounded from overseas." Offices of both The Surgeon General and the Chief of Transportation concurred in its establishment. Each overseas commander was required to report monthly to the port commander serving his area the following information: (1) the total number of patients awaiting evacuation, (2) the number in each of the four classes listed above who were awaiting evacuation at each port within the theater, and (3) the number in each class who were expected to require evacuation at the beginning of the following month. Upon embarkation of patients for the United States, each theater commander was required to report by air mail to port commanders in the United States the name of the ship upon which patients embarked, the number of patients of each class aboard the ship, and the expected date and port of arrival in the United States. Receipt of such information would supply a basis for the Transportation Corps to use in providing transportation and for the Medical Department to use in assuring the availability of sufficient numbers of vacant beds for patients being evacuated.5

Early in 1943 this system was slightly modified. In some instances embarkation reports failed to reach ports in the United States before the arrival of ships carrying patients. In others, theaters failed to submit such reports. In still others, they submitted incorrect reports. For example, on 9 December 1942, 788 patients arrived from the European theater at the port of Halifax in Canada. Although the theater had reported them all as ambulatory, it was discovered upon arrival that seven were litter and 104 mental patients who required attendants. Because of the erroneous report, insufficient medical personnel had been sent to Halifax to care for the patients received and their debarka-

3Ltr AG 704.11 (3 Jun 44) OB-S-E-SPMOT-M, TAG to CGs AAF, AGF, ASF, Base Comds, and TofOpns, 8 Jun 44, sub: Procedure for Evac of Pnts by Water or Air from Overseas Comds. SG: 705.-1.
4(1) Ltr, Hq ComZ ETO to CofT, 10 Jul 44, sub: Accommodations for Class I A Pnts on Trp Trans. TC: 569.6. (2) Telg, CofT (Mvmt Div) to CPE, 28 Jul 44. SG: 560.2. (3) Telg, CofT (Mvmt Div) to CGs PEs, 2 Sep 44. SG: 705. (4) Ltr, CofT (Mvmt Div) to PEs, 21 Sep 44, sub: Sea Evac of Mental Pnts. SG: 560.2.
5(1) Memo, CG SOS for ACofS OPD WDGS, 3 Sep 42, sub: Essential Inf Conc Evac of Sick and Wounded from Overseas. OPD: 370.05. (2) Ltr AG 370.05 (9-15-42) MS-SPOPH-M, TAG to CGs Def Comds, TofOpns, and Base Comds, 16 Sep 42, same sub. SG: 705.-1.


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tion was delayed.6 To prevent similar occurrences, as well as the arrival of patients without prior arrangements for their reception, theaters were directed in January 1943 to exercise more care in making reports of embarkation and to transmit them by radio rather than by air mail.7

Another modification in the reporting system occurred as a result of increasing participation during 1942 of agencies other than the Army Transportation Corps in the evacuation of patients. Some were returned on British ships; others, by the Air Transport Command and the U. S. Navy. For example, by the end of 1942 most patients evacuated from the South Pacific area were returned by the Navy; and from Central Africa, by the Air Transport Command. Commanders of those areas considered it unnecessary to submit reports of patients awaiting evacuation, since they did not normally use Army ships. While failure to receive such reports did not interfere with the Chief of Transportation's efforts to supply sufficient transport lift for patients awaiting evacuation by sea, it did hamper planning for the reception of patients in the United States and for their further transportation, usually by rail, to hospitals of definitive treatment. Therefore, on 13 January 1943 the War Department directed theater commanders to report monthly, in addition to information already required, the number of patients awaiting evacuation by air, by Navy ships, and by any other means, as well as the number in each category who were expected to need evacuation at the end of the following 30 days.8

Further changes were made later in the war. Toward the end of 1944 the return of able-bodied men and officers on "rotation" complicated the problem of evaluating the adequacy of patient lift because such persons sometimes took up space on transports which the Medical Regulating Unit had considered available for patients. In August 1944, therefore, the War Department directed theater commanders to add to reports of patients all other military personnel awaiting transportation to the zone of interior.9 Early in 1945, as the patient load mounted toward its peak, the Surgeon General's Resources Analysis Division requested additional information for planning purposes. As a result, the War Department directed theaters in March 1945 to report not only the patients awaiting evacuation and those expected to need evacuation at the end of the following month but also those that were expected to need evacuation at the end of the second and third months after the date of the report.10

To assure proper use of the information submitted by theaters, the SOS Hospitalization and Evacuation Branch prepared a directive in October 1942 for the Chief

6(1) Memo, Lt Col J. C. Fitzpatrick for Chief Hosp and Evac Br Plans Div Oprs SOS, 21 Dec 42, sub: Rpt on Temp Duty, Hq 2d SvC and Hq NYPE. HD: 705 (MRO, Fitzpatrick Daybook, Aug 42-Jun 43). (2) Memo, CG SOS for CofT, 3 Jan 43, sub: Reception of Pnts Evac by Sea from Overseas Comds. Same file.
7(1) Memo, CG SOS for TAG, 2 Jan 43, sub: Compliance with Directive. AG: 704 (1-2-43). (2) Rad CM-OUT- 1128, AGWAR to ETOUSA, 3 Jan 43, HD: Wilson files, "Book III, 1 Jan 43-15 Mar 43."
8Ltr, TAG to CGs Def Comds, Depts, and Base Comds, 13 Jan 43, sub: Essential Info Conc Evac of Sick and Wounded from Overseas. AG: 370.05.
9OCM form, with message prepared by OCT for dispatch to CGs Def Comds, TofOpns, and PEs, 30 Aug 44, and with Memo for Record. TC: 370.05.
10(1) Memos, SG (Resources Anal Div) for ASF (Plans and Oprs), 21 and 27 Feb 45, sub: Rpt for Overseas Theaters. SG: 705. (2) Rad CM-OUT-55158, WD to all Overseas Comds, 17 Mar 45. TC: 370.05 (Monthly Rpt of Reqmts).


