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Rear Admiral Almon C. Wilson, Medical Corps, U.S. Navy (Retired) (1924-2003)

RADM Almon C. Wilson, MC, USN, in 1982.Based on six interviews conducted by Paul Stillwell from May 1998 to June 1993, the volume contains 281 pages of interview transcript plus an index. The transcript is copyright 2002 by the U.S. Naval Institute; the interviewee placed no restrictions on its use.

This is a rare volume in the Naval Institute collection in that it deals primarily with a staff corps officer. Even so, Wilson was commissioned as a line officer in 1944 and served the last year of the Pacific war on board the high-speed transport USS Liddle (APD-60). After a few months at the Naval Supply Depot, Scotia, New York, he returned to civilian life and earned his M.D. from Albany Medical College. He did an internship in at the Bremerton Naval Hospital and served as medical officer for Mine Squadron Three in the Far East. After another stint of civilian practice he returned to active duty and served in naval hospitals at Subic Bay in the Philippines, San Diego, and Chelsea, Massachusetts. In 1965-66 he was commanding officer of the Third Medical Battalion, the facility in Danang that served Marines fighting in the Vietnam War, then was chief of surgery at the naval hospital in Yokosuka, Japan.

After attending the Naval War College, Dr. Wilson was medical officer on the staff of Commander in Chief Naval Forces Europe. During a subsequent tour in the Bureau of Medicine and Surgery (BuMed) planning division, he had additional duty as personal physician to Admiral Thomas Moorer, Chairman of the Joint Chiefs of Staff. Dr. Wilson then commanded the naval hospital at Great Lakes, Illinois, before becoming assistant chief for material resources in BuMed, 229-244. In the late 1970s and early 1980s he oversaw the fleet hospital program to develop transportable medical facilities. From 1982 to 1984 he served as head of the BuMed resources division and deputy to the Surgeon General. This oral history provides candid assessments of several admirals who served in the billet of Navy Surgeon General over the years.

An index to this volume can be viewed here (.pdf).
 


In this exerpt from his second interview with Paul Stillwell at the U.S. Naval Instiute on 15 February 1989, Dr. Wilson describes frontline field hospital operations in Vietnam, and his very positive impression of Lieutenant General Lewis Walt, USMC.

Admiral Wilson: As mentioned earlier, this particular conflict did not require that the collecting and clearing companies be very mobile, because the infantry regiments didn’t go very far. The truth of the matter is that the terrain is such that moving a collecting and clearing company probably would have been pretty difficult. There just weren’t any roads to amount to anything, and the nature of the clearing companies is that they are pretty heavy to go into the jungle.

At any rate, after thinking the problem through in consultation with my staff medical officers, we concluded that the way to support the regiment going in the field on an operation was to first of all not deplete the staffs at the fixed installations. Those staffs had to be intact to take care of the definitive surgical requirements that would be generated by any action. We therefore decided to try something new and put in the field what we called a shock and resuscitation team.

Basically, what we did was to send out into the field a super-duper emergency room. Under ordinary circumstances, one of two things happened. Either you put a C&C company out in the field and do things in the field, or you have corpsmen out there who are doing basic first aid and sending the patients back. We felt that we could do something intermediate between those two extremes if we were to provide some talented people. We selected six talented people—among them an anesthesiologist, an orthopedic surgeon, and a general surgeon.

An injection of intravenous fluid is given by Hospitalman Leslie G. Osterman to a Marine injured by shrapnel in Vietnam.There were six medical officers and about 25 corpsmen and some Marines on the team. We equipped these people to do effective resuscitative work. They had a blood bank, chest tubes, and tracheotomy tubes. They had sufficient sterile gear to do such things as control hemorrhage, complete amputations that were necessary, and in general to stabilize the injured patients, particularly the severely injured patients. The plan, as it was worked out, was that the patients would be funneled to this group in the field. The line Marines always managed to place the medical unit between the ammo dump and the fuel dump, which told us something. [Laughter] This particular system of doing business worked very well indeed.

The patients would be brought into this unit in the field, where they would be resuscitated with blood, IV fluids, have a chest tube inserted if necessary. After the doctors got the major bleeding controlled and applied sterile dressings, the wounded were then shipped virtually immediately by helicopter to the nearest fixed hospital. In this particular instance, Chu Lai was the nearest one to the operational area. We beefed up Chu Lai and had a shock and resuscitation team in the field. Some of the patients were brought to Danang simply as a matter of taking some of the excess load from Chu Lai.

