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Health of New Zealand Servicemen in Vietnam – Bruce Young  [anyone can contribute to or correct this article]

 

This is a background article on the medical preparation of New Zealand servicemen warned for deployment to the Vietnam theatre of operations, and on the medical system in place in Vietnam to support them.  It is written from the perspective of an infantryman [user] rather than as a statement on Army medical policy at that time.  The detail is specific to the period W3 Company was in Vietnam [1969 - 1970].

 

non-battle casualty - Cpl Wally Goodman late 1970 with an eye injury caused by flying debris after disembarking from a helicopter.  Wally was extracted by jungle penetrator [Goodman]

Introduction

Historically the wastage in an army among soldiers on operations caused by sickness and injury is always greater than its combat losses; in Vietnam the Americans identified that disease accounted for 70.6% of all hospital admissions with the remaining divided between battlefield casualties [15.6%] and non-battlefield injuries [traffic accidents and equipment failures] [13.8%] (see http://www.va.gov/OAA/pocketcard/vietnam_summary.asp). To avoid ill-health impacting on operational capability meant careful preparation of individuals prior to departure for an operational theatre, and continuing care while they were working there. 

 

non-battle casualty - Cpl Wally Goodman late 1970 with an eye injury caused by flying debris after disembarking from a helicopter. Wally was extracted by jungle penetrator [Goodman]

 

Planning for good operational health outcomes can be divided into several fields:

Preventative medicinepreventing disease rather than curing it.
Environmental medicinethe role of the environment in causing or spreading health issues.
General medicine
mainly focused on the art of diagnosis and treatment with medication, but in the context of this article would include surgical intervention at some facilities.
Field sanitation:  hygienic means of preventing human contact with the hazards of wastes such as human and animal faeces, domestic sewage, and agricultural wastes.

 

Military health to be successful requires a continuing interaction between the command chain responsible to equip the deployed personnel and employ them in such a way as to minimise or prevent harm; and when this is not successful the health services tasked to save life, restore function, promote healing and rehabilitate injured personnel so that the majority can be returned to duty.

 

Factors which together determine Army health

There are many factors which together determine Army and individual health, these include: 

  • the standard of military training and good leadership received and the psychological environment encountered [reflecting morale],

  • the physical environment, living and working conditions both in base and when deployed into the field, suitable water and sanitation, adequate food,

  • social networking, individual lifestyle; and

  • adequate medical services. 

These factors will be evident throughout the article.

 

NZ Army Health Policy in the 1960’s

The New Zealand Army health policy in the mid- 20th Century could not be located on-line but would broadly have been expressed as: ‘supporting military capability by ensuring Army personnel are fit in accordance with deployment criteria through the promotion of health, the prevention of ill-health, and the provision of treatment and rehabilitation services’.  The irony for New Zealand service people in Vietnam is that most of the policy was delivered by agencies from allied nations, rather than New Zealand.  Also rather ironic is that the ‘prevention of ill-health’ requirement did not extend to controversial issues such as Agent Orange [AO] or the Dapsone anti-malarial drug controversy.

 

Selection and Preparation for Deployment

Military personnel were routinely screened prior to enlistment and were generally fitter than the average New Zealand population, meaning people with congenital abnormalities, mental disorders and endocrine, nutritional, and metabolic disabilities were screened out [known as the ‘healthy worker effect’ and 'We few, we happy few, we band of brothers; ......' [Gunderson]largely ignored by bureaucratic officials examining the effects of AO as a comparison against the general population].  Once trained and physically prepared to the requisite combat standard all troops earmarked for Vietnam required a complete medical record, a pre-deployment physical exam, and a decision by a doctor as to suitability for theatre.  Assisted by the doctor’s decision and the standard of individual training exhibited, commanders had a reasonably free hand at selecting the soldiers and junior commanders they wanted for the deployment.  Most young soldiers were prepared to go to any length to be selected for deployment as all were professional soldiers and the Vietnam experience was a desirable goal in their military career.  All soldiers were required to have an inoculation regime of injections and other potions [such as the daily anti-malarial pill] to protect against the likely diseases to be encountered in Vietnam; these were reviewed regularly and updated or changed as necessary to meet new criteria.

 

It was the New Zealand Army policy to form sub-units of infantry in Malaya and keep them together as a group throughout their tour, ensuring positive unit cohesiveness which helped with identity and raised effectiveness and morale.  While reinforcements were periodically required to replace casualties these new arrivals had probably trained with their parent unit before it deployed and would be known and accepted by their section on arrival.  

