CORPSMEN WITH MARINES IN THE FIELD
Handbook of Hospital Corps, United States Navy, 1949
The hospital corpsman serving with the Marine Corps in the field performs a duty that through two World Wars and countless other engagements in foreign lands has become as legendary as the exploits of the Marine Corps itself. Highlighted by courageous devotion to the saving of the lives of their comrades in arms under the most hazardous conditions, his actions have earned the respect and gratitude of a military organization that prides itself on its fortitude in battle.
This reputation was not won easily nor will it be maintained easily. The honorable heritage handed down by hospital corpsmen from battlefields wherever Marines have been engaged, demands the best of many attributes of the medical personnel if that heritage is to be carried on.
A brief outline of the organization of the medical department with the Fleet Marine Force and of the method in which casualties are handled will assist to prepare the hospital corpsman for this type of duty, but it is only through training with Marines in the field that he become qualified to carry out his important mission. The comment on the special attributes that are necessary for the full performance of duty in the filed will serve as a guide to the preparation of the hospital corpsman for such duty.
ORGANIZATION OF THE MEDICAL DEPARTMENT WITH THE FLEET MARINE FORCE
The Marine Crops is a flexible organization that allow for task units of varying strengths to be available for specific missions assigned. Similarly the Medical Department with the Marines is so organized that the degrees of medical support can be built up to provide care of casualties for a specific mission. In general, however, he medical department may e divided into two groups according to their functions in the field. First, the organic medical sections of the combat elements that provide initial first aid and such other measures as are necessary to put the patient in condition for further evacuation ; and second, the hospital elements in direct support that provide definitive surgical and medical care for those who cannot be further evacuated.
Organic Medical Sections
The medical personnel attached to these units are a permanent part of the particular combat element ; they train, live, and accompany the unit to which they are assigned, at all times.
Personnel of the infantry battalion medical section are divided, in accordance with their function, into company aid men and the battalion-aid-station personnel.
Company aid men : These are assigned, two to an infantry platoon, and accompany their platoon at all times and in all situations.
Battalion aid station : These personnel, consisting of the two medical officers and the remainder of he battalion medical section, operate one or more aid stations to the immediate rear of the front.
Separate battalion medical sections vary in size depending on the battalion with which they serve. These separate units are the engineer, tank, antiaircraft, amphibian tractor, and headquarters and service battalions. In view of the fact that line personnel of these battalions are assigned to operate in support of the infantry, the casualties that occur during an engagement are handled through the infantry battalion medical sections and the main effort of the separate battalion medical section is directed towards setting up an aid station in the area of their battalion command post, with medical personnel as needed being assigned to small detachments operating independently of the battalion.
Artillery regimental and battalion medical sections are medical sections which set up aid stations in the area of the regimental and battalion command posts and in addition assign two hospital corpsmen to each firing battery.
Shore party regimental and battalion medical sections also vary in size depending on the particular mission and have as their functions the maintaining of the shore party evacuation stations on each landing beach. They facilitate the actual transfer of the casualties from the beach to the landing craft.
Attached Medical Troops
Those medical personnel comprise the medical battalion of a Marine Division and re assigned for hospital support to infantry organizations as need for any given mission. Under the present table of organization, one medical platoon of a medical company, capable of operating a 60-bed surgical installation, is assigned to support one infantry battalion. A section of his platoon, th collecting element, has the function of facilitating evacuation from the battalion-aid station to the hospital installation.
EMPLOYMENT OF MEDICAL SECTIONS IN CASUALTY EVACUATION
Casualties during an engagement are removed from the combat area through a series of medical department facilities called "the chain of evacuation." This chain starts with the company-aid man, who is with the first marines of his outfit to hit the beach and the first member of the medical department to come in direct contact with front line casualties. Other elements of the medical department making up links in the chain in their order of hitting the beach, and through which casualties pass, are the battalion-aid station, the collecting element, and the shore party evacuation station when the medical platoon is committed to the engagement and sets up its installation. A brief description of the employment and function of each link in the chain :
Company Aid Men
He lands with his platoon and maintains a position in the immediate proximity of the front lines. When a casualty occurs, his first duty is to remove the casualty from the direct line of fire. It is here that training and cool appraisal of the situation are paramount. It is neither desirous nor necessary that the hospital corpsman expose himself recklessly in reaching the casualty. A knowledge of the field of fire, the type of fire encountered, and the appreciation of the protective features of the terrain, all add up to lessen the danger to the alert, trained aid man.
If time allows, consultation with the squad or platoon leader will result in a protective fire coverage that will give the venture a better chance of success. after removal of the casualty to a place of relative safety, such first-aid measures as are indicated and feasible are carried out.
