Division and Brigade Medical Support
Two impressive aspects of medical operations in support of combat units in Vietnam were the versatility of the, classic system and the far-reaching modifications of the system, that evolved from the Vietnamese experience.
Doctrine prescribed the structure and type of medical support for combat units sent to Vietnam. A medical battalion of four companies, each with three platoons, supported each division. A single medical company supported each separate brigade. The medical platoon of three sections supported units of infantry and tank battalions or armored cavalry squadrons. Under the fluid conditions of warfare in Vietnam, the employment and deployment of combat units determined the utilization of their supporting medical units, and no two medical battalions were used alike. The action accounts that follow are representative of these varied usages.
Usages of Divisional Medical Assets
1st Cavalry Division (Airmobile)
In September 1965, the 1st Cavalry Division (Airmobile), supported by the 15th Medical Battalion (Airmobile), arrived at the Central Highlands bases of Qui Nhon and An Khe lying southeast of Pleiku. In October the North Vietnamese Army began a major operation in the Central Highlands, opening its campaign with an attack on the Plei Me Special Forces camp 25 miles southwest of Pleiku. The 1st Brigade, 1st Cavalry Division (Airmobile), was moved into the area, south and west of Pleiku to block any further enemy advance and to stand in readiness as a reaction force. On 27 October, the 1st Cavalry Division (Airmobile) was directed to seek out and destroy the enemy force in western Pleiku province. Thus began the month-long campaign known as the Battle of the Ia Drang Valley. The great effectiveness of the airmobile division was demonstrated in its first combat trial.
The IA Drang campaign also proved the worth of the airmobile medical support battalion. An innovation, the airmobile medical battalion differed structurally in several ways from the conventional medical battalion. The most important difference was that it included an air ambulance platoon of 12 helicopters and an aircraft maintenance section.
Doctrinally, the division of responsibility between air ambulances organic to a division and Army-level, or Dust-off helicopters, was clear cut. Divisional air ambulances evacuated patients in the division's area of operations from the site of wounding to one of the division's four clearing stations. Dust-off helicopters evacuated patients from the divisional clearing station to an Army hospital. In practice, the line of demarcation was often blurred. During lulls in combat, divisional aircraft flew patients from the clearing station to a hospital, while during peak periods of combat, Army-level helicopters supplemented divisional aircraft and evacuated casualties from the frontline to the divisional clearing station. Occasionally, assault helicopters were used when the medical air evacuation platoon was overtaxed, but Dust-off was preferred because the medical aidman aboard could give emergency treatment and because the patient could be regulated to the hospital best suited to his needs.
In contrast to the usual practice in Vietnam of evacuating a casualty directly from the site of wounding to a, hospital by air ambulance, 95 percent of the casualties in the 1st Cavalry Division (Airmobile) were first evacuated to one of the division's clearing stations, because of the size of the division's area of operations. The remaining 5 percent, severely wounded or critically ill patients who could not have survived a stop en route, were evacuated directly to the 45th Surgical Hospital in Tay Ninh or the 2d Surgical Hospital in Lai Khe.
Since there was no difference in flying time from the combat area to the helipad of the clearing station of the 15th Medical Battalion (Airmobile) and that of the 45th Surgical Hospital at Tay Ninh, patients were evacuated to the clearing station. The two units complemented each other. Personnel at the clearing station became adept in the triage of combat casualties and in the techniques- such as administering blood and reducing shock- of stabilizing a seriously wounded patient. Surgeons at the 45th Surgical Hospital, in turn, were, freed to devote their full effort to resuscitative surgery without fear that the condition of patients awaiting surgery would deteriorate. The clearing station handled a surprisingly large number of casualties in a short period of time. It also weeded out the slightly wounded and the "sick, lame, and lazy" who would have become the responsibility of the 45th Surgical Hospital had they been evacuated there originally.
25th Infantry Division
In contrast, to the relationship between the 15th Medical Battalion. (Airmobile) and the 45th Surgical Hospital, casualties from the 25th Infantry Division, which also operated in the Tay Ninh area, were
evacuated directly to the 45th Surgical Hospital by Dust-off helicopters which operated from the hospital's helipad. Use of the, 25-bed facility adjacent to the 45th Surgical Hospital operated by Company D, 25th Medical Battalion, which supported the 25th Infantry Division, was limited to the care of the patient with a minor illness or a slight wound.