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of Transportation to issue to port commanders.11 It required them to transmit information received from theaters to the Office of the Chief of Transportation, to other interested port commanders, and to the commanding generals of service commands in which ports were located. Also, port commanders were to compare the number and types of patients to be evacuated during the following month with accommodations aboard transports scheduled to call at theater ports. If it appeared that there would be insufficient "lift"- that is, too few ships returning from theaters or unsuitable accommodations on available ships for different classes of patients-port commanders were to report this fact to the Chief of Transportation in order that additional lift might be provided. Finally, port commanders were to use information received in embarkation reports to plan transportation from ports in the United States to hospitals of definitive treatment.12

In the final months of 1942 transports arriving at overseas ports sometimes found more patients ready for evacuation than theaters had reported and hence had insufficient accommodations for all of them. This situation resulted from the temporary and sudden accumulation of patients, particularly of Class I (mental), after reports had been sent in, and from the preemption of all space on a transport by its first port of call to the detriment of ports of later call. Measures were taken to avoid such occurrences. Port commanders were required to submit their comparisons of evacuation requirements with scheduled sailings of transports to the Office of the Chief of Transportation for review. When that Office found that accommodations on transports scheduled for return trips from theaters were insufficient for patients needing to be evacuated, it directed port commanders to determine through direct communication with theater commanders what additional evacuation space was really necessary. The Chief of Transportation was then responsible for complying insofar as possible with desires of the theater commander. In addition, when transports sailed for a theater with several ports of call, port commanders in the United States were required to inform theater commanders of their capacities and theater commanders in turn were required to suballocate reported space among the several ports under their jurisdiction.13

Later in the war, the Medical Regulating Unit used information submitted in reports of patients being embarked and awaiting evacuation to plan the most effective use of all available evacuation facilities. Its Water Evacuation Section maintained at all times current records of patients needing transportation from different ports in the several theaters. Comparisons of such records with space for patients aboard scheduled transports revealed whether or not anticipated lift for a particular port or theater would be adequate. If not, the Medical Regulating Officer recommended steps to supply the required lift such as changes in the schedules of transports, increases in the number

11Memo, CG SOS (Hosp and Evac Br) for CofT, 10 Oct 42, sub: Sea and Port Evac Oprs. SG: 705.-1.
12Ltr SPTSM 370.05, CofT (Mvt Div) to CGs PEs, 23 Oct 42, sub: Sea and Port Evac Oprs, with incl. SG: 704.-1.
13(1) Ltr, Surg NOPE to CG SOS (Plans Div), 10 Feb 43, sub: Overseas Evac Plan Ships' Hosp Space Almt, with 5 inds. HD: 705 (MRO, Fitzpatrick Daybook, Aug 42-Jun 43). (2) Memo, Chief Hosp and Evac Sec Plans Div ASF for Col [Frank A.] Heileman, 22 Apr 43, sub: Sea Evac Oprs. HD: Wilson files, "Day File." (3) Memos, ACofS for Oprs ASF for SG and CofT, 9 May 43, sub: Hosp and Evac Oprs. Same file.


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of patients to be evacuated by air, or the redeployment of hospital ships.14

While directives issued during 1942 charged the Chief of Transportation and port commanders under his control with evacuation from theaters of operations, they contained no demarcation of areas of responsibility of overseas commanders and the Chief of Transportation for transfer of patients from control of the former to the latter. To insure co-ordination between a theater and the zone of interior, such demarcation was necessary. Hence, early in 1943 the SOS Hospitalization and Evacuation Branch prepared a directive on "sea evacuation operations" which the War Department issued on 25 January 1943.15 This directive detailed specifically for the first time the respective responsibilities of the Chief of Transportation, port commanders, and theater commanders.

The Chief of Transportation was charged with the care, treatment, and safety of patients after their ships had left overseas ports. Up to that point theater commanders were responsible. These commanders were charged with selecting patients to be evacuated, with concentrating them at or near ports of embarkation, and, in co-ordination with overseas port officials, with placing them on ships bound for the United States. They were responsible for insuring that patients were not placed on ships lacking suitable accommodations. For example, a theater commander was not to permit mental (Class I) patients to be embarked in excess of a ship's capacity for patients of that type. Furthermore, he was to prevent the loading of ships with more patients than could be "reasonably expected to be evacuated to lifeboats should it become necessary to abandon ship." This left the decision as to suitability of accommodations up to theaters. Eventually, though, they were forced to substitute the War Department's opinion of suitable accommodations for their own. As transportation and medical officials of ports in the zone of interior completed surveys of transports during 1944, theaters were expected to use officially announced capacities for patients of all classes.16

Theater commanders were also responsible for providing adequate medical personnel for patients embarked and for furnishing any additional medical supplies requested by transport surgeons. Personnel whom they placed on ships normally belonged to the Chief of Transportation and were supplied to theaters on an "attached" basis. Medical hospital ship platoons of various sizes were attached to United States ports by the Chief of Transportation. Port commanders then ordered them to temporary duty in theaters of operations. Only when such platoons were not available were theater commanders required to supply medical troops of their own. As with personnel, theater commanders were expected to furnish additional medical supplies to transports only in unusual or emergency circumstances. Normally port commanders in the United States placed aboard each transport enough medical supplies to care for all troops on its outbound voyage and for patients, on the inbound voyage,