These measures include control of hemorrhage, application of a battle dressing, morphine administration where indicated for pain, splinting of fractures, and the filling out of the emergency medical tag. With the aid of litter bearers, assigned from marine service personnel, the casualty is removed to the battalion-aid station. If the casualty is able to walk, he is directed to proceed to the aid station along the most protected route.
Personnel attached to the battalion-aid station are divided into two echelons and land in the last two waves of the first trip of the landing craft carrying their battalion. They set up an aid station in whatever protected location can be found on the beach. As the battle progresses inland, the aid station deploys forward, maintaining a position as close to the front lines as is reasonably safe from direct rifle and machine-gun fire. Casualties received here are given such further treatment as indicted to put the patient in condition to be further evacuated. Further control of hemorrhage, checking of dressing and splints, and the administration of plasma, serum albumin, or whole blood, to combat shock are within the province of this section.
Collecting Element of Supporting Medical Section
The collecting elements is composed of eight hospital corpsmen and lands with the reserve company of the infantry battalion to which attached. on landing,they consolidate with battalion-aid station and when that echelon moves forward these personnel evacuate the casualties form the aid station to the beach, or to the medical platoon hospital when it becomes established ashore.
Shore Party Evacuation Station
This party lands at approximately the same time as the shore party commander and set up a station for reception of casualties from the front. Casualties are given such supportive treatment as indicated and transported across the beach to landing craft for further evacuation to ships off shore.
The medical platoon lands on order when the combat has progressed sufficiently inland to provide a hospital site insured of relative safety from direct fire. When their 60-bed hospital has been set up, casualties which need immediate definitive treatment are routed through this installation. As the fighting progresses, the hospital moves forward in an effort to bring the surgical facilities as close to the casualties as the combat conditions will allow. It is in this installation that the trained technicians for laboratory, x-ray, and operating-room employment are stationed.
The entire platoon, however, must be trained intensively in their assigned tasks as speed in setting up the .installation and a high degree of mobilization are necessary. The ward must be skilled in the post-operative care of the surgical patient, as once operated on the patient must be retained until he is fit for further evacuation. In landing operations where more than one battalion is employed, the medical platoons assigned to each battalion may leap-frog one another along the line of evacuation or may consolidate with one another to provide one large installation, depending on the tactical situation and the length of the chain of evacuation.
1. Regimental medical sections, which coordinate the evacuation : from three battalion medical sections and maintain a first-aid station for the regimental headquarters area.
2 . Two hospital companies, capable of setting up independent hospitals of 200 beds each. These companies may combine to form the division hospital i the rear of the division zone of action or may leap-frog along the line of evacuation as conditions demand.
Special Attributes of the Well-Trained Hospital Corpsman in the Field
In order that a hospital corpsman may successfully carry out his mission with the landing force, he must have sound basic training to the duties of all hospital corpsmen. In addition, he must possess further attributes that will not only enable him to give proper care to casualties but also provide him with a measure of self-protection as well. A majority of the time a medical officer will not be available at the spot where life-saving first aid must be administered, and he is on his own. Even in situations where a medical officer is present to direct casualty care, the actual measures must be accomplished by hospital corpsmen when the casualty load is heavy.
The hospital corpsman must be an expert in first aid. First aid in the field is directed toward the same goal as in other situations with the important distinction that such measures are taken with the paramount idea in mind of putting the patient in condition for evacuation over a sometimes long and arduous route. The time element involved makes it imperative that particular attention be paid to control of bleeding. It may be several hours before the casualty can reach further medical aid over rough terrain.
Splints must be applied, not only to fractures, but to limbs that have suffered large debridging wounds, to ease the patient during the litter carry and help prevent shock. Morphine must be administered with good judgment. The patient able to walk back along the line must not be "snowed under" with morphine lest he require litter bearers. On the other hand, men in a semicomatose condition, suffering severe pain, must be given enough morphine to quiet them to prevent their giving away the position of the troops to the enemy.
The hospital corpsman must have an accurate knowledge of traumatic shock. The ability to read the signs and symptoms of shock or impending shock and the decision as to what steps to take calls for keen judgment in his caring for a casualty in the absence of a medical officer. Movement of a casualty in shock will increase that shock and sometimes result in the needless death of the casualty. It is better in such circumstances to delay evacuation and give supportive treatment such as rest, warmth, and the administration of plasma. Gentle handling of these patients by the hospital corpsmen, litter bearers, and ambulance drivers is of utmost importance.
The hospital corpsman must have a good knowledge of the introvenous administration of fluids. All hospital corpsmen in the filed must be expert in the administration of intravenous fluids such a saline, dextrose and saline, plasma, serum albumin, and whole blood. The medical offer may be there to direct what should be given, but the hospital corpsman must be prepared to carry out these directives.
