CASUALTY EVACUATION

LOOKING BACK

"Digger" James

Service Details

Major General W B 'Digger' James AO MBE MC OStJ graduated from RMC in December 1951. He served with 1RAR in 1952, was seriously wounded, evacuated home and spent 14 months in hospital. He transferred to the RAAC, and served as Adjutant at the Armoured School for two years, followed by a year as Adjutant of the 12/16 Hunter River Lancers at Muswellbrook. Resigning in 1956, he proceeded to complete a medical course at Sydney University, graduating in December 1963. After hospital residency, he rejoined the Army as a medical officer in the RAAMC. He retired in 1985 after a variety of postings in Australia and abroad, as Director General Army Health Services.

He served in South Vietnam for a year, 1968-69, as Commander of 8 Field Ambulance and Senior Medical Officer of 1ATF in Nui Dat, and later in 1971 headed a British St John's Ambulance medical relief team, at the conclusion of the Biafran Civil War, in Nigeria. Following retirement, he was appointed Queensland Director of Visy Board, a position he still holds.

Greatly involved in veteran affairs, he was elected National President of the Returned & Services League of Australia in 1993.

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My involvement in the Korean War was short and swift. After some seven months of regimental life in Australia as a junior platoon commander in 2 Battalion RAR, then the RAR Depot Battalion (4RAR), I was posted to Japan in September 1952 to await being called forward as a reinforcement to a battalion in Korea. On 30 October I arrived in Korea to join A Company 1RAR commanded by major David Thomson MC who sent me to take over command of 2 Platoon, then commanded by a magnificent soldier, Sergeant L S (Squizzy) Taylor MM. I was wounded on my second patrol in front of Hill 355 on the 7th of November 1952.

In later years, whilst serving in the RAAMC, I was very concerned to ensure that care of the sick and injured on the battlefield was understood; of high quality and given high priority. As history has so often revealed, war is won ultimately on the ground. My thoughts and passion on this truism recently compelled me to put to paper my experience of 1952 in casualty evacuation as an example of teaching lessons learned in war and so that it may be recalled in "Korea Remembered", as a tribute to the magnificent soldiers who served with me..

In his epic textbook "Organisation, Strategy and Tactics of the Army Medical Services in War", published just 60 years ago, Colonel T B Nicholls RAMC wrote from his experiences on the Western Front in World War I, but with a prophetic eye on the looming war clouds that were soon to burst into World War II. Many of his pithy statements, I believe, are timeless and bear repeating.

Firstly:

In regard to the fundamental purpose of the medical services in War he wrote:

"The medical service is neither autonomous nor independent - it exists to serve the rest of the Army and must conform with, and be subordinate itself to, the general plans of the Army".

The aim of an army will always be clear and concise. It may be to defeat the enemy, it may be to withdraw from an area, or it may be to capture a particular feature. Whatever the aim, the Medical Services, in Nicholls words, simply "exist to serve".

Secondly:

Nicholls wrote:

"It has often been said that those who can produce a last 100,000 men will win a war. If the Medical Service is inefficient, or is deprived of anything necessary to enable it to function properly, this last 100,000 will be in hospital and NOT on the battlefield, where their presence might turn the scale."

Thirdly:

Nicholls stated:

"The finest surgeon, however, is powerless unless his patient and his materials can be brought to him ... the success of the treatment of our wounded depends to a large degree upon efficient and rapid movement of the cases."

and went on to say:

"The other secret of success is rapid evacuation. All through the chain of medical units from the Front to the Base, the wounded man is kept the very minimum of time to attend to his wounds, and then he is moved on, and kept moving until he reaches either the Base or Home. Some, of course, are too ill to be moved, and these may have to be retained."

The reason for rapid evacuation is twofold, says Nicholls,

Firstly, it is very bad for morale if troops see wounded men lying about in large numbers; and,

Secondly, unless Medical Units are cleared, they lose their mobility, and also cannot deal with a fresh influx if wounded that might come in quite unexpectedly."

Lastly he stated:

"An efficient medical service is a great conservator of manpower, as, by its insistence on the principles and practice of hygiene, it keeps the troops healthy and avoids wastage from sickness. It is a great incentive to good morale, as they know that, if they are wounded, they will be well looked after."