 

Deployed Medical System

The medical system could be pictured as an inverted pyramid 24 Evac hospital Long Binh - this hospital backed up the Australian medical effort by handling very serious cases from the Australian and New Zealand forces [24 Evac archives]stretching down toward the combat zone and troops deployed in the bush.  Near the baseline of the pyramid were the extensive medical resources of the US forces in Vietnam and neighbouring countries, represented in the Australian medical chain by the US Army 24th Evacuation Hospital at Long Binh near Saigon [24 Evac was a 360 bed neurological hospital].  Closer to the point of the pyramid were the Australian medical facilities:  1st Australian Field Hospital [1AFH - known as Vampire, see photo below] a surgical hospital at 1ALSG in Vung Tau; and 8th Australian Field Ambulance [8AFA - known as Red Earth] with emergency surgical capability and medical wards at Nui Dat.  1AFH had 106 beds comprising a surgical and a medical ward of 50 beds each, and a ICU of six beds with space for 16 if required.  Operating theatres had three operating tables and the full range of hospital services were available [pathology, x-ray, dental, pharmacy, RAP, physiotherapy, psychiatry et al].

US Army 24th Evacuation Hospital at Long Binh

 

1AFH at Vung Tau beach - note red cross on roof as required by Geneva convention on protection of medical facilities [1AFH archives]

At battalion level within Nui Dat was a unit medical facility [called Regimental Aid Post or RAP] with a doctor and several medical corps staff that did personal health checks and minor general medicine.  8AFA ambulances evacuated injured personnel within the base to 8AFA if required for further treatment.  Rifle companies had a medical corps orderly on the strength of the Company HQ to assist and advise with medical practises and to backup the platoon combat medics.  Platoons had one or two cross-trained infantrymen who carried a basic medical satchel with wound dressings, ointments, powders, and basic tools.  Finally every soldier carried a large wound dressing attached to their rifle butt.  Since this wound dressing was the only medical assistance immediately available to the wounded it can be seen as the point of the inverted pyramid as far as troops deployed on operations were concerned.  8AFA field ambulance in Nui Dat [internet]

 

 

1AFH at Vung Tau beach - note red cross on roof as required by Geneva convention on protection of medical facilities [1AFH archives]

 

8AFA field ambulance in Nui Dat [internet]

 

The glue binding all levels of the pyramid together were the dedicated medical evacuation services, predominantly helicopter based, on-call 24/7 to evacuate wounded or injured soldiers to suitable medical facilities. 

 

All soldiers within a platoon were cross-trained in different combat roles; and while all did basic 1st aid training some with an interest in the subject underwent further medical training and could be described as a ‘combat medic’.  The life of a combat medic was a bit comic at times; having been prepared practically and emotionally to deal with a ‘traumatic amputation of the lower limb’ or a ‘sucking chest wound’ the most dramatic cases likely encountered would be from soldiers presenting [normally during a meal stop] with their scrotum covered in bush ticks, or a foot infected with well advanced and very smelly tinea.

 

Display of the Red Cross under the Geneva Convention for the protection of medical services was not used in the field except by dedicated US Dustoff helicopters, and medical staffs were expected to be armed and indistinguishable from other soldiers.  It was commonly accepted that medical staff would not be involved in combat drills but that they were available to stand sentry and to protect their patients.  The Geneva Convention for the protection of mSwingfog in action around vietnamese dwellings [internet]edical services was largely ignored by the VC as is common in counter-insurgency warfare.

 

Commanders Responsible for Preventative Medicine

Commanders at all levels were responsible for introducing and maintaining preventative medicine.  At unit level this comprised having standing operating procedures [SOP] to direct what was required to maintain health.  The RAP had an environmental responsibility for field latrines and anti-malarial checks within the lines.  The most obvious evidence of this was the regular ‘swingfog visits where anti-malarial spray was blown through the accommodation.  Long drop latrines were regularly checked and replaced if necessary and urinals [mainly 44-gallon drums buried level with the ground, the soldiers called them ‘pissaphones’ and regularly flong drop toilet being demolished and replaced [Stock]ell into them] were covered with light oil to suffocate mosquito larvae. 

