Document text
MHI FM 8-55
* hm nL^ — ,
WAR DEPARTMENT
MEDICAL FIELD MANUAL
REFERENCE DATA
March 5, 1941
FM 8-55
MEDICAL FIELD MANUAL
REFERENCE DATA
Prepared under direction of
The Surgeon General
UNITED STATES
GOVERNMENT PRINTING OFFICE
WASHINGTON : 1941
Female hy the Sonerlnteiulentof Documents, Washington. D. C. - Price 10 cents
WAR DEPARTMENT,
Washington, March 5, 1941.
FM 8-55, Medical Field Manual, Reference Data, is pub-
lished for the information and guidance of all concerned.
[A. G. 062.11 (&-10-40).]
By order of thb Secretary of War:
G. C. MARSHALL,
Chief of Staff.
Official :
E. S. ADAMS,
Major General,
The Adjutant General.
Distribution:
D (3) , 8 (10) ; B (2) ,8 (10) ; R (3) , 8 (5) ; Bn 8 (3) ;
C 8 (5).
n
TABLE OF CONTENTS
Paragraphs Fage
Chapter 1. General 1-2 1
Chapter 3. Command and Staff Consideration 3-7 2
Chapter 3, Medical Flans and Orders.
Section I. Medical estimate of situation 8-14 8
II. Medimal plans 15-23 13
HI. Combat Orders of medical units.. 24-28 20
Chapter. 4. Troop Movement 29-38 22
Chapter 6. Supply 38^13 32
Chapter 6. Rates Used by the Medical Service 44-52 36
Chapter 7. Estimations op Medical Bequirements.
Section I. General considerations 53-56 40
II, Admissions from disease and non-
battle injuries 57-63 41
III. Battle casualties 64-75 46
IV. Evacuation Of casualties 76-78 56
V. Hospital bed requirements 7S-86 57
ApewWX. I. Check list of complete formal medical
plan 65
II. ChecK list of complete unit plan 68
III. Combat orders for medical units 69
Inbes , 75
FM 8-55
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MEDICAL FIELD MANUAL
HEFEBEKCE DATA
CHAPTER, 1
GENERAL
B 1. Purpose ah» Scope. — a. The purpose of this manual is
to furnish to medical officers a compact source of information
bearing upon the military aspects of their profession.
b. This manual includes the logistical data reauired for the
movement of medical units and for the evacuation of the sick
and injured; experience tables to serve as points of departure
in medical planning; medical plans and orders; command
and staff relationship.
H 2. Befbebwce Data. — a. Military technique is an art rather
than a science. The many imponderables present in military
situations make precise measurements impossible. Certain
yardsticks are, of course, essential in planning; but it is dan-
gerous to rely with complete confidence upon an average ex-
perience in each spacial situation. The data contained herein
are to be regarded as general guides rather than as authori-
tative predictions applicable to every situation. To them
must be applied as factors the special conditions obtaining
in each situation, ^or example, it will be found in paragraph
35 that the average rate of march of foot troops during day-
light hours is 2V2 miles per hour, and that an average day's
march for a unit as large as a division is 12 to 15 miles for
foot marches. Yet, upon many occasions in war, foot troops
have materially exceeded this rate; and, upon more than one
occasion, large units have marched 35 miles or more in 1
day and subsequently engaged immediately in severe combat.
b, For military symbols &xr medical units, see FM 21-30.
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3-5
CHAPTER 2
COMMAND AND STAFF CONSIDERATIONS
■ 3. Command and Staff. — A general and a special staff are
provided in the division and higher units to assist the com-
mander. The commander and his staff, together with their
commissioned and enlisted assistants, constitute the head-
quarters.
■ 4. Headquarters. — The headquarters of the division and
higher units is organized into two echelons.
a. Forward echelon. — The forward echelon, known also as
the CP (command post) , includes the commander, his general
staff, and such of his special staff whose functions are asso-
ciated primarily with tactical operations.
b. Rear echelon. — The rear echelon is composed of the
special staff sections whose functions are primarily adminis-
trative. Representatives of the G-l and i sections of the
general staff may also be located at the rear echelon. Con-
versely, a special staff section at the rear echelon may have
a representative at the forward echelon when required by the
situation. (See FM 101-5.)
■ 5. Chief Medical Officer. — a. Designation. — The chief
medical officer of the division and higher units is designated
"the surgeon." His capacity comprises both staff and com-
mand functions. Every staff officer, in his staff capacity,
exercises authority only in the name of the commander. In
his command capacity, however, the chief medical officer
exercises, by inherent authority, all the functions pertaining
to his particular command. For example, supply is a com-
mand responsibility. In exercising his functions of medical
supply, the surgeon is acting as an assistant to the com-
mander. But, insofar as the supply of a medical unit of
which he is the commander is concerned, the medical officer
is directly and wholly responsible himself. A clear concep-
tion of the distinction between these two capacities, in which
the chief medical officer serves, is necessary to prevent the
confusion of his various functions.
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REFERENCE DATA
5-6
o. Selection. — Surgeons of divisions and higher units are
specially selected and must be senior in rank to every medi-
cal officer over whom, by virtue of their office, they exercise
direct command. However, since in their staff capacities
their authority derives from, and is exercised in the name
of, their commanders, it is not necessary that they be senior
in rank to surgeons of subordinate echelons.
H 6. Staff Fuhchohs of Surgeons. — a. To keep the com-
mander and his general stafi constantly informed as to the
conditions in, and the capabilities of, the medical service for
which the commander is responsible.
b. To elaborate the medical details necessary to carry the
commander's decisions into effect.
c. To initiate measures for the prevention or reduction of
disability and death in the command. Such of these meas-
ures as involve command responsibility, except in the case of
medical units commanded by the surgeon, are initiated in
recommendations to the surgeon's commander; but such as
pertain only to technical procedures to be followed in the
prevention, care, or treatment of disease and injury may,
"within the scope of the commander's responsibility therefor,
be initiated by direct instructions to the medical officers
concerned.
d. To advise the commander and his general staff upon all
aspects of medical training for which the former is respon-
sible.
e. To advise the commander and his general staff regard-
ing the allocations of medical replacements and medical
reinforcements.
/. To make for the commander the necessary inspections
to insure that his instructions pertaining to the medical serv-
ice in all echelons, including the medical aspects of training,
are being carried out.
g. To advise the commander concerning all command de-
cisions pertaining to, or involving, the medical service.
h. To procure, store temporarily, and distribute all med-
ical, dental, and veterinary supplies for which the com-
mander is responsible; to study medical supply requirements,
and to advise the commander thereon.
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MEDICAL FIELD MANUAL
i. To prepare and forward consolidated reports and re-
turns of the sick and injured, and to furnish this information
to other staff officers who are concerned therewith.
j. To keep the surgeon of the next higher echelon informed
of the medical situation within his own echelon.
k. To examine and report upon captured medical equip-
ment.
■ 7. Command and Staff Relations of Surgeon, — a. With
commander. — The commander is responsible for his medical
service. The surgeon is the special staS officer charged with
keeping the commander informed as to the conditions and
capabilities of the medical service, and with elaborating the
details necessary to carry the decision of the commander, as
it affects medical matters, into effect. (See FM 100-5.) As in
the case of any staff officer, the commander may utilize the
services of the surgeon in a purely advisory capacity; or he
may delegate to the surgeon authority to act in the com-
mander's name, within established policies, in affairs that
fall properly within the jurisdiction of the medical service.
The general responsibilities of the surgeon to his commander
are—
(1) To inform and advise the commander upon all matters
that affect the health of the command and the care of the
sick and injured. The commander is charged with having
ever before him a conception of the physical state of his
command. Of certain factors governing physical state the
surgeon alone can inform him. (See FM 100-6.)
(2) To submit to the commander plans for the training and
employment of medical units. Responsibility for the medical
service includes the responsibility for its training. Every
command that has a medical service comprises other subordi-
nate elements. To act effectively a command must operate as
a coordinated whole. The medical plan is a part of the gen-
eral plan of a command, and must be fitted with the other
subordinate plans. For this reason medical plans must be
submitted for the approval of the commander,
(3) To exercise supervision for the commander over the
technical aspects of the training and operation of the medical
services of subordinate elements. This is purely a staff func-
tion and does not encroach upon the prerogatives of sub-
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REFERENCE DATA
ordinate commanders. It is the duty Of the surgeon to follow
up the execution of the instructions issued by the commander
which apply to any phase of medical service. He may call
for such technical reports from surgeons of subordinate units
as are necessary in supervising the execution of the work
with which they are charged. (See PM 101-5.)
(4) When, In addition to his staff duties the surgeon com-
mands a medical unit, his responsibilities to his commander
are the same as those of any subordinate commander. (See
FM 100-5.)
h. With general staff.— The diversified activities of the
medical service require the surgeon to deal with all sections
of the general staff or, in commands lacking one or more gen-
eral staff sections, with the staff officers discharging such
general staff functions. Insofar as the surgeon is concerned
with any of the matters listed below, he deals with the general
staff sections indicated.
(1) CM section. — (a) Sanitation; measures for the control
of communicable diseases of men and animals.
ib) Medical problems associated with prisoners of war,
refugees, and inhabitants of occupied territory.
(c) Personnel matters, and replacements for medical units.
(cD Reports of human casualties.
(e) Employment of prisoners of war to reinforce the medical
service.
(2) G"2 section. — (a) Nature and characteristics of weap-
ons, missiles, gases, and other casualty-producing agents,
employed by the enemy.
(b) The character of the organization and operation of
the medical service of the enemy, especially as it relates to
new methods which may deserve study and trial.
(c) Communicable diseases in enemy forces.
(<D Supply of maps.
(3) G-3 section. — (o) Current information of the tactical
situation; future plans.
(b) Mobilization, assignment, and training of medical units;
training of all personnel in military sanitation and first aid.
(c) Signal communications in medical installations.
id) Troop movements affecting medical personnel.
(4) Q-4 section. — (a) Tactical dispositions of medical units.
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MEDICAL FIELD MANUAL
(b) Supply matters, both general and medical,
(e) Transportation of medical units.
(cZ) Evacuation by higher echelons,
(e) Reinforcement of the medical service by a higher
echelon.
(/) Hospitalization.
(g) Shelter for medical troops and installations.
(h) Coordination of nonmilitary welfare and relief agen-
cies in medical installations,
(ii Traffic control and restrictions affecting medical
vehicles.
(j) Reports of animal casualties,
(k) Animal replacements for medical unite.
(D All other matters which have not been specifically
allotted to another general staff section, or wherein there is
doubt as to which section has jurisdiction.
c. With special staff. — The expenditure of much time and
energy may be spared the general staff by the close coopera-
tion of the surgeon with other members of the special staff.
In war, time is ordinarily too precious to be wasted in ponder-
ous methods of formal staff procedure. Informal agreements
among special staff officers, succlntly submitted for approval
"When necessary, promote efficiency as well as foster the
friendly personal relations that are so essential to the smooth
functioning of a staff. The more important contacts of the
surgeon with other special staff officers will be in connection
with—
(1) Engineer, — (o) Water supplies; sewerage systems;
electricity,
(t>) Road construction and maintenance in and around
medical installations.
(c) Construction, repair, and maintenance of roads and
structures used by the medical service.
(d) Preparation of signs.
(e) Camouflage.
</) Maps.
(2) Quartermaster. — (a) Disposition of the dead at medi-
cal installations; the sanitary aspect of the disposition of all
<Jead.
(o) Bathing, delousing, and laundry facilities for all troops.
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REFERENCE DATA
7
(o) Clothing for gassed cases, and other patients returning
to duty.
(d) General supply of medical units.
(e) Procurement of land and existing shelter for medical
troops and Installations.
(/) Procurement and operation of utilities allocated to the
Quartermaster Corps. (See FM 100-10.)
(g) Transportation, land and vrater; motor and animal
transport of medical units.
(3) Chemical wwrfms officer. — («) Ofas defense of medical
troops and installations; gas masks for patients.
(ft) Types of gas used and methods ofi identification,
(c) Toxicology and pathology of new gSsses.
(4) Adjutant general. — (a) All official correspondence
through command channels.
(b) Personnel matters.
(c) Postal service for medical units and installations.
(5) Signal officer. — Signal communication for medical
installations.
(6) Judge advocate. — (a) Questions of military and civil
law.
(t>) Administration of justice in medical units.
(7) Headquarters commandant and provost marshal. — (a)
Physical arrangements for the surgeon's office.
fb) Custody of sick and injured prisoners of war,
(c) Disposition of stragglers and malingerers in medical
installations.
1
e-io
CHAPTER 3
MEDICAL PLANS AND ORDERS
Paragraphs
Section 1 I. Medical estimate of situation —
n, Medical- plane
III. Combat orders of medical units.
a-14
15-23
24-28
Section I
MEDICAL ESTIMATE OF SITUATION
■ 8. References. — For general discussions of an estimate of
the situation, see FM 100-5 and FM 101-5.
