CHAPTER FOUR
Hospitalization in Korea

HOSPITAL SUPPORT IN KOREA

In medical planning for combat support, many estimates must be developed from consideration of projected numbers of hospital patients and beds. Estimates may be made, for example, concerning number and classes of hospital beds and hospitals and of medical personnel required to operate them, or numbers and classes of military personnel who will reach personnel replacement depots after hospital treatment. In making these estimates, the planner deals at one time or another with projected hospital admissions; with hospital bed occupancy and the average duration of hospital stay, influencing and influenced by the length of the evacuation policy; and with dispositions from hospital, by type of disposition, returns to duty, out-of-theater evacuations, deaths; and for echelon-to-echelon analysis-transfers to other hospitals. All of these are needed separately for various categories of patients (for example, Army, non-Army; battle casualty, disease and nonbattle injury) and for various types of hospitals (for example, close combat support, and communications zone). While past experience seldom provides exact parallels to the situations with which the planner must deal, it often provides a basis, or at least a starting point, for the development of useful descriptions of relationships among the variables to be considered in planning for hospitalization.

It is extremely difficult at best to present a picture of hospital support in Korea which would reflect the classical configuration of echelon deployment. During the initial stages of the campaign, hospital support was critically short. By the end of the first 6 months, all U.N. casualties had received their care from a maximum of four mobile army surgical hospitals (whose bed capacities increased from 60 to 150 by November 1950), three 400-bed semi mobile evacuation hospitals, four 400-bed field hospitals, one station hospital, and three hospital ships (9). During the year 1951, the same four mobile army surgical hospitals (with bed capacities increased to 200 in May 1951) continued in close support of the frontline divisions. In April 1951, an additional unit of this type became operational. Of the three 400-bed semi mobile evacuation hospitals, only one continued its mission in reasonably close support of combat troops, one was inactivated in December 1950, and the other was returned to Japan upon the withdrawal from North Korea following the intervention of the Chinese Communists When this latter unit was later recommitted in July 1951 at Taejon, it was too far to the rear to permit its utilization in close support of the divisions. A fourth evacuation hospital was at Conju until the fall of 1951 when it moved to Wonju. Although three additional evacuation hospitals were committed in November 1951, they operated more or less in the role of station hospitals. Of the four field hospitals that had been in Korea in 1950, only one functioned in its normal role and it was inactivated in November 1951. Another that had returned to Japan in December 1950 was recommitted at Koje-do in April 1951 to provide medical care for enemy prisoners of war. The other two field hospitals were in Pusan and they also were engaged in treating enemy prisoners. The one station hospital activated in 1950 was operational in Pusan until November 1951, when it was inactivated. A second station hospital was operational in Pusan until October 1951.

HOSPITAL SYSTEM IN KOREA, 1952

With the initiation of truce talks at Kaesong in July 1951 and the subsequent general stabilization of battlelines, the functions of certain hospitals in the chain of evacuation in Korea became identifiable, although somewhat unorthodox, since the functions of those hospitals were not those indicated by their official designations. Nevertheless, by considering the functions actually performed rather than the unit designations, the relationship of the units to the pattern of hospital operations became generally, discernible, and the framework in which these data are presented, represents a reconstruction

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of the way in which the hospitalization. and evacuation systems operated in Korea in 1952.

In this manner, 10 separate functional types of hospitals could be identified among the 25 U.S. Army hospitals which were operated at various times by designated U.S. Army medical units in Korea during this period. It was also possible to group nine of the 10 types of U.S. Army hospitals in Korea into the two major zones of operations: the field army area (combat zone) and the communications zone. Since the POW (prisoner-of-war) hospitals were established expressly to treat and care for internees and enemy prisoners of war, they are considered as a separate group and have not been identified with either of the two major operational echelons of hospitalization.

Calendar Year 1952 is particularly relevant to this analysis because it represented a period during which the hospitalization and evacuation pattern for Korea remained fairly even, reflecting the relative stabilization of battle lines which took place after initiation of truce talks in mid-1951.

