Casualty Reports

 
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CHAPTER FIVE
Evacuation of Patients From Overseas

 

EVACUEE REPORT CARD

Information on evacuees becomes necessary whenever their numbers are large. This information is needed to plan for hospitalization in the United States, as well as for evaluating evacuation policies, and evacuees. During World War II, more than one-half million evacuees were, admitted, with 50,000 received in the peak month. Army regulations (12) in effect at that time contained standby provisions for submission of evacuee report cards (MED-75) by hospitals in the United States which received evacuees for definitive treatment. When the number of evacuees decreased markedly after World War II, submission of the report card was discontinued. With the outbreak of hostilities, in Korea and consequent increased demands on available hospital capacities in the Far East Command and in the United States, the requirement for submitting the evacuee report card was reinstituted in September 1950.

Accordingly, a record was prepared on each evacuee patient from overseas admitted to a hospital in continental United States beginning in September 1950. The evacuee report card was prepared by the first hospital in the United States to which the evacuee patient was admitted initially for definitive treatment. Hospitals were required to

Table 63-All evacuees received in continental United States,
by area of origin and category of personnel, 2 September 1950-31 December 1953

Area of origin Category of personnel
Total Army Air Force Civilian
and other1
All areas
55,382
52,613
1,458
1,311
North America
1,752
1,345
261
146
Latin America
718
637
31
50
Europe
10,141
9,499
217
426
Pacific
1,820
1,487
234
99
Japan-Korea
39,568
38,515
516
537
Africa and Near East
43
16
13
14
Not specified and miscellaneous
2 1,340
1,115
186
39

1 Includes a few U.S. Navy patients.
2 Includes some cases originating at sea.

prepare the card. within 7 days of the date of admission and forward it to the Army Surgeon General at the end of the following report week.

These data cover 55,382 evacuee patients received in the United States during the period 2 September 1950-31 December 1953. The inclusiveness of this period encompasses the complete duration of the Korean War, July 1950-July 1953. Since evacuees were received from other overseas areas as well as from, Japan-Korea, total counts are given in table 63 by category of personnel and by area of origin. Approximately 95 percent (52,613) of the 55,382 evacuee patients were U.S. Army personnel, of whom 73 percent (38,515) were evacuated from Japan-Korea. The mode of transportation was specified as being ship or plane, or both, for 55,163 evacuee patients. For U.S. Army personnel, the number was 52,424, of whom 38,347 were from Japan-Korea. The percentage distributions by mode of transportation are presented in table 64.

Table 64.- Percentage distribution, by mode of transportation of personnel,
all evacuees received in United States, 2 September 1950-31 December 1953

Type of personnel Mode of transportation
Air Water Air and Water
All personnel, all areas
93.2
6.6
0.2
Army personnel, all areas
93.4
6.3
0.3
Japan-Korea
95.4
4.3
0.3
All other areas
88.2
11.7
0.1


EVACUATION POLICY AND DAYS BEFORE EVACUATION

Aside from any limitations which might be dictated by the condition of the patient or by the availability of transport, one of the chief determinants for defining parametric values of the order of magnitude of evacuees is the length of the evacuation policy. At the beginning of the war, the evacua-


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tion policy was 21 days for hospitals in Korea and 120 days for hospitals in Japan. By September 1950, the evacuation policy for Japan was reduced to 60 days and, for a short period, to 30 days, returning to 120 days in October 1950. Because of the Chinese Communist intervention and the resulting influx of casualties from Korea, the evacuation policy was again lowered to 60 days in December 1950 until 19 January 1951, when it returned to 120 days and remained at that level throughout the war. In Korea, during the early period of heavy casualties, evacuation was determined, to a large extent, by the availability of beds and the number of wounded being received. Subsequently, the evacuation policy was increased to 30 days and, later, to 60 days. The evacuation policy for all other overseas areas was 120 days.

The evacuee patients received in the United States from 2 September 1950 to 31 December 1953 spent, on the average, 35 days in overseas medical facilities before evacuation as did U.S. Army personnel from all overseas areas. U.S. Army personnel originating from Japan-Korea, however, averaged about 32 days, slightly less than the overall average for all patients from all overseas areas, but markedly lower than the 42 days averaged by U.S. Army personnel from all other overseas areas, excluding Japan-Korea. These differences reflect the influence of the early days of the Korean War, when large numbers of wounded created a heavy pressure on the available bed capacity in Japan. It was necessary, in the last quarter of 1950 and in the first months of 1951, to evacuate many of the less seriously wounded Patients with minor wounds to make room for the more seriously wounded nontransportable cases. Consequently, a higher proportion of the less seriously wounded was evacuated rapidly upon entering the chain of evacuation and the number of days elapsed before evacuation was low, averaging 17 to 19 days for patients received from Japan-Korea in September and October 1950 and not exceeding 30 days until April 1951.