■ 9. Preparation. — Every medical officer responsible for the
execution of a military task, whether it is to direct the medi-
cal service of a theater of operations or to lead a bearer
platoon into action, must make an estimate of the situation
before arriving at a decision. Formal written estimates are
rarely made except in the advance planning of large units.
A rapid mental estimate is the rule in the field. Never-
theless, the same process of thought is followed. The esti-
mate is a continuing process of thought. New situations
arise constantly. A running estimate of the situation re-
vised as events transpire will be the constant preoccupation
-of the surgeon, because a planned medical service must be
furnished a command from the time it is mobilized until it
is disbanded.
■ 10. Mission; — The mission must never be lost sight of in
any of the considerations that follow. Broadly speaking, the
mission of all medical units under all conditions is to provide
medical service. The mission of the troops served deter-
mines the general type of medical operations and a mission
to provide medical service for the regiment in the attack of a
position implies a different type of medical operation than a
mission to provide medical service for the division In a day-
light withdrawal. For this reason the medical mission should
be stated specifically in conformity with the operations in
which the troops supported are engaged.
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REFERENCE DATA
11
■ 11. Situation .-'■a. Elements of the situation. — A medical
situation may comprise few or many elements. Certain ele-
ments will be present in most situations. Others will appear
only occasionally. In considering the discussion that follows,
it must not be inferred that all the elements discussed are
present in every situation, or that each is equally important.
(1) Enemy capabilities. — The capabilities of the enemy are
a most important factor in any military estimate of the situa-
tion; but the surgeon considers them from his specialized point
of view. Insofar as the medical service is concerned, they
are limited to his potential power of inflicting physical damage
upon personnel and animals, and of impeding or prohibiting
evacuation. These capabilities result from his strength, his
combat efficiency, his position, his weapons, and any other
attributes that may be converted into casualties,
(2) Own situation. — (a) Plan of commander. — The medi-
cal service must be adapted to the operations of combat ele-
ments. The plan of the commander must be known as the
nature of the operations is a factor in the estimation of the
probable number and distribution of casualties.
"tb> Strength, — Strength is one index of the actual number
of casualties to be expected; and, when considered in connec-
tion with the capabilities of the enemy and the plan of the
commander, it is a factor in estimating the rate of casualty
incidence.
(c) Position. — In defense, the characteristics of the position,
particularly its natural strength and the degree of organiza-
tion, influence the Incidence of casualties.
(d) Movements. — Movement under fire is productive of
casualties; and the difficulties of evacuation increase in pro-
portion to the rate of movement. The probable extent,
direction, and rate of movement of the force, or any major
components thereof, should be considered.
(3) Physical factors. — There are always physical factors in
the situation to Influence medical service, either in the number
of casualties or in their collection and evacuation. Some of
these are —
(a) Terrain, — Consider the terrain features that may In-
fluence favorably or unfavorably the task of the medical
service, such as cover, protection, shelter, and sources of
water supply,
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MEDICAL FIELD MANUAL
Cb) Communication. — Avenues of communication are ter-
rain features; taut their importance in evacuation warrants
special consideration because of susceptibility to air attack.
Roads, railroads, and water routes must be considered as
their condition, practicability, and availability influence the
medical task.
(c) Weather*— Weather is a factor in the health of the
command, in the shelter required for casualties, in the move
ments of medical units, and in collection and evacuation.
The meteorological service is in a position to make long-
range predictions with reasonable accuracy, and since plans
are drawn for future operations, predicted weather is more
important than conditions prevailing at the time of the es-
timate. Moonlight may be a factor to be considered.
id) Other physical factors. — In special situations other
physical factors may have to be considered, such as contami-
nation of the soil with pathogenic organisms, noxious vege-
tation, and the pollution of streams with industrial wastes.
(4) Suwfly. — The general and special supply situation is a
restrictive factor, and its present status, sources of replenish-
ment, and difficulties of distribution must be considered
(5) Physical condition of command. — Poor physical condi-
tion will multiply the numbers of casualties requiring evacua-
tion during prolonged combat. Not only does poor physical
condition produce actual disability but it also results in a state
of mind that encourages the magnification of minor afflic-
tions and even frank malingering. The mere sorting of such
cases places a heavy burden upon the medical service. Physi-
cal condition is affected by —
(a) Origin of troops. — Soldiers drawn from densely popu-
lated urban centers will usually have, until they are well sea-
soned, less physical stamina than those reared in rural areas.
On the other hand, those of urban origin will prove more re-
sistant to communicable diseases.
(6) Presence of communicable diseases. — The presence of
communicable diseases in a command increases the burden
upon the medical service out of all proportion to the numbers
of cases involved. Such cases must be isolated during evacu-
ation as well as during treatment; and, in an epidemic, new
cases will occur during combat as well as at other times.
10
REFERENCE DATA.
11
(c) Food supply. — The adequacy and quality of food are
most Important factors in physical condition, but never Is
their influence greater than in combat. The unusual exer-
tion, the lack of rest, and the increase In metabolic rate caused
by excitement increase the food requirements of the soldier
in combat; and inability to supply him will result in the im-
pairment of physical condition that is reflected in the medical
task In the manner described above.
(.&) Water supply. — Far a detailed discussion of water sup-
ply, see FM 8-40. An adequate supply of potable water is
essential both for the effective soldier and for the casualty.
(c) Clothing. — Proper clothing has bearing upon physical
condition and is to be considered in connection with the
weather.
(/) Fatigue. — Fatigue is a most important factor in physical
condition. The state of the command with regard to fatigue
must be given full consideration in a medical estimate of the
situation.
(sr) Other factors in -physical condition. — In special situa-
tions other factors may affect physical condition, such as
extreme heat, insanitary conditions in field fortifications, defi-
ciency diseases, foot injuries, and foot diseases other than
communicable.
(6) Other elements of the situation. — In special situations,
other elements that will influence the medical task may have
to be considered. Morale may have a special importance in a
given situation. Another Is any restriction upon the free-
dom of action of the medical service imposed by the com-
mander in the interests of secrecy, deception, or other mili-
tary necessities.
b. Analysis of the situation. — The Individual qualitative val-
ues of the elements of the situation are considered in a above.
In medical planning they must be reduced and analyzed in
terms of the premises upon which a medical plan is based.
These premises are —
(1) Estimated number of casualties. — The number of cas-
ualties is a product of the combined influences of enemy capa-
bilities, relative strength, position, own scheme of maneuver,
physical factors, morale, and physical condition upon the
standard expectancy shown in experience tables.
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(2) Distribution of casualties in time. — This Is important
in planning the movement of medical units, the establish-
ment of medical installations, and the arrangements for sup-
port by higher echelons; and it will depend upon the enemy
capabilities and the plan of the commander.
(3) Distribution of casualties in space. — The probable dis-
tribution of casualties in space is a most important considera-
tion in the allotment of medical means.
(a) Areas of casualty eternity, — These are predictable from
a consideration of enemy capabilities, position, terrain, and
the plan of the commander. If the factor of physical condi-
tion be not uniform throughout the command, it will also
exert an influence.
(b) Lines of natural drift of wounded. — This is a planning
factor only in f orwaid areas where walking wounded must be
considered. They may be deduced from a consideration of the
terrain and the plan of the commander.
(4) Medical means required, — Prom the estimates of the
number of casualties and their distribution in time and space
are calculated the number and types of medical units re-
quired for the various phases of medical service, such as first
aid, collection, evacuation, and hospitalization, including
medical support by higher echelons. Neither the means
available nor the allotment of specified units should be con-
sidered at this stage. This is merely an estimate of the
medical means required.
(5) Suppty requirements. — The supply requirements will
depend upon the number of casualties and upon the number
of medical units, and to a lesser degree upon the distribu-
tion of the casualties in space.
■ 12. Means. — Having arrived at the medical means required,
the next step is a consideration, of the means at hand or
readily available. To prevent confusion, these should be
separated into four categories.
a. Organic medical units. — The medical units, agencies,
and installations that are organic components of the com-
mand are listed, and under each is stated its location,
strength, and readiness for action.
12
REFERENCE DATA
13-16
&. Attached medical units. — Both medical units already
attached and those that may be readily had are considered
in the manner described in a above.
e. Support by higher echelons. — Here Is considered the
evacuation and other support that will be furnished by higher
echelons.
d. Supply. — This includes the supply agencies and the
amount of supplies on hand and the facilities for replenish-
ment.
■ 13. Plans. — A plan Is the application of the means at hand
to accomplish a task. In arriving at a plan the various fac-
tors involved in the task are considered, together with the
means available. The many variables usually present in any
situation will usually permit more than one plan to be formu-
lated. For this reason the main features of all workable
plans should be considered in arriving at a decision.
■ 14. Decision. — The decision is the result of the estimate
expressed in the form of a brief statement clearly setting
forth the line of action adopted. The decision is the basis of
the plan and states in general terms only the plan adopted
after considering all possible plans. The details will be added
in the development of the plan. (See sec. n.)
Section n
MEDICAL PLANS
■ 15. Definitions. — a. A medical plan is a plan for the op-
eration of the medical service of a command prepared by
the surgeon acting in his capacity of a staff omcer. (See
PM 101-5.)
b. A unit plan deals only with the operations of the par-
ticular unit to which it pertains. It is prepared by the unit
commander, based upon the decisions and orders of the next
higher commander which prescribe the essential elements of
other subordinate plans as well as of the medical plans.
■ 16. Purpose and Scope. — a. Medical plan. — The scope of a
medical plan depends upon the size and complexity of the
command to which it pertains. The medical plan of a bat-
talion usually will include little more than the location of the
aid station. That of a regiment may include, In addition,
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MEDICAL FIELD MANUAL
arrangements for supply or for some redistribution of medical
means; while the medical plan of a division must deal with
more functions because of the greater extent of the medical
responsibilities,
b. Unit plan. — The purpose of a unit plan is to break down
a mission into its component tasks. Its particular virtue is
that it visualizes the entire task before allotting specific tasks
to subordinate elements. Prodigal dissipation of means is
avoided. Committed to action without a plan, a unit may
waste its strength in uncoordinated effort. For this reason
careful planning is an essential precedent of effective execu-
tion. The scope of a unit plan depends upon the situation.
In general, it must provide for the accomplishment of the
mission and for the disposal of all means, including the
means held in reserve.
■ 17. Characteristics of a Satisfactory Plan. — a. Compre-
hensiveness. — A medical plan provides not only for the roles
to be played by medical units but also other information re-
quired by the commander.
b. Flexibility. — Military situations change frequently and
often with little warning; and a plan must be so drawn that,
without fatal delay, it may be modified to meet changes in
the situation arising either before or after the plan is placed
in operation.
c. Simplicity. — Plans are the bases of orders. Elaborate
plans require complex orders for expression. A simple plan
has a greater chance of success than an involved plan.
■ 18. Preparation, — a. Medical plan. — The preparation of a
medical plan is a responsibility of the surgeon. If he has no
assistants he must prepare all the details himself; but, in
larger units, the surgeon ordinarily will indicate by a directive
the general scheme to his assistants who develop the details.
b. Unit plan. — The unit commander prepares his unit plan
with or without the assistance of a staff, A complete formal
plan (par. 23c) toill rarely be prepared. The ordinary
plan will consist merely of the unit commander's basic de-
cision and the supplemental decisions made by him or an
authorized staff officer which, if made of record at all, will
be In the form of memoranda.
14
REFERENCE DATA
19-21
■ 19. Approval. — a. Medical %Aan, — A complete plan of opera-
tions includes the commander's decision and the elaboration
of all the details necessary to carry this decision into effect.
To insure a well integrated general plan, all staff plans must
fee coordinated to reconcile conflicting interests and to pro-
mote complementary action. This is a function of command,
exercised in small units by the commander himself, and in
larger units through his general staff or comparable assist-
ants. In common with other staff plans, a medical plan is not
operative until it has been approved by the commander. It
may be approved item by item; or, if time permits, it may be
submitted for approval in its complete form prior to the start
of the operation,
b. Unit plan. — Since a unit plan is limited by the decisions,
directives, and announced policies of the next higher com-
mander, it does not ordinarily require the approval of higher
authority. However, the higher commander may at any time
call for the plans of his subordinate commanders,
a 20. Medical Anmex. — When the details of a medical plan
are too voluminous to be included in an administrative order,
or are not of general interest or concern, they may be pub-
lished in an annex to that order, with a reference in appro-
priate paragraphs as follows: See Annex No. — , to P. O. — ,
Medical Plan.
■ 21. Scope op Army Medical Planning. — a. General. — The
scope of medical planning far exceeds the brief details sub-
mitted in any one medical plan; for planning is continuous
and contemplates all reasonable contingencies whereas a
plan is the solution of a fairly well-denned problem. Suc-
cessive plans are the periodic dividends of continuous
planning.
b. Prior to concentration. — The army commander is desig-
nated and his staff assembled some time in advance of con-
centration. Planning commences at once; and the army
surgeon must make the most of this opportunity to assemble
from every possible source the pertinent data bearing upon
the medical problems that will be encountered In the theater.
c. Supply planning. — Considered separately, the scope of
medical supply planning in the army is relatively restricted.