14Examples of the records kept may be found in "Estimate of Evac Reqmts [Weekly]," Books 1 thru 8, 31 Jan 44-27 May 46, and "Evac Reqmts-Monthly Rpt," Books 1 and 2, Nov 43-May 46. SG: 705. Also see Study of Pnts Evac. HD: 705 (Evac).
15Ltr AG 370.05 (1-19-43) OB-S-SPOPH-M, TAG to CGs Theaters, Depts, Base Comds and Task Forces, and COs Base Comds and Task Forces, 25 Jan 43, sub: Sea Evac Oprs. AG: 704 (1-19-43). 
16
See above, p. 327.


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equal in number to one fourth of the transport's troop capacity.

Theater commanders were given additional responsibilities in connection with sea evacuation operations in the latter part of the war. To reduce the medical personnel who would be needed for assignment to regularly organized medical hospital ship platoons, they were required after 8 June 1944 to form Medical Department officers, nurses, and enlisted men being returned to the United States on "rotation," into provisional medical hospital ship platoons. Regularly organized platoons were saved for use only when provisional platoons could not be formed. In the same month, theater commanders were directed to furnish transport surgeons and hospital ship commanders not only with evacuation orders but also with lists of patients showing diagnosis, transportation classification, and type of accommodation needed for each. Similar lists had formerly been prepared by transport surgeons and hospital ship commanders for submission to zone of interior port officials for use in debarkation activities. Now, their preparation by theaters saved time for medical officers aboard ships and assisted them in placing patients in suitable accommodations. Theater officials were expected, in addition, to assemble complete sets of records for each patient and to deliver them, along with patients' baggage and valuables, to ships upon which patients were embarked. When records were missing, theater commanders either had new ones prepared or submitted to ships' officers certified statements of those missing and of the reasons for their absence.17 Near the end of the war an additional duty was placed on theater personnel. Up to that time debarkation tags containing information similar to that found on embarkation lists were prepared and attached to patients aboard ship.18 In July 1945 a War Department circular required theater hospitals to prepare and attach identification tags to each patient before his embarkation. These tags were made of four perforated sections. The first three could be detached to serve theater ports, ships, and United States ports as records of patients handled. The last section, containing information about a patient's diagnosis, could be used by debarkation hospitals in assigning patients to wards.19

The directives just discussed served as a basis for co-ordination of activities of theaters and the zone of interior in the evacuation of patients by sea. A further step-the co-ordination of activities of transport surgeons with those of the ports of debarkation in the United States-was taken in 1943. In the spring the New York Port issued instructions for transport surgeons. In addition to describing the manifold duties and responsibilities of transport surgeons for sanitation aboard transports, for the care of outbound troops, and for the care and treatment of inbound patients, these instructions covered the duties of transport surgeons in the transfer of patients from ships to ports. Upon arrival at a zone of interior port, each transport surgeon was required to submit to a port surgeon's representative a list of all Army patients, showing for each a

17(1) Ltr AG 704.11 (3 Jun 44) OB-S-E-SPMOT-M, TAG to CGs AAF, AGF, ASF, Base Comds, and TofOpns, 8 Jun 44, sub: Procedure for Evac of Pnts by Water or Air from Overseas Comds. SG: 705.-1. (2) Ltr, CofT to CG NATOUSA, 13 Nov 43, sub: Embarkation of pnts. HD: 705 (MRO, Fitzpatrick Stayback, 493). (3) Ltr, Stark Gen Hosp to CG CPE, 10 Jan 44, sub: Pnt Lists for Hosp Ships, with 4 inds. SG: 705.-1. (BB).
18TC Cir 50-31, 30 May 44, sub: Use of Debarkation Tag (Manual for Trans Surg); (Revised 17 Jul 44). TC: 710.
19WD Cir 218, 20 Jul 45.


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brief diagnosis, a classification (neuropsychiatric, medical, or surgical), and whether litter or ambulatory, along with records accompanying each patient. Each transport surgeon was required to submit a list of the baggage of patients and a list of patients' money and valuables in the surgeon's possession. Finally, he was to complete all entries on a debarkation tag for each patient and was to insure the attachment of such tags to the clothing of all except those who were neuropsychiatric. Tags for the latter were to be delivered to debarkation officers. These actions were designed to assist ports in planning the transfer of patients to general hospitals and to assist these hospitals in assigning them to proper wards.20

As experience accumulated and the evacuation load grew heavier, the Transportation Corps, assisted by the Medical Regulating Officer, supplied transport surgeons and hospital ship commanders with more specific instructions than formerly. Toward the end of 1943 the guide for transport surgeons which the New York Port had issued earlier was sent to other ports for transmission to the surgeons of transports which called at them.21 About the same time, general regulations covering the sailing of hospital ships were published. Later, as the number of hospital ships in service increased, the Charleston Port, which had been designated as the home port for Army hospital ships serving the European and Mediterranean theaters, issued a sixty-one page manual of instructions for their commanders. It covered such subjects as reports and records, procedures in case of death, regulations for sanitation and hygiene, quarantine procedures, suggestions for the care of patients at sea, supplies and equipment, and the like.22 Instructions issued to transport surgeons and hospital ship commanders also included procedures to be followed in preparing for debarkations at ports in the United States, but gradually many of their duties in this connection were transferred, as already described, to theater officials. As that happened medical officers on ships became responsible for checking for accuracy and completeness the embarkation lists and identification tags prepared in theaters.