Another factor which contributed to the lower elapsed time before evacuation from Japan-Korea is the possibility that the duration of hospital stay, before the decision to evacuate the patient, may have been considerably lower for wounded patients than for patients hospitalized for disease conditions. Since all wounded patients originated in Korea, this factor, in itself, would diminish the time spent before evacuation for patients from Korea.

Figure 10 shows that, after April 1951, the average days elapsed before evacuation from Japan-Korea exceeded the average for the entire period, except for the months of September, October, and November 1951. As wounded admission rates declined and bed capacities in Japan were built up, sufficient capacity was on hand to return the less seriously wounded in Japan and return them to duty without draining away manpower through evacuation. Once the usual criteria for evacuation could be applied, the average duration before evacuation rose. For example, the average before evacuation was 19.6 days in 1950, 30.8 days in 1951, 39.1 days in 1952, and 46.4 days in 1953.


TYPE OF SPECIALIZED TREATMENT REQUIRED

The type of specialized treatment required for evacuee patients in hospitals of definitive treatment in the United States is shown. in table 65 for all evacuees received and in tables 66 and 67, in more detail, by category of admission, for U.S. Army evacuee patients. The three largest categories of specialized treatment were general surgery, general medicine, and neuropsychiatry. Excluding cases with type of specialized treatment not specified, approximately 36 percent of all evacuee cases from all overseas areas required general surgery. When amputations, hand surgery, neurosurgery, ophthalmologic surgery, orthopedic surgery, plastic and maxillofacial surgery, thoracic surgery, and vascular surgery are included, the percentage of cases requiring surgery increased to 59 percent, a condition to be expected considering the high proportion of wounded-in-action cases included. Cases requiring neuropsychiatric care comprised 11 percent of all evacuee cases with slightly more than half of the cases requiring closed ward care.

The cause of admission, whether for disease, nonbattle injury, or wounded in action, determines markedly the type of specialized treatment required. The more detailed data, as previously noted, are presented in tables 66 and 67 for U.S. Army evacuee patients by category of admissions. The former table is in terms of numbers of cases; the latter is in terms of percentages of type of specialized treatment required by category of admissions. This latter distribution provides, in effect, a probability table of the expected type of specialized treatment likely to be required among a given


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Figure 10.- Average number of days elapsed before evacuation from Japan-Korea,
U.S. Army personnel, 2 September 1950-31 December 1953.


73

Table 65.- All evacuees received in United States by specialized treatment required and category of personnel, 2 September 1950-31 December 1953

Specialized treatment required Category of personnel
Total Army Air Force Civilian Other
Total
55,382
52,613
1,458
1,203
108
Amputations
1,238
1,194
23
20
1
Arthritis
961
896
62
3
--
Blindness
47
44
--
2
1
Cold injury
714
713
1
--
--
Deafness
718
661
56
1
--
Deep X-ray therapy
5
4
--
1
--
Dermatology
534
487
39
8
--
General medicine
9,771
9,166
321
276
8
General Surgery
19,282
18,742
226
246
68
Hand surgery
61
58
2
1
--
Hepatic-metabolic
191
172
11
8
--
Neurology
1,089
1,005
61
23
--
Neuropsychiatry
5,999
5,426
285
282
6
    Closed ward, NP
3,321
2,954
185
178
4
    Open ward, NP
2,678
2,472
100
104
2
Neurosurgery
3,458
3,343
64
35
16
Neurosyphilis
16
15
1
--
--
Obstetrics and gynecology
215
186
--
29
--
Ophthalmological surgery
1,847
1,784
34
23
6
Orthopedic surgery
4,893
4,776
47
70
--
Plastic and maxillofacial surgery
216
212
1
3
--
Radium therapy
1
1
--
--
--
Thoracic surgery
119
114
2
2
1
Tropical disease
11
11
--
--
--
Tuberculosis
1,549
1,320
145
84
--
Vascular surgery
212
192
13
7
--
Not specified
2,235
2,091
64
79
1