I consider the words of T B Nicholls are as sound today as they were when written all those many years ago.

I write here in general terms on the 'Evacuation Chain' in war, and in so doing, try to pick out valuable lessons from history, and, if I may, relate some personal anecdotes in regard to 'Evacuation'. Many authors of military medicine, and indeed, in all official military histories I have studied, always point out two fundamental axioms of war surgery that seem to always require repeating to the next generation of military medical men, and these are:

Firstly:

High velocity gunshot wounds are very different from all other wounds. Tissue and structure damage is related to the imparted Kinetic Energy of the missile - half mass times the velocity squared. IT IS the 'squaring' of velocity that is the significant feature. As an Armalite bullet, for example, travels at about 1000 ft/sec. This means when squared, energy is 1,000,000 units times the mass.

 

Secondly:

Casualties must be evacuated for both their best care, and moreover to allow the forward medical unit to continue to support the battle.

Let me quote the British Army 1962 publication, 'A Field Surgery Pocket Book of the RAMC" which in this regard is still most relevant.

"A surgeon with extensive experience of civilian surgery may make costly mistakes under field conditions. His new and strange circumstances may cause him to forget basic surgical principles. Unorthodox individual techniques, which may have worked well in civilian practice, in war conditions may jeopardise the patient's chances of survival. Patients cannot remain under an individual surgeon's personal care in the forward area, but must, after prompt stabilisation, be evacuated at once. He will then come under another doctor. For this reason, surgery, in general, must be as simple and standardised as practicable."

In my own case, on the battlefield in Korea - November 1952 - I was wounded leading a 12 man infantry patrol to capture an enemy held outpost. As a consequence, I rapidly became interested in war surgery and casualty evacuation.

In the midst of the final assault on the small enemy objective, I stood on a landmine and was blown up. One of my men was killed instantly and three others wounded. My injuries were serious, including traumatic amputation of my left leg below knee, multiple complicated compound fractures of my right leg and foot, and Gun Shot Wound's to my hands, arms and head. Following the explosion, I, with my wounded men, had the classic evacuation and subsequent restoration to good health. Let me detail some of the relevant points in the medical care and evacuation process that occurred to me.

As is normal with a small patrol, we did not have a medic, so we each applied basic first aid to each other. I applied a tourniquet (bootlace from right foot boot lying near me) to my left amputation using a gold propelling pencil (a gift from my fiancee Barbara, who later became my wife). A stretcher party was called for by radio, and as only one stretcher was available, there was some delay in getting the three stretcher cases back to base. Being last to be picked up, it was some ninety minutes before I reached the forward company position and from there taken by a jeep fitted with a stretcher frame to the battalion regimental aid post (RAP).

Here I was given my first attention by way of formal first aid and resuscitation by the controlling of pain and haemorrhage, ensuring a good airway and circulation. Despite loss of blood, adequate intravenous fluids in those days was not available at the RAP. All of this occurred in winter and it was snowing throughout the time. I was very cold but was made comfortable with blankets and the warmth of a fire at the RAP. It was here that much of my infantry equipment was removed, but I remained on the same stretcher for the next phase of the evacuation.

The next phase was via a road ambulance of the 60th Indian Field Ambulance to the US 8055 MASH - a distance of perhaps some 15 kms over rather bumpy roads. I remember being very thirsty and the very attentive Indian medics provided me with a beautiful cold drink of water - now I know that shock had set in. The MASH was exactly as you have seen on the TV series, only the Unit Number was changed for the series.

The care in the MASH was superb - X-rays and immediate stabilisation surgery undertaken to control haemorrhage and immobilise fractures. 'Hot Lips' was not in attendance (at least I don't remember her!) They saved my life for which I shall always be grateful. One silly incident was that I had developed a pain in my back during the ambulance trip with the Indian Field Ambulance and complained to the doctors in the MASH. Still on my stretcher, an X-ray soon detected the problem - one of my hand grenades (fully primed) was under my back. I think I heard the shout "Get Radar!" - in fact, as it was a 36M grenade, unknown to the US medical personnel, I made it safe.