The hospital corpsman must know how to administer preoperative and post-operative care. The success of surgical procedure depends a great deal on his ability to properly prepare the patient for operation and to give supportive care following surgery. Routine hygienic care, the administration and supervision of continued flow of intravenous fluids, careful attention to the pulse, blood pressure and respirations of the patient and an appraisal of any change in his condition, changing of surgical dressings, and many more details of patient care and ward management must be well learned.
The hospital corpsman must possess an ability to improvise. This is one of his most important attributes in the field. while the general pattern of medical department activities and the methods of caring for casualties remains the same, every operation and every situations encountered in an operation has its problems that must be met and overcome. terrain features, climatic conditions, and enemy interference combine to produce new situations that demand initiative and aggressive action. Laboratory, x-ray, and operating room technicians will at times have to accommodate themselves to working spaces that at first view appear hopelessly inadequate, but with intelligent appraisal and improvisation may be made to do. The medical supply man may find that some of his vital supplies have been lost through enemy action and he must secure replacement from some other unit or from ships off shore. The man directing litter bearers may find the route of evacuation impossible due to terrain features or enemy interdiction of the usual route and must utilize all his knowledge i selecting alternate channels. His whole attitude in the field must be that of accurately sizing up the conditions under which he must work and then strive to make them as near the optimum as possible.
The hospital corpsman must possess an extensive knowledge of sanitation and preventive medicine. In the field he must have an intimate knowledge of all individual preventive medicine measures that must be carried out by the troops, not only to be able to instruct them thoroughly but to insure that the troops are complying with such instruction. He must know the proper method of construction of such installations as gallies, seepage pits, garbage dumps, and heads, and must be able to intelligently inspect them for proper maintenance. He must be familiar with the use of various compounds for preventive medicine employment such as DDT, insect repellent, and dimethl-phthalate for impregnation of clothing. Water purification, under all circumstances, must be a part of his learning. The hospital corpsman, himself, is not charged with actually carrying out such sanitary measures, but must be able to supervise and see that personnel so detailed to carry them out.. . .
To successfully accomplish the purposes for which he is assigned, the hospital corpsman must be aware of those factors that enable him to adjust himself to life int he field and those which aid in preserving his well-being tot he end that he may carry out his duties to the fullest extend. They include :
1 . Physical fitness : The field hospital corpsman must be in the best physical condition that it is possible for him to attain if he is to withstand the grueling days and nights of any prolonged engagement. Short rations, lack of sleep and exposure tot he elements in the presence of constant danger will break down the physically unfit individual quickly. Long hours i the shock ward and operating room likewise call for the highest physical stamina.
2 . Terrain appreciation : This implies the ability of the hospital corpsman to take advantage of whatever terrain features are available in order to provide the maximum protection for his patients and himself. This is especially necessary for the company-aid man to help him in reaching and evacuating to a place of relative safety, the casualty on the front lines. It also is vitally important that all other medical personnel and installations take advantage of whatever protection the terrain offers, both from direct enemy fire and indirect fire such a artillery, mortars, and enemy air activity.
3 . Map reading : Every field hospital corpsman must be able to accurately read military maps. By use of these maps he can orient himself with the surrounding terrain and more intelligently plan the routes of evacuation. Travel between the various links in the evacuation chain and the search for isolated groups of casualties is greatly dependent on the individuals' ability to read these maps.
4 . Use of small arms : Under many conditions, the hospital corpsman is called upon to bear arms for the defense of his patients and himself. All men, therefore, must be trained in the care and firing of the pistol and carbine. This training is routinely carried out in marine combat units and hospital corpsmen are entitled to such emoluments as are rated by marines for qualifying as expert in the use of these arms
5 . Ability to live int he field under combat conditions : The hospital corpsman must be able to accommodate himself to his surroundings and make the best of the conditions under which he must function. He must learn to construct fox holes, erect shelter from the elements, employ camouflage, prepare his individual ration, and in many other ways acquire the tricks of the trade. The willingness and courage with which he faces the rigor of field existence will determine, to a large degree, his ability to persevere.
A resume of the duties of the hospital corpsman in combat with the landing force indicates the need for resourceful, well-trained, and courageous individuals. The corpsman who can successfully carry out these duties may regard his efficient participation with utmost price and the sense of a job well done. Not only does the opportunity for saving life present itself more frequently in this branch of the service but he has the knowledge of the tremendous morale factor that his presence inspires. The certainty of the fighting man that his aid man accompanies him into battle, shared his dangers and is every ready to give him quick and competent medical assistance, cannot be overrated as an aid to his willingness to carry on in the face of enemy fire. To the Marine, the hospital corpsman is "Doc," the family doctor, and to fulfill such a position to the utmost of his ability is a calling worthy of the best the hospital corpsman can give.
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