Table 66.- U.S. Army evacuees received in United States by specialized treatment
required and category of personnel, 2 September 1950-31 December 1953

Specialized treatment required Type of admission
Total Disease Nonbattle Wounded
Total evacuees
52,613
25,684
7,464
19,465
Amputations
1,194
8
171
1,015
Arthritis
896
889
5
2
Blindness
44
14
5
25
Cold injury
713
22
673
18
Deafness
661
622
14
25
Deep X-ray therapy
4
4
--
--
Dermatology
487
483
2
2
General medicine
9,166
8,443
267
456
General Surgery
18,742
3,647
3,354
11,741
Hand surgery
58
7
33
18
Hepatic-metabolic
172
166
6
--
Neurology
1,005
899
43
63
Neuropsychiatry
5,426
5,313
73
40
    Closed ward, NP
2,954
2,877
53
24
    Open ward, NP
2,472
2,436
20
16
Neurosurgery
3,343
660
417
2,266
Neurosyphilis
15
14
--
1
Obstetrics and gynecology
186
186
--
--
Ophthalmological surgery
1,784
868
162
754
Orthopedic surgery
4,776
1,086
1,910
1,780
Plastic and maxillofacial surgery
212
13
60
139
Radium therapy
1
1
--
--
Thoracic surgery
114
12
8
94
Tropical disease
11
11
--
--
Tuberculosis
1,320
1,308
5
7
Vascular surgery
192
177
3
12
Not specified
2,091
831
253
1,007

hundred evacuees by category of admission, when the "not specified" cases were excluded.

The variation in type of specialized treatment required according to category of admission is readily apparent from table 67. Of each 100 wounded evacuees, approximately 64 required general surgery, and about 97 required some type of surgery. Among each 100 Army nonbattle injury evacuees, 47 required general surgery and 85 required some type of surgery. But, among each 100 disease evacuees, only 15 required general surgery, and only 26 required some type of surgery.

Roughly, 9 percent of the nonbattle injury evacuees required specialized treatment for cold injury, largely frostbite. Of each 100 disease cases, 21 were evacuated to the United States to receive specialized treatment for neuropsychiatric conditions.

The wounded evacuees reported its requiring certain types of specialized treatment for disease conditions, such as arthritis (two cases), neurosyphilis (one case), general medicine (456 cases), neuropsychiatry (40 cases), dermatology (two cases), and tuberculosis (seven cases), presumably represented cases hospitalized for wounds and for disease concomitantly, with the disease condition being reported as the primary cause of evacuation although


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Table 67.- Percent distribution of U.S. Army evacuees,
by specialized treatment required and type of admission, 2 September 1950-31 December1953

Specialized treatment required Type of admission
Total Disease Nonbattle injury Wounds
  Number of evacuees
Total
52.613
25.684
7.464
19.465
Specialized treatment. not specified
2.091
831
253
1.007
Specialized treatment. known
50.522
24.853
7.211
18.458
Percent distribution by specialized treatment
Total specialized treatment known
100.00
100.00
100.00
100.00
Amputations
2.36
0.03
2.37
5.50
Arthritis
1.77
3.58
0.07
0.01
Blindness
0.09
0.06
0.07
0.13
Cold injury
1.41
0.09
9.33
0.10
Deafness
1.31
2.50
0.19
0.13
Deep X-ray therapy
0.01
0.02
--
--
Dermatology
0.96
1.94
0.03
0.01
General medicine
18.15
33.97
3.70
2.47
General surgery
37.10
14.67
46.52
63.61
Hand surgery
0.11
0. 03
0.46
0.10
Hepatic-metabolic
0.34
0.67
0.08
--
Neurology
1.99
3.62
0.60
0.34
Neuropsychiatry
10.74
21.38
1.01
0.22
    Closed ward, NP
5.85
11.58
0.73
0.13
    Open ward, NP
4.80
9.80
0.28
0.09
Neurosurgery
6.62
2.66
5.78
12.28
Neurosyphilis
0.03
0.06
--
0.01
Obstetrics and gynecology
0.37
0.75
--
--
Ophthalmological surgery
3.53
3.49
2.25
4.08
Orthopedic surgery
9.45
4.37
26.49
9.64
Plastic and maxillofacial surgery
0.42
0.05
0.83
0.75
Radium therapy
0.00
0.00
--
--
Thoracic surgery
0.23
0.05
0.11
0.51
Tropical disease
0.02
0.04
--
--
Tuberculosis
2.61
5.26
0.07
0.04
Vascular surgery
0.38
0.71
0.04
0.07

the case was classified as a battle casualty on the basis of the primary cause of admission. The same comment is applicable to the 18 wounded cases reported as requiring specialized treatment for cold injury.