Procedures for Air Evacuation

Though few patients were transported by air from theaters to the United States in the first year and a half of the war, such demands for air evacuation as were made resulted in the establishment during 1942 of a basic system of air evacuation.

Earliest requests for the evacuation of patients by air from outlying areas came particularly from the Alaska Defense Command. Before the war that Command had asked for airplane-ambulance service to the United States; in the first half of 1942 it renewed its requests, pointing out then and later that evacuation by sea was uncertain, delaying the movement of patients in some cases from two to four weeks and subject at all times to interruption by enemy activities.23 To the demands of Alaska were added in July

20(1) Instructions for Transport Surgeons, Off Port Surg, NYPE, 26 May 43. HD: 560 (NYPE), (2) ARs 55-350, 14 Sep 42; 55-415, 11 Dec 42.
21Ltr, CofT (Mvmt Div) to CGs PEs, 9 Dec 43, sub: Guide for Trans Surgs. HD: 705 (MRO, Fitzpatrick Stayback, 583).
22(1) AR 55-530, 30 Dec 43. (2) CPE, Instructions (Med) to Hosp Ship Comdrs, 30 Aug 44. HD: 560 (CPE). (3) TCP 16, 4 Apr 45, US Army Hosp Ship Guide. HD: 560.
23(1) Gordon H. McNeil, History of the Medical Department in Alaska in World War II (1946), pp. 167-192. HD. (2) Ltrs, CG Alaska Def Comd to CG Western Def Comd and Fourth Army, 14 Jul and 6 Oct 42, sub: Aircraft Amb for Alaska. AG: 452. The 14 July 1942 letter cites earlier letters on the same subject dated 10 November 1941 and 6 April 1942.


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1942 a request of the Newfoundland Base Command for air evacuation to New York. The Surgeon General's Office and SOS headquarters approved this request and passed it on to the Army Air Forces, which in June had been charged with responsibility for the development and operation of air evacuation.24

The Air Surgeon saw in these demands an opportunity to develop an air evacuation system,25 but basic decisions had to be made first as to (1) who within the Army Air Forces would be responsible for planning and operating this system, (2) whether or not special airplane ambulances would be provided, and (3) the extent to which air evacuation would be encouraged or permitted. On 25 August 1942 the Air Surgeon foreshadowed the answer to the second question when he stated that "airplanes have not been produced in sufficient quantity to allot planes solely for ambulance use. . . ."26 On the same day he recommended that the Air Transport Command be charged with planning, developing, and operating a system of air evacuation from outlying bases to the United States.27

Three days later the Air Staff announced its decisions. Special planes would not be provided for the evacuation of patients from overseas bases and theaters; but air evacuation would be carried out in connection with the routine operation of air transports. Since the Air Transport Command operated such transports, it would operate the air evacuation system. The Air Surgeon-not the Air Transport Command-would be responsible for planning and establishing policies for this system.28 To discharge this responsibility, the Air Surgeon expanded his Office, assigning to it in September and October two officers-Maj. (later Col.) Richard L. Meiling and Col. Wood S. Woolford-who had already demonstrated an interest in air evacuation.29

Meanwhile the Air Surgeon had drafted a policy governing the extent of air evacuation. After approval by the Air and General Staffs it was announced to theaters by the Chief of Staff of the Army on 25 September 1942. Air evacuation would be accomplished "upon call" on the Air Transport Command, but such calls would be kept "to [a] minimum." Theater commanders would classify patients for air evacuation according to the following order of precedence: first, emergency cases for whom essential medical treatment was not available locally; second, cases for whom air evacuation was a "military necessity"; and third, cases-except psychotics-who required prolonged hospitalization and rehabilitation.30

24(1) Ltr, CG Eastern Def Comd and First Army to CG AAF, 31 Jul 42, sub: Air Amb Evac of Pnts from Newfoundland Base Comd, with 3 inds. SG: 705.-1 (Newfoundland)F.
25The chief of the SOS Hospitalization and Evacuation Branch gained this impression after conferring with representatives of the Air Surgeon. Diary, Hosp and Evac Br SOS, 12 Nov 42. HD: Wilson files, "Diary."
264th ind, CG AAF (Air Surg) to SG, 25 Aug 42, on Ltr, CG Eastern Def Comd and First Army to CG AAF, 31 Jul 42, sub: Air Amb Evac of Pnts from Newfoundland Base Comd. SG: 705.-1 (Newfoundland)F.
27Ltr, Air Surg to ACofAir Staff A-4, 25 Aug 42, sub: Evac of Casualties by Air. AAF: 370.05.
28(1) Memo, CG AAF (ACofAir Staff A-4) for CG ATC, 28 Aug 42, sub: Evac of Casualties by Air. (2) 1st ind, Same to Air Surg, 28 Aug 42, on Ltr Air Surg to ACofAir Staff A-4, 25 Aug 42, same sub. Both in AAF: 370.05.
29(1) An Rpt, FY 1943, Oprs Div ASO. USAF: SGO Hist Br. (2) Medical History, I Troop Carrier Command From 30 April 1942 to 31 December 1944, pp. 49-50. Same file. (3) Ltr, Dr. Richard L. Meiling to Col Calvin H. Goddard, 30 Jun 52. HD: 314 (Correspondence on MS) XI.
30(1) Rad CM-OUT-8628 thru 8637, Marshall to CGs Bases, Def Comds, and Theaters, 25 Sep 42. OPD: 704.1. These messages were all identical. (2) Memo, Lt Col Milton W. Arnold, AC, for Lt Col M. T. Stallter, 9 Sep 42, sub: Evac of Casualties by Air. AG: 580.-1.