To elaborate further on the contrast between these two methods, the 15th Medical Battalion (Airmobile) operated a clearing station and used the 45th Surgical Hospital in the classic role of a surgical hospital Company D, 25th Medical Battalion, provided a holding area for patients who could be returned to duty in a few days. Under this arrangement, the 45th Surgical Hospital also served as a clearing station.
The same relationship existed between the remaining companies of the 25th Medical Battalion and the 12th Evacuation Hospital at Chu Lai. The three, companies together operated a single 25-bed facility as a holding area. The 12th Evacuation Hospital served as a clearing station as well as an evacuation hospital.
In 1968, the 25th Medical Battalion operated facilities at three locations and treated 75,184 patients. Dust-off helicopters flew 8,159 missions and evacuated more than 20,000 patients. In 1969, the 25th Medical Battalion treated more than 58,000 patients. That same year, Dust-off aircraft flew approximately 7,000 missions and evacuated about 14,000 patients.
326th Medical Battalion
During its service in Vietnam, the 326th Medical Battalion was converted from an airborne to an airmobile unit. It lost some men and ground vehicles and acquired an air ambulance platoon which became known as "Eagle Dust-off." This conversion paralleled the conversion of the 101st Airborne Division to the 101st Air Cavalry Division to the 101st Airborne Division (Airmobile). Even so, the battalion still did not match the table of organization for an airmobile medical battalion. Instead, it operated under a modified table of organization.
To insure adequate medical support for the 101st Airborne Division (Airmobile) which operated primarily in the vicinity of Hue and Phu Bai, except for its 3d Brigade which was retained in the critical Saigon area, all elements of the 326th Medical Battalion were monitored and evaluated continually. As a result of this surveillance, changes were made from time to time to improve the unit's performance. For example, four litter bearers, one from each medical company, were deleted in exchange for four preventive medicine specialists who were added to the staff of the division surgeon.
Mobile Riverine Force
The Mobile Riverine Force, created in 1967, was composed of the 2d Brigade, 9th Infantry Division, and two Navy river assault squadrons of 50 boats each. The force, designed to deny the extensive river and canal complex of the Mekong Delta to the enemy, was wholly independent of fixed support bases and operated entirely afloat. Company D, 9th Medical Battalion, supported the Mobile Riverine Force in a highly unorthodox manner. Shortly after Company D arrived at the Dong Tam base in early 1968, it established a medical, facility in a converted armored troop carrier to provide more effective medical support for riverine operations. Later this facility, the only Army medical facility in Vietnam based in a Navy ship, was moved to a barracks ship, the U.S.S. Colleton. After the arrival of Company A, 9th Medical Battalion, at Dong Tam in August 1968, Company D established a 37-bed facility for medical cases aboard the U.S.S. Nueces, thus freeing the unit on the Colleton for care of surgical patients. When the U.S.S.Mercer replaced the Colleton a few months later, the medical and surgical units were united aboard the Nueces. The rear section of the aid station of Company D was maintained in these ships at the base anchorage.
On tactical operations, Navy armored troop carriers, preceded by minesweeping craft and escorted by armored boats, transported the soldiers along the vast network of waterways in the Delta. The units debarked upon reaching the area of operations or upon contact with the enemy.
Small, specially designed craft with an aid station aboard, called aid boats, accompanied the troop boats into combat. A physician, attached to Company D during these riverine operations, went forward on an aid boat with the combat units. The aid boats functioned at night when most combat in the Delta took place. Casualties were, evacuated to the ship-based rear aid station at the base anchorage by aid boats, or by helicopters permanently assigned to the Mobile Riverine Force, at first by the Army and later by the Navy.
The primary medical problem in riverine operations was "immersion foot," which was minimized by alternating units in combat every 2 or 3 days. While the fresh troops sustained, the attack, those units relieved were allowed to "dry out" and refit.
Riverine operations brought extensive modifications in the use of personnel and equipment as well as in the structure of Company D. Ground ambulances and tents were eliminated. The aid station, as noted, was split into two sections. One section remained aboard the vessel at the rear anchorage; the other accompanied the combat units.
