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WW2 Air Evacuation
Wartime evacuation of sick and wounded personnel from overseas Theaters involves problems quite different from those encountered in peacetime because of the volume of traffic and the abnormal transportation conditions! As reported before, the United States Army had not made adequate advance plans, and much had to be done in developing facilities and procedures after the United States entered World War 2 (you are kindly invited to also read our Articles on Hospital Trains and Hospital Ships).
World War 2:
The US Armed Forces had their first large-scale experience with Air Evacuation during WW2. Because incapacitating wounds frequently occurred in areas remote from available medical facilities, providing care to soldiers and airmen often required evacuation by air! In fact, informal Air Evacuation operations began in 1942 in the Pacific Theater and in Asia. Most sea and land routes in the CBI Theater and the Southwest Pacific region inhibited rapid medical evacuation. Cargo and Troop Carrier planes returning empty from the front lines were often the ONLY swift means of evacuation, and transported medical patients to General Hospitals in New Caledonia, the New Hebrides, and Australia.
According to T/O 8-455 dated November 19, 1941 a Medical Air Ambulance Squadron (later designated Medical Air Evacuation Transport Squadron) consisted of one Squadron Headquarters, one Ambulance Section (single-engine transport plane), and two Ambulance Sections, (bi-engine transport planes). Total personnel included 45 Commissioned Officers, and 218 Enlisted, with a number of vehicles, such as 10 Cross-Country Ambulances, 4 Five-Passenger Sedan Cars, 7 ¼-Ton Trucks, and 4 1 ½-Ton Cargo Trucks. When necessary, suitable light aircraft capable of operating from small fields or airstrips were to be substituted in the bi-engine transport planes, on the basis of 18 single-engine airplanes for 12 bi-engine planes.
The MAETS was generally assigned to one of several commands of the United States Army Air Forces for the purpose of providing Medical Department personnel to Troop Carrier and Air Transport units utilized in air evacuation of sick and wounded. By late 1944, T/O 8-477 described the Squadron as consisting of one Squadron Headquarters and four identical Evacuation Flights. Each Flight was normally composed of 1 Medical Officer, 6 Army Nurses, and 8 Enlisted Men. It could be further subdivided into 1 Classification Section (Flight Surgeon, Clerk, and Supply Corporal) and 6 Evacuation Teams (Nurse, Medical Technician). The majority of vehicles were light Trucks and Trailers, including a Water Trailer.
During and after ‘Operation Torch’, the invasion of North Africa, (Algeria-French Morocco Campaign 8 Nov 42 > 11 Nov 42) hospitalization and evacuation of Task Force casualties remained the responsibility of the expeditionary surgeons until the medical section of the Allied Force Headquarters was securely established. Evacuation of critical cases from the Western Task Force at the time was by Troop Transport to the United States, while casualties from the Center and Eastern Task Forces took place by British Hospital Ships to the United Kingdom. It was only during the early phases of the Tunisian Campaign (17 Nov 42 > 13 May 43) that more patients were to be evacuated by air, utilizing medical facilities and aircraft furnished by the Twelfth United States Air Force. Casualties were now being flown out, but the operation was still informal and infrequent - with time it would quickly prove its worth!
Hospitalization and evacuation in the Sicily Campaign (9 Jul 43 > 17 Aug 43) showed marked improvement over practices in North Africa and Tunisia in particular. Critical, but transportable cases were sent directly to Evacuation Hospitals, where they were held for additional treatment, or evacuated to the North African ComZ, according to circumstances. Overcrowded hospital facilities and the strain placed upon medical units, who not only had to care for American troops, Allied patients, and captured enemy personnel, but also for a large number of Italian civilians who had no other means of medical treatment, made evacuation out of Sicily necessary! The Seventh United States Army Surgeon arranged for immediate evacuation from the island by Hospital Ships and Carriers, while arrangements were made with the North African Air Force Troop Carrier Command to handle part of the evacuation by air from airfields around Gela and Licata, starting July 14, from Agrigento, starting July 23, from Palermo, starting July 27, and from Termini, starting August 5, 1943. Between July 10 and August 10, 1943, a total of 5,967 patients were evacuated by air to Mateur and Tunis. Air evacuation from Sicily followed the basic patterns developed in Tunisia, but was more highly organized. It must be noted, that only a handful of critical patients were evacuated by air to the United States. In fact over 20,000 US Army patients were evacuated from N. Africa to the ZI by American Hospital Ships and Troop Transports (Jan > Dec 43). The total percentage of medical patients evacuated by air during 1943 only represented 4.5%.