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After basic decisions were made about air evacuation from theaters, representatives of the Air Surgeon's Office, the SOS Hospitalization and Evacuation Branch, and the Air Transport Command collaborated in establishing operational procedures and delineating responsibilities of various participating commands. Whereas the Air Transport Command was responsible for equipment attached to planes, such as litter brackets, the Medical Department was to furnish all medical supplies and equipment used in the care of patients en route. Supplies such as litters and blankets were to be furnished by theaters, but were to be returned by the Services of Supply after patients arrived in the United States. Medical air evacuation transport squadrons, consisting of nurses and enlisted technicians, were to be assigned to the Air Transport Command to furnish attendants for patients aboard transport planes. Theater commanders were to transfer patients to points along regular ATC routes. They were also to co-ordinate plans for air evacuation to the United States with the commanders of ATC wings serving their respective areas, reporting to the latter daily the location and number of litter, hospital ambulant, and troop class patients who should be picked up. Flight surgeons alone would determine the suitability for flight of patients selected by theater commanders. Finally, the Air Transport Command would be responsible for the care and treatment of patients from the time it accepted them in theaters until it delivered them to SOS or AAF control in the United States.31

Although ATC medical officers alone could determine the final suitability of patients for flight, after the first half of 1944 theater medical authorities were responsible for establishing the general groups of patients to be transported by air. They agreed that litter patients should take precedence over the less serious cases. The chief surgeons of both the European and Mediterranean theaters considered patients requiring neurosurgery, maxillofacial surgery, and plastic surgery, as well as those who were blind, to be among those who should have priorities in air evacuation. Both believed that serious mental disturbances were a contraindication to transportation by air.32 On the other hand, in the fall of 1944 the Southwest Pacific theater included mental patients among the groups to be evacuated by air as a regular procedure. Success in this practice resulted in the preparation in August 1945 of a standing operating procedure for the air evacuation of psychiatric patients.33

Early in 1943 the Air Priorities Division of the Air Transport Command determined the priority of patients designated for air transportation as against priorities already established for passengers and

31(1) Rpt, Mins of Mtg, ATC, 13 Oct 43, Air Evac of Wounded. AAF: 370.05. (2) Memo, CG SOS for CG AAF, 9 Nov 42, sub: Evac Oprs. AG: 704 (17 Jun 42)(1). (3) Memo, CG SOS for CG AAF, 12 Nov 42, sub: Status of Hosp Cons and Evac Fac for Alaska Sta. AG: 632. (4) 2d ind, CofSA to CG Alaska Def Comd, 21 Nov 42, on unknown basic Ltr. AG: 632. (5) Ltr, CG AAF to Surg 11th AF, 13 Dec 42, sub: Recommended Plan of Air Evac. AAF: 370.05. (6) Diary, SOS Hosp and Evac Br, 17 Dec 42. HD: Wilson files, "Diary."
32(1) Logistical History of NATOUSA-MTOUSA, 30 November 1945 (Naples, Italy, 1945), pp. 328-29, HD: MTO, 314. (2) Off Chief Surg Hq ETO, Admin Memo 147, 2 Nov 44; Admin Memo 16, 23 Mar 45, and other correspondence dealing with selection of patients for air evacuation. HD: ETO, 370.05 (Evac Br Corresp 1944-45).
33History of the Medical Department, Air Transport Command, 1 January 1945-31 March 1946. HD: TAS. For a discussion of medical considerations involved in air evacuation, see Sidney Leibowitz, "Air Evacuation of Sick and Wounded," The Military Surgeon, vol. 99, No. 1 (July 1946), pp. 7-10.


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cargo in general. Three degrees of precedence for the latter two were announced in January. Persons whose movement was required by an emergency so acute that any delay would seriously and directly impair the war effort were given a Class 1 priority. Passengers and cargo whose transportation by air was absolutely necessary for the accomplishment of a mission essential to the prosecution of the war were given a Class 2 priority. Class 3 priorities were given to passengers and cargo whose transportation by air was vital to the war effort but not of an extremely urgent nature.34 In February 1943 ATC headquarters announced that patients would normally have Class 3 priorities but could not be displaced, or "bounced," once they were en route, except at the discretion of ATC flight surgeons at stopover points. In effect, this gave patients a Class 3 priority for loading but a Class 1 priority for the duration of flight. In emergencies, ATC announced, patients might be given initially the highest priority at a theater commander's disposal. Medical attendants were to travel under the same priorities as patients during flights to the United States; to insure their prompt return to theaters which supplied them, they were then to be given a Class 2 priority.35

An important change in the system of determining priorities was made in 1944. Beginning in April the Air Transport Command allocated transport space on a tonnage basis to each theater commander, and theater priorities boards then determined the amount of space that would be set aside for patients, for other personnel, and for cargo.36 Among the obvious advantages of this system was the increased certainty with which both theater surgeons and Medical Regulating Officers in the United States could plan air evacuation.