The two sections of the aid station were often separated for days. The section accompanying the, combat units was split even further when
two or three missions were, conducted simultaneously in different areas. Since the physician attached to the company was almost always forward with the combat elements, the medical operations assistant, a Medical Service Corps officer, usually supervised the rear section at the base anchorage. This officer and the senior enlisted medical aidmen he supervised had considerably greater responsibility for the treatment and evacuation of patients than was customary. Casualties requiring more extensive care than could be provided in the rear section were evacuated by helicopter to a hospital. Helicopters as well as shuttle craft were used to supply the aid boats from the ship-based rear section. The rear section itself was supplied from shore.
4th Infantry Division
The 4th Infantry Division was deployed to Vietnam in July 1966. Each brigade moved by sea with all its supporting elements. Thus, the attached medical company was able to maintain a continuous record of the health of the command.
Although one brigade of the 4th Infantry Division was initially positioned in the coastal area of Phu Yen Province in III CTZ, the entire division was deployed to the Central Highlands by the end of 1966 to counter the steady buildup of North Vietnamese, units in that region. During 1967, the division, and its predecessors in the Central Highlands, the 101st Airborne and the 25th Infantry Divisions, remained on the defensive. The brigades of these divisions were moved from one location to another in a series of spoiling operations as the need dictated, making it expedient at times to attach, detach, or exchange components of one division with those of another.
An example of this practice was the exchange between the 3d Brigade, 4th Infantry Division, and the 3d Brigade, 25th Infantry Division. The 3d Brigade, 25th Infantry Division, was operating in the, Pleiku area when the 4th Infantry Division arrived in II CTZ. Thus it was assigned to the 4th, Infantry Division along with its attached medical company. The 3d Brigade, 4th Infantry Division, and its attached medical, company operated as a separate task force in the area of operations of the, 25th Infantry Division. It was therefore inactivated and reactivated as the 3d Brigade, 25th Infantry Division, The exchange permitted direct operational control over these units. The medical companies exchanged became components of the medical battalions organic to their new divisions, the 4th and 25th Medical Battalions of the 4th and 25th Infantry Divisions, respectively.
Army-level medical support for the 1st Brigade, 4th Infantry Division, operating in the Tuy Hoa area, was provided by the 8th Field Hospital at Nha Trang. The 18th Surgical Hospital, supplemented by
the 71st Evacuation Hospital in late 1967, serviced the main base camp at Pleiku.
United States forces in the Central Highlands went on the offensive in 1968 and 1969. Predicated on the mobility of the helicopter, landing zones and fire support bases were set up temporarily and operational sweeps were conducted from these sites. Since combat units were widely dispersed, it was necessary to subdivide the medical assets supporting them to insure the best coverage. The "light" clearing station was evolved for this purpose.
Under this concept, teams, each consisting of a physician and from seven to 10 medical enlisted men, deployed to the landing zones or fire support bases with the units they supported. These operations usually lasted from several days to several weeks. The forward area "light"' clearing station worked in unison with the main components of the parent medical company at the semipermanent base camp in the rear where treatment facilities were housed in protected bunkers. The purpose of the "light" clearing station was to prepare the casualty for helicopter evacuation to the main section at the, base camp. At this field station casualties were quickly sorted out as to seriousness and type of wound to allow the worst cases to be evacuated first. An innovation in field medical service, the "light" clearing station allowed medical support to be provided concurrently at the base camp and in the field.
As combat activities diminished in 1970, the operations of the 4th Infantry Division were curtailed. In April 1970, the 3d Brigade, 4th Infantry Division, with its attached support elements, including Company D, 4th Medical Battalion, departed Vietnam for the continental United States. The other three components, of the, 4th Medical Battalion remained in Vietnam to support the division base camp at Pleiku and the combat activities of the 1st and 2d Brigades of the division in the Central Highlands.
To support the mission of the 4th Infantry Division in the Cambodian incursion, during May and June 1970, the 4th Medical Battalion positioned a, clearing station at a fire support base close to the Cambodian border. Use of the six Dust-off helicopters assigned to support the clearing station was dictated by the nature, of the operation. Two maintained an orbit over the landing zone, two remained on standby at the clearing station, and two were retained on call at the base camp. The majority of casualties from the Cambodian incursion received initial medical treatment at the 4th Medical Battalion's clearing station on the border.
