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Chapter XXIV

Contents

CHAPTER XXIV

Providing the Means for Evacuation by Air

Experiences of World War II firmly established air transportation as an acceptable if not preferable method of evacuation, not only within theaters but also from overseas areas to the zone of interior and from one point to another within the latter. Because of insatiable demands from all quarters for aircraft, the movement of patients by plane, even more than by surface vessels, had to be fitted in with the transportation of troops and cargo. In theaters this problem was often solved by informal arrangements between local surgeons and air force commanders. In the zone of interior agreement was reached only after a debate over whether special planes would be provided for evacuation alone or whether all transport planes would have a dual purpose-the transportation of troops and cargo in one direction and of patients in the other. The Medical Department wanted special ambulance planes for use in all areas-combat zones, communications zones, and the zone of interior. AAF headquarters, on the other hand, insisted upon maximum use of all planes and therefore adopted a policy of using aircraft with other primary missions for evacuation also. Thereafter, the Medical Department and the Army Air Forces collaborated in arrangements for the adaptation of transport planes to the evacuation mission.

Aircraft

Prewar Plans for Airplane Ambulances

Before the war, plans for the procurement and use of airplane ambulances were nebulous. Perhaps one reason was that there was no tradition of using special planes in wartime for evacuation only. With the development of air transportation during World War I and the years that followed, surgeons of various airfields had experimented with the development and use of small airplane ambulances.1 Repeatedly in the 1930's The Surgeon General had requested the procurement of at least seven airplane ambulances for the movement of patients in the United States during peacetime and for experiments upon which plans for their use in wartime could be based. In each instance, because of difficulty encountered in securing sufficient funds for the procurement of requisite planes for training and for defense of the United States, the General

1David N. W. Grant, "Airplane Ambulance Evacuation," The Military Surgeon, vol. 88, No. 3 (1941), pp. 238-43.


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Staff, on the advice of the Chief of the Air Corps, had disapproved The Surgeon General's requests.2 Instead, a policy established as early as 1931 continued in effect. Special airplane ambulances were not normally provided, but regular transport planes were fitted with litter-holding brackets to enable them to move patients from one hospital to another. In exceptional cases only, training centers were permitted to convert small planes into airplane ambulances for crash-rescue work (that is, the rapid removal of persons from airplane accidents to hospitals of their home stations).3

During 1940 opinion among medical officials as to the need for airplane ambulances in wartime crystallized. Experience of the Germans in air evacuation during the Polish campaign, an account of which appeared in the Army Medical Bulletin,4 perhaps contributed to this development. The chief of the Medical Division of the Office of the Chief of the Air Corps, the surgeon of GHQ Air Force, and The Surgeon General agreed that two types of planes would be needed-small planes for the transportation of one or two casualties from medical stations in divisional areas to hospitals farther in the rear, and large planes for the removal of greater numbers of patients from evacuation hospitals to general hospitals in communications zones or the zone of interior. They agreed also that such planes should be set aside exclusively for air evacuation and should be under the control of theater headquarters.5 The Chief of the Air Corps and the General Staff implied approval of these propositions, and the latter on 5 September 1940 directed the Chief of the Air Corps to maintain plans for converting standard transport airplanes and suitable single-engine airplanes to ambulance use.6

This directive uncovered an important problem. While the procurement of large ambulance planes was expected to be relatively simple, since either civilian or military transports could be readily converted by the installation of litter racks, the procurement of small airplane ambulances promised to be considerably more difficult. In September 1940 the Chief of the Air Corps stated that no small planes suitable for conversion were either available or anticipated for procurement. The General Staff then verbally modified its directive, relieving the Air Corps of responsibility for maintaining plans for the wartime conversion of single-engine airplanes.7 Soon afterward, when the Gulf

2(1) Memo, ACofS G-4 WDGS for CofSA, 8 Jun 32, sub: Aircraft for Amb Serv. HRS: G-4/29413. (2) Ltr, SG to TAG, 7 Nov 33, same sub, with 3 inds. AAF: 452.1 (Amb Planes). (3) Memo, ACofS G-4 WDGS for CofSA, 22 Nov 33, same sub. HRS: G-4/29413. (4) Ltr, SG to TAG, 5 Sep 34, same sub, with 3 inds. AAF: 452.1 (Amb Planes). (5) Memo, ACofS G-4 WDGS for CofSA, 17 Sep 34, same sub. HRS: G-4/29413.
3(1) 2d ind, CofAC to Chief Mat Div AC Wright Fld, 5 Dec 31, on Ltr, Maj Robert [E. M.] Goolrick, AC to CofAC thru Chief Mat Div Wright Fld, 23 Oct 31, sub: Amb Airplanes. AAF: 452.1 (Amb Planes). (2) Memo, Chief Med Sec OCofAC for SG, 25 Jan 38. SG: 451.8-1.
4(1) Ltr, SG to CofAC, 5 Apr 40, sub: Airplane Casualty Evac in the German-Polish War. SG: 580.1. (2) Army Medical Bulletin, No.53 (July 1940), pp. 1-10.
5(1) Ltr, Surg GHQ AF to Chief Med Div OCofAC, 20 Jun 40. SG: 320.3-1. (2) Memo, Chief Med Div OCofAC for SG, 21 Jun 40. Same file. (3) Ltr, SG to TAG, 11 Jul 40, sub: Air Corps Med Trans Group. AG: 320.2 Med (7-11-40).
6(1) 2d ind, CofAC to TAG, 24 Jul 40, on Ltr, SG to TAG, 11 Jul 40, sub: Air Corps Med Trans Group. (2) Memo, ACofS G-3 WDGS for CofSA, 7 Aug 40, sub: Air Amb Serv. (3) Memo, TAG to CofAC, 5 Sep 40, same sub. All in AG: 320.2 Med (7-11-40).
7(1) R&R Sheet Comment 1, Exec OCofAC to Tng and Oprs, Plans and Mat Divs OCofAC, in turn, 9 Sep 40, sub: Air Amb Serv. AAF: 452.1-B (Amb Planes). (2) R&R Sheet Comment 3, Plans Div OCofAC to Mat Div OCofAC thru Exec, 17 Sep 40, same sub. Same file.


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Coast Air Corps Training Center requested procurement of single-engine airplane ambulances for peacetime crash-rescue work, the Chief of the Air Corps disapproved the purchase of airplanes exclusively for ambulance service, but stated, strangely enough, that small planes already in service might be converted into ambulances.8 A subsequent investigation confirmed his earlier opinion that light planes in service were not suitable for conversion. Some were too old; others were too small; and still others had openings that were too small to admit litters and were incapable of enlargement without weakening the fuselages of planes.9 Early in 1941, therefore, the Chief of the Air Corps permitted the conversion into ambulances of three small planes of a new type just being procured-0-49s-provided this action did not seriously delay the assignment of planes to observation squadrons.10 By July 1941 it was reported that each of these had been converted to carry one litter patient and a medical attendant, in addition to the pilot, and had been assigned to training centers.11

Meanwhile the Surgeon General's Office and the Medical Division of the Office of the Chief of the Air Corps had been making plans for the use of airplane ambulances in both forward and rear areas of combat zones. During 1940 and 1941, as will be seen later, they developed a table of organization for units that would evacuate patients in airplane ambulances and requested the publication of information about such units in a Medical Department field manual. They also devoted attention to the problem of developing a small plane suitable for use in front-line areas. From the time when the National Research Council suggested in October 1940 that an Autogiro might solve this problem, the Surgeon General's Office maintained a steady correspondence with the company producing such planes. In September 1941 representatives of that Office and of the Medical Division of the Office of the Chief of the Air Corps witnessed a demonstration of an Autogiro and discussed with company officials the characteristics desired in a front-line airplane ambulance.12 By the latter part of November the company producing Autogiros submitted drawings for an ambulance. The Air Corps Materiel Division agreed that this type of plane, if successfully developed, would be useful in forward areas, but believed that the one proposed would be unsuccessful because of its weight. It recommended, therefore, that further action on the question of an ambulance Autogiro be suspended until after completion and testing of others being developed for Air Corps tactical missions.13