The character of tactical operations is reflected in the frontispiece which shows admissions for U.S. Army personnel to hospital and quarters, for each month, in terms of numbers per year per 1,000 average strength. For the first 5 months of 1952, the trend of the battle casualty rates reflects relatively minor engagements, patrol skirmishes, and occasional raids into enemy territory. In June, the battle casualty admission rate tripled when heavy fighting for possession of strategic heights broke out in the Chorwon-Yonchon sector of the central front. A seesaw "battle of the ridges" continued during July, settling down in August to localized though bitter battles for individual hills: "Old Baldy," "T-Bone," and "Bunker Hill." Fighting for the latter hill raged on indecisively during September. Battle casualty admissions reached their peak for the year during October, when the Communists launched a coordinated attack (the largest of the year) on the western and central fronts. Wounded admissions declined sharply in November and December, reflecting curtailment of combat operations in the severe winter weather.

Variations in admission rates for nonbattle causes reflected annual seasonal influences to some extent; the rate for February represented a winter peak, and rates for January and March were relatively high. The subsequent decline was interrupted in May- increased incidence of neuropsychiatric conditions and of malaria was reported, coincident with increasing intensity of combat- but the downward trend was resumed in September.

It should be pointed out that the situation depicted is perhaps completely atypical in some respects- for example, a very high proportion of patients in Army hospitals in Korea in 1952 were non-Army personnel, chiefly, prisoners of war. On the other hand, these data present a body of data pertaining to all hospitals in a combat area-communications zone system although, ordinarily, readily available logistical information pertains only to fixed hospitals. While the data provide a historically valid quantitative account of a 12-month period of wartime Army hospital operations in Korea as they actually took place, it is necessary to emphasize that any critical analysis of these data should evaluate very carefully the many special factors which influenced them.

SOURCE OF DATA

Each Army medical treatment facility which provided hospital beds was required to submit a Beds and Patients Report (DD Form 443) each month to The Surgeon General and to senior medical officers in appropriate intermediate headquarters. These data were obtained from that report, which was submitted weekly as required by Army regulations in effect in 1952 (10). The report included the number of admissions to hospitals, distinguishing "initial" admissions (patients, admitted directly, and patients referred from dispensaries, aid stations, and other nonhospital facilities) from admissions by transfer from other hospitals. The number of dispositions from hospital by type (such as duty, death, evacuation to the United States, and transfers to other medical treatment facilities) was also included, along with the patient census and the number of beds occupied. These data were reported separately for several types of patients- Army, Navy-Marine Corps, and Air Force active-duty personnel, and other patients as a group. When a facility's patients included battle casualties, a separate report pertaining to battle casualties was submitted. Medical treatment facilities providing hospital care for prisoners of war also furnished data pertaining specifically to that category of patients.

OUTPATIENT AND QUARTERS CARE

Although these data deal with hospitalization in Korea, it is of background interest to note briefly the size of the nonhospital patient care workload in

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that particular area during this period of the Korean War.

Of those who required care at Army medical treatment facilities, the majority were not, of course, admitted to hospital or excused from duty for treatment elsewhere, but were, in reality, attended as outpatients. During 1952, in Korea, there were more than 4,700,000 visits to Army medical treatment facilities by outpatients; and almost 1,500,000 of these outpatient visits were made by Army active-duty personnel, at sick call or at other times (11).

The patient who is admitted in the course of a visit to a medical treatment facility is not reported as an outpatient. He is a "direct admission"- that is, for U.S. military personnel, a patient excused from duty (retained past midnight, so that his organization's Morning Report reflects a change in his status) for treatment in hospital or "quarters," including nonhospital facilities such as aid stations, clearing stations, and dispensaries. During calendar year 1952, Army, hospitals and other Army medical treatment facilities in Korea reported some 133,172 admissions "to hospital and quarters" for Army active-duty personnel, including 12,007 wounded admissions and 121,165 disease and nonbattle injuries.

Of these admissions to hospital and quarters, treatment for a high proportion was completed forward of hospital or while they were in a "quarters" status- they did not become hospital admissions. Thus, in Korea during 1952, there were approximately 73,000 initial admissions to hospital for U.S. Army personnel, the remaining excused-from-duty patients being treated not as hospital patients but in "quarters" or in nonhospital facilities. For U.S. Army personnel in Korea, the rates of admission per year per l,000 average strength were as follows: to hospital and quarters for all causes, 576, and to hospital, 326; for wounded, to hospital and quarters, 52, and to hospital, 44; and for nonbattle causes, to hospital and quarters, 524, and to hospital, 282.

LIMITATIONS OF DATA

Tables 54 through 57 present data on patient flow and other hospitalization data in detail, for all personnel and for U.S. Army personnel, separately, by cause of admission (battle and nonbattle) for individual U.S. Army hospitals operating in Korea during 1952. The data are also presented for functional groups of hospitals.