23d (Americal) Infantry Division
Task Force OREGON, which later became the 23d (Americal) Infantry Division, was formed in April 1967. Operating from bases at Duc
Pho and Chu Lai, it moved into Quanq Ngai and Quang Tin Provinces south of Da Nang along the coast. Its mission was to free Marine units operating in I CTZ South to reinforce the area southwest of DA Nang and near the Demilitarized Zone in I CTZ North where the enemy threat continued to grow in size and intensity throughout 1967.
The task force was composed of the 196th Light Infantry Brigade, the 3d Brigade, 25th Infantry Division (later the 3d Brigade, 4th Infantry Division.), and the 1st Brigade, 101st Airborne Division. Formed as separate brigades, each had an attached medical company. Thus, the task force did not have a medical battalion. Medical planning and supply functions were provided by adding specialized administrative, personnel to the staff of the task force surgeon, thus giving him the equivalent of a divisional medical battalion staff.
Task Force OREGON having accomplished its mission, the 23d (Americal) Infantry Division was formed in September 1967 for sustained combat operations in I CTZ. At that time, the 3d Brigade, 25th Infantry Division, and the 1st Brigade, 101st. Airborne Division, were replaced by the 198th and 11th Light Infantry Brigades which had just arrived in Vietnam. These joined the 196th Light Infantry Brigade as organic components of the Americal Division. The 3d Brigade, 1st Cavalry Division (Airmobile), supported by Company A, 15th Medical Battalion (Airmobile), and the 3d Brigade, 4th Infantry Division, supported by Company D, 4th Medical Battalion, remained as attached units of the division. Initially, the 23d, Medical Battalion, which was formed in December 1967 to support the Americal Division, operated with only a Headquarters and Company A since the other medical companies were organic to their brigades. When the Americal Division was reorganized under the ROAD (Reorganization Objective Army Divisions) concept in February 1969, three companies were added to the battalion and it was authorized a strength of 38 officers and 333 enlisted men.
Medical service in the Americal Division was a mixture of the old and the, new. Casualties were evacuated from the forward area mainly by helicopter, but ground ambulances were used extensively for routine resupply, nonemergency patient evacuation, and to support MEDCAP (Medical Civic Action Program). Ground ambulances were also used extensively in the Chu Lai base area, which was more than 9 miles long, and by medical units stationed at brigade and battalion base areas along Route 1 in the Duc Pho and Chu Lai regions.
Since the size of the Americal Division's area of operations entailed fairly long air ambulance flights, medical companies were stationed at remote, inland bases, such as Duc Pho. These companies retained sick and lightly wounded soldiers for early return to duty, and also provided emergency resuscitation of the severely wounded in preparation for the long helicopter flight to a hospital.
Battalion aid stations at the firebases were near the areas of extensive combat and could provide emergency medical treatment. Inclement weather often made it impossible to evacuate patients immediately, and the battalion surgeon was on hand to care for the seriously wounded. He was also available to advise the battalion commander on medical matters and, when necessary, could use the tactical communications net to assist his aidmen in the field.
Since there was no evacuation hospital in the Americal Division's area of operations- the nearest evacuation hospitals were located at Qui Nhon, more than 125 miles from Chu Lai- patients with predictable recovery rates were retained longer than normal at the medical clearing companies. Seriously wounded or critically ill patients were evacuated to the 2d Surgical Hospital or the 1st Marine Hospital Company at Chu Lai.
The companies of the 23d Medical Battalion were housed in semi-permanent installations. Throughout 1968 and 1969, patients were held for a period of 7 days at these clearing stations. At times, they were held longer, but this was the exception. Admissions to the clearing stations of the 23d Medical Battalion involving nonbattle injuries exceeded those resulting from hostile action; fever of undetermined origin was a primary cause for hospitalization.
The 23d Medical Battalion was also responsible for treating sick and wounded Vietnamese civilians. During the period from 1 January to 31 December 1969, the, combined companies of the battalion treated 21,891 Vietnamese patients. While much of this treatment was outpatient care for the often neglected peasant in the villages and hamlets, a large percentage of more definitive medical, surgical, and rehabilitative treatment was done on the wards of the 23d Medical Battalion. Company B, 23d Medical Battalion, for example, maintained a civilian war casualty ward which accommodated 30 Vietnamese patients. The ward was constantly full and averaged about 110 patients a month. While constantly engaged in care of the sick and injured, the 23d Medical Battalion also conducted a vigorous program to train Vietnamese health workers So they could assume greater medical responsibilities in their own villages and hamlets.