Resupply was of interest. The unit in the field had good control over its inventory. They knew what they had with them, and, of course, they knew what they’d been using. We beefed up the supply capability at the Bravo Company down in Chu Lai and put some people on the edge of the helo pad on a 24-hour watch. So anytime a chopper came in, it might carry just a simple slip of paper from the commanding officer of the unit in the field saying that he needed more blood or more supplies of some kind. Ninety percent of the time the chopper could carry the needed resupply item back out into the field in a matter of minutes. This worked extremely well and provided no complications. A simple matter of a little foresight answered a bad problem. The concept was worthwhile, and it has eventually become a standard piece of the doctrine for the Marine Corps when it goes into the field now.

A wounded Marine is loaded aboard a CASEVAC helicopter in Vietnam.What we called the shock and resuscitation unit was called other things by my successors as CO of the Third Medical Battalion. Such terms as a light clearing company were used to describe it, but the basic idea was to provide more sophisticated support for the regiments in the field.

In early December the Marines tangled with the VC in this operation called Harvest Moon.[1] We took a lot of casualties. We had so many casualties that on one occasion the field unit from the Third Medical Battalion, the shock and resuscitation team, saw 94 wounded in 24 hours. Seventy of those casualties were flown into Danang. Since we were unable to get to all of them with the necessary dispatch, some of them were sent immediately to Clark Air Base.

Paul Stillwell: Was there anything in the airplanes to keep them going?

Admiral Wilson: Yes, they all had IV fluids, dressings, and medications. But the thing that is important is the fact that those patients were very carefully selected. We sent only patients who had been fully resuscitated and only patients with relatively minor wounds who could actually get to treatment quicker by going to Clark Air Base than they could if they were put in the queue in our own hospitals. That was the reason: we could not get to them in time.

Paul Stillwell: Who was making the decisions on who went where? Was that your job?

Admiral Wilson: Yes. One of the things that has to be learned very quickly by everybody, but particularly by the surgeons and anesthesiologists, is the concept of sorting. I’d like to make one more plea to anybody who reads this to understand the difference between triage and sorting. Triage is a term that was brought into play when the world at large began to talk about nuclear casualties which were estimated to be in the tens of thousands. In that case there are patients who are going to die, and there is nothing in the world you can do about it. There are three categories for a triage: those expected to die, the seriously wounded, and the lightly wounded.

In the methodology that supports triage, the lightly wounded and the intermediately wounded are the ones who are treated, because they are the greatest source of people who can continue to live and to help with the problem. Those who are over-radiated and cannot be expected to live will not have resources expended in their care. This is something very foreign to our nature, but this is the way the thinking is run in relation to triage.

Navy doctors and Corpsmen prepare a wounded Marine for an emergency operation at the field hospital at Phu Bai, South Vietnam.In Vietnam we did not use triage; we sorted patients. We sorted them out and took the most seriously wounded first. By this technique we applied the immediate emergency resuscitative and therapeutic measures earliest on the most severely wounded. It’s of interest that an analysis of our first experience in the field of this shock and resuscitation team revealed that the team probably saved at least seven people from certain death by their prompt resuscitation efforts.

One of these was a colonel and operations officer for the First Marine Air Wing. He was hit in the left leg by a .50-caliber bullet and brought to us. The bullet blew out four inches on his left leg, left shin, and left both arteries open. The fellows in the field put a tourniquet on him, gave him some blood and fluids, tied off his open arteries, and sent him on to the Danang hospital when he was resuscitated. He underwent amputation and even agreed to have it photographed.

Paul Stillwell: What was the purpose of the photography—as a teaching tool?

Admiral Wilson: It was apparently a war record that somebody wanted.

Paul Stillwell: In what way did Harvest Moon lead you to expand your capabilities?

Admiral Wilson: Well, it taught us several things. First of all, as I mentioned quite a lot earlier, we had only two operating rooms. It’s a fact that the average operation in a war zone such as that requires between three and four hours. You cannot count on doing more than six cases in one operating room in a 24-hour period. When you consider operating time, cleanup time, and preparation time for the ORs, you are lucky to get six patients through there. Some people even use five per operating room per day for planning.