The classification by type of specialized treatment, however, does not provide a count of the number of cases of certain categories of considerable special interest; namely, the amputees, the paraplegics , the blind, and the deaf. Some cases of blindness are included under the category blindness," but some might be classed elsewhere; for example, in a case where a penetrating wound resulted in loss of an eye and also in some brain damage, the specialized treatment might be classified as "neurosurgery" rather than "blindness." Likewise, amputees ordinarily would be reported by specialized treatment as "amputations," but some small number might have been included elsewhere; for example, as general surgery cases. This is also true of the evacuees suffering from deafness. Paraplegics cannot be separately identified by consideration of specialized treatment alone.

Because of the difficulty in identifying certain of these groups from any distribution by type of specialized treatment, cases that fall into these particular categories must be identified separately, taking into account the actual diagnoses and operations reported. Among the 52,613 U.S. Army evacuees reported to The Surgeon General for the period 2 September 1950-31 December 1953 were 1,354 major amputations of one or more of the upper and lower extremities, 111 hemiplegics, 247 paraplegics, 178 blindness involving both eyes, 1,325 blindness involving one eye only, 314 deafness involving both ears, and 299 deafness involving one ear only (154 of these cases also had defective hearing in the other ear). These disabilities totaled 3,828 and involved somewhat less than 3,800 individual patients.

Nearly all of these cases originated in Japan-Korea; for example, 1,306 amputations, 98 hemiplegics, and 227 paraplegics were evacuated from the Far East Command (Japan-Korea). With respect to blindness, 1,253 of the cases involving one eye and 161 of those involving both eyes were evacuees from Japan-Korea. Unlike the other disabling conditions, it substantial proportion of the evacuees with deafness originated in areas other than Japan and Korea, although 193 of the 314 evacuees with deafness involving both ears, and 161 of the 209 involving one ear originated in Japan and Korea. Of the 161 cases of deafness, 67 also had defective hearing in the other ear. A total of 3,399 disabilities of those special categories were reported for almost the same number of individual patients evacuated from Japan and Korea.


CATEGORY OF ADMISSION

For U.S. Army evacuee cases, table 68 shows the respective category of admission (disease, nonbattle injury, and wounded) for all overseas areas, for Japan-Korea, and for all other overseas areas excluding Japan-Korea. Disease cases accounted for 49 percent, nonbattle injury for 14 percent, and


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Table 68.- U.S. Army evacuees, by prior operation overseas,
category of admission, and overseas areas, 2 September 1950-31 December 1953

Category of admission
and prior operation
Number of evacuees Percent
Evacuees with prior
operation in each
category of admission
Evacuees in each
category of admission
All
overseas
areas
Japan-
Korea
All other
overseas
areas
All
overseas
areas
Japan-
Korea
All other
overseas
areas
All
overseas
areas
Japan-
Korea
All other
overseas
areas
Total
52,613
38,515
14,098
100.0
100.0
100.0
100.0
100.0
100.0
    With prior operation
18,925
17,459
1,466
36.0
45.3
10.4
--
--
--
    Without prior operation
33,688
21,056
12,632
64.0
54.7
89.6
--
--
--
Disease, total
25,684
13,077
12,607
100.0
100.0
100.0
48.8
34.0
84.4
    With prior operation
1,529
789
740
6.0
6.0
5.9
--
--
--
    Without prior operation
24,155
12,288
11,867
94.0
94.0
94.1
--
--
--
Nonbattle injury, total
7,464
5,974
1,490
100.0
100.0
100.0
14.2
15.5
10.6
    With prior operation
4,061
3,335
726
54.4
55.8
48.7
--
--
--
    Without prior operation
3,403
2,639
764
45.6
44.2
51.3
--
--
--
Wounded in action, total
19,465
19,465
--
100.0
100.0
--
37.0
50.5
0.0
    With prior operation
13,335
13,335
--
68.5
68.5
--
--
--
--
    Without prior Operation
61130
61130
--
31's
31.5
--
--
--
--

wounded in action for 37 percent of all Army evacuees for all areas combined.

