History provides less than sanguine evidence of the periodic neglect of medical support factors by combat arms leadership.
Gallipoli
As described by Colonel John L. Beeston of the Royal Australian Army Medical Corps at Gallipoli during World War 1: "The whole beach is filled with wounded of all kinds and all description. It has quite unnerved me for a time. Some of the wounds are so ghastly, whole abdomens blown away and the men still living. They are in such numbers that it is difficult to get along, and there is only one hospital ship in the bay."
The British failure to take the Dardenelles at Gallipoli was adjudged, to a large degree, to lack of coordination between attack and supporting elements such as medical services.
On 26 April 1915, for example, Surgeon General Birrell, director of medical services for the British attack, requested that he and his deputy join general headquarters on board the Queen Elizabeth, where the operational commander was located, to supervise casualty evacuation. His request was refused, and he was embarked on board the Arcadian, a ship that possessed no wireless communications with the shore or other medical assets.
On 28 April, Birrell was sent the message, "Lutzow filling up rapidly. Request name of next hospital ship. Where is the advanced depot of medical stores? Running short of supplies." Another message read, "Wounded arriving rapidly—about 500. Probably require another hospital ship." To these messages there was no reply. The director of medical services was isolated. All signals from shore were conveyed by wireless to the Queen Elizabeth, where the general staff, who was supposed to be coordinating the wounded evacuation, remained silent.
Grenada
On 21 October 1983, intensive operational planning was begun for Operation Urgent Fury, military operations to seize Grenada, but combat support planners—including medical planners—were not participants. Consequently, the logistics estimate of supportability was not done prior to execution of the plan, and the required medical support system did not develop.
The short lead time and absence of a designated task force surgeon for coordination of medical services at the joint level left medical planners initially on their own. Each service planned within the scope of its organic assets with little or no reference to joint coordination of such activities as casualty care management, whole blood procurement, and aeromedical evacuation. Erroneous assumptions may have been made as well. For example, the Commander of the 82nd Airborne Division had been informed that the Guam (LPH-9) and Trenton (LPD-14) had significant medical and surgical capabilities to provide offshore medical support and that these ships were in the vicinity of Grenada. It is unclear whether this assumption about Navy capability was responsible for his ultimate decision to keep Army medical support to a minimum.
During the first day of the operation, the Guam was overwhelmed following the near simultaneous receipt of 36 casualties at the inception of ground operations. A general medical officer working in the casualties staging area remarked, "We were overwhelmed, and the word was not out that we were. It was almost as if casualties were obliged to 'take a number.'"
On board the Trenton, in the absence of a casualty regulating communication network, Army pilots, unfamiliar with Navy ships, tended to deposit casualties on any convenient flight deck. A wounded 82nd Airborne officer in shock as a result of a gunshot wound through his chest and abdomen was left on the flight deck of the Trenton. With no blood bank or laboratory facilities on board, the ship's junior medical officers had to obtain blood donations from crew members, and based on dog tag matching alone, type-specific blood was transfused, warm, directly into the casualty. They attempted medical discussion with the Guam but lack of communications made this futile. Likewise, the Guam's position was not known on board the Trenton. Subsequently, a Marine helicopter, guided by AWACS overhead, was able to locate the Guam, which contained a surgeon, and bring the casualty on board.
Captain Smith is a professor of urology at the Medical College of Georgia in Augusta. He also is adjunct professor of surgery and military and emergency medicine at the Uniformed Services University School of Medicine in Bethesda, Maryland.