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MEDICAL FIELD MANUAL
If properly stocked supporting depots be constantly at hand,
the army problem is limited to the disposition and stockage
of the army medical depot. But the army medical supply
problem cannot be separated from that of the supporting
echelon since the supply plan of the latter will depend, In
large measure, upon the requirements of the army. Conse-
quently, initially and throughout operations there must be
close supply liaison between, and joint planning by, the army
and the next higher supply echelon. The latter must be
informed in advance of unusual requirements and antici-
pated variations In the rate of consumption.
The yardstick of supply planning is the day of supply (see
par. 42). The components of a day of medical supply will
be influenced by many factors, the more Important of which
are 1 the epidemiological characteristics of the theater, the
nature of the operations, and the amount and type of supply
transport available. The OEly point of departure in the ini-
tial estimate of a. day of medical supply is the accumulated
experience of United States troops in the; same or similar
theaters. The component items are selected from the Medi-
cal Department Supply Catalog, and the number of items
should be held to the minimum consistent with proper medi-
cal service in the army area, dispensing 1 with unnecessary
equipment and with articles of individual preference. The
daily rate of consumption can only be estimated by apply-
ing to past experience the factors expected to be operative
in the situation at hand. Subsequent adjustments can be
made as the experience in, the theater accumulates, and
supply planning thereby will become increasingly accurate.
d. Evacuation and hospitalisation, — For detailed discussions
of the estimation of requirements for evacuation and hospi-
talization, see chapter 7, this manual, and Army Medical
Bulletin No. 24. The more important factors to be considered
are —
(1) Disease and nonbattle injuries. — Admission rates and
duration of treatment by classes of disease. These casual-
ties are the backlog of medical service and enter into every
estimate.
<2) Battle casualties. — Total numbers, distribution by units,
and classification by transportation required (sitting or
16
REFERIIHCE DATA
21
prone) ; classification by causative agent (such, as casualties
from chemical agents), and classification by type of injury
(such as head injuries) when these require special provisions
for evacuation or treatment.
(3) Transport required and available. — Ambulances, cargo
trucks, light railways, special transport.
(4) Surgical hospitals. — Numbers and disposition.
(5) Evacuation hospitals. — Numbers and disposition; avail-
ability of routes to the front and rear.
(6) Convalescent hospital. — Location, available capacity.
(7) Veterinary hospitals. — Necessity for, if none are already
available. Factors similar to those considered in the case of
human casualties.
(8) Evacuation policy. — The proper evacuation policy for
an army 'will vary within wide limits, depending upon the
military situation, prevailing causes of admission, the chain
of evacuation, and other factors. In general, it may safely be
longer than that of a corps under similar circumstances, but
no rigid rules can be laid down.
e. Preventive medicine. — It is an axiom in health adminis-
tration that the first requirement in prevention and control
is information of the sources and distribution of disease and
injury. The best method of obtaining such information is
by a thorough sanitary survey, but this frequently is impos-
sible prior to the occupation of a theater of operations . Other
sources of information must be exploited until first-hand in-
formation can be obtained. Some of these sources are the
offices of the surgeons general of the Army, the Navy, and the
Public Health Service; the Q-2 division of the War Depart-
ment General Staff; published public health reports from
the area in which the theater is located, ordinarily to be found
in the Army Medical Library; and international health re-
search organizations such as those maintained by the League
of Nations and certain universities and philanthropic founda-
tions. All available data bearing upon the health of troops
should be collected, evaluated, and tabulated in the medical
section of army headquarters prior to concentration. After
concentration a continuing sanitary survey adds to such in-
formation, both in quantity and in reliability. There is a
sanitary aspect to almost every military plan and the army
17
21
MEDICAL FIELD MANUAL
surgeon, must be prepared to advise the commander accord-
ingly. There is rarely time to obtain sanitary information
after the need for it arises. Therefore, the surgeon must
anticipate such need and collect in advance all possible sani-
tary inf ormation. There is scarcely a limit to the Information
that may be at some time of great importance; and the fol-
lowing list of the more important subjects is not intended to
be restrictive:
(1) Prevailing diseases, human and animal, among the
civil population of the theater — character, geographic dis-
tribution, and other epidemiological features; reservoirs of
infection.
(2) Animate vectors of disease, actual and potential; iden-
tification, distribution, methods of control.
(3) Climate — seasons and seasonal distribution of disease.
(4) Noxious vegetation — poisonous and irritant plants,
their distribution and means of prevention 'of disabling
effects.
(5) Venomous reptiles and insects, and dangerous ani-
mals — distribution, means of protection and treatment.
(6) Susceptibility of the command — race, nativity, season-
ing, and immunity.
(7) Local food and forage supply — character, sources,
quality, and hygiene; diseases transmitted by food stuffs.
(8) Local water supplies — sources, potability, treatment—
both that applied and that required, and capacities of all
public supplies.
(9) Sewage disposal — type, efficiency, and capacity of each
local sewerage system in the theater.
(10) Local civU health agencies — organization, scope of
activities, and efficiency of all civil health agencies in the
theater.
(11) Sanitary habits of the civil population — sanitary con-
science and level of instruction in hygiene.
(12) Disability among troops — current information of the
incidence of all disease and Injury. This information is of
no value -whatsoever unless it be properly classified and
closely analyzed. Admission rates for the army as a whole
are not very helpful; and gTaphs depicting such experience
are of little value other than decorative or to impress the
18
REFERENCE DATA
21-23
uninitiated. Admission rates must be broken down by causes
and by organizations. In this way only can unusual incidence
be localized and investigated. If, for example, two organ-
izations are equally exposed to the risk of injury by animals
and one of them shows a much higher admission rate from
this cause than the other, there is a presumption of faulty
management or want of care in the one with the higher
rate which should be inquired into. Organization showing
a higher or a lower admission rate than the average for
intestinal infections should be carefully investigated — the
former to unearth defects in sanitation and the latter to
discover practicable measures of general application. Within
the registers of sick and wounded are locked all the problems
of preventive medicine; and competent search will reveal
the keys to the solution of most of them.
H 22. Sanitary Ohder. — The sanitary order publishes to the
entire command the sanitary measures to be enforced. It
is drafted by the army surgeon and, as approved, issued by
the army commander, usually as a general order. This
order should cover only the routine instructions of general
application. Special instructions, applicable to only a frac-
tion of the command, should be issued in communications
or other suitable form; and special instructions, of general
application, but for limited periods, should be issued as para-
graphs in administrative orders or in memorandums. (See
FM 8-^0.)
S 23. Check Lists. — a. General. — The check lists Capps. land
II) are intended as guides to the preparation of a complete
formal plan. Rarely will plans of a surgeon or a medical
unit commander include all of the items in these lists. Many
of the items are covered habitually by standing operating pro-
cedures; but they must be provided for in some way in the
situations in which each is involved.
b. Medical plan. — As approved, a medical plan will appear
in whole or in part in the administrative order of the command
or in the administrative paragraph of the field order. It will
facilitate the preparation of such orders if the medical plan
follows the sequence of an administrative order. A check
list along these lines appears in appendix I; only the items
pertaining to the command in question are to be considered.
19
23-27
MEDICAL FIELD MANUAL
c. Unit plan. — A complete plan for a medical unit may take
the form outlined in appendix II.
Section m
COMBAT ORDERS OP MEDICAL TJNITS
■ 24. References. — For a detailed discussion of combat
orders, see FM 101-5.
■ 25. Purpose. — The purpose of orders is to place In effect
the decisions and plans of a commander. The adequacy and
clarity of orders become, therefore, vital factors in. the execu-
tion of plans.
■ 26. Scope. — An order must include all the information and
instructions required by subordinates to execute their tasks,
but nothing more. It should not trespass upon the province
of subordinates; and the general rule is that a subordinate
should be told what he is to accomplish, but not how to do it.
The scope of an order, not to be confused with its length, will
depend upon —
a, Establishment of standing operating procedures. — A
standing operating procedure may be prescribed by the com-
mander in order to reduce the volume of orders and instruc-
tions, and to establish in the command a common understand-
ing of routine operations to be executed. The adoption of
such a procedure will save time in the preparation and issu-
ance of orders, minimize the chances for confusion and errors
when under stress of combat, and greatly simplify and expe-
dite the execution of operations in the field. (See FM 100-5.)
&. Situation, — A plan may project operations into the
future; but plans can be modified without creating confusion
as the situation develops. On the other hand, orders should
prescribe only so far as conditions can be foreseen. When
details are arranged too far in advance, orders usually have to
be countermanded with consequent confusion and misunder-
standing, possible needless hardships on the troops, and injury
to their morale (FM 100-5) . Considerations of secrecy may
also limit the scope of orders.
■ 27. Types. — a. General — A medical unit will rarely issue
arty type of combat order other than a field order. For a
discussion and form of a field order, see FM 101-5.
20
REFERENCE DATA
27-28
6, Warning orders. — In certain situations it may be neces-
sary or desirable to issue a warning order. A 'warning order
usually consists of a brief message giving information 'which
will enable subordinate commanders to make the necessary
preparations for a contemplated operation. Its principal
purpose is to gain time for preparatory measures and to con-
serve the energy of the troops. (See PM 100-5.)
c. Field order. — A field order is divided into four principal
parts — the heading, the distribution of troops (rarely appli-
cable in the field order of a medical unit), the body, and the
ending. (See FM 101-5.)
d. Examples. — Examples of field orders of medical units
appear in appendix III.
■ 28. Preparation. — The unit commander is responsible for
the preparation of all orders Issued in his name. The de-
tails of preparation of orders are a staff function; but, if
there is no staff, the commander must prepare his orders
without assistance. Orders frequently are issued in fragmen-
tary form as the situation develops and supplemental deci-
sions are made. Such fragmentary orders may be extracts
from a complete order, or they may cover various phases of
an operation successively. A medical battalion or regiment
rarely will be able to issue a complete formal field order prior
to initiating operations. A series of fragmentary orders will
be the rule.
291816° — «■
21
29-30
CHAPTER 4
TROOP MOVEMENT
* 29. Basic Road Spaces. — a. Foot and animal elements.
Element Yards
Animals:
In single file, per animal 4
In column of twos, per animal 2
In column of fours, per animal 1
Animal-drawn transport:
Vehicles drawn by 2 animaLs, not tandem 15
Vehicles drawn by 4 animals 20
Foot troops:
In single file, per man 2
In column of twos, per man 1
In column of threes, per man %
In column of fours, per man V 2
Units, minimum distances between:
Companies, foot or mounted 50
Battalions, foot or mounted 50
b. Motorized elements at twit.
Element Yards
Ambulances, per vehicle 10
Car, 5-passenger, per vehicle 10
Motorcycles, per vehicle 5
Trucks:
14 -ton. to 3-ton, per vehicle 10
Vi -ton to 3-ton with trailer 13
Over 3-ton, per vehicle 13
Units, distances between 50
c. For the length of moving motorized columns, see para-
graphs 32 and 33b.
■ 30. Road Spaces of Medical Units. — In tables I, n, and HI
are shown the road spaces of medical units when halted and
closed up. The figures given include 50 yards between battal-
ions, squadrons, companies, or troops to facilitate control and
servicing. All personnel, other than the mounted personnel
22
REFERENCE DATA
30
of veterinary units, are assumed to be transported in vehicles,
which is the normal manner of marching these units.
For the lengths of moving motor columns, see paragraphs
32 and 33b, and for the lengths of columns of foot elements,
when not transported in vehicles, apply the basic data in
paragraph 29a.
Table I. — Road space of motor columns when halted and
closed up
Unit
Eon?]
space
Medical regiment, sguare (iifieirm (8—21):
Collecting battalion (8-26).
Collecting company (8-25)
Ambulance battalion (motor) (8-35)_
Ambulance company (8-3S) ---
Amhulance company less 1 platoon-
Ambulance platoon
Medical clearing battalion (hospital) (S-45),
Clearini; company (8-46)__ —
Headquarters and service company <S-22)
Yards
Total,
Medical battalion, triangulat, dirtstoffl and corps (8-8B):
Headquarters detachment (8-88)
Collecting companies (B-«7)
Clearing company (B-68)
Total.
Medical battalion, armored diminto (8-75);
Headquarters detachment (3-76)
Collecting company (8-77)-.
Clearing company (S-78)
Total -
290
65
836
215
145
100
505
136
170
2,480
155
670
215
940
180
280
23
30-32
MEDICAL FIELD MANUAL
Table II. — Road space of medical squadron when halted and
closed up iT/O 8-SS>
Road space
Unit
Collecting troop (8-87)
Clearing troop (8-8S)
Veterinary troop (8-89)
Headquarters detachment (S-S6)
Totol ._ _
Table III. — Road space of army medical units and, additional
motor transport required for their movement
Unit
Additional
tract-tons
required to
move equip-
ment only
Additional
lM-ton tracks
required for
personnel and
equipment
Road space
when halted
and closed
up l
Surgical hospital (8-231)
60
51
MS
E valuation hospital (8-232)
184
155
1.62S
Convalescent hospital (8-233)
232
IDS*
2,030
6
6
M
Medical depot (8-236)
90
77
m
SO
26
m
Veterinary evacuation hospital (S-236)„-
fl
13
m
Veterinary convalescent hospital *
(8-237)
21
34
340
1 Includes both the organic and the additional motor vehicles required to move
personnel and equipment.