It was obvious from our Harvest Moon experience that we did not have enough ORs to keep up with the heavy casualty load. I made this clear to General Walt. Almost immediately, three Quonset huts were made available to us in Danang, and several were made available to the other units, a couple down at Chu Lai and a couple up at Phu Bai. Phu Bai was a smaller unit, and they used one of their Quonsets to incorporate two operating rooms, expanding them to three, and the other Quonset hut was used for an intensive-care ward. In Chu Lai they did essentially the same thing. In Danang we got three Quonsets; two of them were made into ORs, giving us a total of four, and the other one was made into an intensive-care ward. The addition of those Quonset huts, which were air-conditioned and plumbed, was an immense improvement in our capability. These improvements were stimulated by the Harvest Moon operation in which we were essentially overrun with casualties.

Paul Stillwell: Did you get more people, or did you need more people?

Admiral Wilson: Well, we really didn’t need all that many more, although over time we did build the staff up to much more reasonable levels. The reserves began to come in sometime along about the first of the year in 1966, so within a matter of four to six months we started to get more people. A lot of the people who were out there when I arrived were out there on a TAD basis.[2] Some of them converted and stayed on for a whole year, and some went home at the end of six months or so.

Paul Stillwell: How much personal dealing did you have with General Walt?

Major General Lewis W. Walt confers with the commanding officer of E Company, 3rd Battalion, 7th Marines, during Operation Harvest Moon.Admiral Wilson: General Walt was always around. When I say that I mean this. In all the time I was in Vietnam, I don’t think he ever missed coming to see the wounded after an action. He was down at the compound twice a week before our routine evacuations to pin Purple Hearts on people. I used to wait up for him after the actions. Later on, it was quite common for us to get casualties at the end of the day, about sundown. We might get 30 or 40 or 50 of them at the end of the day. Then by midnight or so, or maybe 1:00 or 2:00 o’clock in the morning, the fighting would have settled down. The tactical area would be secured, and the general’s work would be essentially accomplished. Then he would arrive at the hospital at 2:00 or 3:00 or 4:00 o’clock in the morning to see the wounded, talk to patients, and cheer up my guys. So I got to see him very often.

He also used to invite me to have lunch with him on occasion, particularly on Sundays. I would go down to his China Beach house or up to his quarters in the bunker, and we’d have lunch and chat about things. Of course, he was always vitally interested in what was going on with us. He did a lot of things for us, by way of material things, that made it a lot easier for us to work. His influence was, of course, the important influence over there for us.

On one occasion, we were down in Chu Lai, and there were some casualties there from a local action. There were, oh, maybe 40 or 50 of them, and they were all lightly wounded. He said, “What’s going to happen to these patients?”

I said “General, we’re going to have to send them over to Clark, because we don’t have the beds to put them in to keep them here long enough to heal them up and still have any beds to take care of an emergency.”

He said, “How much more facility do you need to keep them in country?”

I had started work on this problem, and I said, “I can’t tell you right here in the field, General, but I have the information in my office.”

He said “You go get in my helicopter, and when I go back there I want you to go back with me, and I want you to come down and tell me what you need.”

So I did. I went back to the office, picked up the information, took it down to him, and the very next morning there was an engineer battalion at the gate with truck loads of materiel and an engineer force. I can’t remember exactly now, but it seems to me they put up about three 40-bed wards in a matter of a few days. The unfortunate part of it was that we didn’t have the staffing to go with it right at the time to make all that construction useful to us in the manner he wished it could be accomplished.

Paul Stillwell: What do you remember about General Walt as a person, as a leader?

Admiral Wilson: Well, I think the most important thing about him was the fact that he was a Marine’s Marine. He was a huge man, you know. He was well over six feet tall and a stocky man, so there was an awful lot of him. He was a very impressive mortal and had boundless energy. I rarely saw him ever get angry. Once is all I can ever remember. He always spoke to me in terms of his Marines as patients with the kind of attitude that made me understand that he was concerned about them. He showed some really deep personal concern about the way the men were injured and was deeply grateful to our staff for the way they treated them. At the same time, he was a Marine’s Marine. He was a tough guy, and when you sat in on meetings with him, where they were talking about problems and things they had to do and situations that needed to be corrected, he was tough. He was a demanding man, and he got more out of people who didn’t know they could do it than you can imagine. How do you get people to work 16 hours a day, six and a half days a week?




[1] U.S. and Vietnamese Army units set out on Operation Harvest Moon on 8 December 1965; the first engagement by U.S. Marines was the following day.

[2] TAD—temporary additional duty from some other command.

 


 
 

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