8(1) R&R Sheet Comment 6, Mat Div OCofAC to Med Div OCofAC, 3 Dec 40, sub: Air Amb Serv. (2) R&R Sheet Comment 7, Med Div to Mat Div, 16 Dec 40, same sub. (3) R&R Sheet Comment 10, Plans Div OCofAC to Exec, OCofAC, 31 Dec 40, same sub, with approval by CofAC. All in AAF: 452.1-B (Amb Planes).
9Memo, Fld Serv Sec Mat Div Wright Fld for Tec Exec Mat Div Wright Fld, 17 Jan 41, sub: Info . . . Regarding Amb Airplanes. AAF: 452.1-B (Amb Planes).
10(1) R&R Sheet Comment 1, Mat Div OCofAC to Exec OCofAC, 23 Feb 41, Comment 3, Tng and Oprs Div OCofAC to Exec OCofAC, 1 Mar 41; and Comment 4, Exec OCofAC to Mat Div OCofAC, 4 Mar 41, sub: Amb Airplanes. All in AAF: 452.1-B (Amb Planes).
11Memo, Mat Div Wright Fld for Mat Div OCofAC, 29 Jul 41, sub: 0-49 Amb Airplanes. AAF: 452.1-B (Amb Planes).
12See SG: 452.-1, and Off file, Research and Dev Bd SGO, "Amb Airplane."
13(1) Memo, Mat Div OCofAC for Mat Div Wright Fld, 28 Nov 41, sub: Amb Autogiro. AAF: 452.1-B (Amb Planes). (2) Memo, Mat Div Wright Fld for Mat Div OCofAC, 3 Jan 42, same sub. Same file.


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C-46 TRANSPORT PLANE READY TO UNLOAD PATIENTS. The ambulance on the right is a ton (4x4) knock-down type.

Decision Not To Provide Separate Transport Planes for Evacuation

Soon after war began, the need for air evacuation was met by the peacetime practice of using regular transports. The first occasion requiring the movement by air of large numbers of patients occurred in January 1942 during construction of the Alcan Highway to Alaska. The second occurred in Burma in April 1942. In both instances regular transport planes (C-47s) already equipped with litter brackets were pressed into ambulance service.14

Successful evacuation by transports did not remove the desire of some military agencies for separate airplane ambulances. In July 1942 the Alaska Defense Command asked for a large airplane ambulance, and was supported in its request by the Western Defense Command. The next month The Surgeon General requested an airplane ambulance for use in transporting patients from the Newfoundland Base Command to the United States. These requests produced a confirmation-in view of the wartime demand for planes for other purposes-of the existing policy of not providing special planes for ambulance service only, but of equipping all transports with litter brackets so they might be used for evacuation as well as for normal missions.15

AAF headquarters encountered some difficulty in the observance of this policy.

14Frederick R. Guilford and Burton J. Soboroff, "Air Evacuation: An Historical Review," Journal of Aviation Medicine, Vol. 18 (December, 1947), pp. 601-16.
15(1) Ltr, CG Alaska Def Comd to CG Western Def Comd, 14 Jul 42, sub: Aircraft Amb for Alaska, with 2 inds. AG: 452 (7-14-42). (2) Ltr, CG Eastern Def Comd to CG AAF, 31 Jul 42, sub: Air Amb Evac of Pnts from Newfoundland Base Comd, with 4 inds. SG: 705.-1 (Newfoundland)F.


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INTERIOR OF C-46 TRANSPORT PLANE, equipped with webbing strap litter supports.

Litter brackets were not always installed in transport airplanes, particularly in new types developed to meet wartime needs. In August 1942 the Air Service Command stated that C-53 transport planes were being procured without litter supports and that the makers of these planes considered it impossible, because of difficulty in obtaining parts for litter racks for C-47s, to install them in C-53s before January 1943. The commanding general, Army Air Forces, then directed the Materiel Command to review its transport procurement program to assure the installation of litter supports in planes during their manufacture and to provide for their installation in all C-53s purchased without them.16 Several months later the Air Transport Command requested that litter supports be provided by manufacturers for all C-46s. Expressing irritation with failure to equip transport planes with litter supports, the AAF Directorate of Military

161st ind, Chief Fld Serv Air Serv Comd AAF to CG Air Serv Cornd AAF, 4 Aug 42, and 3d ind, CG AAF to CG Mat Comd AAF, 21 Aug 42, on Ltr, Chief Overseas Div Air Serv Comd AAF to Chief Fld Serv Air Serv Comd AAF, 20 Jul 42, sub: Litter Racks for C-53 Airplanes. AAF: 370.05 (Evac).


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INTERIOR OF C-54 TRANSPORT PLANE equipped with metal litter supports.

Requirements called upon the Materiel Command for a report. In reply that Command summarized the situation. All C-47s were completely equipped with litter supports during production. While a shortage of critical materials had prevented installation in the first twenty-four C-46s delivered, all others would come equipped. Beginning in December 1942, all C-53s would be provided with litter brackets by manufacturers. Meanwhile, the Air Forces would install them in 200 planes of that type already delivered. Beginning in January 1943, supports for ten litters would be placed in each C-60. Finally, all new types of transports would be equipped with litter supports when deliveries began.17

Small Planes for Ambulance Service at Training Centers

The question of the assignment to training centers of small ambulance planes for rescue work was raised again when the

17R&R Sheet Comment 1, CG ATC to Mil Reqmts Dir AAF, 26 Oct 42; Comment 2, Mil Reqmts Dir AAF to Mat Comd AAF, 2 Nov 42; and Comment 3, Mat Comd AAF to Mil Reqmts Dir AAF, 5 Nov 42, sub: Removable Insulation and Litter Supports for C-46 Airplanes. AAF: 370.05 (Evac).


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Southeast Air Corps Training Center requested in May 1942 the assignment of one each to its flying training schools. While the AAF Directorate of Military Requirements observed a policy of neither developing nor altering an airplane so as to provide an additional type, it was willing that planes of other types be used to carry patients. It therefore directed the AAF Materiel Command on 18 June 1942 to examine all small transport and liaison planes being procured in order to determine which could be readily adapted, with least modification, to carry litters.18

The Materiel Command reported in August 1942 that small planes most suitable for adaptation to ambulance service were the AT-7 and the C-64. The Air Forces had 127 of the former on hand, and 300 C-64s were being procured. Either could be modified to carry at least two litters and a medical attendant, in addition to the pilot. They would be more suitable than the O-49s (L-1s) already converted, because the latter required more extensive modification and carried only one litter and a medical attendant, in addition to the pilot. The Materiel Command therefore requested authority to have a local subdepot modify one AT-7 and to have a manufacturer modify one C-64 in production, in order to determine which would be preferable as an ambulance.19

This recommendation was considered by AAF headquarters, along with a request of the Flying Training Command for assignment to the Gulf Coast, West Coast, and Southeast Air Force Training Centers of sixty-two small ambulance planes and of thirteen larger planes of greater cruising range, such as C-60s.20 On 20 August 1942 the Assistant Chief of Air Staff for Training, A-3, announced that all small planes being procured were earmarked for other missions.21 AT-7s were in such demand for the navigation training program that C-60s were being modified to supplement them. All C-64s being procured were to be used in communications work, pilot dispersal, and light cargo movement. Consequently it was decided not to modify AT-7s, but to have manufacturers equip all C-64s, beginning in January 1943, with brackets for three litters. Since none of the latter were assigned to the Flying Training Command, the commanding general, Army Air Forces announced on 8 November 1942 that it would have to meet its requirement for airplane ambulances by having litter supports installed in planes already on hand.22