! Less animal elements.
B 31. Additional Transport Required bt Army Medical
Units. — In table III is shown the amount of motor transport,
aver and above the organic transport of the units, that is
required to move certain medical units.
■ 32. Transportation op Duty Personnel in Motor Ve-
hicles. — a. Trucks. — Motor transport requirements for duty
24
REFERENCE DATA
32-33
personnel, with individual equipment, moved by trucks are
computed on the basis of 12 men per lVa-ton cargo truck and
20 men per 2% -ton cargo truck.
b. Ambulances. — An average of 8 men, with individual
equipment, may be transported in a motor ambulance in
addition to the driver and his assistant. For short trips over
good roads the number may be increased to 10.
B 33. Average Road Space Occupied by Marching Columns. —
o. Foot and animal elements. — See paragraph 29a.
&. Motor columns. — The length of motor columns varies
with the speed with which they are moving. Special in-
structions may prescribe a given load density per mile, or a
given extended distance between vehicles. Table IV is based
upon road movements In whieh vehicles keep closed up to
safe driving distances. Safe driving distance is assumed to
be constant (15 yards, center to center, for cars or trucks up
to 3-ton) for speeds up to 5 miles per hour, and to increase
with the speed for rates above 5 miles per hour. This table
gives average road space. Actual road space may vary 25
percent either -way, depending upon conditions.
Example: Find the road space of the medical battalion
of the triangular division traveling at 30 miles per hour.
From table I, the road space, when halted and closed up,
is 940 yards. Prom table IV, the road space of a motor col-
umn, which is 900 yards in length when halted and closed
up and which is traveling at 30 miles per hour, is 6,390 yards;
and each yard in length, when halted and closed up, in-
creases to 7.10 yards at 30 miles per hour. So;
Length of 900-yard column at 30 mph=6, 390
Length of 40-yard column at 30 mph
(40X7.105 = 284
Length of 940-yard column at 30 mph=6, 674
25
33
MEDICAL FIELD MANUAL
Table IV. — Average road space of moving motor columns
(See par. 33 in connection with this table)
Boad
Boad space, in yards, occupied Trhen moving at 1 —
Moupiet
wItpti at
a halt
closed
5mph
or less
6mph
lOmph
15mph
20mph
25mph
30mph
35inph
40 mph
upi
Yards
1.45
1. 64
2,35
3. 50
4. 70
5. no
7. 10
8.30
9.50-
53
7. 25
8. 20
Jl. 75
17. 50
23. 50
29. 60
35.50
41.50
47.50
SO
75
80
120
175
235
295
3.55
415
475
100
145
165
235
350
470
590
710
830
950
200
290
330
470
700
940
1,180
1,420
1,660
1,900
300
435
490
705
1,050
1, 410
1 770
2, 130
2 490
400
580
955
840
1,400
1,880
2,360
2,840
3,320
3,800
500
725
820
1,175
1,750
2,350
2,950
3,550
4,150
4,750
ADO
870
985
L410
2,100
2,820
3,540
4, 260
4,980
5,700
700
1,015
1,150
3,645
2,450
3,290
4,130
4,970
5,810
6,650
800..
1,160
1,310
1,880
2,800
3, 760
4, 720
5,680
6,640
7,600
900
1,305
1,475
2,115
3,1,50
4.230
5,310
6,390
7,470
8,550
1,000
1,450
1, 040
2,350
3,500
4.700
5,900
7,100
8,300
9,500
1,500
2,175
2,460
3,525 5,250
7,050
8,860
10, 650
12,450
14,250
2,000
2,900
3,280
4.700
7,000
9,400
11,800
14,200
16,600
19,000
1 Since this table is based upon (actors introduced by speed, (cet or miles may be
substituted for yards 11 the substitution is made la both columns used.
1 To be used in interpolation.
26
REFERENCE DATA
33
Table V. — Average time lengths of moving motor columm
(See par. 34b in connection with this table)
Eoad
space
Time length, in minutes, when traveling at—
occupied
when at
a halt
and
closed up
2 mph
2.5 mph
3 mph
3.5 mph
5 mph
6 mph
10 til 35
mph
Yards
li
5>
0.025
.125
0.020
.10
0.01687
.08333
0. 01426
.07126
0.010
.050
0.00933
.045S5
0.008
.040
60
100
300
300
■(00
BOO
800
700
800
900
1,000
1,500
2,000
1
8
5
S
10
S3
16
IS
20
23
25
38
50
1
2
4
6
8
10
12
14
19
18
20
30
40
1
2
3
5
7
8
10
12
13
15
17
25
33
1
1
3
4
6
7
9
10
11
13
14
21
20
.5
1
2
3
4
5
6
-7
8
fl
10
16
20
.6
1
2
3
4
»
8
7
7
s
9
14
19
.6
1
2
2
3
4
6
6
e
7
S
12
13
' To be used in interpolation.
27
34
MEDICAL FIELD MANUAL
■ 34. Average Time Lengths of Moving Coumsssj—a. Foot
and animal elements. — There are no foot and animal elements
in medical troops of sufficient size to mate such computations
necessary.
b. Motor columns. — Table V is based upon road movements
In which vehicles keep closed up to safe driving distances. At
5 miles per hour or less the safe driving distance is assumed
to be constant at 15 yards between centers of vehicles up to
3-ton trucks, and the time length of a column varies inversely
with the speed. Prom 10 to 35 miles per hour the safe driving
distance varies directly with the speed, and the time length
of the column therefore is constant. Above 35 miles per hour
the safe driving distance increases so rapidly as the speed is
increased that the time length of such columns tends to in-
crease even though the speed of the individual vehicles is
greater. Table V gives average time length. Actual time
length may vary 25 percent in either direction, depending
upon conditions.
Example: Find the time length of the medical battalion of
the triangular division traveling at 30 miles per hour.
Prom table I, the road space, when halted and closed up,
Is 940 yards. Prom table V, the time length of a column,
which is 900 yards in length when closed up and which is
traveling 30 miles per hour, is 7 minutes; and each yard of
increased length when closed up adds 0.008 minutes in time
length. So:
Time length of 900-yard column at 30 mph_ =7.
Time length of 40-yard column at 30 mph
(40X0.008) =0.32
Time length of 570-yard column at 30 mph_ =7. 32 (or
7 minutes) .
28
REFERENCE DATA
35-36
B 35. Rates and Lengths op Marches. — The following rates
and lengths of marches are based upon modern vehicles,
trained personnel, and favorable conditions of roads and
weather.
Unit
Average rates of march
(miles per hour)
Lengths ot
march
(average)
Remarks
On roads
Across
country
Day
Night
Day
Night
On roads
(miles per
day)
Foot troops
2^
2
m
1
12-15 for a
di vision,
15-20 tor
smaller
units.
Length of inarch In-
creased with well-
seasoned troops on
good roads in favor-
able weather, when
required by the
tactical situation.
Animal-drawn
trains.
m
3
1
20
May cover greater
distances for short
periods.
Trucks, ambu-
lances, motorized
units.
25
10(nolighte).
8
5
175
May cover consider-
" ably greater dis-
tances for short
periods.
Cars and motor-
cycles, passen-
ger.
86
S5 flights),
10<nolights>.
8
5
260
H 36. Railway Car Space Reqtjibements. — The following
space requirements are used as a basis for computing car
requirements for movements by rail. The figures show the
space requirements, in inches of lineal car length, of Items
of equipment and transport. The length of flatcars is
assumed to be 40 feet. (Bee EM 35-10.)
291816' — 41 5 29
36-37 MEDICAL FIELD MANUAL
Ye Platcar : inches
Motorcycle, with side car 80
Trailer, 2-wheel, %-ton. (empty) 80
Ya Flatcar:
Trailer, 2-wheel, %-ton (loaded) 112
y 3 Platcar:
Trailer, water, 250 -gallon 128
Vz Fiatcar:
Ambulance, field motor 225
Car, light, passenger 188
Car, medium, passenger 208
Trailer, command post, 2-wheel 240
Trailer, cargo, 4-wheel 204
Truck, automotive repair 240
Truck, cargo, iy 2 -ton 220
Truck, cargo, 2y 2 -ton 234
Truck, kitchen, 220
Truck, pick-up, y 2 -ton 191
Truck, pick-up, iy 2 -ton 220
Truck, reconnaissance, 8 -passenger 195
Truck, spare parts 240
Truck, tank, 500 -gallon 240
1 Coach:
30 men.
1 Boxcar (modified) :
36 men.
1 Stock car or boxcar (modified) :
20 animals.
■ 37. Standard Railway Trains.— There are two types of
standard railway trains for troop movements. Medical units
almost Invariably require type B trains for movement.
Type of train
Composition
Total num-
ber of cars
Boil
Flat
Coach Caboose '
A
18
9
23
1
i
1
1
M
U
B
1 One Itrr kitchen and supplies- ' For train crew.
30
REFERENCE DATA 38
B 38. Standard Railway Train Requirements for Medical
Units,
Unit
Medical regiment, division (army)
Medical regiment (corps)
Medical battalion (triangular division and corps)
Medical battalion (armored division)
Medical squadron.
Surgical hospital
Evacuation hospital
Convalescent hospital..-.
Medical laboratory
Medical supply depot
One section medical supply depot
Ambulance battalion (motor)
Veterinary evacuation hospital— -
Veterinary convalescent hospital
31
39
CHAPTER 5
SUPPLY
■ 39. Classification op Sttpplt,— Supplies are classified in
several ways, depending upon the purposes of the classifica-
tion. The principal classifications are —
a. By using arm or service.— This classification is fixed by
law and regulation and there are many exceptions to the gen-
eral rule. Except for the purposes of original procurement,
however, the following definitions are sufficiently accurate.
General supplies are those used by two or more arms or serv-
ices, such as rations, clothing, cleaning materials, etc., with the
exception of certain special and technical articles such as
arms, compasses, first-aid packets, etc. Special supplies are
those used by a single arm or service together with the spe-
cial and technical articles excepted from the general sup-
plies such as surgical instruments, map-making equipment,
telephones, and airplane parte.
&. By procuring arm or service. — (1) General supplies. —
General supplies, insofar as the army Is concerned, are pro-
cured by the Quartermaster Corps.
(2) Special supplies^ — Special supplies are procured by the
several supply arms and services, according to allocations
made by the War Department, and are known by the name
of the procuring arm or service, such as engineer supplies,
ordnance supplies, quartermaster supplies, medical supplies,
etc.
e. By necessity for accountability. — The necessity for ac-
countability is fixed by regulations or orders for each item
of supply. In general, however, articles which are "con-
sumed" In use, such as ammunition, foot powder, paint, fuel,
forage, cleaning and preserving materials, surgical dressings,
drugs and medicines, etc., and such articles as spare or repair
parts, which are used to repair or complete other articles
and thereby lose their identity, are classified as expendable.
Such articles as are "worn out," rather than consumed, such
as arms, surgical instruments, X-ray apparatus, motor trans-
port, etc., other than spare or repair parts therefor, are
classified as nonexpendable.
32
REFERENCE BAZA
39-40
d. For distribution in yield.— For simplicity and conveni-
ence in administration, all supplies required by troops in the
field, regardless of other classifications, are divided into five
classes as follows:
(1) Class I. — Those articles which are consumed at an
approximately uniform daily rate irrespective of combat oper-
ations or terrain, and which do not necessitate special adapta-
tion to meet individual requirements, such as rations and
forage. These supplies are distributed automatically on the
basis of strength returns, and no requisitions are necessary.
(2) Class II. — Those authorised articles for which allow-
ances are established by Tables of Basic Allowances and
Tables of Allowances, such as clothing, gas masks, arms,
trucks, radio sets, tools, and instruments (including medical) .
(3) Class III, — Engine fuels and lubricants, including gaso-
line for all vehicles and aircraft, Diesel oil, fuel oil, and coal.
(4) Class IV. — Those articles of supply which are not cov-
ered in Tables of Basic Allowances and the demands for which
are directly related to the operations and contemplated or in
progress (except for articles in classes III and V), such as
fortification materials, construction materials, and machinery.
(5) Class y. — Ammunition, pyrotechnics, antitank mines,
and chemicals.
■ 40. Rations.— a. Field ration. — The field ration is that pre-
scribed for use only in time of war or national emergency
when the garrison ration is not used. It is issued in kind and
no ration savings are allowed. Its components and substi-
tutes are prescribed by the War Department or the com-
mander of the field foTces, There are four kinds of field
rations —
(1) Field ration A corresponds as nearly as practicable to
the components or substitutes therefor of the peacetime gar-
rison ration, and is generally perishable.