Medical Support of Separate Infantry Brigades
Several brigade-sized units with organic or attached medical companies operated in Vietnam. These included the 11th, 196th, and 198th Light Infantry Brigades, that later became the 23d (Americal) Infantry Division, with their organic medical companies still intact. Others were the 3d Brigade, 82d Airborne Division, the 3d Brigade, 5th Mechanized Division, the 199th Light Infantry Brigade, the 173d Airborne Brigade,
and the 11th Armored Cavalry Regiment. The medical companies of these units operated independently of any higher headquarters in contrast to their divisional counterparts which were under the command of the division's medical battalion.
The medical companies of the 199th Light Infantry Brigade and the 173d Airborne Brigade were organic to their support battalions, the 6th and 173d Support Battalions, respectively. On the other hand, the 3d Brigade, 82d Airborne Division, and the 3d Brigade, 5th Mechanized Division, belonged to the division structures even though they operated as separate brigades. Therefore, their medical companies were attached and not organic. The 37th Medical Company, which supported the 11th Armored Cavalry Regiment, differed from the others in. that it was neither an element of a support battalion nor a medical battalion. It had been specifically tailored for an armored cavalry regiment.
37th Medical Company
At the beginning of 1969, the function of the 37th Medical Company was to support the 11th Armored Cavalry Regiment operating in the Blackhorse area. Since all combat casualties from January through April 1969 were treated at the 7th Surgical Hospital, which was adjacent to the 37th Medical Company's clearing station, the company limited its activities to routine sick call and vigorous support of MEDCAP.
In May 1969, the 7th Surgical Hospital was inactivated. The 37th Medical Company inherited its superior facilities and reorganized its treatment capability considerably. The emergency room and ward were expanded, the dental clinic was enlarged, and an X-ray unit was installed. At the same time, a section was deployed to Quan Loi to support combat operations in the forward area.
When the 37th Medical Company was assigned the task of supporting the 3d Brigade, 1st Cavalry Division (Airmobile), which was also operating in the Blackhorse area, in May 1969, a mutual support program was established with Company C, 15th Medical Battalion (Airmobile), 1st Cavalry Division (Airmobile), with which the 37th Medical Company shared its facilities. During the summer months, the 37th Medical Company received an average of 2.7 casualties a day, who were evacuated to the rear clearing station by a medical evacuation helicopter from the 15th Medical Battalion (Airmobile). The superior facilities at this rear station, especially the X-ray unit that had been installed, permitted many less serious battle injuries to be treated entirely at the, clearing station level. When the 199th Light Infantry Brigade replaced the 1st Cavalry Division (Airmobile), the 37th Medical Company, in cooperation, with Company C, 7th Support Battalion, 199th Light Infantry Brigade, continued to provide routine sick call and casualty support in
the area. Early in December 1969, the main body of the 37th Medical Company was deployed in Quan Loi to support the elements of the 11th Armored Cavalry Regiment. A small element was based at Bien Hoa to take advantage of access to the supply depot at Long Binh.
Task Force Shoemaker
Task Force SHOEMAKER, which participated in the Cambodian incursion, was composed of the 1st Brigade, 1st Cavalry Division (Airmobile) ; the 11th Armored Cavalry Regiment plus the 1st Squadron, 9th Cavalry Regiment; the 2d Battalion, 47th Mechanized Infantry Regiment; the 2d Battalion, 34th Armored Regiment; the 5th Battalion, 12th Infantry Regiment; and the 5th Battalion, 60th Infantry Regiment. The medical support of this operation illustrated the flexibility of the medical service in offensive sweeps by brigade-type units.
The task force received its medical support from elements of the 15th Medical Battalion (Airmobile) and the 37th Medical Company at the base camp at Quan Loi, near the center of the intended zone of operations. In addition two clearing stations in protected bunkers existed at this site. A forward command post of the 15th Medical Battalion (Airmobile) was added to Company C, 15th Medical Battalion, and the 37th Medical Company, the units operating the two clearing stations.