The use of air evacuation necessitated a system by which airports in the United States and air bases along Air Transport Command routes could be informed of the arrival of patients by plane. In October 1943 the Air Transport Command issued a regulation making ATC officers responsible for the necessary reports. It required a base embarking patients for another to inform it by the fastest means of communication available. It also required the pilot of a plane carrying patients to report his cargo to the operations officer of the next stopping point thirty minutes before arrival. After planes landed in the United States, ports of aerial debarkation-using a code devised by the ASF Medical Regulating Unit-reported patients received to the Air Forces Regulating Officer.37

Procedures for Debarkation

Patients transported from theaters to the zone of interior by the Transportation Corps and the Air Transport Command had to be transferred soon after arrival to service commands for definitive treatment. It was necessary, therefore, to determine the point where responsibility for their transportation and care devolved upon service commands, and to establish procedures for their debarkation, their movement from ships and planes to near-by

34Air Priorities Div, ATC, Directive No 5, Priorities for Air Trans, 9 Jan 43. AAF: 580 "Air Trans."
35(1) Ltr AFATC 580.1, CG ATC to CGs Overseas Comds, Wing Comdrs, 26 Feb 43, sub: Air Priorities Instruction No 4. AAF: 370.05. (2) WD Memo 95-6-43, 26 Feb 43. AG: 580.81 (1-10-43).
36(1) WD Cir 130, 4 Apr 44. (2) AAF Reg 25-6, 29 Apr 44.
37(1) ATC Reg 25-6, 15 Oct 43. (2) AAF Ltr, 4 Oct 44, sub: Rpt of Pnts for Trf. (3) Comments by Brig Gen Richard L. Meiling USAF, 30 Jun 52. HD: 314 (Correspondence on MS) XI.


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hospitals, and their reception and preparation for further transportation to hospitals of definitive treatment. Problems in this connection were not as great for air bases as for port commands because patients arrived by plane in smaller groups and fewer numbers than by ship.

In the early period of the war ports of embarkation were responsible for sending patients who arrived from theaters to general hospitals for further treatment.38 This responsibility conflicted with a basic principle of Army evacuation, namely, that support was always from rear to front. According to it, responsibilities of ports for the movement of patients should have ended at their normal rear boundaries. Failure to observe this principle is perhaps accounted for by the lingering influence of peacetime practices. In peacetime the most common movement of patients in the United States was from station to general hospitals and in such instances station commanders were responsible for issuing orders and arranging transportation. So long as the number of evacuees arriving at ports was small, it was perhaps logical that port commanders should perform this service for them as well as for patients from port complements.

The practice of considering commanders of ports of embarkation responsible for transferring evacuees to general hospitals had to be partially modified after patients began to return to the United States by air. Under current regulations theater commanders issued orders directing them to report to commanders of seaports responsible for the supply and evacuation of respective theaters. As a result patients who traveled by air from the Caribbean, for example, landed in Florida with orders to report to the commander of the New Orleans Port of Embarkation. In such instances they had to be sent by rail from Miami to New Orleans for subsequent transfer to a general hospital, rather than directly to the general hospital which was nearest Miami (Lawson General Hospital, Atlanta, Ga.). This not only caused inconvenience to patients and delayed their treatment, but also added unnecessary burdens to transportation facilities that were already overtaxed. In February 1943 SOS Headquarters referred this problem to the Air Surgeon's Office. On the recommendation of the latter the War Department in May directed overseas commanders not to designate, in orders transferring patients to the United States, specific commanders to whom they were to report. At the same time air bases in the United States were granted authority to issue orders transferring patients to general hospitals for definitive treatment.39

Unlike port commanders, commanders of air bases serving as debarkation points operated debarkation hospitals or at least used station hospitals located on such bases for debarkation processing of patients. They were responsible for removing patients from airplanes and transporting them and their baggage to such hospitals. To discharge this responsibility they were required by ATC regulations to supply a team of at least one medical officer and four enlisted men to meet each plane bringing in patients. They did not assume the additional responsibility and authority of arranging for the transportation of patients from air debarkation hospitals to

38(1) AR 40-1025, 12 Oct 40; C 1, 21 Aug 42; C 4, 5 Jul 43. (2) WD Cir 64, 1 Jun 42. (3) WD Cir 316, 6 Dec 43.
39(1) Ltr, CG Trinidad Sector and Base Comd to CG NOPE, 27 Jan 43, sub: Designation of Specific Hosp in Evac Orders with 5 inds. AAF: 370.05 (Evac). (2) WD Cirs 119, 11 May 43, and 137, 16 Jun 43.


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general hospitals. Instead they normally called upon service commands to perform this function, but in extreme emergencies might arrange locally, or apply to the Air Surgeon, for air transport.40

Early in the war commanders of ports of embarkation were responsible for removing patients from ships and also for transporting them to debarkation hospitals operated by service commands. By the middle of 1943 several developed "SOP" (Standing Operating Procedures) for this operation. The SOP for the New York Port, for example, explained procedures for the transfer of patients from transports to near-by hospitals. Upon arrival of a ship, a party from the port went aboard to verify the reported number and classification of patients and to receive from the transport surgeon his list of patients classified according to diagnosis (medical, surgical, or neuropsychiatric). This list was sent immediately to Halloran General Hospital, so that room in appropriate wards could be prepared. Ambulatory patients, the first to be debarked, were dispatched to Halloran in commercial buses in groups of ten, with two enlisted men as medical attendants for each group. Litter patients were placed in ambulances, each carrying four patients and one attendant. Finally, mental patients were consigned to ambulances, with necessary attendants. After patients were removed from a ship, their valuables were turned over to the boarding officer for transmission to the receiving hospital. Baggage of small groups was sent by the port direct to the hospital, while that of large groups was handled by the baggagemaster's section of the Army Transport Service or, later, the port's water division. Patients' records were put in proper order and transmitted to Halloran General Hospital. The port surgeon's office then sent reports of debarkation to the Chief of Transportation, The Surgeon General, the commander of the New York Port of Embarkation, and the surgeon of the Second Service Command.41

