Medical Support in Vietnam

Written around December 2001

Introduction

The Vietnam War is the longest military conflict that the United States has participated in. It cost the US $150 billion and 58,000 American lives and estimates on North Vietnamese losses range up to a million[1]. The Republic of Vietnam lies entirely within the Tropics. Saigon is halfway around the world from Washington, D.C. and there is a 12-hour difference in time between the two cities. The nearest off-shore U.S. hospital is almost 1,000 miles away at Clark Air Force Base in the Philippines, The nearest logistical support base is about 1,800 miles away in Okinawa. The nearest complete hospital center is in Japan, some 2,700 miles distant. Patients being evacuated to the United States must travel, some 7,800 miles to reach Travis Air Force Base in California, or almost 9,000 miles to reach Andrews Air Force Base, near Washington, D.C[2]. When considering the nature of the Vietnam War, it is surprising that there were not many more fatalities on the American side. With staggering casualty rates, but high survival rates, one can begin to understand the success of the medical operations in during the war. During the 18 years of conflict the medical units of the army, navy and air force continued to provide exceptional care under extremely difficult circumstances.

History

For most of military history, a wounded soldier would find himself lying on the field where he had fallen with no hope of aid. However, by the late 18th century, the first medical help for the injured was organized. Napoleon’s army was the first to have a unit of “litter-bearers”, consisting mainly of inept and expendable soldiers, whose task it was to remove the wounded from the battle field[3]. By 1862, due to the enormous number of casualties at the battle of Manassas, Dr Jonathan Letterman, Head of Medical Services of the Army of the Potomac, decided to redesign the Arm Medical Corps. His plans included the basic three tiered structure that is still used today[4].

Structure

As with everything in the military, the medical units were highly structured. Every platoon was accompanied by a medic, or if they were lucky, two. Medics were the first line of medical care available to an injured or sick solider[5]. The major difference between Vietnam and another war however, was the use of helicopters.  Choppers were used not only as gunships and transports, but also as ambulances[6]. After being evacuated from the battle field, a patient would find himself at a field hospital or “MASH” station. The final destinations for those beyond the care of field hospitals were the main army hospitals stationed in Japan.

Medics

Medics were used to their full potential for the first time in Vietnam. By definition, medics were soldiers (grunts) with medical training. All units received basic training together for eight weeks, regardless of their future MOS (Military Operating Specialty)[7]. From there, a combat medic would move on their medical training, often at Fort Sam Huston, Texas, for another eight weeks of training. There, they trained constantly in how to draw blood, start IV’s, use splints, treat shock, head wounds, gunshot wounds, burns, seizures, VD, dislocations, perform tracheotomies, C.P.R and hospital duties along with numerous other techniques[8].  As with most of the Vietnam conscripts, combat medics were normally boys of just 18 or 19 years old[9]. Under the massive amounts of stress of fighting in a jungle guerilla war, many of the medics “freaked out”[10]. They would start cutting down on their own food and water so they could carry more medical supplies; start stealing plasma bottles and writing parents and friends for medial catalogues so they could order their own endotracheal tubes or simply refusing to leave when their tour was over. A tour of Vietnam was 12 months for everyone – except medics, theirs was only seven[11].

So the medics in Vietnam fought side by side with their fellow soldiers. A medic would not only carry blood, splints and a surgery kit, but also an M-16 and grenades. Medics also often doubled as radio operators, making them especially valuable to a platoon. In fact, it was a practice of the North Vietnamese fighters to shoot for the leg or stomach, because they knew that the medics were so dedicated that they would come to aid the fallen grunt, and walk into a trap. Medics no longer wore red cross arm bands or helmets. But the front line of medical aid supplied by the combat medics was invaluable. 98% of wounded who were evacuated from the battle grounds survived.

Dust offs

As more soldiers arrived, the Army Medical Service began its own buildup, which included an increase in the number of medical evacuation units. During the next three years the Surgeon General of the Army sent two air ambulance companies and six more helicopter ambulance companies to Vietnam. In March 1966 the 44th Medical Brigade, which had been activated in January, assumed control of most Army medical units in Vietnam[12]. The platoon owed its existence to the creation of the first airmobile division in the U.S. Army, the 1st Cavalry Division (Airmobile)[13]. In August 1962 the U.S. Army Tactical Mobility Requirements Board, chaired by Lt. Gen. Hamilton H. Howze, had recommended the creation of a new airmobile division, which would be served by an air ambulance platoon.[14]

With the advent of the Airmobile Division came new advantages. Patients could be moved with relative speed from a battle situation to a field hospital. Often, the medic who had treated the solider on the ground would accompany him on the way to the MASH (Mobile Army Surgical Hospital) to stabilize him[15]. Once on board, the chance for survival soared, and only increased as the evac approached the hospital.