The issue of airplane ambulances in the United States came up again on 12 January 1943 when the Air Surgeon proposed the assignment of L-1Bs-liaison planes

18Ltr, CG Southeast AC Tng Ctr to CG Flying Tng Comd AAF, 7 May 42, sub: Amb Airplanes, with 5th ind, Dir Mil Reqmts AAF to CG Mat Comd AAF, 18 Jun 42. AAF: 452.-1 (Amb Planes).
19(1) Rpt, AAF Mat Ctr Wright Fld, 10 Aug 42, sub: Selection and Modification of Small Aircraft for Amb Serv. (2) R&R Sheet Comment 1, Mat Comd AAF to War Orgn and Mvmt Dir AAF, 16 Aug 42, sub: Amb Airplanes. Both in AAF: 452.-1 (Amb Planes). 
20Ltr, CG Flying Tng Comd AAF to CG AAF, 5 Aug 42, sub: Amb Airplanes. AAF: 452.-1 (Amb Planes).
21R&R Sheet Comment 5, AC of Air Staff for Tng A-3 to War Orgn and Mvmt Dir AAF and Indiv Tng Dir AAF, 20 Aug 42, sub: Amb Planes. AAF: 452.-1-B (Amb Planes).
22(1) Interoffice Memo, Capt John P. Marshall Mat Comd AAF to Col Seesums, 19 Aug 42, sub: Amb Airplanes. (2) R&R Sheet Comment 3, Indiv Tng Dir AAF to War Orgn and Mvmt Dir AAF, 5 Oct 42; Comment 7, Indiv Tng Dir AAF to Mat Comd AAF, 22 Oct 42; Comment 10, War Orgn and Mvmt Dir AAF to Idiv Tng Dir AAF, 2 Nov 42, same sub. (3) Memo, CG AAF for CG Flying Tng Comd AAF, 8 Nov 42, same sub. All in AAF: 452.1 (Amb Planes).


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modified by manufacturers to carry one litter and one medical attendant, in addition to the pilot-to meet a need expressed by the Second Air Force. Soon afterward the Flying Training Command renewed its attempt to get airplane ambulances. By this time-the spring of 1943-training programs, such as the glider towing program, were being curtailed and small liaison planes (L-1s) formerly used were no longer needed. As a result, some of them were assigned for ambulance service to the Second Air Force, and the Flying Training Command was permitted to modify about 100 liaison-type planes to meet its needs.23 Soon afterward the AAF Requirements Division announced officially a policy which it had formerly observed without publicity. When a training station needed a special airplane to be held always in readiness purely as an ambulance airplane, its requirement would be treated as a special one and would be met by the conversion of a suitable available plane. Such conversions were to be held to a minimum and were to be made only when specifically approved by AAF headquarters.24

The Question of Airplane Ambulances for Use in Combat Zones

After the war began, the Air Surgeon and The Surgeon General continued to plan for the use of small airplane ambulances in combat zones. Their problem in this instance was twofold: (1) to find a suitable plane and (2) to get it delivered in appropriate numbers for use by evacuation units. 

Various types of planes were considered. It was agreed that a successful one would have to accommodate at least two litters and a medical attendant, in addition to its pilot, and would have to be able to go in and out of small fields over tops of trees and other obstructions. Before the war, as mentioned above, The Surgeon General had thought that an Autogiro might be developed with these characteristics. In May 1942 an aircraft corporation submitted photographs of a small airplane ambulance which it had developed.25 Both The Surgeon General and the Air Surgeon proposed that it be studied and demonstrated, even though it could accommodate only a pilot and one patient,26 but after consultation with the AAF Directorate of Military Requirements the Materiel Command informed the company that the Army had no use for such a plane. It stated that litter bearers were the most effective means for removing casualties from battlefields with rough terrain; that even if the terrain were suitable for landing, a plane was too vulnerable a target to risk in advanced areas; and, finally, that any plane that lacked room for a medical attendant was unsatisfactory.27 Somewhat later, in June, another manufacturer demonstrated to representatives

23(1) R&R Sheet Comment 1, Air Surg to Mil Reqmts Dir AAF, 12 Jan 43, and Comment 3, War Orgn and Mvmt Dir AAF to Air Surg, 16 Mar 43, sub: Airplane Amb (L-1A). AAF: 452.1 (Amb Planes). (2) Routing Slip, [Lt Col] C. W. G[lanz], Mil Reqmts Dir AAF to Col M[ervin] E. Gross, 15 May 43. AAF: 370.05-A (Evac).
24AAF Mil Reqmts Policy No. 41, 25 May 43, sub: Amb Airplanes-Provisions for Evac Wounded by Cargo Airplanes. AAF: 370.05-A (Evac).
25Ltr, Aeronca Aircraft Corp to Hon John J. McCloy, Asst SecWar, 20 Apr 42, with incl. SG: 452.1. A similar letter to the Commanding General, Army Air Forces is on file in AAF: 452.1-B (Amb Planes). 
26(1) Ltr, SG to Hon John J. McCloy, Asst SecWar, 5 May 42. (2) Memo, Col David N. W. Grant, Air Surg for Col H[oward] T. Wickert, SGO, 11 May 42. Both in SG: 452.1.
27Ltr, Lt Col F. I. Ordway, Jr, AC, Asst Exec Mat Comd to Aeronca Aircraft Corp, 5 May 42. AAF: 452.1-B (Amb Planes).


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of the Air Surgeon and The Surgeon General a small plane which he had converted into an ambulance. It was likewise considered unsatisfactory because it also had room for only one patient and a pilot.28 Meanwhile, the Air Forces had begun the investigation, already mentioned, of small transport and liaison planes which training centers might adapt to ambulance use. Apparently the Air Surgeon believed that this might result in discovery of an existing plane that could be used in combat zones as well as in the zone of interior.29

Despite uncertainty about the availability of a suitable plane for use in forward areas, the Air Surgeon continued to plan in those terms. One method of getting approval for his plans was to have airplane ambulances considered as organic equipment of evacuation units. One could assume that upon activation of such units, planes authorized for them would be made available. When the Air Surgeon revised the table of organization for air evacuation units during 1942, he included twenty small planes along with an equal number of flight officers in the table for the air evacuation squadron, light.30 This table was approved by certain sections of the Air Staff and by the Chief of Air Staff, and one air evacuation squadron, light, was activated on 11 November 1942.31 When the matter of providing planes for it came up, the Directorate of Military Requirements objected. Not having been consulted in advance, it had made no plans for supplying evacuation units with either planes or pilots. It insisted that litter bearers and automobile ambulances could best move patients from divisional medical stations to rear areas, for pick-up by transport planes. It maintained, therefore, that squadrons equipped with small planes, or "puddle jumpers," were not required and should not be provided.32 The commanding general, Army Air Forces, supported Military Requirements, and its position was subsequently announced as policy in May 1943.33

Consideration of Helicopters for Air Evacuation

Announcement of this policy did not quash the hopes of many, including the Air Surgeon, The Surgeon General, and Army Ground Forces headquarters,34 that a suitable plane for evacuating patients from front-line areas might be found and its use approved. Late in 1942 a civilian doctor in Virginia had pressed upon the War Department the possibility of using