For debarking patients from ships and transporting them to general hospitals port commanders normally used personnel and vehicles belonging to installations under their control. For example, the Charleston Port trained as litter bearers enlisted men belonging to its own medical detachment and to port and service battalions in training or on duty in the area. It also used its own ambulances, trucks, and passenger cars to carry patients to Stark General Hospital, which was located near by.42 This procedure sufficed when the number of patients received was small. When large-scale operations were expected, other arrangements had to be made. In the fall of 1942, for instance, to assist in the reception of casualties from the North African invasion the New York Port called upon the Second Service Command for both personnel and vehicles and used, in addition, an ambulance section of a Ground Forces medical regiment.43 In

40(1) Memo, Air Surg for ACofAir Staff A-4, 24 Feb 43, sub: Air Evac Casualties, with draft of directive to all air commands in the United States. AAF: 370.05. (2) ATC Reg 25-6, 15 Oct 43 and 29 Apr 44; AAF Reg 25-17, 6 June 44; AAF Ltr 25-10, 11 Jul 44 and 9 Dec 44.
41Ltr, Surgs Br NYPE to Port Surg NYPE, 12 Jul 43, sub: SOP of Trans and Evac Off, with inds. HD: 370.05.
42(1) Ltr, Surg CPE to CofT, 19 Nov 42, sub: Overseas Evac Plans. SG: 705.-1. (2) An Rpt, 1943, Med Dept CPE. HD.
43(1) Mins, Conf on Evac of Mil Pers, 26 Oct 42. TC: 370.05. (2) Ltr, Surg NYPE to Col H. D. Offutt, SGO, 12 Nov 42, with incls. SG: 705 (NYPE). (3) Memo for Record, on 1st ind SPOPH 370.05 (11-24-42) Hosp and Evac Br SOS to CofT, 26 Nov 42, on unknown basic Ltr. HD: 705 (MRO, Fitzpatrick Daybook, Aug 42-Jun 43).


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such instances ports actually controlled the movement to hospitals of only small numbers of patients, while they continued to be responsible for the larger groups moved in service command vehicles by service command personnel.

Early in 1944 this procedure was changed. To provide a clear-cut line of demarcation between responsibilities of ports and service commands and to simplify operations by having only one agency furnish vehicles and personnel for transportation from ports to hospitals, the Second Service Command proposed, and the commanding general of the Service Forces approved, a change in the transfer point.44 After 11 April 1944 it was normally at shipside rather than in trains or hospitals.45 In the case of New York this proved advantageous. The Second Service Command controlled a number of nearby medical installations upon which it could call for ambulances and personnel to move large shipments of patients to Halloran and Mason General Hospitals. In other instances this change introduced the very situation it was designed to correct. The Ninth Service Command, for example, had to call upon the San Francisco Port for twenty buses each capable of carrying thirty-seven ambulatory patients to assist in transporting patients from docks to the Letterman General Hospital. In any event the removal of patients from ships to debarkation hospitals required close co-operation between port and service command officials.46

For the transportation of patients from docks to hospitals, service commands used ambulances, buses, and trains, depending upon the physical condition of patients and the distances to be traveled. The Second Service Command, for example, transferred patients from piers located in Brooklyn, Staten Island, New Jersey, and the North River to service command debarkation hospitals by ambulance, government bus, commercial bus, and hospital train. During 1944 this Command called upon as many as twenty of its installations to supply vehicles and personnel for such movements. In a single day, it reported, more than 200 ambulances and 55 buses were used to move 3,000 patients received in one convoy. The First Service Command normally used trains to move patients from ships in the Boston harbor to Camp Edwards and Camp Myles Standish hospitals. The Fourth Service Command used motor vehicles almost exclusively to transport patients from the Charleston port to Stark General Hospital. In the Ninth Service Command patients were transported from the San Francisco port to Letterman General Hospital in buses and ambulances, but they were moved from the Seattle port to Madigan General Hospital in small groups by ambulance and in large groups by rail.47

Ports continued to be responsible for debarking patients from ships. Normally they used their own men, including specially trained port and sanitary companies, as litter bearers, but in some instances they

44(1) Rpt, Conf CGs of SvCs, Dallas, Tex, 17-19 Feb 44. HD: 337. (2) Memo, CG ASF (Control Div) for CofSA thru SG and CofT, 26 Feb 44, sub: Control of Med Serv at PE, with 3 inds. SG: 705. (3) Rpt, Conf to Discuss Proposed Changes in AR 170-10 and Cir 316, 6 Mar 44. SG: 337.-1. (4) Memo, Opns Div ASF for Planning Div ASF, 10 Mar 44, sub: Evac of Returning Casualties from Ports. TC: 370.05 (Evac of Pnts).
45ASF Cir 99, see IV, pt 2, 11 Apr 44.
46An Rpts, 1944, Letterman Gen Hosp; NYPE; and 1st, 2d, 4th, and 9th SvCs. HD.
47An Rpts from SvCs, Ports, and Gen Hosp (Halloran, Hammond, LaGarde, Letterman, Lovell, Madigan, McGuire, Stark) and Sta Hosps (Cp Edwards, Cp Myles Standish) for 1944 and 1945 explain debarkation procedures and reception of patients by hospitals. HD.