The MASH was very busy, and I had several surgical operations in the succeeding days. I recall being given a marvellous 'smoke' by a medic in the snow, awaiting entry to the primitive 6 table operating theatre. Anaesthetists these days would shudder at this! After some days in the MASH with further surgical stabilisation, I was evacuated to the US 121 Evacuation Hospital in Seoul on a Hospital Train. This, I recall, was a converted series of sleeping carriages, rather airy, short bunks and warmed using wood-burning pot-bellied stoves. It was a comfortable three hour journey, as I remember. The 121 US Evac Hospital was in a converted school, and I was placed in the origins of what we now call 'Intensive Care'. I was there for six days and needed more surgery, as my right foot required further partial amputation due to distal ischaemia. Nursing was very poor.

The next phase of evacuation was to Japan by air. The RAAF, using converted DC3's flew regular sorties of casualty evacuation to Iwakuni air base in Japan. It was not a very comfortable journey for we were placed three stretchers high, but Morpheus was a great help. We stayed overnight in a glorious RAAF hospital, and then travelled by road to the British Commonwealth General Hospital in Kure, Japan.

For the next four weeks I was given excellent care, and underwent more surgery in this very well equipped general hospital. Anxious to be home for Christmas, the next evacuation was arranged. This involved a short journey by sea back to the air base in Iwakuni, over-nighting at a US hospital at the US Naval Base at Guam, and a glorious boozy stop over at Port Moresby which was put on by the Australian Army staff and families, with music and good cheer.

The flight to Sydney was painless and not remembered, such is the excellent analgesic qualities of alcohol. In Sydney, I was transported by ambulance to the Repatriation General Hospital at Concord. I was there for 2 days, and, with considerable difficulty, gained approval to be transferred to my home state of Victoria. Australia was at peace, Christmas was 2 days away, and for the first time in my evacuation, I observed and felt the lethargy of a peacetime service which put staff needs before patient needs. I was told that I would be moved to Melbourne after the Christmas holidays! I got very angry, and insisted I should speak to Mr Bob Menzies, our PM at the time, on the subject. Suddenly a flight home was arranged. I arrived in Melbourne on Christmas Eve to my fiancee and family.

For the next 14 months I was managed at RGH Heidelberg in Melbourne, and returned to duty to take up the appointment as Adjutant of the Armoured School in Victoria.

The point of my story is to give a typical process of evacuation of a war casualty. This story was typical of evacuation in both World Wars, and in subsequent wars. It happened then, and it will happen again.

I conclude by a summary of some major points in the process of the 'Evacuation Chain."

1. The wounded soldier has invariably been in the front-line for hours, usually days, at time of wounding. Although usually a very fit chap, he is dirty and he is dehydrated.

Needs: First Aid at point of wounding - self, mate or medic. Fix airway, and blood loss. Save own blood early, as this is better than transfusions later. Simple temporary immobilisation of fractures is good for both the long term healing, and is excellent to relieve pain.

Also Suggest: Fluids and antibiotics.

2. Medical care must be continuous.

3. Medical/surgical care must be simple, orthodox, and above all .....

* highest of quality of medical notes must be kept, recorded, and travel with the

patient at all times. Diagrams of wounds, procedures, investigations are essential for proper ongoing management.

4. Overfly particular casualties to specialised unit if needed and if possible.

eg. Neurosurgical, Facio/maxillary.

5. Maintain military hospitals at home for care, including rehabilitation, for return to duty.

Editors Note:

The incident referred to by "Digger", in all modesty, is better recorded in the official history:

" One of the early 1 RAR patrols, led by Lieutenant W.B. James on the night of 7-8 November, was badly blown up when it unwittingly entered an unmarked and unrecorded minefield which the Canadians had laid around an out post position. A group of enemy was heard moving nearby as James' patrol approached the outpost. When he deployed his men to ambush the Chinese, they entered the minefield. One man detonated a mine and was killed. Four others, including James were wounded. The force of the blast took off James' left foot and badly broke his right leg. He remained conscious and in command of the patrol, although in great pain. He organised the evacuation of casualties, insisting he was the last to be moved, even though it was over three hours until he was back in the battalion position. He was awarded the Military Cross."