All of the wounded evacuees, of course, originated from Japan-Korea; of each 100 U.S. Army evacuees from the Far East Command, 51 were wounded cases, 34 were disease cases, and 16 were nonbattle injury cases.

As one should expect, the flow of wounded evacuees fluctuated with the tactical situation. This may be seen graphically from the data included in figures 11 and figure 12. The greatest number of wounded evacuees were received in September and October 1950 and again in December 1950 at the time of the Chinese Communist Intervention (fig. 11). During the first 2 months, three of each four evacuees received in the United States were wounded patients. In December 1950, one of each two evacuees received was wounded. Throughout most of 1951, the majority of all evacuees received from Japan-Korea were wounded. Nonbattle evacuees exceeded battle evacuees in January and February 1951, when the number of nonbattle injury evacuees included increased numbers of cold injury cases.

Reflecting the start of truce talks in July 1951, the proportion of wounded evacuees dropped in August and September, but even in these months, such cases comprised about 40 percent of all Army evacuees from Japan-Korea (fig. 12). The number of wounded evacuees rose precipitously during October 1951 at the time of the U.N. offensive to secure Line JAMESTOWN on the western front.

The situation was reversed throughout the first 6 months of 1952, when the number of wounded evacuees dropped each month to a low of 94 in June 1952. The predominant cause of evacuation was then related to nonbattle causes and the number of wounded evacuees was as low as 21 percent and rose no higher than 40 percent in the first, 9 months of 1952. In October 1952, the Chinese Communists launched their largest attack of the year on the western and central fronts, increasing the proportion of wounded evacuees to 52 percent in the last quarter of 1952. During the first 6 mouths of 1953, wounded evacuees never exceeded 40 percent. However, their number increased to 48 percent in July and reached a peak at 58 percent in August, reflecting the last two enemy offensives in June and July 1953, before the signing of the Armistice agreement at Panmunjom.


SURGICAL OPERATIONS PERFORMED OVERSEAS

Data On the number of surgical operations performed overseas before evacuation are also presented, in table 68. Operations as defined for the purposes included, here do, not include all surgical procedures, such as debridement of wounds and transfusions. They do, however, include most other major and minor surgery. An operation was recorded, even though only one step of the operation (as in the ease of a surgical amputation) may have been performed overseas.

Approximately 18,925 Army evacuees required surgical operation overseas before evacuation to


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Figure 11.- Number of U.S. Army evacuees received in United States from Japan-Korea, monthly by cause of evacuation, 2 September 1950-31 December 1953.


77

Figure 12.- Percentages of battle evacuees received in United States compared with percentage of battle admissions in Korea, 2 September 1950-31 December 1953.


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U.S. hospitals of definitive treatment. This total represents an impressive overseas surgical workload since approximately 36 percent of all Army evacuees from all overseas areas required some surgical procedures before evacuation. In Japan-Korea, 45 percent of all evacuees were subjected to some surgical procedure before evacuation from overseas as contrasted with 10 percent requiring prior operation Overseas among evacuees originating in all overseas areas other than Japan-Korea.

The high proportion of operations performed in Japan-Korea reflects the influence of the wounded evacuees who originated from this area. The proportions of disease cases requiring operation before evacuation in Japan-Korea and in all other overseas areas are notably consistent. The proportions requiring operation for nonbattle injury, however, are markedly higher for Japan-Korea. Of 19,465 wounded evacuees, 13,335 (69 percent) required some surgical procedure before evacuation to the United States.


CAUSATIVE AGENTS

Analysis of the 19,465 evacuee cards for wounded cases by causative agent (table 69) shows that, as in World War II, explosives and fragmentation weapons accounted for more than half the cases; in this instance, 59 percent.

However, this proportion for wounded evacuees is somewhat smaller than the 66 percent shown in table 40 for all nonfatal wounds of both World War II and the Korean War.