28(1) Ltr, SG to Piper Aircraft Corp, 5 Jun 42. SG: 452.-1. (2) Memo by Lt Col Thomas N. Page, MC, SGO, 7 Nov 42, sub: Air Evac of Pnts. HD: 370.05.
29Memo by Lt Col Thomas N. Page, MC, SGO, 7 Nov 42, sub: Air Evac and Air Trans of Med Sups and Pers. HD: 580.1 Air Evac.
30(1) R&R Sheet Comment 1, Air Surg to War Orgn and Mvmt Dir AAF, 15 Sep 42, sub: Air Evac, with incl. AAF: 370.03. (2) Rpt of Mtg, ATC, 13 Oct 42, sub: Air Evac of Wounded. AAF: 370.05 (Evac).
31(1) R&R Sheet Comment 3, Ground-Air Support Mil Reqmts Dir AAF to Mil Reqmts Dir AAF, 24 Nov 42, sub: Conversion of Airplanes to Evac Wounded. AAF: 370.05 (Evac). (2) Hubert A. Coleman, Organization and Administration, AAF Medical Services in the Zone of the Interior (1948), p. 689.
32(1) R&R Sheet Comment 4, Dir Mil Reqmts AAF to AC of Air Staff for Tng, A-3, 31 Oct 42, sub: Conv of Liaison Type Airplanes. AAF: 370.05 (Evac). (2) R&R Sheet Comment 3, Ground-Air Support Mil Reqmts Dir AAF to Mil Reqmts Dir AAF, 24 Nov 42, sub: Conv of Airplanes to Evac Wounded. Same file. 
33(1) R&R Sheet Comment 1, C of Air Staff to Dir Mil Reqmts AAF, 12 Nov 42, sub: Conv of Airplanes to Evac Wounded. AAF: 370.05 (Evac). (2) Mil Reqmts Policy No. 41, 25 May 43, sub: Amb Airplanes-Provisions for Evac Wounded by Cargo Airplanes. AAF: 370.05-A (Evac).
34For the Army Ground Forces' viewpoint, see: 10th ind, CG AGF to CG ASF, 20 Nov 43, on Ltr, Dept of Air Tng Fld Artillery Sch to CG ASF thru Repl and Sch Comd AGF, 7 Sep 43, sub: Air Evac by Light Airplane. AAF: 452.-1 (Amb Planes).


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helicopters in front-line medical service.35 Both the Air Surgeon and The Surgeon General quickly adopted the idea as a solution to the problem of evacuating patients by air from inaccessible areas in combat zones and called upon the AAF Materiel Command for information in this connection.36 The Command reported early in 1943 that it had been testing helicopters for a period of eight months. Although it had begun the procurement of several types, none of them were expected to be delivered before the middle of 1943. The Command had already given preliminary consideration to the use of helicopters for evacuation and was requiring that they be fitted for the external attachment of "capsules" suitable for carrying litter patients. It was anticipated that this would enable each XR-5 and R-5 helicopter to carry four litter patients and each XR-6 to carry two. In collaboration with the Aero Medical Research Laboratory, the Materiel Command was studying the possibility of modifying XR-5 and XR-6 helicopters so they might carry four and two litters respectively within their fuselages, rather than in externally attached capsules. Meanwhile, it expected that an XR-5 helicopter, with capsules attached, would be ready for testing by September 1943 and that additional ones could be procured, after their use as ambulances had been approved, in from ten to eighteen months.37

Progress in the general helicopter program was apparently not as rapid as had been expected. In the winter of 1943-44 the Air Forces had on hand only eight or nine serviceable helicopters and expected that few more would be delivered before the latter half of 1944.38 The development of an ambulance helicopter had also lagged. Believing that patients should not be transported in capsules beyond the reach of medical attendants except in emergencies, the Air Surgeon succeeded in having a "requirement" established early in March 1944 for a helicopter that could accommodate at least four litter patients and an attendant within its fuselage. In conformity with established policy, the AAF Requirements Division directed that any helicopter developed to meet this requirement should be suitable for basic use as a cargo plane and should be equipped for carrying litters only if this did not interfere with such use.39 The Air Surgeon also apparently requested the procurement of 150 helicopters for use by his proposed air evacuation squadrons but he reconsidered the matter after discussion with the AAF Requirements Division. In view of the shortage of helicopters of all types and the lack of one that could transport patients within its fuselage, he agreed in March 1944 not to organize helicopter evacuation squadrons but instead to use

35(1) Ltr, Dr Huston St. Clair to Maj Gen W[ilhelm] D. Styer, CofS SOS, 23 Nov 42. Off file, Research and Dev Bd SGO, "Amb Airplanes." (2) Ltr, same to Col G[ustave] E. Ledfors, Air Surg Off, 7 Dec 42. AAF: 452.1 (Helicopters). (3) Ltr, Mr. G. H. Dorr, Spec Asst to SecWar to Col W[ood] S. Woolford, Air Surg Off, 31 Dec 42. Same file.
36(1) Ltr, SG to Chief Engr Div Wright Fld, 21 Dec 42, sub: Helicopter Dev. AAF: 452.1 (Helicopters). (2) Memo, Air Surg for Mat Comd Wright Fld, [22 Dec 42], same sub. AAF: 452.1 (Amb Planes).
37(1) Memo, Mat Comd AAF for SG, 16 Jan 43, sub: Helicopter Dev-Util as Air Amb. (2) Memo, Mat Comd AAF for Air Surg, 3 Mar 43, sub: Helicopter Dev for Air Amb Serv. Both in AAF: 452.1 (Helicopters).
38(1) Memo, CG AAF for ACofS G-3 WDGS, [12 Dec 43], sub: Status of AAF Helicopter Program. (2) Ltr, CG AAF to CG Tng Comd AAF, 20 Jan 44, sub: Availability of Helicopter Aircraft. Both in AAF: 452.1 (Helicopters).
39(1) Ltr, Mat Div AAF to Mat Comd Wright Fld, 3 Mar 44, sub: Dev of Large Type Helicopters. (2) R&R Sheet Comment 2, Oprs, Commitments, and Reqmts Div AAF to Air Surg, 23 Mar 44, sub: Status of Helicopters. Both in AAF: 452.1 (Helicopters).


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LOADING A PATIENT ON AN L-5 PLANE

for emergency evacuation helicopters ordinarily employed otherwise.40 Soon afterward he stated that it was AAF policy to use C-64 and L-5 airplanes equipped to carry litters for the evacuation of patients singly or in small numbers.41 Meanwhile, the general helicopter program continued, and toward the end of the war there were indications that some might soon be modified to carry patients within their fuselages and that they would be available in sufficient numbers for assignment to overseas commands.42

Relaxation of the Policy Limiting the Use of Special Planes for Evacuation

Despite AAF policy against the use of airplanes exclusively for evacuation, assignment of additional transport planes to supply enough "lift" for evacuation in addition to normal operations became an accepted practice in the zone of interior

40R&R Sheet Comment 1, Air Surg to Oprs, Commitments, and Reqmts Div AAF, 4 Mar 44, and Comment 2, Oprs, Commitments, and Reqmts Div AAF to Air Surg, 7 Mar 44, sub: Use of Helicopters for Air Evac. AAF: 452.1 (Helicopters).
415th ind, CG AAF (Air Surg) to CG Air Serv Comd, 24 May 44, on Memo, 2d Lt William R. Kee, AC for Air Surg, thru Channels, 17 Apr 44, sub: Evac of Wounded by Air. AAF: 370.05 (Evac). Also see The Air Surgeon's Bulletin, vol. I, No. 8 (1944), p. 19 and vol. I, No. 9 (1944), p. 16.
42(1) R&R Sheet Comment 1, Reqmts Div AAF to Mat Div AAF, 31 May 45, sub: Litter Capsules for Helicopters. (2) Ltr AG 320.3 (11 Apr 45) OB-I-AFRTH, TAG to CG ETO, 5 May 45, sub: AAF Helicopter Program. Both in AAF: 452.1 (Helicopters).


