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Introduction - Part IV





The evacuation of patients from theaters of operations to the zone of interior and from one point to another in the United States was an intricate operation, involving not only the transportation but also the care en route of patients suffering from all kinds of diseases and injuries. It was complicated by many factors, among them the means employed. Various types of transportation facilities were used-motor vehicles, trains, ships, and airplanes. Each of these had subtypes. For example, both hospital and transport ships returned patients from theaters. Various kinds of personnel, civilian and military, were employed to operate transportation facilities and care for patients aboard them-doctors, nurses, technicians, pilots, and many others. Moreover, equipment and supplies needed to care for patients in transit were extensive and sundry, ranging from aspirins to operating tables. To some degree personnel and equipment required were governed by transportation facilities employed, because hospital ships, for instance, needed more elaborate equipment and larger staffs than did airplanes.

Evacuation was further complicated by its interrelationship with plans, policies, and procedures for hospitalization. For example, the division of general hospital beds between the theaters and the zone of interior was determined by-among other factors-the evacuation facilities expected to be available. On the other hand, the number of beds supplied to theaters influenced the number of patients to be transferred to the zone of interior, and hence the transportation facilities that would be required. Successful operation of the specialized hospital system in the United States and observance of a policy of hospitalizing patients as near their homes as possible depended upon the evacuation system.1

To co-ordinate evacuation with hospitalization and to use all available means-transportation facilities, personnel, and equipment-in such a way that large numbers of patients would be moved as safely and expeditiously as possible required a highly organized operational system. Its development and conduct were complicated not only by the divers means employed but also by the distances traversed and the agencies involved. Patients traveling by land, air, and sea from hospitals in theaters of operations to those in the zone of interior were the responsibility of successive military agencies. Among them were the bases and headquarters of theaters of operations; the Air Transport Command with its overseas wings; the Transportation Corps with its ports of embarkation and debarkation in the United States; the Offices of the Chief of Transportation, The Surgeon General, and the Air Surgeon; service and air commands in the United States; and the headquarters of both the Air and Service Forces.

Involvement of so many agencies made it important to define their respective areas of responsibility-particularly after 

1Interrelationships between hospitalization and the policies and processes of evacuation have been discussed at various points in preceding chapters and will be referred to again from time to time.


the War Department reorganization in March 1942. On recommendation of SOS headquarters, this was done for major agencies the following June. The commanding general, Army Air Forces, was charged with development and operation of air evacuation. Commanders of theaters of operations and of major commands in the United States were declared responsible for the movement of patients within their own commands. The commanding general, Services of Supply, was charged with evacuating patients from all major commands-those overseas as well as in the United States-and of co-ordinating all plans of such commands for the evacuation of sick and wounded to be delivered to his control.2 To assist him in this function, various responsibilities (which will be discussed later) were assigned to the Chief of Transportation, The Surgeon General, and port and corps area commanders. In the early part of the war their activities were closely supervised and coordinated by the SOS Hospitalization and Evacuation Branch.

Beginning in 1943 a series of events transferred that Branch's responsibility and authority for evacuation to The Surgeon General and the Chief of Transportation. Early that year, it will be recalled, ASF (formerly SOS) headquarters began to return to The Surgeon General some of the functions it had assumed earlier in hospitalization and evacuation operations. Some of the officers of its Hospitalization and Evacuation Branch were transferred to the Surgeon General's Office after the Branch was reduced in status to a section of another branch in ASF headquarters. One of them was Lt. Col. John C. Fitzpatrick, who had been active in sea evacuation operations while in ASF headquarters. Soon afterward, The Surgeon General and the Chief of Transportation decided that the latter would need constant technical advice from the Medical Department on matters of evacuation that concerned him and that the former would need a means of exercising technical supervision over evacuation operations. Accordingly The Surgeon General in June 1943 assigned Colonel Fitzpatrick as his liaison officer with the Chief of Transportation, who gave him office space for a Transportation Liaison Unit. In this capacity Colonel Fitzpatrick assisted the Chief of Transportation in estimating evacuation requirements and in planning and supervising the transportation of patients by water and rail.

In the spring of 1944, in anticipation of the patient load expected as a result of aggressive combat operations, the unit headed by Colonel Fitzpatrick was increased in size and given additional authority and responsibilities. In May, it will be recalled, The Surgeon General removed the Evacuation Branch from his Hospital Division and merged it with the Transportation Liaison Unit to form a Medical Regulating Unit. This step combined the function of regulating the flow of patients from ports to hospitals of definitive treatment with that of providing for their transportation. Thus one office, representing The Surgeon General and belonging to his Operations Service but located in and working as a part of the Movements Division of the Office of the Chief of Transportation, assumed responsibility in the latter half of the war for supervising all evacuation operations ex-