 

Swingfog in action around Vietnamese dwellings [internet]

 

Other examples of SOP were the requirements to use insect repellent and cover arms and legs at night [since Anopheles malaria mosquitoes are active during the hours of darkness], and to take the anti-malarial pill daily.  These requirements were enforced in one manner or another by Company NCOs, and commanders’ would have their command effectiveness judged on the number of malarial cases among their soldiers.  W3 Company had few if any cases of malaria.

 

 

 

long drop toilet being demolished and replaced [Stock]

 

Need a Medic Here…!

In the bush if a soldier was wounded during a contact or mine incident, or injured in an accident, or fell ill, the circumstances would be assessed by those in control, both at the scene and in the command post.  The treatment of wounded [battle casualty] typically began with the ‘buddy’ system where small groups looked after their own.  Those wounded in contact would be placed in shelter if possible, and during a lull in the engagement someone nearby would assess the wounds and apply the wound dressing from the injured soldiers rifle.  The actual treatment was not necessarily a higher priority than winning the fire fight as all surviving soldiers might be required to suppress the enemy.  In the event the injuries were from a mine or booby-trap the area surrounding all the troops first had to be carefully checked for other devices before some soldiers would be allowed to slowly probe forward to assist the wounded soldier.  The treatment of injured [non-battle casualty] or ill soldiers would start immediately but evacuation [often called MEDEVAC to distinguish it from a battle casualty] might be delayed depending on the degree of urgency for treatment and other operational imperatives. 

 

First aid for shock and blood-loss were the initial priority in an attempt to stabilise the patient.  The combat medics did not routinely carry specialist medical stores [such as intravenous drips, adrenaline injections or morphine] to relieve these conditions if major shock or blood-loss was present, relying instead on a swift evacuation to get the soldier seen by properly qualified medical staff [the use of morphine was discontinued because administering it to a wounded soldier could further complicate or delay his treatment on arrival at 1AFH].  Usually another soldier would remain with the patient until the evacuation was complete, as much to protect him as to provide reassurance.  The scene commander would be on the command net two sitting patients being extracted on a jungle penetrator [Pavlovich]advising his commander on the situation and requesting ‘standby DUSTOFF’ but would be as engrossed with other aspects of the operational battle as with the circumstances of the wounded.

Casualty details would be reported by radio using standardised reports called NOTICAS [or worst still NOTICAS FATAL], identifying the individual by using the subunit call sign, individual regimental number, rank, first letter of surname, and LOCSTAT of the incident. In base the details would be checked against the sub-unit nominal roll and the full name expanded for more routine administrative reporting as a PUBLINTICAS.

two sitting patients being extracted on a jungle penetrator [Pavlovich]

The platoon members and others involved in a DUSTOFF were pulled administratively and psychologically in several directions at once.  The platoon commander and most soldiers would be concerned with the security of the perimeter against incursions by VC, worried they may come under fire at the point the helicopter arrived overhead.  The platoon sergeant and a couple of soldiers, responsible for handling the casualty and managing the evacuation, would be concerned for security of the pad and the patient.  The DUSTOFF crew would be concerned that the pickup might be ‘hot’ [under fire by the VC] or that they would be unable to land, while the patient [if conscious] would be hoping he was not going to be extracted by jungle penetrator on the end of a long winch cable, dragged upwards through the trees.  The soldiers would ultimately be distracted by worry about the fate of their injured colleague although Kiwi soldiers mainly took such losses or absences stoically.  For the record W3 Company had three deaths in action, 16 other soldiers were evacuated wounded, and there were numerous MEDEVAC.

 

Air Evacuation was Normal

Air evacuation was normal because there was no real alternative for reaching into the close-country environment to remove patients quickly.  The request for DUSTOFF would be forwarded on the company and then unit administrative radio nets to the Air Tasking Cell at the 1ATF command post.  Resources normally available to the air cell staff for tasking were the routine movement of 9Sqn RAAF Iroquois utility helicopters airborne over Phuoc Tuy Province or on the ground at Kangaroo pad in Nui Dat, the specialist US Army MEDEVAC Iroquois Dustoff20 normally stationed at Red Earth pad beside 8AFA during daylight hours [Dustoff20 carried specialist evacuation equipment not routinely available on 9Sqn helicopters], or a more general appeal to the US Forces or for 9Sqn Iroquois on the ground at Vung Tau.  Flying time one-way from Nui Dat to most parts of Phuoc Tuy province was within 20 minutes.  If the DUSTOFF call was for a wounded digger, obtaining a DUSTOFF aircraft had a very high priority among air cell planners and aircrews but their choices were still restricted by available aircraft fuel and internal loads, and the operational situation on the ground which might require armed helicopter escorts to protect the evacuationUsually wounded soldiers were uplifted at or very close to the scene where they were injured, even if this required the helicopter to Dustoff20 at Nui Dat [Young]do a slow winching exercise to retrieve the casualty.  Injured or ill soldiers were likely to be given a lower priority until aircraft were routinely empty and returning to base toward the end of the day, meaning there would be time for the soldier to be moved to a clearing suitable as a LP.  However whether injured or wounded, where the patient condition was likely to deteriorate most evacuations were done as quickly as possible under existing conditions to maintain the ‘Golden Hour’ rule for preservation of life, or to maintain the operational tempo as part of a larger plan.