(2) Field ration B corresponds as nearly as practicable to
the components of field ration A with the exception that non-
perishable processed or canned products replace items of a
perishable nature. This ration is suitable for reserve pur-
poses.
(3) Field ration C consists of previously cooked or prepared
food, packed in hermetically sealed cans, which may be eaten
33
40-42
MEDICAL FIELD MANUAL
either hot or cold. Each ration includes 3 cans containing
a meat and vegetable component and 3 cans containing
crackers, sugar, and soluble coffee.
(4) Field ration D consists of three 4-ounce bars of con-
centrated chocolate. It is a nonperlshable ration and is suit-
able for use as an individual reserve.
b. Grains. — The grain component of the animal ration
averages 10 pounds of gTain per animal.
c. Hap. — The hay component of the animal ration averages
14 pounds per animal.
■ 41. Motor Fuels and Lubricants. — The unit mite is a unit
of measure for requirements of motor fuels and lubricants.
It is the amount (in gallons or pounds) of such supplies re-
quired to move all motor vehicles of a specified unit a distance
of 1 mile. Service records of individual vehicles should be
maintained as completely as practicable, and the unit mile
value should be revised from time to time as indicated by
experience.
■ 42, Day of Supply. — a. General, — The term "day of sup-
ply" is a unit of measure in the operation of supply of large
units in campaign, and is used to express collectively, in
pounds per man per day, the estimated average expenditure
of the various items of supply, per day, in campaign. It is
a yardstick used by the higher echelons of the staff for
determining levels, credits, transportation requirements, etc.
b. Day of medical supply, — (1) A day of medical supply
includes hundreds of items of medical supply. The exact
composition is fixed from time to time as experience In-
dicates. While a unit of measurement based upon bulk or
weight is well adapted to the broader aspects of supply ad-
ministration, it does not meet the requirements of procuring
and distributing agencies. They must define a day of supply
in terms of specific articles and unit quantities thereof.
(2) The quantities of the various items which, taken col-
lectively, represent a day of medical supply are determined
by the commander upon the recommendations of the sur-
geon. These recommendations are based upon experience
tables, the size and composition of the army, the character
of the operations, the nature of the enemy, and the climatic
34
REFERENCE DATA
42-43
and epidemiological characteristics of the theater of
operations,
(3) For a list of Medical Department chests, with contents,
and individual equipment, see the appendixes III and IV,
FM 8-10, or the current Medical Department Supply
Catalog.
B 43. Depot Stockages akd Supply Credits. — a. Depot stock-
ages. — (1) The level at which depot stockages will be estab-
lished or maintained is a command decision. It is ordinarily
prescribed in terms of days of supply, and will vary with the
situation and. the plan of the commander. Stockages in
army depots usually are maintained at relatively low levels —
3 to 5 days of supply on the average,
(2) It is the duty of the army surgeon to keep the medical
supply officer informed of anticipated variations in the rate
of consumption; and it is the duty of the army medical
supply officer to initiate, in ample time, the necessary steps
for the replenishment of stocks so that prescribed levels are
approximated at all times.
b. Supply credits. — In order to simplify supply adminis-
tration and to expedite the replenishment of supplies in
army depots, credits may be established in favor of the army
in supporting depots — in the communications zone or the
zone of the interior, as the case may be. Such a credit is an
allocation of a definite quantity of supplies, placed at the
disposal of the army commander for a prescribed period of
time. Credits are ordinarily measured in terms of days of
supply. The amount of credit will vary with the situation
and the levels of stockage maintained in supporting depots.
A credit of from 10 to 15 days of supply might be considered
suitable for an army.
36
44-46
CHAPTER 6
RATES USED BY THE MEDICAL SERVICE
■ 44. General. — a. Definition. — A rate is an abstract num-
ber by means of which concrete frequencies are reduced to
common bases. The occurrences of any event in two or
more groups cannot be accurately compared until the in-
fluences of such factors as the duration of the experience
and the numbers involved have been equalized.
b. Basic formula, — The basic formula for all rates is —
Rate _ Number experiencing a specified event
Number that might have experienced the specified event
If the numerator of the above formula is designated as f
(frequency), and the denominator by n (mean strength, or
numbers Involved), then —
Rate=—
n
■ 45. Rates per Constant. — Fractions are more difficult to
visualize and to remember than whole numbers; and, to avoid
them, it is customary to express rates in terms of occurrences
per 1,000, per 10,000, per 100,000, or, in general, per K of those
exposed to the occurrence of the event. When this constant
(K) is introduced, the general formula becomes —
Hate-**-'
n
In most rates used by the medical service, if=l,000. The case
fatality rate is an exception (see par. 50) .
■ 46. Time Factor in Rates. — The « in the general formula
in paragraph 45 resolves differences in the numbers exposed
to the occurrence of any event; but in many rates the dura-
tion of the experience is also an essential element. For ex-
ample, a rate which measures the actual admissions to sick
report over a period of 10 days is not comparable to one
which measures actual admissions over a period of 3 weeks.
Experiences are reduced to a common base as regards dura-
tion by the introduction into the formula of a factor express-
36
REFERENCE DATA
46-47
ing time. It is assumed arbitrarily that the experience lasted
a certain time, and the relationship of the actual duration
to this arbitrarily selected duration is expressed as a fraction.
This is to say, that—
Where !T=the arbitrarily assumed duration — ordi-
narily 1 day, 1 week, 1 month, or 1 year; and
t=the actual duration of the experience in
days, weeks, months, or years;
then the factor of T/t, introduced into the rates measuring
two or more experiences, will reduce all to a common base as
regards duration. So, when duration is an essential element,
the formula becomes
nxt
It is obviously necessary that T and * be expressed in the same
unit of time— months, weeks, or days. T will always be either
12, 52, or 365, depending upon whether t expresses months,
weeks, or days, respectively. Where T and t are the same,
they cancel and the faetor is 1 (see par. 47&CD); n, of
course, is the mean strength during the experience.
H 47. The Admission Rate.— a. General— The force of mor-
bidity is expressed, in the military service, in terms of admis-
sions (to sick report) per 1,000 mean strength. The time
element must always be stated when referring to this rate,
as "the daily admission rate" or "the annual admission rate."
The formula for deriving this rate is that given In paragraph
46; in this case —
K= 1,000.
/ =the number of admissions to sick report.
T =the time base of the rate — 1 day, 365 days, 12 months,
etc.
n =mean strength of the command during the experience.
t =the length of time required for / admissions.
b. Examples. — (1) On July 7, there were 35 admissions to
sick report in a command, the strength of which on that day
was 1,856. What was the daily admission rate for July 7?
Daily admission r ate= ^ * 6 x I * = 18,85
291816 "^11 a 37
47-51
MEDICAL FIELD MANUAL
(2) In a command with a mean strength of 3,467, there
were 254 admissions to sick report during the month of Feb-
ruary. What was the annual admission rate for the month
of February?
Annual admission rate^ 1 ' 00 , *^* 12 =879.1
(3) In a command with a mean strength of 3,467, there
were 131 admissions to sick report during the first 2 weeks
of February. What was the annual admission rate for these
2 weeks?
Annual admission rate= 1,00 P * * a * * 52 - =982.4
0,407X2
■ 48. Death Bate. — Death rates are derived similarly to ad-
mission rates — / denoting the number of deaths instead of
the number of admissions. Unless otherwise specified, death
rates are ordinarily rates per annum.
■ 49. Casualty Rates. — Casualty rates are derived similarly
to admission rates — the / denoting the number of casualties
instead of the number of admissions. It must be remembered
that casualties Include the killed in action as well as those
admitted to sick report. The time base of the rate must
always be specified, such as the dally casualty rate, the cas-
ualty rate for a specified operation, or the casualty rate for
the entire war.
■ 50. Case Fatality Rates. — Case fatality rates measure the
force of mortality in a specified group suffering from diseasei
or Injury. Such a rate may measure the fatality from a
specific disease or injury, or may be used to measure the
fatality of all diseases or all injuries, or both. "Die scope
of the exposure to risk must be stated, for example, case
fatality from pneumonia, case fatality from gunshot in-
juries, etc. They are ordinarily computed as percentages,
rather than as rates per 1,000, and the formula is —
Case fatality rate— 10 ^ X ~
where n is the number of cases that occur and / is the number
of deaths among such cases,
■ 51. Noneffective Rates. — Loss of time from disease and
injury is measured, in the military services, by noneffective
33
REFERENCE DATA
51-52
rates. The same general rules apply. The noneffective
rate is the ratio of days lost from disease or injury to the
total number of days that could have been lost had every
man been incapacitated every day. It is expressed in terma
of 1,000 mean strength (per K) , and the formula is —
„ T - t 1,000 x days lost
Noneffective rate= w ~ ■
mXdays of experience
Par example, during July, in a command of 5,147 (mean
strength) there was a total of 6,504 man-days lost from
all causes, an average of 209.8 men on sick report each day.
The noneffective rate per 1,000 for the month of July would
be—
Noneffective rate=
_ 6,504,000
150,557
= 40.76
which is to say that there was an average of 40.76 men in
each 1,000 men constantly noneffective from disease and
injury during that month.
B 52. Ratios. — Ratios express relationships between fre-
quencies of occurrence of more or less related events as,
for example, the ratio of head injuries to all injuries. Ratios
are usually expressed as percentages, and the general for-
mula is the ratio a:b expressed as a percentage:
100 X number of a's
Number of b's
where a and b are the two variables being prepared.
39
53-55
CHAPTER 7
ESTIMATIONS OF MEDICAL REQUIREMENTS
Paragraphs
Section I. General considerations 53-66
n. Admissions irom disease and nontattle Injuries 57-63
in. EMattle casualties 64^-75
IV. Evacuation, ot casualties 76-78
V, Hospital bed requirements,., 79-86
Section I
GENERAL CONSIDERATIONS
■ 53. Referehce. — The greater part of this chapter is an
adaptation of the material in Army Medical Bulletin No. 24
(War Casualties). The data have been condensed and, for
the most part, rearranged in the interest of simplicity. How-
ever, this chapter in nowise supplants Bulletin No. 24; and the
fundamentals set forth therein must be mastered before any
serious medical planning is undertaken.
■ 54. Strength. — a. General. — Strength is a most important
factor in estimating medical requirements. It is represented
by the n In the formulas given in chapter 6. Unless other-
wise specified, military strength Includes all military personnel
but none other. In estimating medical requirements, how-
ever, to military strength must be added all other elements
of the population for which medical service must be provided.
b. Mean strength. — Military strength, especially in war,
varies from day to day and, in smaller commands, within wide
limits. Mean strength 13 the average daily strength of a com-
mand or other group. It is computed by adding the strength
on each day of the period under consideration and dividing by
the number of days in the period.
■ 55. Causes of Sickness and Injury. — Admissions to sick
report are caused either by sickness or injury; and injuries
are classified into —
40
REFERENCE DATA
E5-58
a. Nonbattle injuries, — Those sources of disability or death
arising out of external causes other than hostile acts of a
military enemy are classified as nonbattle injuries.
&. Battle injuries. — Wounds caused by primary or secondary
missiles, or by chemical agents, set in motion by the hostile
set of a military enemy are classified as battle injuries.
Wounds or injuries from projectiles dropped by airplanes at
considerable distances from the operations of ground troops,
and those resulting from torpedo attacks on ships, are prop-
erly included among battle injuries. On the other hand,
accidental injuries, although received in battle, are not to
be regarded as battle injuries.
HI 58. Place of Treatment. — Cases of sickness and injury that
are Incapacitated for duty are treated either in hospital or in
quarters. In the latter instance, no hospital beds are re-
quired. Dispensary cases include the less serious cases that,
although they require medical attention, are not excused from
duty. Dispensary cases must be considered in estimating
the requirements of medical personnel and supply; their care
increases these two requirements by about 50 percent over
similar requirements for cases admitted to sick report.
Section EE
ADMISSIONS FROM DISEASE AND NONBATTLE
INJURIES
H 57. Average Peacetime Experience. — The average daily ad-
mission rate for sickness and nonbattle injuries for troops
serving in the United States during time of peace is about
two per thousand. This rate is influenced by many factors,
the more important of which are discussed in succeeding
paragraphs.
n 58. Seasonal Variation. — The incidence of sickness varies
with the season. Seasons, in turn, vary with the climate.
The seasonal variation In troops for the United States is shown
41
58-60
MEDICAL FIELD MANUAL
in the following table, which sets forth the experience from
1920 to 1927, inclusive:
Month
January—
3Tebrunry—
March
April-
May
June
July.
August
September
October.
November.