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during the later war years. This practice began in January 1944, when three C-47s were temporarily used to move 661 patients from Stark General Hospital to other hospitals in the zone of interior. Several months later the Air Transport Command temporarily assigned twelve C-47s to its Ferrying Division for a similar "special operation." These operations were so successful that, after the Ferrying Division was made responsible for air evacuation in the zone of interior in May 1944, twelve planes were permanently assigned to that mission. They could, of course, be used for the transportation of other persons and of cargo when not carrying patients. The next month twelve additional C-47s were assigned to provide planes for evacuation. As the number of patients arriving from theaters increased and the calls for air evacuation became more frequent, the number of transport planes assigned to the Ferrying Division for evacuation operations grew until it reached forty-nine by September 1944.43

As patients continued to be evacuated from theaters to the zone of interior in regular transport planes, efforts were made during 1944 and 1945 to increase the number of patients they carried. The increase was accomplished in two ways. One was the installation of newly developed webbing-strap litter supports. More patients could be accommodated in planes using these supports than in those equipped with metal-type supports. In the summer of 1944 the Air Forces installed webbing-strap litter supports in C-54s already in use and provided for their installation in others during production.44 Another method of increasing the use of airplanes for evacuation was to modify the system of determining the number of patients theaters would evacuate by air. In the spring of 1944, it will be recalled, the Air Transport Command authorized theaters to ignore the old system of priorities for air transportation and determine locally the proportion of space on returning transport planes that would be reserved for patients.45

Medical Flight Attendants

Early Plans for Medical Personnel for Air Evacuation

Since plans for air evacuation during the period before the war and well into its first year were tentative only, plans for units to be employed in such operations were of necessity also uncertain. In the prewar years The Surgeon General and the Medical Division of the Air Corps collaborated in the development of an organization-sometimes called a task force-that would be used exclusively for the evacuation of patients from forward to rear areas of theaters of operations and perhaps to the zone of interior. While there were differences of opinion on some points-such as the name of the organization, the number of subordinate units it should have, and the amount of personnel

43(1) Organizational History of the Ferrying Division, June 20, 1942 to August 1, 1944, pp. 271-78. ATC: Hist Div. (2) Initial Medical History (11 February 1943 to 30 June 1944), Headquarters Ferrying Division, Air Transport Command. HD: TAS. (3) Quarterly Medical History, Headquarters Ferrying Division, Air Transport Command, 1 July-30 September 1944. HD: TAS. (4) Memo, Air Surg for SG, 27 Jul 44. SG: 580. (5) Memo, Comdt Sch of Air Evac for CG AAF, 16 Feb 44, sub: Air Evac. AAF: 370.05 (Evac). (6) The Air Surgeon's Bulletin, vol. I, No. 4 (1944), pp. 10-11.
44(1) 1st ind, CG ATC to ACofS OPD WDGS thru CG AAF, 15 May 44, on unknown basic Ltr. OPD: 580.81. (2) The Air Surgeon's Bulletin, vol. I, No. 7 (1944), p. 17.
45See above, p. 340.


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required for each unit-there was general agreement on major issues. An air ambulance organization should be composed of both Air Corps and medical personnel, the former to maintain and operate ambulance airplanes and the latter to care for patients. This organization should operate under the control of theater headquarters, augmenting surface evacuation, and should perhaps be assigned on the basis of one unit per field army. Medical officers and enlisted men of the organization would not only serve as attendants to patients during flights but would also operate medical stations at large airfields, fifteen to fifty miles from the front, and at small emergency landing fields, two to ten miles from the front. They would collect and transport patients by motor ambulances to such stations, care for them as they awaited air evacuation, and load them on planes for transportation to the rear.46

Several tables of organization for an air evacuation unit were developed through the collaboration of the Surgeon, GHQ Air Force; the Medical Division of the Air Corps; and the Surgeon General's Office. One submitted in July 1940 was disapproved by the General Staff because airplane ambulances were included as organic elements of medical rather than Air Corps units of the evacuation organization.47 Another, submitted by The Surgeon General in October 1940, apparently remained in the G-3 Division of the General Staff without action until the late summer of 1941. It was then revised and resubmitted for approval in November.48 It was published shortly afterward as the table of organization for a medical air ambulance squadron. This squadron was to be a companion unit for an Air Corps transport group composed of a headquarters squadron, a flight squadron, light, equipped with eighteen single-engine liaison planes for front-line evacuation, and two flight squadrons, heavy, each equipped with twelve two-engine transport planes for intra-theater evacuation. The medical squadron was to consist of a headquarters section, a single-engine transport ambulance section, and two two-engine transport ambulance sections. It was to have 45 Medical Department officers, no nurses, and 218 enlisted men. One unit of this type, the 38th Medical Air Ambulance Squadron, was activated at reduced strength as a test unit in May 1942.49

After AAF was charged with responsibility for air evacuation in the summer of 1942, the Air Surgeon's Office developed a new plan for an air evacuation unit, called an air evacuation group. This group was to be composed of a headquarters

46(1) Ltr, SG to TAG, 11 Jul 40, sub: AC Med Trans Group. AG: 320.2 Med (7-11-40). (2) Memo, Chief Med Div OCofAC for SG, 3 Oct 40. SG: 320.3-1. (3) 2d ind, SG to TAG, 18 Mar 41, on Ltr, Dir Dept Extension Courses MFSS to SG thru Comdt MFSS, 31 Jan 41, sub: FM 8-5, Mobile Units of MD. AG: 300.7 (1-31-41) FM 8-5. (4) David N. W. Grant, "Airplane Ambulance Evacuation," The Military Surgeon, vol. 88, No. 3 (1941), pp. 238-43. (5) FM 8-5, Mobile Units of MD, 12 Jan 42, pp. 157-69.
47(1) Ltr, Surg GHQ AF to Chief Med Div OCofAC, 20 Jun 40. SG: 320.3-1. (2) Memo, Chief Med Div OCofAC for SG, 21 Jun 40. Same file. (3) Ltr, SG to TAG, 11 Jul 40, sub: AC Med Trans Group. AG: 320.3 Med (7-11-40). (4) Memo, ACofS G-3 WDGS for CofSA, 7 Aug 40, sub: Air Amb Serv. Same file. (5) Memo, TAG to SG, 5 Sep 40, same sub. Same file.
48(1) Ltr, SG to TAG, 29 Oct 40, sub: New T/O Med Bn, Airplane Amb, with 3 inds. (2) DF G-3/42108, ACofS G-3 WDGS to CofAAF, 15 Aug and 27 Oct 41, same sub. (3) R&R Sheet Comment 1, C of Air Staff AAF to CofAC (Med Div), 7 Nov 41, same sub. All in AAF: 320.3 L-1. (4) DF, C of Air Staff to TAG, 19 Nov 41, sub: T/O for Med Airplane Amb Sq. AG: 320.2 (11-19-41).
49(1) T/O 8-455, 19 Nov 41, Med Air Amb Sq. (2) Guilford and Soboroff, op. cit.


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squadron; an air evacuation squadron, light; and three air evacuation squadrons, heavy. While it was anticipated that the heavy squadrons would consist of medical personnel only and would use planes of either troop carrier or air transport commands, the light squadron was to have twenty small planes and twenty pilots assigned as organic elements. The light squadron was to consist of only enlisted men and officers, but the heavy squadron was to have nurses also. The entire group was to have 49 Medical Department officers, 20 Air Corps officers, 78 nurses, and 458 enlisted men. It was anticipated that air evacuation groups would be assigned as the situation required to air forces, theaters, defense commands, task forces, or field armies.50 The Air Staff having approved the plan for this organization, the I Troop Carrier Command activated such a unit in October 1942, using initially officers and men transferred from the 38th Medical Air Ambulance Squadron. This unit-the 349th Air Evacuation Group-at first consisted of a headquarters squadron and one heavy squadron. In November, when a light squadron and two additional heavy squadrons were activated and assigned to it, the 349th Air Evacuation Group was given the mission of training personnel for air evacuation operations.51 Meanwhile, as already explained, the Air Staff had decided that transport planes would not be earmarked for evacuation only and that small ambulance airplanes would not be provided for use in forward areas. This decision cut short the life of the squadrons just activated because it destroyed the basic concept underlying their formation.