It will be observed that "initial admissions" have not been supplied for the individual hospitals listed in tables 54-57. While the total number of hospital admissions reported from Korea in 1952 appears to be valid, analysis indicates that the reported number of initial hospital admissions was understated, particularly for Army patients admitted for nonbattle causes, with a corresponding overstatement in the number of admissions by transfer. Such, a disparity may arise when personnel at rearward hospitals assume erroneously that patients from forward units should be reported as "transfers," the presumption being that they will already have been reported as initial admissions by forward hospitals. Unfortunately, such an assumption is perhaps least valid when it is most tempting to make it during periods of peak admission loads. Peak work-loads at hospitals in the rear may reflect increased activity at the front, which, of itself, may have required unusual or changed evacuation procedures- that is, medical treatment facilities normally in the chain of evacuation may have been bypassed, or fighting on a flank may have resulted in a large number of casualties in an area to which forward medical facilities had not yet been deployed, so that the casualties were moved directly to rearward hospitals. Valid estimates of the correct numbers of the initial admissions and of admissions by transfer may be obtained for the entire area by considering the number and nature of the dispositions reported. Reasonably precise "corrections" may also be made in the data pertaining to groups of hospitals. However, estimating "corrections" for individual hospitals is more difficult and requires information not readily available. Consequently, estimated numbers of initial hospital admissions and of admissions by transfer are presented for the Korean area as a whole and for groups of hospitals, but such estimates for individual hospitals are not shown. It may be presumed with some certainty, of course, that virtually all admissions to hospitals in the field army close-support group were initial admissions.

FIELD ARMY AREA HOSPITALS

Units operating hospitals in the field, army area included five, designated as 60-bed mobile army surgical hospitals, but augmented to 200-bed evacuation hospitals. These evacuation hospitals (semimobile) furnisbed close support to the frontline troops. One of these hospitals (8225th MASH) became inoperational at the end of May 1952. At that time, the portion of the line to its front was held by Republic of Korea troops. However, it was later reopened, in September 1952, as a 60-bed

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¹ Group totals estimated.
² As indicated in these notes, some hospitals were not operational throughout the entire calendar year. Averages in this column pertain to the actual period of operation for individual hospitals; for echelon and other groups, however, averages pertain to the entire year. Consequently, individual hospital averages as shown do not in all cases add to averages for the groups.
³ Estimated on the basis of summary report data.
⁴ Indicates no patients and so forth were reported, or that a computed average was smaller than 0.5 or 0.05, as applicable.
⁵ In 1953, these hospitals were reorganized and redesignated from 200-bed units functioning as evacuation hospitals (and one specialized hospital) to 60-bed surgical hospitals with missions appropriate to that type of unit. For convenient reference, the new designations applicable in 1953 are shown in parentheses.
⁶ Although group totals have been estimated, such estimates are not feasible, on the basis of available data, for individual hospitals. See discussion in text.
⁷ Functioned as an evacuation hospital, January-May 1952, inclusive. In June 1952, this hospital was placed on a standby training basis, and was reopened in September 1952 as a 60-bed surgical hospital, operating as such through the remainder of the year.
⁸ Functioning during the period May-December 1952, inclusive. This unit operated seven holding stations at points of transfer from ambulance to rail or air transport. This table does not reflect the unit's holding station operations, however ; patients received at transfer points and held for very brief periods awaiting further transportation are not accounted for as admissions or otherwise in summary statistical reports of hospital patients. Data shown pertain to personnel from organizations in the vicinity of those stations, for which the clearing company provided primary medical care.
⁹ Functioning during the period April-December 1952, inclusive.
¹⁰ Functioning during the period April-December 1952, inclusive. These two units were designated as the 123d Medical Holding Hospital.
¹¹ Functioning during the period January-May 1952, inclusive.
¹² These two units combined operated a single POW hospital at Pusan until the summer of 1952, when the 3d Field Hospital moved to the island of Cheju-do. However, single monthly reports for the two hospitals combined were received throughout 1952.
¹³ Functioning during the period April-Deceraber 1952, inclusive.
¹⁴ Functioning during the period August-December 1952, inclusive. The lst Platoon operated a 150-bed hospital, while the 2d and 3d Platoons each operated a 50-bed holding hospital for POW patients awaiting evacuation to the rear. However, only single monthly reports for the three platoons combined were received throughout 1952.

Source: Beds and Patients Report (DD Form 443).

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