 

Dustoff20 at Nui Dat [Young]

 

Where there was sufficient free internal cargo space DUSTOFF aircraft on a LP would usually take patient personal packs and weapons but not other ammunition or munitions [it was a safety issue mainly], and on departure would usually radio the dispatching field unit about which medical facility they were first taking the patient to [which allowed the unit administrative staff to later track him down].

 

The Stuff of MASH…

Once they had uplifted the patient the helicopter crewman would take over treatment [but only the US Army DUSTOFF helicopter had a dedicated medical corps orderly (on loan from 8AFA) who could put in intravenous lines and do other paramedic tasks] while the pilot would head for either 1AFH or 8AFA [although I can find no record of a DUSTOFF actually off-loading at 8AFA], calling ahead to describe the patient condition and helicopter ETA.  The receiving unit would have a specialist trauma team on the LZ and if the circumstances required they would start treatment while the patient was still on the helicopter.  The patient condition was also asseoperating theater at 1AFH [1AFH archives]ssed at this time and in some serious neurological cases [head wounds etc] the patient remained aboard the helicopter and was immediately flown to 24 Evac.  Otherwise triage was performed at the pad and the patient would accordingly be prepared for surgery.  Wounded soldiers as a norm required surgical intervention to stop serious bleeding, clean wound sites, remove debris and shrapnel, and to close open punctures.  Afterwards fractures would be set, wounds closed and bandaged, and post-operative and acute assessment undertaken.  Thanks to the speed of evacuation by helicopters and to greatly improved medical technology, casualty survival rates in Vietnam were well over 90% while of those who reached a medical triage area alive, 98% survived.  [see http://www.markedixon.com/medicine_and_war.htm]

 

operating theatre at 1AFH [1AFH archives]

 

They Gave Their All

It was not normal for deceased troops [KIA] to be transported on the same helicopter as wounded [WIA], several reasons were given and are probably still valid today: the effect on the wounded of having dead comrades nearby, cultural practices, less urgency for deceased over live patients, and aircraft space.  It was rarely acceptable for a deceased serviceman to be left with his friends in the bush and another helicopter would always be tasked as soon as possible after the wounded were retrieved, to collect the body.  The deceased would be transferred to a military mortuary, embalmed under arrangements from the New Zealand Embassy in Saigon, and shipped home as cargo to Auckland Army Area for handover to family.  This was a departure from an earlier practice of having the bodies buried in the Commonwealth War Graves cemetery outside Terendak Garrison in Malaya.  It is doubtful that the bodies were escorted home as was the US military custom. 

Pte CHris Kennedy recovering in 1AFH before returning to duty, WIA 29 May 1970 in the same booby-trap incident that took the life of Pte John Gurnick [Stock]

 

Drama Over, Start the Hard Yards

Once the patient was treated for his injuries and was out of danger the hard yards of rehabilitation started.  It is the role of the medical services to return as many patients as possible back to active duty.  They accomplish this by healing the body and the mind, and by rehabilitating the spirit.  Army physical training instructors handled physiotherapy.  Red Cross and Red Shield [Australian Salvation Army services] staff gave encouragement and practical help, and ward staff and other specialists worked on the medical bits.  Patients located in 24 Evac or other hospitals were relocated to 1AFH when their condition permitted and finished their treatment and disposal under Australian rules.  If recovery would normally take longer than a certain time-frame [I think this was 14-days] then the patient once stabilised was shipped South to the Australian military hospital at RAAF Base Butterworth in northern Malaya, or further South to mainland Australia.  From Australia Kiwi patients would be transferred to New Zealand public facilities close to their home or family locations.  Air transport was always used from Vietnam; usually a litter equipped C130 Hercules.