With the landings at Salerno on September 9, 1943, began ‘Operation Avalanche’, the invasion of the Italian mainland. Since the Tunisian and southern Italian campaigns supported the principle of air evacuation by the Twelfth and Ninth US Air Forces, the method now proved suitable for every type of patient, except those in shock. Moreover this method of evacuation was available and suitable day and night and demonstrated enough safety to be increased. During the Italian Campaigns (Naples-Foggia 9 Sep 43 > 21 Jan 44 – Anzio 22 Jan 44 > 24 May 44 – Rome-Arno 22 Jan 44 > 9 Sep 44 – North Apennines 10 Sep 44 > 4 Apr 45 – Po Valley 5 Apr 45 > 8 May 45), Fifth US Army patients were moved as rapidly as possible to fixed hospitals in North Africa and in the developing Communications Zone area around Naples. All evacuation out of the combat zone was to Africa, by sea from the Salerno Beachhead, and by air from Naples. Between September 9, 1943 and January 21, 1944, 19,048 patients were evacuated by air from Italy to North Africa.
In the European Theater of Operations, a small but growing number of medical patients now crossed the Atlantic by air. Following categories of priority patients were established for this method of evacuation: emergency cases without further treatment locally available – men whose evacuation was deemed a military necessity – men who required prolonged hospital and convalescent care. Most patients in these categories were transferred from General Hospitals to the Transatlantic Military Air Terminal at Prestwick, Scotland, where USAAF and SOS personnel loaded the evacuees on C-54s for the flight to the United States. In the course of 1943, USAAF Medical Air Evacuation Transport Squadrons began arriving in the United Kingdom to formally run the operations (with the 811th MAETS operating out of Prestwick).
Additional units were organized and would serve overseas, including the Pacific and the China-Burma-India Theaters. They involved the 803d – 810th – 813th – 815th – 816th – 817th – 819th – 820th – 821st – 823d – 824th – 830th MAETS …
In 1944, 18.2% of all Army casualties were evacuated by plane. The expansion of the Communications Zone, and the rapid advance of the Allied Armies precipitated the installation of Air Holding Units, consisting of Field Hospitals and other medical facilities in order to send off patients by air (lack of trucks, long evacuation routes). The widening gap between combat forces and ComZ rear medical treatment and evacuation still clustered near the Normandy beaches and in England held up normal evacuation by road or by train. Between August and September 1944, C-47s carried about 54,000 patients to Britain, and 6,300 to various destinations in France. Although the European Theatre used Air Evacuation more than other Theatres, especially from forward areas, the majority of patients still travelled by Hospital (or Transport) Ship, especially for evacuation to the Zone of Interior. There were simply not enough transport aircraft, or suitable patients to justify a more significant use of Air Evacuation to the United States. The end of the war in Europe, and the enhanced military operations in the Pacific, did increase medical air evacuation, notwithstanding the lack of priority for evacuating patients (as opposed to supply of military personnel and materiel), and in 1945, the number of patients evacuated by air reached 22.5%.
Flying Nurses: in 1944, over 6,500 Nurses were on duty with the AAF. Of this, 500 were Flight Nurses serving throughout the world whenever wounded needed to be evacuated by plane. When assigned to the US Army Air Forces, Army Nurses were sent to 11 different AAF Training Centers for 4 weeks of military training and physical conditioning, before being sent to the various USAAF Station Hospitals throughout the Zone of Interior.
In June 1942, the War Department established the Air Transport Command (ATC) to move equipment, cargo, and personnel between the various Theaters. In September, the command began to assign high-priority to sick and wounded patients returning to the ZI. As new and more powerful C-54 ‘Skymasters’ soon became available, the first regular scheduled medical evacuation flights from the United Kingdom to the United States got under way in the summer of 1943. Similar routes were set up from North Africa.
After 6 months’ duty in an AAF Hospital, members of the ANC were eligible to apply for Flight Nurse training. If they met all the demands, the Nurses were sent to the ‘School of Air Evacuation’, Bowman Field, Kentucky. Here they underwent 8 weeks of academic, professional, military and physical training to prepare them for the strenuous duties ahead. Upon graduation, they were rated Flight Nurses and were permitted to wear special gold Combat Observer wings with the A.N.C. insignia superimposed. The first Flight Nurses arrived in the Sicilian and Italian Theaters as soon as it was possible to send transport planes to the front for evacuating the wounded.
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