Shell fragments of unspecified explosive projectile shells alone accounted for approximately one-fourth of all wounded evacuees. The specified explosive projectile shells, (artillery, mortar, and bazooka) caused another 17 percent of the casualties, so that the two categories combined, specified and unspecified explosive projectile shells, were the causative agents for roughly 41 percent of the battle casualties evacuated. This compares to explosive projectile shells of 58 percent for the overall World War II distribution of nonfatal wounds and 51 percent overall for Korea. Other types of explosives and, fragmentation weapons accounted for 18 percent (the balance for this group), including grenades (6 percent) and land mines (5 percent) for wounded evacuee patients. A similar distribution for all nonfatal wounds, for World War II, was 9 percent for the balance, including 2.5 percent for grenades

Table 69.- U.S. Army wounded evacuees received in United States,
by causative agent, 2 September 1950-31 December 1953

Causative agent Battle injury and wound
Number Percent
Total all agents
19,465
100.0
Small arms weapons (subtotal)
(6,460)
(33.2)
Rifle bullet
934
4.8
Machinegun bullet
602
3.1
Other or unspecified small arms bullet
4,924
25.3
Explosives and fragmentation weapons (subtotal)
(11,559)
(59.3)
Rifle artillery
18
0.1
Other specified projectile explosives, mortar, bazooka, etc.
3,357
17.2
Explosive projectile shells, unspecified
4,734
24.3
Bombs or other air-launched explosive missiles
19
0.1
Land mine
899
4.6
Grenade
1,232
6.3
Other or unspecified explosion or fragment
1,300
6.7
Parachute jump and aircraft accidents
29
0.1
Land transport vehicles
184
0.9
Incendiaries and other chemical warfare agents
52
0.3
Direct, or indirect intended effects of other instrumentalities of war
341
1.8
Use of own instrumentalities of war
640
3.3
Falls or jumps
128
0.7
Machinery, tools, objects, etc.
35
0.2
Miscellaneous, other, or unspecified agents
37
0.2

and 3.4 percent for land mines. For Korea, the remaining distribution for fragmentation weapons was 15 percent, of which 9.0 percent was grenades and 3.5 percent was land mines.

The proportion of battle wounds caused by small arms weapons among the evacuees is considerably higher than the 20 percent experienced in World War II, and even surpassed the 27 percent for small arms included in the overall distribution of nonfatal wounds for the U.S. Army, Korea. This difference, however, reflects partly the comparative lack of enemy aerial activity in support of enemy ground troops; thus, bombs, or other air-launched explosives, were not so significant a factor as a cause of casualties among U.S. Army personnel during the Korean War.

Another and more decisive factor for differences between the World War II and the Korean War small arms totals is the relative weight from evacuees incurring wounds in the earlier fighting in Korea; that is, before the buildup of Communist artillery.

Also of some interest is the fact that only 0.3 percent sustained burns from incendiaries and other chemical warfare agents serious enough to require evacuation. It is entirely probable that some battle casualty evacuees whose primary diagnoses involved


79

Table 70.- Number and percent of U.S. Army wounded evacuees,
by type of traumatism, 2 September 1950-31 December 1953

Type of traumatism Number Percent
Total
19,465
100.0
Fracture, compound
9,687
49.8
Fracture, other, or not elsewhere clarified
956
4.9
Wounds
6,868
35.3
Amputation, traumatic
708
3.6
Burns
85
0.4
Concussion
77
0.4
Other or unspecified
1,084
5.6

any of the other types of causative agent also sustained burns. These additional diagnoses and causative agents are not, of course, included with these data. However, an indication that burns are not a major factor may be derived from the fact that only 0.4 percent of the total traumatisms among wounded evacuees were evacuated because of burns.

Another item of interest in table 69 on causative agents is the proportion (3.3 percent) who were evacuated because of wounds caused by use of our own instruments of war. Included in this group of causative agents are explosions of weapons and ammunition and handling of weapons and ammunition.


TYPE OF TRAUMATISM AND ANATOMICAL LOCATION OF WOUND

Of all traumatisms among the 19,465 U.S. Army wounded, evacuees, 90 percent fell into the two main categories of fractures and wounds. Compound fractures represented approximately 50 percent of all traumatisms while wounds of all types were about 35 percent. The distribution, by type of traumatism is shown in, table 70.

Table 71 shows the number and percent distributions by anatomical location of wound for U.S. Army wounded evacuees for the complete period, 2 September 1950-31 December 1953, and for seven elected periods. If one compares the two periods before the peace talks began in July 1951 with the four periods after that date ending in June 1953, it will be observed that the proportion of wounds involving the head, face, and neck increased while the proportion of wounds involving the upper extremities decreased. Wounds of the trunk area, (thorax, abdomen, pelvis, and spinal cord) and of the lower extremities remained relatively unchanged.

The increase in the proportion of head wounds, as previously noted in the section on "Anatomical Location of Wounds and Tactical Operations" included in chapter three, resulted from the change in the character of fighting from a mobile combat situation to defense of fortified lines. This, of course, required the individual soldier to expose his head more often than any other part of his body.