 

Pte Chris Kennedy recovering in 1AFH before returning to duty, WIA 29 May 1970 in the same booby-trap incident that took the life of Pte John Gurnick [Stock]

 

For an actual example of how the system worked read this story of the DUSTOFF of four casualties from 3Pl in October 1970. 

 

And Those Left Behind…

Troops remaining in the bush faced a number of health issues.  Conditions in the field were not pleasant due to the tropical temperatures, high humidity and during the 6-month monsoon season many soldiers were unable to get dry, suffering fungal infections of the feet, skin diseases, scrub typhus, and poor personal hygiene - I can recollect how after 14 days Anopheles malaria mosquitoes [internet]of the wet my shirt under my field pack had become attached to my back by sores and fungi.  There was a daily battle against malaria and diarrhea and the anti-malarial tablets were unpleasant to take [it was a standing joke to tell soldiers new to the theleech on skin [internet]atre to ‘bite’ the tablet, their reaction to the unpleasant after taste was thought hugely funny].  Also daily confronted was the myriad array of ‘resident nasties’ in the form of insects, haemophagic leeches, snakes and other fauna, and thorny vegetation such as spiky bamboo and bush lawyer which clawed at and wounded exposed skin.  Despite these issues, and despite life in Nui Dat being comfortable, most soldiers were happier living in the bush away from the contrived atmosphere of the Australian base.  Shaving was not encouraged in the field [but under Australian rules had to be done before being extracted back to Nui Dat] as cuts could turn septic, the growth was reasonable face camouflage, and in the dry season all water was needed for drinking.  Smell in close-country is an important tool to locate enemy people or camps; the VC could often be detected 100-300 metres away by their cooking smells, use of deodorants in personal hygiene, or the smell of cigarette smoke.  New Zealand troops used poor hygiene to better blend into the jungle environment to hide their presence, something helicopter crews and base staff wished they could escape from when dealing with the effect post-operation..!

 

Catering in the field was basic, based upon dry or tinned meals and snacks.  The menu of meals was monotonous, the size of a meal minimal, and the choice was often made by individuals that items would not be carried due to weight, bulk or dislike, destroying the ‘balanced’ diet that required all items to be consumed in a 24-hour period. Consequently the individual soldier would lose weight and physical conditioning, ultimately becoming tired and prone to having problems with operational issues.  Water was limited in the dry season even though around 12 water bottle equivalents would be carried for the 3-day period between resupply.  Salt tablets were not used [bad for health long-term], neither were electrolytes [not available in the 1960's].

 

Here’s an illustration of one way of catering under these conditions: remove the label from a can of meat and place can inside US issue field mug.  Top up the mug with water and boil; this heated the food without exploding the can and left water for a hot drink.  If it were breakfast consume the meal and drink most of the coffee but retain enough coffee to brush teeth.  Finally soak a small amount of water into personal sweat rag and wipe face, which finished individual personal hygiene for the day apart from later wiping bum.  Do this every meal for a week or so.  Enjoy..!

 

Eating Fresh:  One experience eagerly looked forward to on resupply days was the big bun, a treat from the cooks comprising a hamburger bun filled with fresh meat and salads and accompanied by a carton of flavoured milk.  Unfortunately the effect could be short-lived as the introduction of fresh food into the diet was guaranteed to move the bowels.

 

Morale among infantry in W3 Company remained at a high level most of the time, the notable exception being the accidental death of Pte Tom Cooper and the wounding of three other colleagues.  The manner in which morale was assisted is described in this article about the routine back in base between operations.

 

For various reasons to do with folk lore and Hollywood movies, ‘DUSTOFF’ has been accorded cult-hero status; but the helicopter crews deserve this accolade for their acceptance that wounded getting treatment had priority over personal safety and the helicopter crews would willingly hover over patients, land on ‘hot’ [under VC fire] or ‘not yet cool’ pads and attempt casualty extraction under all weather conditions.  It needs to be noted however that the soldiers in contact remained on duty in the field long after the DUSTOFF had departed; that the majority of soldiers in the field never required medical evacuation, and that they had their own brand of bravery which when combined with that of the DUSTOFF crews and the medical staff in the operating theatres and ICUs reflects the extraordinary devotion to duty displayed by all servicemen in Vietnam.

 

'I Was There' - add a comment    anyone can contribute to or correct this article

 

 

 

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