Deeember-
DaHy ad-
mission
rate per
thousand
■ 59. Effect of Climate. — Climate Is so closely associated
with other environmental factors, such as density of popula-
tion, sanitation, etc., that it is difficult to evaluate the effect of
climate alone. However, it is estimated that under favorable
conditions the sickness in temperate climates should not ex-
ceed that expected in the United States; and in tropical cli-
mates it may be expected, under similar conditions, to be
somewhat greater. Under unfavorable conditions, however,
it may be expected to exceed "United States experience by 30
percent in temperate climate, and 40 percent in the Tropics,
■ 60. Effect of Race. — While the peacetime experience
shows that the admission rate for colored troops is slightly
less than 75 percent that of white troops, it is believed that
the effect of seasoning is largely responsible for this. (See
par. 62.) There is considerably less turn-over in colored
troops than in white troops in time of peace. The experience
of the World War showed the admissions for sickness and
nonbattle injuries in colored troops to be 50 percent higher
than among white troops.
42
REFERENCE DATA
61-62
B 61. Effect of Nativity of Troops. — -The origin of the troops
profoundly affects the admissions for sickness and nonbattle
injuries. During the World War, for example, the admission
rate for troops from Montana was only 37 percent of the
average admission rate for the Army as a whole while the
admission rate for troops from Mississippi was 205 percent
of the average. The following table shows the ratio (as per-
centages) of the admission rates for the white troops only, of
the several states to the general admission rate for all white
troops:
Nativity ol troops, States of—
General
admission
rate for
entire Army
Montana and Wyoming
Arizona and Idaho
District of Columbia, Nevada, and Washington
North Dakota, California, Oklahoma, New Terser, and Connecticut..
Colorado, New York, Khode Island, Massachusetts, South Dakota,
and New Mexico
Oregon, Michigan, Utah, Pennsylvania, Ohio, Minnesota, and
Delaware _.
Maryland, New Hampshire, Illinois, and Wisconsin
West Virginia and Maine _
Iowa, Indiana, Nebraska, and Vermont. _.
Missouri, Virginia, and Kansas
Florida, North Carolina, South Carolina, Texas, and Louisiana
Tennessee and Arkansas
Alabama, Kentucky, and Georgia.
Mississippi
The average admission rate for white troops from the south-
ern states (Virginia, Florida, North Carolina, South Carolina,
Texas, Louisiana, Tennessee, Arkansas, Alabama, Kentucky,
Georgia, and Mississippi) was 156 percent of the general
admission rate for all white troops.
ffl 62. Effect of Seasoning op Troops. — All other factors
being equal, the admission rate for disease is always higher
among recruits than among seasoned troops. In all the wars
of the United States, the sick rate of volunteers or newly
inducted personnel has been much higher than that of regu-
43
62-63
MEDICAL HELD MANUAL
lar troops under exactly the same conditions. At least two
factors are involved in this — improvement of sanitary dis-
cipline with training, and an increase in immunity resulting
from the close associations in military units. The daily admis-
sion rates for troops in the United States in the year 1918
exceeded comparable experience in the Regular Army in the
post-war years by an average of 10 percent. Although the
influenza pandemic months of September and October, 1918,
are excluded from this comparison, the endemicity of influenza
throughout the year 1918 does introduce an unusual factor
into the experience of that year. However, the sick rate of
recently mobilized units should be expected to exceed the
recent experience of the Regular Army by 50 to 60 percent.
■ 63. Range of "Variation From Average Experience. — a. In
the foregoing paragraphs are discussed certain factors which
influence the admission rate for disease and nonbattle Injuries,
such as the constitution of the command as regards race and
nativity, the location of the command as regards climate, the
season of the year, and local sanitary conditions. The varia-
tion from average experience that may result from combina-
tions of these factors is considerable. The following table
shows the average daily admission rates in 30 large camps
during the year 1918 together with the maximum daily rate
for any one month. The influenza pandemic months of Sep-
tember and October are excluded. It will be seen that not
only does the average daily rate vary widely with local condi-
tions but also that the deviation from the average local rate
varies within wide limits.
44
REFERENCE DATA
63
Average daily rate
Masdmnm daily rate
Camp
Average
daily ad-
mission
rate for
year
average
daily ad>
Hussion
rate for
all troops
jri.iaA.iiii urn
daily ad •
mission
rate for
any one
month
Percent of
average
local daily
admission
rate
JL Llf L'Cill/ \}1
maximum.
daily ad-
mission
rate for
all troops
All camps-
3.50
100
-4.80
137
100
Travis
5.93
171
9.79
164
20*
4. 18
H9
8.66
207
ISO
WhBeler -
3. 69
105
J. 92
215
165
Pike -
5. 21
149
7. 82
140
159
Funston. _
5. 43
165
7.18
132
150
Jackson - ~
4.02
115
7. 14
178
149
Dodge-
4.11
117
6. 00
168
144
Sherman..
4.29
1S3
ft, 73
167
140
3.26
93
6, 73
208
140
Mills -
2. 13
61
6. 52
308
136
3.65
104
6, 10
187
127
Taylor - -
3.76
107
5.91
149
117
Sevier—
3.53
101
6.63
157
IIS
Dix,
2.75
79
5.45
198
114
Shelby
3.42
98
5.42
168
113
ifowie
3. 75
107
5.32
142
111
Xewis
3.56
102
5.27
148
no
Kearney
3.23
02
5.14
159
107
Wadsworth
3.67
76
5. 08
190
106
Upton
3.23
92
5.06
156
105
2,59
74
4. 99
193
104
Gordon
3.81
109
4, 79
128
100
2.74
78
4.63
105
94
3.23
02
4.42
137
92
Cody-'- —
2.28
05
4.28
IBS
89
80
MeOlellan
2.68
74
3.S4
149
-Sheridan.-
2.66
78
3.74
141
78
Hancock
2,41
09
3.72
154
78
Deven$
2.42
m
3. 68
152
77
Grant
2.23
04
3.39
152
71
b. It will be seen, In the foregoing table, that the experi-
ence of no one camp is identical with average experience.
Wlille Camp Mills enjoyed an average rate 39 percent below
the average for all camps, this average rate was more than
trebled (306 percent of its average) in its peak month. On the
45
63-85
MEDICAL FIELD MANUAL
other hand, Camp Funston with an average rate 55 percent
higher than (he average for all camps, showed a less-than-
average increase (32 percent against 37 percent) during its
maximum month.
■ 64. Introduction. — The experience set forth herein is
largely that of the World War. Weapons and methods of
warfare have changed since that time and such changes have
always been reflected in battle casualties. The experience of
the American Civil War would have proved to be largely un-
reliable in 1917-18; and it may well be that the experience of
the World War will prove to be equally unreliable in future
wars. But, even if such experience is of no greater value
than to serve as the basis of an educated guess, it is still better
than no experience at alL (See also PM 101-10.)
■ 65. Casualty Estimates — General. — a. Classification. — AH
casualties are classified as follows:
f Slight .Walking
b. Sick casualties. — (1) Casualties from sickness and non-
battle injuries from front-line troops of a seasoned com-
mand in campaign, except in a particularly unhealthful re-
gion, cause an average daily increment of sick of about 0.6
percent. Of these, two-thirds will remain under treatment in
their own organizations (at aid station or dispensary) or in
the division clearing station; one-third will be evacuated
outside the division area, half of them recumbent and half
of them sitting.
(2) The daily admission rate to the hospital for an entire
field force for sick and nonbattle injuries will be approximately
0.165 percent (based oh A. E. F. experience) . This rate will
vary depending on the location of the theater. After some
months, this will cause a constant noneffective rate of about
4,5 percent. •
Section in
BATTLE CASUALTIES
Gassed
Wounded
Dead
Communicable
.Ncncommunlcable
rBecumbent
ISittlng
46
REFERENCE DATA
65
<3) Of the sick admitted to hospitals in the theater of
operations about 1.5 percent die, 3 percent will be invalided
home, and 95.5 percent will be returned to duty eventually.
The average stay in the hospital is 37 days.
c. Battle casualties. — (1) The following table has been de-
veloped from American experience in active operations of the
World War:
Battle casualties, including killed, in percent of the unit
strength
Unit
Average
for all
days Inline
Severe bat-
tle day
Maximum
battle
day
Percent
Percent
Percent
Infantry regiment _ _ -
2.6
13-15
3S
Division -
1.0
e-s
12
.5
2-3
5
.35>
.7-1.6
2.5
i As this is for sustained active operations, tbe average tor one or several armies
over a long period of time would be leas, and may be taken as 0.2 percent.
(2) In estimating battle casualties in an army, an estimate
based on front-line divisions engaged will usually be more
accurate than if based on a rate for corps or the army as
a whole.
(3) The battle casualties of an entire expeditionary force
or theater of operations can best be estimated by using the
rates incurred In the component divisions or armies, as the
relative proportion of front-line troops to the total force wiU
vary widely in each situation.
(4) The following data relative to battle casualties are
approximately accurate for a severe engagement and can be
used as the basis for calculations:
<a) In Temperate and Tropical Zones, the ratio of killed
to wounded is as follows:
Open operations about 1: 5
Trench operations about 1 : 4
Hence from 16% percent to 20 percent of all battle casualties
may be expected to be classed as killed. In the Arctic Zone,
47
65-66
MEDICAL FIELD MANUAL
the ratio of killed to wounded will be considerably higher due
to death of the wounded from exposure to cold.
(6) The transportation requirements for battle casualties
of a division are as follows:
Percent
Dead „ - 20
Able to wall: to collecting station but requiring transportation
(sitting) to rear 40
Require transportation, (recumbent) 40
Of all casualties, about 1 percent are nontransportable beyond
the surgical hospital, except by air.
Total 100
fl 66. DISTRIBUTION OF CASUALTIES BY AEM AND SERVICE. — In
the A. E. P., for the entire period of the war, battle casualties
were distributed as shown in the following table:
Ann or service
Bate per 1,000 mean total strength
in the A. E. F. for entire war
Relative
rate with
infantry
taKen as
100'
Killed in
action
Wounded
in action
Total
85. 70
498. 17
683-96
100
Signal Corps
7.70
94.04
101. 74
17.4
7.56
65. 55
73.11
12.5
Corps of Engineers
6.47
52.77
69.24
10.1
Medical Department
2.25
40.37
51.82
8.8
Quartermaster Corps
.96
17. 85
18. SI
3.2
.60
17.25
17.81
3.0
5.00
8,64
13.64
3.3
Ordnance Department
.09
10.27
10. 3ft
LB
All arms and services
34. 98
213.65
243.63
42.6
i These figures vary slightly from those given in paragraph 44, Army Medical
Bulletin No. 24. The basic data for this table were taken from vol. XV, pt. 2, the
Medical Department of the U. S. Army in the World War.
However, the foregoing table does not portray accurately the
relative hazards of front-line service. The greater propor-
tion of infantry and artillery were engaged at the front.
A much less proportion of engineers and Signal Corps were so
engaged; and, among the services, the greater proportion
were employed In rear areas. For example, by assuming that
all battle casualties in the Medical Department occurred in
48
REFERENCE DATA
66-69
medical personnel with infantry divisions, the battle casualty
rate for the Medical Department would have been around 125
per thousand instead of approximately 52. The truth lies
somewhere between these two extremes; and the same prin-
ciple applies in the case of other arms and services engaged in
rear areas as well as at the front.
■ 67. Ratio of Killed to Wouhdbd is Action. — The experi-
ence of the A. B. P., considered as a whole, was that 14 percent
of all battle casualties were killed in action and 86 percent
were wounded in action. This proportion of killed in action
varied directly with the severity of combat, reaching 18 percent
in severe engagements. This ratio is also affected by the pro-
portion of gas casualties among all battle casualties, since
relatively few gas casualties die on the field. (See also
par. 68.)
II 68. Distribution of Casualties by Producing Agent. — a.
Classification. — Battle casualties are classified as those due to
missiles and those due to chemical agents. The latter are
known as gas casualties, although the chemical agent need
not be a gas, and the former as gunshot wounds (GSW)
regardless of the character of the missile,
b. Killed in action (KIA) . — In the A. E. K, the cause of
death of 93.2 percent of the KIA was GSW; and only 6.8
percent died on the battlefield as the result of the action of
a chemical agent.
c. Wounded in action (WIA) .-—The average distribution,
by producing agent, of battle wounds in the A. E. F, was
31.S percent from gas and 68.5 percent GSW. This pro-
portion, however, varied within wide limits with the type
and severity of combat. The proportion of gas casualties
rose when troops occupied relatively quiet sectors where
field fortifications afforded considerable protection against
missiles but none against gas. In severe open combat, how-
ever, gunshot wounds increased greatly, rising to 82 percent
of all wounded while the proportion of gas casualties fell
to 18 percent.
IB 69. Distribution of Casualties Within Units.— Rarely are
casualties equally distributed throughout a unit larger than
a company. Normally some fraction of a unit is in reserve
49
69-71
MEDICAL FIELD MANUAL
and the tasks of other fractions actively engaged are not
ordinarily equally productive of casualties. This unequal
distribution within units must constantly he recognized In
estimating probable casualties. (See also pars. 73a and 75d.)
■ 70. Influence op Type op Action. — The type of military
operation determines, to a large extent, the casualty rate.
With the advent of automatic weapons attack became gen-
erally more costly than defense. Organization, of the ground
by the defender further increases the disadvantage of the
attacker in the matter of casualties. The usual dispersion
of covering forces and security detachments reduces the
casualty rates in the actions that they engage in.