With the decision to consider air evacuation as a secondary mission of planes engaged in general transport service, a different kind of organization was needed. The Air Surgeon therefore developed a smaller unit, the Medical Air Evacuation Transport Squadron (MAETS), whose table of organization was issued in advance form at the end of November 1942 and was published in regular format in February 1943. This unit had no personnel for the movement of patients in motor ambulances or the operation of medical stations at loading points. It consisted of a headquarters and four evacuation flights, each made up of six flight teams. A commanding officer, a chief nurse, an administrative officer, and 29 enlisted men comprised the headquarters. Each flight, headed by a flight surgeon, consisted of 6 flight nurses and 8 enlisted men, of whom 6 were surgical technicians. Flight teams, made up of one nurse and one technician, could be placed on transport planes as needed.52 In December 1942 members of the three heavy air evacuation squadrons already activated were used to form six medical air evacuation transport squadrons. The next month the light air evacuation squadron was disbanded and its personnel was absorbed by the 349th Air Evacuation Group. Subsequently, during 1943 and 1944, additional MAETS were organized, trained, and sent overseas.53

50(1) Coleman, op. cit., pp. 685-87, 703. (2) R&R Sheet Comment 1, Air Surg to Dir War Orgn and Mvmt AAF, 15 Sep 42, with incl. AAF: 370.03. (3) Rpt, Mins of Mtg, ATC, 13 Oct 42, Air Evac of Wounded. AAF: 370.05.
51(1) Medical History, I Troop Carrier Command From 30 April 1942 to 31 December 1944. HD: TAS (2) Coleman, op. cit., p. 689. (3) Guilford and Soboroff, op. cit.
52(1) An Rpt, FY 1943, Oprs Div Air Surg Off. DAF: SGO Hist Br. (2) T/O 8-447, Med Air Evac Trans Sq, 15 Feb 43.
53(1) Guilford and Soboroff, op. cit. (2) Unit Cards, 801st thru 831st Med Air Evac Trans Sqs, filed in Orgn and Directory Sec Oprs Br Admin Servs Div AGO.


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School of Air Evacuation

Charging the 349th Air Evacuation Group with the mission of training personnel for air evacuation operations indicated recognition by the Air Surgeon of the need for specialized training for such work. Despite the fact that it was not to be used in the theaters of operations as originally anticipated, the 349th continued in existence as a training school until June 1943. At that time the Air Forces established a School of Air Evacuation at Bowman Field, Kentucky. This school operated under the Troop Carrier Command until August 1944. Then, after a short period of operation directly under AAF headquarters, it was merged in October 1944 with the School of Aviation Medicine at Randolph Field, Texas. During the period from June 1943 through September 1945 it trained in air evacuation duties 109 medical officers, 1,331 nurses, and 837 enlisted men.54

Method of Controlling and Supplying Flight Attendants

Teams of one nurse and one Medical Department technician per plane continued in use throughout the war. As air evacuation operations within the United States began to assume significant proportions early in 1944, ATC headquarters announced in April that additional nurses trained in air evacuation would be assigned to ATC hospitals and would be used, along with enlisted technicians qualified to assist them, to form flight teams for planes transporting patients between hospitals in the United States.55 When the Ferrying Division took over domestic air evacuation soon afterward, it acquired flight surgeons, flight nurses, and enlisted technicians as part of its bulk allotment of Medical Department personnel for use in air evacuation only.56 For evacuation within theaters of operations and for flights between theaters and the zone of interior, flight teams were supplied by medical air evacuation transport squadrons. The table of organization for these squadrons was revised in July 1944, reducing the number of enlisted men in squadron headquarters from twenty-nine to twenty-four. Personnel in the squadron's four flights, each of which contained six flight teams, remained unchanged, but the rank of nurses was raised.57 Squadrons used for intra-theater evacuation were attached to troop carrier commands or to Air Transport Command divisions in theaters. Those for evacuation from theaters to the zone of interior were assigned to ATC wings until the end of 1944. Gradually thereafter the squadrons assigned to ATC wings were disbanded and flight teams used to accompany patients from theaters to the United States were grouped under the 830th Medical Air Evacuation Squadron Headquarters, organized in the office of the ATC surgeon in Washington in November 1944. By the end of the year this squadron consisted of 44 flights; by April 1945 the number had been increased to 56; and by July, to 78. This centralization of administrative and

54(1) Coleman, op. cit., pp. 691ff. (2) Guilford and Soboroff, op. cit. (3) An Rpt, FY 1943, Oprs Div Air Surg Off. DAF: SGO Hist Br. (4) AAF Reg 20-22, 22 Jul 43.
55ATC Memo 25-6, 29 Apr 44, sub: Med Air Evac. AAF: 370.05.
56(1) Organizational History of the Ferrying Division, June 20, 1942 to August 1, 1944. ATC: Hist Div. (2) Quarterly Medical History, Headquarters Ferrying Division, Air Transport Command, 1 July-30 September 1944. HD: TAS.
57(1) T/O&E 8-447, 19 Jul 44. (2) DF, CG AAF to ACofS G-3 WDGS, 8 Jul 44, sub: T/O&E 8-447, Med Air Evac Sq. AG: 320.3 (2 Jun 44) (1).


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operational control resulted in a saving of overhead personnel and permitted the rapid reassignment of flight teams to areas where they were needed most. It also permitted the establishment of a procedure in the spring of 1945 which enabled each flight team to accompany patients to the United States. Formerly, flight teams located along ATC routes had flown from their home stations to stations en route and then had returned to home stations.58

The economy of men made possible by air evacuation was a major factor in enabling the War Department to meet the demands for large-scale transportation of patients in 1944 and 1945 with the limited number of attendants at its disposal. Early in 1944, when there was concern in Washington lest there be not only insufficient shipping but also insufficient personnel to move the patient load anticipated for the latter half of the year, the Surgeon General's Office and ASF headquarters asked for an increase in air evacuation from theaters as a means of saving manpower.59 The saving was possible, for one reason, because air evacuation was so much faster than surface evacuation that patients required the care of only nurses and enlisted technicians. Moreover, for such short periods, fewer attendants per patient were needed. The saving of personnel can be illustrated by comparing the number of attendants required for a trip by hospital ship with the number required for the same trip by planes that did not stop to change medical attendants or to give patients treatment at hospitals en route. In such a case, the transportation of 500 patients by hospital ship required eight doctors, eight other officers, thirty-four nurses, and 135 enlisted men. To transport a similar number of patients by air in one continuous flight required seventeen planes (assuming that each carried thirty patients) with seventeen teams consisting of one nurse and one technician each, or a total of thirty-four persons, together with the personnel rounding out the flights to which these teams were attached-three doctors and six enlisted men. The economy is more strikingly realized if man-days are compared. For example, the transportation of 500 patients across the Atlantic by hospital ship normally required approximately seven days and therefore used about 1,295 man-days of medical attendance, while the same evacuation could be accomplished by airplane within from one to two days, depending upon whether or not an overnight stop was made in Newfoundland, and required from forty-three to eighty-six man-days only.60

Efforts To Supply Appropriate Equipment for Air Evacuation

Confirmation as policy during 1942 of the peacetime practice of using operational planes instead of special airplane ambulances for the evacuation of patients required the development of special equipment that could be used easily and quickly to adapt cargo and transport planes to their secondary mission-the

58(1) Guilford and Soboroff, op. cit. (2) History of the Medical Department, Air Transport Command, 1 January 1945-31 March 1946. HD: TAS. (3) AAF Manual 25-0-1, Flight Surgs Ref File, 1 Nov 45. HD: 321 (AAF).
59Memo, CG ASF for ACofS OPD WDGS, 26 Apr 44, sub: Air Evac from ETO and NATO. HRS: ASF Planning Div Program Br file, "Hosp and Evac, vol. 3."
60This paragraph is based upon a comparison of the tables of organization of hospital ship complements and medical air evacuation transport squadrons and upon comments by Brig Gen. Albert H. Schwichtenberg on a first draft of this chapter. Also see Journal of the American Medical Association, Vol. 141, No. 8 (1949), pp. 540-41.