Dressing stations, Mobile stations and MASH units

The MASH units, made famous by the TV show about the Korean War, were the first stops for injured soldiers. They were staffed by doctors, dentists, nurses and medics. This is where most of the women serving in the war worked. The field hospitals did the best they could under extremely difficult circumstances. Surgery ranged from procedures such as amputations to minor brain surgery, normally performed by doctors who had little or no experience in the kind of operations required to treat some of the wounded. The doctors however earned the reputation that inspired the MASH series. This was mainly because they did not approve or believe in the war effort, and even though they worked up to14 hours in a day to save as many lives as they could, they had very little time for the military way of doing things. Insolent and disrespectful to fellow officers, the doctors of the field hospital unit would often wear their uniforms mismatched, salute with the wrong hand and ignore military rank[16]. There irreverence for the system was in most ways a protest against being in Vietnam against their wishes, but their humor and mockery of the military was more a way of coping with their situation. Even though most of the doctors serving in Vietnam felt strongly against the reasons that the United States was fighting the war, many extended their tours because as much as they didn’t like it, they realized that they were more helpful in saving lives there than anywhere else[17].

One frequently overlooked segment of the medical personal, serving in Vietnam, is that of women. Women’s enlisting in the Army was a relatively new concept in the 1950s, and although they were noncombatants, they helped a great number of people by serving in the medical field as nurses, doctors and administrators. The women (and men) of the ANC (Army Nurse Corps) provided high quality nursing to U.S. troops in Vietnam beginning in mid-1962. Thirteen nurses were included on the staff of the 5th Field Hospital which arrived at Nha Trang in March 1962. Thereafter the number of nurses sent to Vietnam increased gradually as the troop buildup continued. The number reached its peak strength of 900 in January 1969, after which it fell rapidly to about 650 by July 1970 as the withdrawal of U.S. troops gained momentum. These numbers are often sketchy because of poor record keeping in regards to women in the military, and partly due to the fact that women are so often over-looked in war situations.

The role of female nurses and doctors was extremely important in both the MASH units and the Japanese Hospitals. One of the more important, and mire difficult tasks that nurses had to do was that of sorting out the incoming sick and injured. During large offensives such as Tet (Vietnamese New Year), nurses lined up patients in order of who the doctors were most likely to be able to save in the shortest amount of time. The reality of war is that a doctor’s time is better used to save three patients who demand 2 hours in the theater than to be taken up with one case that could take six hours.

Japanese Hospitals

Once the field hospitals had done all they could do, patients were turned over to the Army hospitals in Japan. In 1966, there was only one 90-bed Army dispensary in Japan, but by 1975 there were four the largest of these being Zama[18]. When the escalation began in the war, the Army had the choice of either building up the current facilities in the Philippines, starting from scratch in Okinawa or building more hospitals in Japan. The Philippines seemed however to be unstable at the time, and Okinawa was too expensive so the Army chose Japan even though it was four hours further away. Zama was staffed with internists, anesthesiologists, ophthalmologists, plastic surgeons, gynecologists, oral surgeons, ENT specialists, thoracic surgeons, vascular surgeons, pediatricians and even an allergist[19]. The hospitals often averaged six to eight thousand patients a month, and during the Tet offensive it was closer to eleven. There were days and weeks when the evacs didn’t stop coming in and when they couldn’t fly, the army brought patients in by ambulance from the Air Force bases.

Some doctors would try to send as many of the soldiers as they could home, keeping them up to the end of their tour, or pronouncing them unfit for combat. Others did exactly the opposite, sending as many men back to the front lines because they felt that they needed to keep the force strong enough to win the war. Neither of the kinds of doctors actually believed in the war, they just wanted to get America out of Vietnam.

Conclusion

Vietnam changed much of the way that wars are fought today. New techniques and unit are expected to accompany war, but Vietnam changed much more than the use of helicopters and combat medics. The war was the first to be widely televised, and the first American war to be so widely protested by the public. The Secretary of Defense once remarked that “The picture of the world’s greatest power killing or injuring 1000 noncombatants a week, while truing to pound back a tiny backward nation into submission on an issue whose merits are hotly disputed is not a pretty one.” [20] The medical personal of the war made the greatest contribution to saving lives in an armed conflict ever, with much of the heroism of the Vietnam War revolving not around taking lives, but rather saving them.


[1] World Book, 393.

[2] Medical Support Of The U.S. Army In Vietnam 1965-1970

[3] Napoleon

[4] Dr Letterman

[5] Dust off

[6] Dust off

[7] Combat Medic Training During the Vietnam War

[8] Combat Medic Training During the Vietnam War

[9] Body Shop

[10] 365 Days, 54

[11] 365 Days, 54.

[12] Dust off

[13] Medical Support Of The U.S. Army In Vietnam 1965-1970

[14] Dust off

[15] Dust off

[16] Dr. E

[17] 365 Days, 12

[18] Medical Support Of The U.S. Army In Vietnam 1965-1970

[19] 365 Days, X.

[20] America, 1184.

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