TIME FROM WOUNDING TO FIRST MEDICAL CARE

Table 72 presents a cumulative percentage distribution of the elapsed time from wounding to first medical care.

This period of time is defined as extending from the time of wounding as recorded in the diagnosis space on the Emergency Medical Tag (WD AGO Form 8-26) (4) to the time shown on that same record as "hour tagged," usually the time of admission to an aid station.

Table 71.- Percent distribution of U.S. Army wounded evacuees,
by anatomical location of wound, 2 September 1950- 31 December 1953

Time period Anatomical location of wound
Total Head, face,
and neck
Trunk Upper
extremities
Lower
extremities
General, or
unspecified
Total period
Total cases
19,465
3,108
3,063
5,866
7,381
47
Percent
100.0
16.0
15.7
30.1
38.0
0.2
September-December 1950
100.0
11.6
16.8
31.2
39.9
0.5
January-June 1951
100.0
14.4
14.1
33.7
37.6
0.2
July-December 1951
100.0
18.3
16.6
29.1
35.9
0.1
January-June 1952
100.0
18.1
16.9
26.7
38.3
--
July-December 1952
100.0
20.7
16.8
28.4
34.0
0.1
January-June 1953
100.0
22.5
15.4
24.1
37.7
0.3
July-December 1953
100.0
21.3
11.5
27.3
39.8
0.1


80

Table 72.- Army wounded evacuees, from time of wounding
to first medical care, 2 September 1950-31 December 1953

Elapsed time (hours)

Number

Cumulative percent

Total cases
9,549
--
0 to
2,105
22.0
to 1
1,653
39.3
1 to 2
1,823
58.4
2 to 3
1,097
69.9
3 to 4
704
77.3
4 to 5
452
82.0
5 to 6
306
85.2
6 to 7
247
87.8
7 to 8
184
89.7
8 to 12
390
93.8
12 to 18
255
96.5
18 to 24
98
97.5

The data in table 72 are based on the records of 9,549 of a total of 19,465 Army wounded evacuees received in the United States on whom the time wounded and the time first admitted to medical care were specified. The remaining 9,916, or 51 percent, of the total battle casualties received in the period 2 September 1950-31 December 1953 did not have one or both of the time periods specified on their evacuee report cards.

For the cases with specified information, slightly more than 58 percent received medical care during the first 2 hours and slightly more than 85 percent during the first 6 hours after wounding. The median number of hours between the time of wounding and first, medical care was about 1 hours; that is, half of the cases for which data are available obtained their first medical care within the first 1 hours after being wounded.


TIME FROM WOUNDING TO FIRST HOSPITALIZATION

Another measure of the time elapsed from wounding to medical care is afforded by consideration of the number of days elapsed before hospitalization. Data were reported in this connection for 17,503 of the 19,465 Army, wounded evacuees received in the United States during the period 2 September 1950-31 December 1953. The necessary information was not specified for 1,962 of the cases, or about 10 percent of the total received.

In the entire period, 55 percent, of the Army wounded evacuees were hospitalized on the same day wounded, 30 percent were hospitalized on the first day following, 6 percent on the second day following, and 9 percent on the third day or later (table 73).

The method by, means of which this type of information was gathered wounded in action patients who became evacuees should be noted, however. Only the date, not the precise hour, was specified in reporting the length of interval between wounding and hospitalization. Thus, a patient, wounded late in a 24-hour day during one of the frequent Communist night attacks (for example, at 2100 hours), might be admitted to hospital only 4 hours after wounding (at 0100); yet he would be reported as having been hospitalized the day following wounding, not the same day wounded.

The overall percentages for the complete period are somewhat misleading. During the first months of the Korean War particularly, the fluid tactical situation sometimes interfered with early hospitalization of patients. Some clearing stations were used in a role other than their conventional one of evacuating patients to hospitals. The overall percentages for the complete period are, therefore, affected by heavy weighting of evacuees wounded in the first 9 months of the war (see table 74). Moreover, throughout the war, many patients were treated and returned to duty at echelons forward of the surgical and evacuation hospitals, particularly at the clearing station. Some patients temporarily held for treatment in forward installations undoubtedly were found to require evacuation.