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evacuation of patients. Early in 1942 the Air Forces began to use Douglas removable metal-type litter racks, which had already been designed for this purpose, to enable large cargo planes such as the C-47s to carry eighteen litter patients.61 These racks had important disadvantages. Their detachable parts frequently were lost or damaged in stowage, and replacements had to be stocked at various fields. Furthermore, it was discovered in the fall of 1942 that standard racks did not accommodate all types of American litters currently in use in combat theaters. The Materiel Center at Wright Field (Ohio) therefore undertook a series of experiments, and by the early part of 1944 it developed litter supports made of webbing straps.62 They were superior to Douglas metal-type racks in many ways. The racks had to be disassembled after each evacuation mission and stowed in floor compartments while two sets of webbing straps could be spaced and anchored permanently along the roof and side walls of the interiors of planes. Douglas racks weighed nearly 200 pounds in comparison with 110 pounds for webbing-strap supports. Metal supports would accommodate only eighteen litter patients in certain aircraft, but webbing straps would hold twenty-four. Preparation of planes for evacuation with webbing-strap supports could be accomplished in six to eight minutes, a fraction of the time needed to assemble and install metal-type racks. In March 1944, therefore, the use of metal-type racks was curtailed and airplane production was modified to require the installation of the new supports.63 The Air Forces later issued technical orders to guide those engaged in air evacuation operations in the use of webbing-strap supports in C-47, C-47A, C-46, C-64, and C-54 airplanes.64

Litters were important items because they served as patients' beds during flights. Before the war the Air Corps had used a metal litter, based upon the best features of the Navy's Stokes litter. It was noninflammable, easy to disinfect, and could be carried, with a patient strapped in, in either a horizontal or a vertical position, but it was costly, bulky, heavy, and difficult to carry.65 At the beginning of the war, therefore, the Air Corps substituted for it aluminum-pole litters which had been developed in 1937 especially for Air Corps use. In 1942 growing shortages of aluminum stimulated development of a straight carbon-steel-pole litter. A potential steel shortage in turn brought about the development early in 1943 of both straight and double-folding laminated-wood-pole litters. The latter could be collapsed into a smaller space than others, and it soon came to be generally regarded as the best of Medical Department folding litters and ideal for Air Forces use.66

When aluminum and steel again became available in the summer of 1943, the 

61David N. W. Grant, "A Review of Air Evacuation Operations in 1943," The Air Surgeon's Bulletin, vol. I, No. 4 (1944), p. 1.
62Tec Instruction 1255, Hq Mat Comd AAF Hq to Tec Exec Mat Ctr, Wright Fld, Ohio, 9 Sep 42, sub: Correction of Standard Type Litter Support Now Being Installed in Army Trans Aircraft. AAF: 452.1-B (Amb Planes).
63D. M. Clark, "Litter Support Installations for the C-47 Airplane," The Air Surgeon's Bulletin, vol. I, No. 4 (1944), p. 10.
64AAF Tec Orders 00-75-1 (1 Jul 44); 00-75-2 (30 Nov 44); 00-75-3 (5 Jan 44); 00-75-4 (15 Jan 44); Air Evac Technique of Loading Pnts in C-47 and C-47A, C-46, C-64, and C-54 Airplanes respectively. AAF: AF Admin Ref Br, Air AG. 
65John B. Johnson, Jr., and Graves H. Wilson, A History of Wartime Research and Development of Medical Field Equipment (1946), pp. 1-245.
66Sup Plan 16, Procurement Div SGO, 20 Oct 43, sub: Litters. Off file, Sup Div SGO, 400.114/3815 (Litter, Steel, Folding).


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Air Forces shifted procurement back to straight steel-pole and folding aluminum-pole litters. Those issued were unpopular-the former because of its weight and the latter because it did not fold up well in field use.67 The folding laminated-wood-pole litter continued to be preferred until February 1944. At that time the Air Forces recommended that straight aluminum-pole litters be procured for the remainder of the war. This change was due not so much to dissatisfaction with the special folding litter as to basic changes in aircraft construction. By the early part of 1944 doors and internal capacities of cargo and transport planes had been so enlarged that difficulties formerly encountered in loading, unloading, and stowing litters were no longer problems in air evacuation. Thus the litter which had been designed originally for Air Force use was supplanted, in Air Force procurement, by the standard Ground Force litter. In the summer of 1945, general preference for straight aluminum-pole and folding laminated-wood-pole litters was sanctioned by keeping only these two types classified as standard.68

Supplies and equipment for the care of patients during flight similarly had to be specially designed and selected because weight and space were important factors in air movements. At the beginning of the war, two medical chests had been developed for the Air Corps as Medical Department items. A flight service chest, standardized before and improved during the war, was furnished each air evacuation transport squadron. An airplane ambulance chest, developed by the Air Corps and a plastics corporation in St. Louis, Mo., for issue to each flight team, was lighter and contained a minimum of supplies and equipment to care for the immediate needs of patients.69 The latter type of chest appears to have been satisfactory only for trips requiring six to nine hours. For shorter trips, like those in the North African campaign, the chest was too large and frequently was not used at all if a nurse had to provide medical care unassisted. For longer ones, medical evacuation personnel considered the chest too small for efficient use.70 Variation in distances between theaters and the zone of interior and in the types of patients evacuated was so great that standardization of a chest for universal use was impractical. Therefore, improvisations of cabinet-type containers for long trips and the development of experimental kits for short trips continued to the end of the war.71

The provision of adequate oxygen equipment and improvement of facilities to control and restrain psychotic patients were other problems the Air Forces faced. The availability of oxygen was essential to minimize physiological changes due to the altitude at which flight was maintained. The Air Forces developed and issued a portable continuous-flow therapeutic-oxygen kit to be used for both air evacuation and air and sea rescue. Beginning in the summer of 1944, each air evacuation team received four of these kits to augment the

67See n. 66.
68
Johnson and Wilson, op. cit., p. 45.
69(1) See documents in Off files, Sup Div SGO, 400.112/2642 (Chest, Flt Serv, Empty), and 400.114/3023 (Chest, Amb, Airplane, Empty). (2) T/E 8-447, 30 Nov 42. (3) Ltr, SG to CG SOS, 14 Jan 43, sub: Airplane Amb Chest, with 5 inds. SG: 428.
70(1) Weekly Staff Rpts, Staff Mtgs ASO, 13 Sep 43. HD: TAS. (2) Daily Rpt, Sup Div ASO, 3 Oct 44. HD: TAS.
71(1) An Rpt, Sup Div ASO, FY 1944. HD: TAS. (2) Daily Rpt, Sup Div ASO, 3 May 45. Same file. (3) Andres G. Oliver and Hampton C. Robinson, Jr., "Domestic Air Transportation of Patients," The Air Surgeon's Bulletin, vol. II, No. 11 (1945), p. 401.