■ 71. Casualties m an Infantry Regiment.— a. Average, —
The average battle casualties of an infantry regiment in
combat in the A. E. P. was around 2 percent per day of
combat, but this rate is based upon time spent In reserve
as well as time spent in active combat.
6. Maximum. — The heaviest loss suffered in any one day
of combat by an infantry regiment in the A. B. P. was 35
percent. The average of the 20 heaviest casualty days of
infantry regiments was about 20 percent per day.
c. Frequency, of occurrence of heavy losses. — The following
tabulation shows the frequency of heavy losses in casualties
In infantry regiments In the A. E, F. The casualty rate
was more than —
Percent per day in
Feroeat of combat <iays
20
0.29
18
.44
16
.69
14
1.08
12
1.74
10
2. 85
8
4.79
6
8.30
4
15. 11
2
30.00
These rates are also based upon time spent in reserve as well
as time spent in active combat.
SO
REFERENCE DATA
72-73
8 72. Casualties m an Infantry Division. — a. General. —
These data are also based upon the experience of infantry
divisions in the A. E. F. p including time spent in reserve as
well as in active combat.
b. Maximum. — The heaviest losses sustained by any one
division in 1 day of combat were 10.56 percent of its
strength. The average of the five heaviest daily battle losses
in divisions was 8.15 percent. These figures are comparable
with British experience in the World War.
c. Frequency of occurrence of heavy losses. — The following
tabulation shows the frequency of heavy losses in casualties
in infantry divisions in the A. E. F. The casualty rate was
more than —
Percent per day in
Percent of combat days
6
0,83
6
1.20
4
% 48
3
4.80
3
12. 00
1
31.00
fl 73. Casualties iw a Corps. — a. General. — As units increase
in size, a greater proportion of their personnel is less exposed
to the risk of battle injury. While a corps may be engaged
in active fighting, one or more of its divisions may not be in
contact with the enemy. Elements of corps troops serving
in rear areas suffer relatively few casualties. While the
strength of corps troops approximates the strength of a divi-
sion, they consist of artillery, engineers, signal troops, and
service troops, the casualty rates of which are low compared
with those of infantry. All these factors operate to reduce
the casualty rates of a corps as a whole far below those of its
infantry divisions actively engaged with the enemy.
b. Maximum. — The heaviest losses sustained by any one
corps in 1 day of combat were 2.13 percent. Toe average
of the six heaviest daily battle losses in corps was 1.92 percent.
This also compares with British experience in the World War.
c. Frequency of occurrence of losses. — The following tabula-
51
73-75
MEDICAL FIELD MANUAL
tfon shows the frequency of occurrence of certain casualty
rates in a corps in the A. E, F. The casualty rate was more
than —
Percent per day la
Percent of combat days
2.0
1.95
1.6
3.31
1.2
6.99
.8
17.08
.4
44.79
.2
73.41
H 74. Casualties m an Army. — a. General, — The factors dis-
cussed in paragraph 73a (large units in reserve and a consid-
erable strength of troops In rear areas) operate with even
greater effect in the army; and army casualty rates are con-
sequently even lower than those of the cotps.
b. Maximum* — The heaviest losses sustained by any one
army in 1 day of combat were 0.775 percent. The average of
the five heaviest daily battle losses in an army was 0.704
percent.
c. Frequency of occurrence of losses. — The following tabu-
lation shows the frequency of occurrence of certain casualty
rates in an army in the A. E. P. The casualty rate was more
than —
Percent per day in
Percent of combat days
0.7
1.02
.6
11.91
.6
20.82
.4
31.92
.3
48. 35
.2
74.47
.1
97.87
■ 75. Estimation of Probable Casualty Rates. — a. Casualty
expectancy tables used for school purposes. — The foregoing
paragraphs clearly indicate that the estimation of probable
62
REFERENCE DATA
75
casualty rates in advance is not a simple matter that can. be
reduced to a general formula. While casualty expectancy
tables have been prepared and are being used for purposes of
instruction in service schools, it must be understood that such
tables bear no closer relationship to actual experience than do
map problems to actual combat. They are among the many
arbitrary assumptions (based in general, it is true, upon
experience) that are necessary to create the artificial situation
wherein a battlefield is brought Into a classroom; and it was
never intended that any reliance should be placed upon, them
in actual operations.
&, Method. — The first step in estimating probable casualty
rates is the selection of a point of departure. This is prefer-
ably what might be termed an average casualty day for the
unit concerned. To this average casualty day must be applied
the quantitative combined effect o£ all factors In each situ-
ation that may be expected to fnfluence the casualty rate.
The more important of these factors are —
(1) Enemy capabilities. — These include all the means and
characteristics of the enemy that can be translated into
casualties, such as his numerical or relative strength, the
strength of his position (both natural strength and improve-
ment by organization of the ground) , his weapons, his atti-
tude, and his morale and general combat efficiency.
(2) Terrain. — Terrain is not to be confused with position.
Open terrain, affording little cover or protection, may favor
either side, depending upon the situation.
(3) Own scheme of maneuver. — This is a most important
factor. Attack is usually more costly than defense. Losses
in defense are tempered by the type of defense, the degree of
organization of the ground, and relative combat strength in-
cluding the element of fire (see (4) below) . Frontal attacks
are, in general, more productive of casualties in the attacking
force than are envelopments. Daylight withdrawals are ex-
tremely costly; and, when withdrawal becomes disorderly,
losses may be staggering.
(4) Relative fire ponosr. — A preponderance of friendly Are
power, especially in heavy weapons including aviation, will
greatly decrease the capability of the enemy to inflict casu-
53
75
MEDICAL FIELD MANUAL
alties by smothering his weapons. Conversely, relative weak-
ness in heavy Are power will operate to increase casualty rates.
(5) Movement under hostile fire, — All other factors being
equal, troops moving under hostile fire suffer more heavily
than those remaining in position.
c. Sickness and nonbattle injuries in combat. — In estimating
casualties to be evacuated, it must be remembered that disease
declares no armistics during combat and that soldiers do not
become unusually careful to avoid ordinary injuries at such
times. On the contrary, the admission rate for this class of
casualties may, in combat, even rise above the average for
the following reasons:
(1) Necessity for haste causes a disregard of ordinary pre-
cautions in the handling of materiel.
<2) Fatigue not only causes actual disability, but it pro-
duces a state of mind that tends to exaggerate minor ailments
and injuries, if not to foster frank malingering. While care-
ful sorting should prevent the evacuation of any great pro-
portion of such cases, the operation of sorting alone places
an additional burden on medical units.
d. Proportion of troops actively engaged. — The proportion
of a command actively engaged in combat determines, to a
considerable degree, the casualty rate of the unit as a while;
and this proportion varies within wide limits in units of
different sizes and operations of different types. While the
retention of a reserve is habitual in all units, local reserves
of smaller units are ordinarily located so near the front line
that their exposure to risk is at least comparable with that of
other elements of the unit. On the other hand, general re-
serves are ordinarily located well to the rear and outside the
zone of greatest casualty incidence. Furthermore, reserves
are committed to action by smaller units at more frequent
intervals than by larger units. Whereas during active fight-
ing it might be unusual for a battalion reserve to remain in-
active for an entire day, in the same battle the reserve of a
corps or army might not be committed for several days. All
this points to the dangers in generalizations in the estimation
of casualties. Each situation must be studied, and an esti-
mate made for each major fraction of the command rather
£4
REFERENCE DATA
75
than one estimate for the command as a whole, else the result
will be no more than a poor guess. This is to say that the
army surgeon should not base his estimate of probable cas-
ualties in the army upon army experience, but upon the
experience of corps or, better yet, of divisions as influenced
by the situation confronting them at the time.
e. Average battle casualty dans.— (1) Infantry regiment. —
The experience of the A. E. P, indicates that, in severe com-
bat, an infantry regiment frequently loses 15 percent in cas-
ualties in one combat day. After a careful study, it is con-
sidered that the average battle casualty day for an infantry
regiment in the A. E, F, was around 2% percent.
(2) Infantry division. — The average battle casualty day of
an infantry division in the A. E. P. was about 1 percent; and
in severe combat the maximal casualty day was between 8
and 10 percent.
(3) Corps. — The average battle casualty day of a corps in
the A. E. P. was about 0.4 percent; and in severe combat the
maximal casualty day was slightly more than 2 percent. In
each instance of a maximal casualty day for a corps, how-
ever, the great bulk of casualties occurred in one division —
the other divisions being either in reserve or slightly engaged.
It is believed, therefore, that the maximal rate for a corps
should be about 3 percent.
(4) Army. — In paragraph 74 it will be seen that the army
suffered a daily casualty rate of around 0.3 percent for about
one-half of its combat days and that the maximal rate was
only 0.7 percent. However, a similar situation obtained in the
army experience as in the corps experience, during the maxi-
mal casualty day experiences only about one-third to one-
half of the corps of the army were actively engaged; and it is
believed that a maximal battle casualty day for an army should
be around 1.5 percent.
55
76-77
MEDICAL FIELD MANUAL
Section IV
EVACUATION OP CASUALTIES
■ 76. Capacities of Thansport. — The following table gives the
average capacities of the various types of transport used to
move sick and injured men and animals:
Vehicle
Ambulance, air_
Ambulance, animal-drawn _
Ambulant*, motor
Ambulance, cross-country
Truck, lj^-ton
Truck, 2H-ton -
Railway car, coach _
Pullman car:
ia«ectiou
IS-section - -
Hospital train. _ —
Ambulance, motor (veterinary):
Truck, l?4-ton with trailer, 2-horse
van
Truck, 2J^-toHBtock rack body
Stock car. -
Boicar-
Veterinary lead line
Men
Sitting
16
B
10
6
10
16
SS
«
700
Recum-
bent
24
32
300
Average
3fl
48
500
Animals
2
6
IS
IS
20
■ 77l Time Factoes in Evacuation. — a. Litter squads, — Under
average conditions, a litter squad will complete one round trip
of 1,000 yards in 1 hour, including the time required to load
and to unload the patient. The use of a wheeled litter car-
rier will reduce this time to 45 minutes. Fatigue of bearers is
a most important factor, and will reduce the tempo of litter
carry by hand to a marked degree.
b. Ambulances; and trucks used as ambulances. — Under com-
bat conditions, motor ambulances and other motor vehicles
used in lieu thereof may be expected to average about 10 miles
per hour while in transit. Animal-drawn ambulances will
average about 4 miles per hour under similar conditions.
66
REFERENCE DATA
77-79
e. Veterinary lead lines. — Veterinary lead lines may be ex-
pected to complete one round trip of 1,000 yards in 30 minutes,
including the time required for tying and untying.
d. General formulas. — The time (1) , and the number of
units of transport (2) , required to evacuate a given number
of casualties may be computed ■with the following formulas;
Where: W=the total number of casualties to be evacuated.
n =the number that can be transported in one
load.
T=the total time.
t =the time required for one round trip.
t7=the number of units of transport (litters,
ambulances, lead lines, etc.).
(1) (2)
Uxn TXn
■ 78. Average Distribution or Casualties by Transporta-
tion Requirements. — a. General. — The type of wound will
vary within relatively narrow limits in different operations.
The figures presented in succeeding subparagraphs are be-
lieved to be fair averages, although no accurate figures are
obtainable from the experience of the A. E. P. These figures
apply only to battle injuries. If the sick requiring evacua-
tion during combat is added, the proportion requiring evac-
uation by litter or in the prone position falls somewhat.
In the Meuse-Argonne offensive, for example, including the
sick, 42 percent required evacuation in the prone position
and 58 percent could be evacuated in the sitting position.
b. Forward of collecting station. — Eighty percent of gas
patients and 44 percent of GSW cases will be able to walk
to aid and collecting stations.
c. Rear of collecting stations. — Eighty percent of gas
patients and 49 percent of GSW cases can be transported
in a sitting position.
Section V
HOSPITAL BED REQUIREMENTS
■ 79. Governing factors. — The number of hospital beds
required is a function of —
a. The admission to hospital rate for sickness and non-
battle injuries.
57
79-82
MEDICAL FIELD MANTJAL
b. The admission to hospital rate for battle injuries.
c. The average duration of treatment for each class of
admissions.
■ 80. Duration of Treatment. — a. GeneraL — Duration of
treatment in any particular echelon of medical service de-
pends upon the echelon, the type of case, and the evacuation
policy (see par. 81). Forward of general hospitals the type
of medical installation determines, in general, the duration
of treatment although the severity of the case, particularly
as it affects the transportability of the patient, also exerts
an influence in individual cases.
b. Case fatality rate. — The proportion of cases that die in
a medical installation, and their average longevity after
admission, influence the average duration of treatment of
all cases. This factor has been accounted for in the ex-
periences set forth in c and d below.
c. Sicic and nonbattle injuries. — During the World War,
for cases treated in hospital only, the average duration of
treatment of cases of sickness and nonbattle injuries was
20.36 days for those admitted in the United States and 27.29
days for those admitted in the A. E. P.
d. Battle injuries. — During the World War, the average
duration of treatment of gas cases was 41.77 days and of
GSW cases 94.84 days.