Table 73.- Percent of U.S. Army evacuees wounded, reaching surgical and evacuation
hospitals within a specified number of days after wounding, July 1950-August 1953

Month wounded Same day
wounded
First day
after day wounded
Second day
after day wounded
Third day
after day wounded
July 1950-August 1953
54.9
30.1
6.2
8.8
July-December 1950
34.3
32.8
12.4
20.5
January-June 1951
51.5
35.6
5.8
7.1
July-December 1951
65.9
29.5
2.5
2.1
January-June 1952
76.4
18.4
2.8
2.4
July-December 1952
71.6
24.3
2.8
1.3
January-June 1953
73.2
24.2
2.1
0.5
July-December 1953
73.2
22.6
2.2
2.0


81

Table 74.- Cumulative percentage reaching surgical or evacuation hospitals after day wounded, Army wounded in action evacuees by month wounded, July 1950-August 1953

Month of
wounding
Number
of
evacuees
Percentage reaching surgical or evacuation
hospitals within specified number of days
Same day
wounded
First day
after day wounded
Second day
after day wounded
Third day or later
after day wounded
Total
17,503
55
85
91
100
    1950
July
100
26
52
64
100
August
730
35
64
75
100
September
2,673
33
64
77
100
October
271
45
82
90
100
November
1,130
33
71
84
100
December
369
45
74
87
100
    1951
January
484
38
82
93
100
February
1,075
40
79
87
100
March
703
54
90
96
100
April
717
60
93
96
100
May
753
55
89
92
100
June
603
66
94
97
100
July
237
67
96
97
100
August
377
57
93
96
100
September
998
60
93
97
100
October
1,277
68
97
99
100
November
294
79
96
98
100
December
181
79
98
99
100
    1952
January
161
83
97
99
100
February
84
79
96
96
100
March
102
74
96
99
100
April
146
68
92
97
100
May
100
65
81
90
100
June
313
81
98
99
100
July
262
71
98
99
100
August
221
78
99
100
100
September
339
78
96
98
100
October
643
66
94
99
100
November
241
70
96
98
100
December
131
79
100
100
100
    1953
January
119
85
97
100
100
February
142
73
100
100
100
March
218
64
96
99
100
April
207
78
96
99
100
May
179
74
98
99
100
June
366
72
98
99
100
July
554
73
96
98
100
August
3
67
100
100
100

If time from wounding to first hospitalization is considered in intervals of 6-month periods, as in table 73, a considerably different picture is presented. For example, the percent hospitalized on the same day wounded rose from 34 percent for July-December 1950 to 76 percent in January-June 1952. Thereafter, the percent hospitalized the same day remained constant at about 72 to 73 percent.

The monthly fluctuations in the percentage of wounded in action cases hospitalized within specified numbers of days are shown in table 74. The percentages shown are cumulative within any 1 month, reading from left to right.

It will be noted that, beginning in April 1951, the percentage of wounded in action evacuees hospitalized on the day wounded at all times was at, or above, the average of 55 percent shown for the complete period.

Similarly, except for May 1952, the cumulative percentage hospitalized on the day wounded and


82

the first day following wounding, from March 1951 on, exceeded, the average of 85 percent for the complete period. An explanation of the drop in the percentage hospitalized in May 1952 is not discernible; the number of cases involved, however, is small, and the percentage may only be indicative of chance variation.

The changed character of the war is, of course, reflected in the increasing proportion hospitalized on the day wounded and the day following. By March 1951, the United Nations Forces were again established north of the 38th Parallel. The campaign was becoming less a war movement and more fixed positional type warfare prevailed. Conditions were, therefore, more favorable to the rapid recovery and evacuation of wounded to forward hospitals.

In addition, the use of helicopters for evacuation of the seriously wounded in need of immediate surgical treatment markedly affected the percentage of those hospitalized on the day wounded or on the day following.

In September and October 1951 during heavy fighting for possession of "Heartbreak Ridge" and the, "Punchbowl," and the major offensive in October 1951 to secure Line JAMESTOWN, 93 percent and 97 percent, respectively, of all the wounded during these 2 months were hospitalized on the same day they were wounded or on the following day.

Furthermore, during August and September 1952 when bitter battles waged for "Old Baldy," "T-Bone," and "Bunker Hill," and during the following month of October 1952 when the Chinese Communists launched a major attack on the western and central fronts, the percentage of wounded hospitalized on the same day or the day following wounding was 99 percent during August, 96 percent during September, and 94 percent during October. During 1953, these percentages ranged from 96 to 100 percent for wounded hospitalized on the same day or the day following.

 

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