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still borrowed enlisted men from service command hospitals. To save personnel and speed operations the Boston Port used wheeled litters to move patients on its piers. Ports differed in the order in which they unloaded patients. Some unloaded mental patients first, and then ambulatory patients. Others reversed this order. Usually litter patients were debarked last because such preparations as transferring them to litters could be made while other patients were being debarked. As ports gained experience in operations and improved procedures, the time required to unload ships decreased. For example, the Charleston Port cut the time from five hours at the beginning of 1944 to two hours by the end of 1944 and then to one hour for a 600-patient hospital ship during 1945. The Boston Port reported that on one occasion in 1945 as many as 1,958 patients, among them 287 litter cases, were moved from a transport to near-by trains in two hours and twenty minutes.48

The manner in which general hospitals received evacuees differed from one to another. In May 1943 The Surgeon General directed hospitals receiving large numbers of patients from either ships or trains to admit them directly to wards, without "processing" them through hospital receiving offices. The reason was to avoid delays in giving patients needed food, rest, and treatment. Halloran General Hospital had developed a different system, and on request of the hospital and the Second Service Command, The Surgeon General approved its continued use. There, a receiving ward had been established to care for a large number of patients. It contained a mess hall for the prompt feeding of patients, space for the medical inspection of patients and for the care of those needing immediate medical treatment, bathing facilities, and a clothing room in which patients received fresh hospital clothes and stored their own clothing. There was also space for a battery of typists brought in to complete all of the paper work required for the admission of patients. The average length of time patients stayed in this building, before being admitted to wards, was reported to be 61 minutes.49

With the growth of the evacuee load in 1944 and 1945 debarkation hospitals had to transfer evacuees to other hospitals as rapidly as possible-normally within seventy-two hours-so as to keep enough beds vacant for large groups of new patients arriving in quick succession. With such a short period of time the medical and surgical care afforded evacuees had to be limited. They were given necessary medications and their dressings were changed, while a brief examination served to check the accuracy of the diagnosis carried in medical records and to determine their ability to undertake further travel. Primary emphasis was upon administrative matters. Records required for use in debarkation hospitals had to be prepared; reports of patients received had to be made to Washington; orders for their transfer to other hospitals had to be issued; patients had to be outfitted with complete

48(1) Files SG: 705 (ports or debarkation hospitals) contain correspondence dealing with debarkation difficulties and operational procedures; for example, Memo, CG 4th SvC for CG ASF, 13 Jun 44, sub: Evac of Overseas Casualties at Stark Gen Hosp. SG: 705 (Stark GH). (2) History of Stark General Hospital, Charleston, S. C., 1941-45. HD. (3) An Rpts, Boston, Charleston, Hampton Roads, New Orleans, New York, San Francisco, and Seattle PEs, 1944, 1945. HD.
49Ltr, Halloran Gen Hosp to SG, 19 May 43, sub: Admission of Pnts when Arriving in Convoy. SG: 705.1 (Halloran GH). (2) An Rpt, Halloran Gen Hosp, 1943. HD.


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uniforms and given partial payments;50 and arrangements had to be made for their transportation. The paper work thus required was voluminous. Beginning in the latter part of 1944 attempts were made to simplify it. Concurrently, it will be recalled, the Surgeon General's Office was engaged in a more general project to standardize and simplify administrative procedures in all hospitals. Changes that were made in debarkation procedures were of two types. In June 1944 the Control Divisions of Stark General Hospital and the Fourth Service Command proposed the elimination of records required for patients admitted to hospitals for definitive treatment but not needed for those in transit and the simplification of entries in other records. As a result, evacuees were not admitted to the registers of debarkation hospitals and their names were not entered on admission and disposition sheets. In addition, standard rubber stamp entries were authorized for use in patients' service and field medical records.51 During the winter of 1944-45 another measure toward simplifying the work of debarkation hospitals was adopted: the installation of addressograph equipment. With this equipment hospitals prepared plates for use in making rosters and in issuing orders and thus eliminated the necessity of typing each separately.52 Though seemingly small when considered individually, the significance of such measures can be judged more accurately if the total evacuation load of different hospitals is taken into account. Stark General Hospital, for example, admitted 44,003 patients in the nine-month period from 1 January 1945 to 30 September 1945, while Halloran admitted about 69,500 and Letterman about 73,000 during the entire year.53

50That is, partial payments of the pay and allowances due service men, made by the Army pending full settlement of their accounts.
51(1) Memo, CofT (Mvmt Div by Lt Col J. C. Fitzpatrick) for SG (Hosp Div), 23 May 44. TC: 370.05. (2) Memo, CG 4th SvC for CG ASF (Control Div), 13 Jun 44, sub: Evac of Overseas Casualties at Stark Gen Hosp, with inds. SG: 705 (Stark GH).
52(1) Memo, SG (Control Div) for QMG, 30 Aug 44, sub: Use of Addressograph and Embossing Equip in Debarkation Hosps. SG: 413.51. (2) Ltr, SG to CG 2d SvC, 20 Dec 44, sub: Admitting Off Procedure for Pnts Retd from Overseas. SG: 705 (2d SvC). (3) Memo, Hosp Div SGO for HD SGO, 18 Jun 45, sub: Add Mat for An Rpt for FY 1945. HD: 319.1-2. (4) Memo, NP Cons Div SGO for Hosp Div SGO, 14 May 45, sub: Procedure of Pnts Recd from Overseas thru Stark Gen Hosp. SG: 705 (Stark GH).
53An Rpts, Stark, Halloran, and Letterman Gen Hosps, 1945. HD.

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