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standard oxygen system available for the crew and able-bodied passengers.72 A rather knotty problem developed from the transportation of psychotic patients. Since planes had no facilities for isolation, such patients constituted a potential danger to others during flight. Although the Air Transport Command returned several hundred of them from the Southwest Pacific to the zone of interior during 1944 and 1945, it was not until the end of the war that the Command produced a really suitable flexible restraint.73

Although feeding was a normal part of pre- and post-flight care, a serious problem in feeding patients developed when flights extended over long periods of time. Cargo and transport planes had no facilities for cleaning or washing dishes, trays, or silverware; and their crews lacked experience in preparing suitable meals for patients from a limited variety of available foods. By January 1944 this problem became serious and the Air Forces started a survey to find a solution. Nevertheless, provisions for feeding patients being evacuated from theaters continued to be little more elaborate than sandwiches, hot coffee, and cold drinks carried in thermos jugs. Patients transported in the domestic air evacuation system, operated by the Ferrying Division of the Air Transport Command, were more fortunate. In November 1944 Wright Field began testing and later approved for installation in planes of the Ferrying Division a galley unit containing four large cups to heat food, a container for coffee, and two "hot cups" for preparing chocolate, soup, and bouillon, as well as drawers for the storage of food.74

Both patients and medical attendants complained of fatigue on long flights, patients because of lying on litters for several hours and medical attendants because of lifting and changing the position of patients frequently. An air mattress was therefore developed by the Air Forces to fit on Army litters. It took little space in stowage, weighed little, inflated easily, and could be washed with soap and water. Authority was granted in January 1945 to issue twenty-four air mattresses to each flight team.75

Patients transported by air along both tropical and arctic routes suffered from uncomfortable temperatures in planes when they landed for servicing. Early in 1944 the Air Forces collaborated with the Quartermaster Corps and other agencies in the development of portable air conditioners to cool planes' interiors at stopover points. By August 1944 the Supply Division of the Air Surgeon's Office had issued forty-two air conditioners to the Air Transport Command for use both in the zone of interior and in overseas theaters.76 In arctic areas, large heaters that could be moved up to planes on the ground were used to warm cargo areas until planes were ready for flight.77

72(1) The Air Surgeon's Bulletin, vol. II, No. 3 (1945), pp. 78-79, and vol. II, No. 4 (1945), pp. 106-07. (2) T/O&E 8-447, C 1, 11 Dec 44.
73History of the Medical Department, Air Transport Command, 1 January 1945-31 March 1946, pp. 91-97. HD: TAS.
74(1) A mimeographed copy of a broad plan to study certain equipment problems in connection with air evacuation of patients, developed around January 1944, may be found in AAF: 370.05 (Evac Book 2). (2) Oliver and Robinson, op. cit., pp. 400-01.
75(1) Ltr, CG AAF (Air QM) to CG ASF, 2 Jun 44, sub: Air Mattresses and Pillows. AAF: 427. (2) Rpt, Off of Air Insp (I. B. March) to Air Insp Hq AAF, 21 Aug 44, sub: Summary of Med Insp of ATC and Stas In CBI Wing. HD: TAS (ATC and Misc). (3) T/O&E 8-447, C 2, 25 Jan 45.
76(1) An Rpt, Sup Div ASO, FY 1944. HD: TAS. (2) Daily Rpt, Sup Div ASO, 29 Aug 44. Same file. 
77The Air Surgeon's Bulletin, vol. II, No. 10 (1945), pp. 330-31.


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Until the fall of 1943 loading and unloading litters in high-door planes were accomplished manually. When air evacuation increased in the latter part of 1943, this method was discarded generally in favor of a fork-lift truck with a "litter adaptor" made from a simple wooden pallet platform used to move and store cargo. The mechanical loading and unloading of patients proved to be rapid, safe, and comfortable and was adopted at most Air Transport Command installations throughout the world by the end of the year.78

The exchange of property used in air evacuation constituted a difficult problem. A patient was seldom separated from his litter and blankets until he reached a hospital. When the Air Forces released patients to Ground or Service Forces installations, comparable equipment seldom was returned in exchange and the Air Forces sustained a gradual loss.79 This was particularly important in the case of litters in the first part of the war because the Ground and Service Forces were using straight-pole litters while the Air Forces preferred and used folding-pole litters. The Air Surgeon and The Surgeon General were acquainted with the problem and by the middle of 1943 began to study means of solving it.80 A new procedure was established by directives issued by the Air Transport Command in April and the War Department in June 1944. According to it, the Air Transport Command was to furnish necessary medical supplies for use in flight, while commanding officers of medical installations, through medical supply officers, were to be responsible for providing such equipment as litters and blankets. When a hospital requested air transportation for a group of patients, a shipping ticket was to be prepared by its medical supply officer listing necessary litters, blankets, splints, etc. The flight nurse was to turn in the shipping list to the medical supply officer of the receiving hospital where it would be signed and mailed to the originating hospital. Later, the equipment was to be turned in to a depot for return to the theater by boat. If the originating hospital was in the zone of interior, the equipment would be shipped directly to that hospital.81 This system did not work as well as anticipated. Shipping by water was slow and did not always return property as fast as it was used. As a result, successive efforts were made during 1944 to increase the number of blankets and litters supplied to air evacuation squadrons so that a pool of this equipment could be established overseas.82

Changes in the table of organization and equipment for air evacuation squadrons reflected both the development of special equipment for air evacuation operations and attempts to eliminate shortages of equipment in theaters of operations. The table, first published on 30 November 1942, authorized the Air Forces to issue such items as flight clothes and equipment to nurses and enlisted technicians and the Medical Department to issue blankets, litters, and flight service medical chests. As revised in June 1943, this table doubled the allowance of blankets, undoubtedly to

78John M. Collins, "Litter Loading Device," The Air Surgeon's Bulletin, vol. I, No.9 (1944), p. 22.
79Diary, SOS Hosp and Evac Br (Fitzpatrick), 27 Nov 42. HD: Wilson files, "Diary."
80Johnson and Wilson, op. cit., p. 152.
81(1) ATC Memo 25-6, Air Evac, 29 Apr 44. AAF: 370.05 (Evac Book 2). (2) Ltr, TAG to CGs AAF, AGF, ASF, Theaters, Def and Base Comds, etc., 8 Jun 44, sub: Procedure for Evac of Pnts by Water or Air from Overseas Comd. AG: 704.11 (3 Jun 44).
82Memo SPMOO 400.34 (15 Nov 44), CG ASF (Lutes) for CG AAF, 20 Nov 44, sub: Change 1 to T/O&E 8-447. AG: 320.3 (2 Jun 44).


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cover shortages growing out of unsatisfactory operation of the property-exchange system.83 Medical supplies were to be requisitioned from medical depots operated by the Air Service Command according to requirements determined by the Supply Division of the Air Surgeon's Office.84 A revision of the table in July 1944 authorized the Air Forces to issue four portable oxygen assemblies per air team, and it increased the number of litters per squadron from 432 to 576. Five months later, a further change reflected the substitution of the Air Forces' newly developed therapeutic-oxygen kit for the portable assembly. It also authorized an increase in straight aluminum-pole litters from 576 to 1,500, and the addition of 3,732 olive drab blankets for each squadron. The increase in litters and blankets was made to cover part of the shortages of these items in the theaters. Another change in the table, published 25 January 1945, added as Air Forces organizational equipment 576 pneumatic mattresses per squadron.85

83T/E 8-447, 30 Nov 42, with C 1, 14 Jun 43.
84Coleman, op. cit., pp. 635-36.
85T/O&E 8-447, 19 Jul 44; C 1, 11 Dec 44; C 2, 25 Jan 45.

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