A special emergency medical team composed of a physician, two clinical technicians, three aidmen, and a radio operator was formed out of the Headquarters and Company A, 15th Medical, Battalion (Airmobile). Available for duty, anywhere in the task force's area of operations, it established a forward emergency treatment station at Katum where an aid station existed. Flown in with its equipment by helicopter, the team was functioning within an hour. A medical helicopter remained on station with the team.
In anticipation of many casualties, the bulk of the whole blood supply in Vietnam was moved forward for use by the 37th Medical Company and Company C, 15th Medical Battalion (Airmobile). The estimate of 500 to 800 casualties within the first 3 days of the operation failed to materialize, and the usable portion of the whole blood supply was returned to the 9th Medical Laboratory for redistribution.
The Air Ambulance Platoon, 15th Medical Battalion (Airmobile), moved up to Quan Loi for the operation. The platoon leader and his operations assistant were joined by the battalion commander, S-3, and an assistant of the 15th Medical Battalion (Airmobile) to coordinate the use of medical, assets. Two helicopters were assigned to the 37th Medical Company in direct support of the 11th Armored Cavalry Regiment while three others operated out of Quan Loi with Company C, 15th Medical Battalion (Airmobile). Other medical evacuation helicopters were sta-
tioned at landing zones and fire support bases. A Dust-off helicopter remained on standby at Quan Loi to evacuate casualties from the clearing station to a hospital.
After 4 days, the task force was dissolved and the 1st Cavalry Division (Airmobile) took over the operational control of all the former components of the task force. Operations shifted eastward inside of Cambodia north of Bu Dop. A second emergency medical team from Headquarters and Company A, 15th Medical Battalion (Airmobile), was emplaced at Bu Dop.
To summarize the operation, the 15th Medical Battalion (Airmobile) moved a "jump" command post forward to Quan Loi, which consisted of the battalion commander, S-3, an assistant, and the air Ambulance platoon leader and his operations officer. Two emergency medical teams were established, one at Kantum and one at Bu Dop. Each team treated about 30 emergency cases. The air ambulances of the 15th Medical Battalion (Airmobile) were positioned at a variety of places within the area of operations to insure adequate evacuation capability. The 45th Medical Company (Air Ambulance) provided one helicopter on standby at Quan Loi for the backhaul missions in addition to a liaison officer in the forward area with the medical battalion. This arrangement proved to be one of the key factors in providing the best possible medical care to the combat troops involved in the Cambodian operation.
By mid-summer of 1967, it was apparent that the impact of the helicopter on the doctrine and organization of field medical service was not transitory. The almost exclusive reliance upon the helicopter ambulance had virtually eliminated the battalion aid station, and often the division clearing station, from the chain of evacuation when a surgical evacuation, or field hospital was within the same flying time or distance.
Many medical officers with combat experience in Vietnam agreed that the reliance upon the helicopter was not a condition that was limited to the peculiarities of the Vietnam conflict. Enough experience in a variety of operations over the previous 2 years had been accumulated to support the belief that the time had come to conduct the appropriate, tests so that modifications could be instituted. A hundred physicians were interviewed in the field, often under combat conditions, as to their recommendations. Their reports were analyzed along with the critiques that had been solicited over the previous 2 years.
It was apparent that realignment of personnel and organization was needed to allow for a more, efficient application of medical assets. The consensus was that there were too many physicians in the division and brigade medical organization to make full use of their talents. Plans for
a new alignment were developed and tested by the 1st Infantry Division from October 1967 into March of the following year. It was estimated, on the basis of the test that the number of physicians in the division could be, reduced from 34 to approximately 12 without impairing the quality of medical care available to the troops.
During the test period, the brigade surgeon, artillery battalion surgeon, and engineer battalion surgeon positions were eliminated. The artillery and engineer battalions retained their medical sections as did the aviation battalion and cavalry squadron. The medical battalion was moved from the support command to division control and the infantry battalion medical platoons were placed under its direct command. Thus the medical battalion commander controlled all medical resources.
As a result of the test, all the brigade, artillery, and engineer surgeon positions were eliminated from the division medical organization. One-half of the wheeled ambulances and their crews were eliminated from the medical battalion while the medical platoons of the infantry battalions were reassigned to it. Operational control of the entire division medical service was delegated to the division surgeon.
Exact utilization of medical officers varied with each division and brigade, but by the end of 1970, all were operating under the general concept that physicians should not be assigned to combat and combat support units.