2(1) Ltr AG 704 (6-17-42) MB-D-TS-M, TAG to CGs AGF, AAF, SOS, et al., 18 Jun 42, sub: WD Hosp and Evac Policy. (2) Ltr SPOPM 322.15, CG SOS to CGs and COs of CAs, PEs, Gen Hosps, and SG, 18 Jun 42, sub: Opr Plans for Mil Hosp and Evac. Both in AG: 704(6-17-42).


cept the movement of patients by air. The Air Forces Medical Regulating Service in the Air Surgeon's Office controlled the transfer of patients between AAF hospitals and supervised air evacuation operations. Collaborating closely with the ASF Medical Regulating Unit, the Air Regulating Office followed the pattern of the ASF office both in its development and in its procedures.3

In contrast with wartime operations, evacuation of patients from overseas areas and within the United States in peacetime had been a small-scale affair. The few troops who were in overseas areas were not engaged in combat activities; and therefore the number of patients who needed to be returned to the United States for hospital care was not large. General hospitals in this country were located in relation to troop density and served on a regional basis to treat complicated cases of all types rather than on a specialized basis to treat few types of cases from wide areas; and therefore the movement of patients from station to general hospitals was also a relatively simple procedure.

The primary means of transporting patients from overseas areas was by troop transports. No hospital ships were available, and the movement of patients by air was still in the experimental stage. Transports delivering troops and supplies at overseas ports took aboard patients for return trips and transport surgeons cared for them in ships' hospitals or in ships' quarters.4 Before arrival in the United States, transport surgeons radioed to ports of debarkation lists of patients aboard, with their diagnoses and proposed dispositions. Ports receiving such information arranged with the corps area (later called service command) in which they were located for the transportation of patients being evacuated. Upon arrival of transports, port commanders issued orders transferring patients to general hospitals in which ports had bed credits and then informed The Surgeon General of the number received and of the hospitals to which they had been transferred. The New York Port, for example, had bed credits in both Tilton and Lovell General Hospitals and transferred patients within the limit of its allotments to these hospitals. Because the nearest meant an ambulance trip of more than two hours, the port occasionally kept in its station hospital for short periods of time patients who needed rest before further travel. Personnel both for transports and for the debarkation of patients was supplied by ports from their bulk personnel allotments or was borrowed from corps areas.5

Within the United States patients were moved from ports to hospitals, or from one hospital to another, by ambulance, by trains, and by airplanes. Ambulances available to all hospitals were used, as hospital commanders directed, for short trips. Accommodations for patients aboard regularly scheduled passenger trains were

3(1) Ltr, SG to CG ASF thru CofT, 17 Apr 43, sub: Coord Med Serv for PE, with 2 inds. HD: Wilson files, "Book IV, 16 Mar 43-17 Jun 43." (2) ASF Cir 147, 19 May 44. (3) WD Cir 140, 11 Apr 44. (4) AAF Reg 25-17, 7 Feb and 6 Jun 44. (5) An Rpt, FY 1944 and 45, Oprs Serv SGO. HD. (6) An Rpt, FY 1944, Oprs Div Off Air Surg. HD. (7) Ltr, Dr. Richard L. Meiling to Col Calvin H. Goddard, 30 Jun 52. HD: 314 (Correspondence on MS) XI.
4Reports of transport surgeons, required as a part of each voyage report by AR 30-1150, 19 September 1941, were submitted through port surgeons to Army Transport Service. For surgeon's reports see files SG: 721.5, QM or TC: 569.1 under name of Army transport.
5(1) AR 40-1025, 12 Oct 40. (2) WD Cir 120, 21 Jun 41. (3) An Rpt, NYPE, 1943, contains an account of activities before 1943. HD.


arranged by corps area officers with local agents of carriers involved. Normally, transfers were made without reference to such higher authority as the Surgeon General's Office, because station hospitals, corps area surgeons, and port commanders had general hospital beds set aside for their use by the bed-credit system.6 Some airfields and air training centers converted airplanes available to them into airplane ambulances and used them to transfer patients from scenes of crashes to near-by hospitals or, in some instances, from one hospital to another. When airplane ambulances were not available, medical personnel on duty with the Air Corps made local and informal arrangements with Air Corps operations officers for the transportation of patients in operational planes.7 Such an informal system worked well enough as long as the number of patients to be evacuated was small and the distances they were to be moved were short, but it was not easily adaptable to the movement of large numbers of patients over long distances. The way this system was transformed will be discussed later. It will be helpful, though, to consider first the magnitude of operations that made necessary such a transformation.

6An Rpts, Lovell and Tilton Gen Hosps, 1941. HD.
7(1) Ltr, Walter Reed Gen Hosp to SG, 11 Jan 41, sub: Airplane Trans of Pnts, with inds. SG: 580.-1 (Walter Reed GH)K. (2) Ltr, Hq West Coast ACTC to CofAC, 15 Aug 41, sub: Air Amb, with inds. AAF: 452.-1B (Amb Planes).