■ 81. Evacuation Policy, — It may be decided that only cases
of relatively short expected duration will be retained for
definitive treatment in a theater of operations and that all
cases expected to require prolonged treatment will be evacu-
ated as soon as possible to general hospitals in the zone
of the interior. The expected duration of treatment fixed
as a line of demarcation between cases to be retained in
the theater of operations and those to be evacuated to the
. zone of the interior is usually a multiple of 30 days — such
as 30 days, 60 days, 90 days, or 120 days. Such a decision
is known as an evacuation policy of 30 days, of 90 days, or of
whatever period may be set. The establishment of an
evacuation policy is a command decision.
■ 82. Dispersion Factos. — It is practically impossible, and
wholly impracticable, to attempt to fill each hospital bed
58
REFERENCE DATA
82-83
with a patient. Hospital trains must deliver full loads to
one installation rather than peddle a few cases here and
there tc fill the last few beds. Furthermore, some segrega-
tion of patients in hospital is necessary. Infected wounds
must be treated in separate wards rather than with clean
wounds. Contagious diseases must be isolated from each
other and from all other cases. These practical considera-
tions cause a certain proportion of beds to remain empty
at all times. This proportion of empty beds due to such
causes is known as the dispersion factor. The minimum
dispersion factor consistent with safety is about 10 percent.
That is, for every expected thousand patients, 1,100 beds
should be provided. Where segregation by sex is necessary,
and both sexes are well represented as in peacetime, a disper-
sion factor of 20 percent is necessary.
■ 83. Accumulation op Patients in Hospitals. — a. Gen-
eral. — Table VI shows the rate at which the three general
classes of hospital patients accumulate under various evacua-
tion policies and when all patients are retained in the
theater of operations until finally disposed of. No disper-
sion factor having been applied to these figures, they repre-
sent merely the estimates of net bed requirements per 1,000
strength of command when the daily admission rates are
1 per 1,000.
b. Bed requirements for diseases and nonbattle injuries, —
In paragraph 80c it is stated that the average duration of
treatment of this class of patients in the A. E. P. was 27.29
days. This datum, however, is of no assistance in arriving
at the number of beds required in the theater of operations
when cases of longer duration are evacuated to the zone of
the interior. Other experience indicates that approximately
28 percent of cases of disease and nonbattle injuries remain
in hospital longer than 30 days, 12 percent longer than 60
days, 6 percent longer than 90 days, and 2y 2 percent longer
than 120 days. By deducting these proportions from total
bed requirements, assuming that all such cases are evacu-
ated promptly to the zone of the interior, the approxima-
tions in table VI, which apply to the several evacuation
policies, are arrived at.
59
83-84
MEDICAL FIELD MANUAL
e. Bed requirements for GSW cases.— The average dura-
tion of treatment of this class of cases in the A. E. F. was
94.84 days. Approximately 66 percent remained in hospital
longer than 30 days, 45 percent longer than 60 days, 35
percent longer than 90 days, and 27 percent longer than
120 days. For the application of these data in table VI,
see t above.
d. Bed requirements for gas eases. — The average duration
of treatment of Injuries from chemical agents in the A. E. F.
was 41.77 days. Approximately 46.5 percent remained in
hospital longer than 30 days, 22 percent longer than 60 days,
11 percent longer than 90 days, and 5 percent longer than 120
days. For the application of these data in table VI, see b
above.
■ 84. Method of Estimating Hospital Bed Requirements. — a.
General. — Since patients of the three general classes are ad-
mitted at different rates and accumulate at different rates,
separate estimates must be made for each class and these
results added to arrive at the total bed requirements.
b. Estimating admission rates. — The medical planner, by
applying the various factors in the situation to general ex-
perience (see sees. II and III) , estimates the average daily
admission rate for each class of patients.
c. Evacuation policy. — As shown in table VI, the evacuation
policy exerts a considerable influence upon the rates at which
patients accumulate, and must be taken into account in the
estimate of bed requirements.
d. Use of table VI. — Table VI shows the rates at which each
general class of patients accumulate when the average daily
admission rate for that class is 1 per 1,000 mean strength.
Having estimated, for any particular situation, the average
daily admission rate for each class of patients, there remains
only the multiplication of the appropriate figures in table
VI by the estimated admission rates and the mean strength
in thousands.
e. Examples. — CI) The mean strength of a command is ex-
pected to be 575,000. All patients will be retained in the
theater of operations until final disposition. After a study of
60
REFERENCE DATA
84
the situation it is estimated that the following average daily
admission rates will obtain:
Estimated
GencrnI class of patients
average daily
admissions
per 1,000
2,6
Battle casualties:
Average dally battle losses, 3.5 per 1,000.
U>ss killed in action, .5 per 1,000.
Admitted to hospital, 3.0 per 1,000.
2.1
Gas-casualty admissions (30 percent).
.9
(a) Beds required for diseases and nonbattle injuries.—
In 30 days: 575 X 2.6X16.78=25,086. In 180 days: 575X2.6X
27.07=40,470.
(b) Beds required for GSW cases.— In 30 days: 575 X 2.1 X
26.69=32,228. In 180 days: 575x2.1X81.07=97,892.
(c) Beds required for gas cases. — In 30 days: 575 X 0.9 X
22.24=11,509. In 180 days: 575 X 0.9X41.28=21,362.
(&) Total beds required.
In 30 days In ISO days
For diseases and nonbattle Injuries 25,086 40,470
For GSW cases 32, 228 97, 892
For gas cases 11, 509 21, 362
Total net requirements 98,823 159,724
Dispersion factor of 10 percent 6, 882 15, 972
Total estimated bed requirements 75, 705 176, 696
(2) A theater of operations is expected to maintain a mean
strength of 1,000,000. Of these, 425,000 are expected to en-
gage more or less daily in combat. The following evacuation
policy has been established: for disease and nonbattle in-
juries, 90 days; for GSW cases, 60 days; and for.gas casualties,
61
84-85
MEDICAL FIELD MANUAL
120 days. After a study of the situation it is estimated that
the following average daily admission rates will obtain:
Estimated
General class of patients
3V£TRg6 dflily
admissions
per l,uw
l.S
Buttle casualties:
Average dafly battle losses, 2.8 per 1, 000
Less killed in action, A per 1, 000
Admitted to hospital, 2.2 per 1, 000
1.72
.48
(a) Beds required for diseases and nonbattle injuries. —
In 60 days: 1,000X1.8 X 21.21=38,178. In 150 days: 1,000X
1.8 X23.65=42,570.
(b) Beds required for GSW eases.— In 60 days: 425 X 1.72 X
24.91=18,209. In 150 days: the same.
(c) Beds required for gas cases. — in 60 days: 425 X 0.48 X
30.70=6,263. In 150 days: 425X0.48X37.54=7,658.
(d) Total beds required.
In 60 days In 1 50 days
For diseases ana nonbattle injuries 38, 173 42, 570
For GSW cases 18, 209 18, 209
pgr gas cases 6, 263 7, 658
Total net requirements 63,650 68,437
Dispersion factor of 10 percent 6, 266 6, 844
Total estimated bed requirements 68,915 75,281
■ 85. Estimation of Hospital Bed Requirements in Mobili-
zation. — During mobilization, as in certain other situations,
estimates are complicated by a constantly increasing mean
strength. Such estimates must be made by separate incre-
ments and the requirements of the several increments added
to obtain total requirements. The bed requirements of each
increment are estimated by the method shown in paragraph
84. The following example illustrates this method:
62
REFERENCE DATA
Strength of
inurement
Date of
mobilization
Estimated
ndmission
rate
Bed requirements on—
30 M
CO M
90 M
120 M
Etc.
66,000
M
1.5
1.5
2.1
1.8
Etc.
1,636
2, 163
1 203
2,445
1 013
4,394
a 561
1 798
5,889
378
47,800
30 M
124,700
12,600
80
90 M
75 te.
Etc..-
Etc.
Etc.
Etc.
10,fl26
1,083
i
Net hospital bed requiremei
Dispersion factor of 10 percei
its
it
1, M6
104
3,399
310
8, 452
845
Total hospital bed requirements...
1.B0O
3,736
9,297
11,689
Etc.
MB 86, Estimation of Hospital Bed Requirements in Demobi-
lization. — In commands decreasing in strength, hospital bed
requirements are estimated in a similar manner to that shown
in paragraph 85, except that the beds that would have been
required for the demobilized or detached fractions are sub-
tracted from the initial estimates.
63
86
MEDICAL FIELD MANUAL
Table VI. — Accumulation of patients admitted for diseases
and Twribattks injuries, gunshot wounds, and injuries from
chemical agents
With a daily admission rate of 1 per
1,000—
ijfid requirements per 1 |000 mean siren^tB
of command in —
For dis-
eases and
For OS W
For gas
cases
tiopbattlfl
cases
injuries
With an evacuation policy of SO day*:
30 days and over
12. 04
0.07
11. SO
With an evacuation poZtcy of 60 dae>:
30 days
14.70
1.4. 07
17.30
60 days and over.
19.70
24,91
25.20
With ofi evacuation policy Of SO days:
30 days
15.82
17.31
19.83
60 days
21.21
29. 40
28.89
23. 65
38.20
33.25
With an evacuation policy of ISO (faj/s-
30 days _
16. 34
19,38
21.07
60 days
21.90
32.03
30.70
90 days
24. 42
43.77
35.33
120 days and over
25. 5S
40.93
37.54
With all cases retained until finally disposed of:
30 days
10. 78
2S.6S
22. 24
60days.„ __
22. 49
46. 34
32.41
90 days
25.08
58. 90
37.30
120 days
26.27
68. 75
30.63
15fldays_-- - - -
26. 83
75. 89
40.74
180 days
27.07
81.07
41.28
2l0days
27.10
84.83
41.63
240 days -
27.24
87.57
41.66
270 days.
27.27
89.57
41.72
300days.-
27.28
91.01
41.74
64
Appendix I
CHECK LIST OP A COMPLETE FORMAL MEDICAL PLAN
1. SUPPLY.
a. Class I supplies. — Recommendations for distribution to
hospitals, if special methods are desired (army) .
b. Medical depotis). — Location(s), hour(s) of opening and
closing, and organizations served by each, if such be
necessary (army).
c. Medical supply point(s). — Loeation(s), hour(s) of open-
ing and closing, and organizations served by each,
when necessary (division, corps, and army) .
d. Other medical supply matters. — Such as recommenda-
tions concerning policies and general instructions to
be issued.
, 2. EVACUATION.
a. Casualties, — Pertinent data regarding the following in-
stallations, such as location (s), unit(s) served,
hour(s) of opening and closing.
(1) Persomiel;
(a) Aid station(s) (battalion and regiment) .
(b) Collecting station (s) (division, corps, and
army) .
(c) Clearing sttation(s) (division, corps, and
army).
(d) Hospital (s) (surgical, evacuation, and
convalescent hospitals (army) ) .
(2) Animals:
(a) Veterinary aid station (s) (regiment).
(b) Veterinary clearing station(s) (division) .
(e) Veterinary evacuation hospital(s) (when
attached) (GHQ).
(d) Veterinary convalescent hospitaKs)
(when attached) (GHQ) .
(e) Other provisions for evacuation of ani-
mals.
b. Burial. — Arrangements for burial of the dead at army
medical installations (division, corps, and army) .
c. Salvage. — Arrangements for the disposition of clothing
and equipment of casualties, left in medical installa-
tions.
MEDICAL FIELD MANUAL
d. Prisoners of war.
(1) Arrangements for security of sick and injured
prisoners of war.
(2) Utilization of able-bodied prisoners of war to
augment the medical service.
e. Other evacuation matters. — Such as evacuation policy,
special instructions to lower echelons, etc.
3. TRAFFIC
a. Circulation. — Special priorities desired for ambulances or
other medical transport.
&. Construction and maintenance of routes.
CI) Roads, — Necessary construction and mainte-
nance of roads and bridges in the vicinity of
medical installations or for use in evacuation.
(2) Railroads. — Necessary construction and mainte-
nance of sidings and loading facilities at ,
evacuation hospitals (army).
4. TRAINS.
Recommendation with reference to movement of medical
trains on the march, release from march control, and
control in bivouac.
5. PERSONNEL.
a. Stragglers. — Arrangements for the disposition of strag-
glers and malingerers in medical installations.
Z>. Mail. — Arrangements for postal service for medical units
and installations.
c. Shelter. — Shelter required for medical units and installa-
tions.
6. MISCELLANEOUS.
a. Attachment of medical troops. — Instructions desired with
reference to attachment of medical units to subordi-
nate units Cdivision, corps, and army).
t>. Movement of medical units. — Instructions desired cover-
ing changes of location of medical units in rear areas.
c. Arrangements with higher eehetonis) for evacuation. —
The arrangements desired.
d. Sanitation.— -Any instructions concerning sanitation
which should be published,
c. Medical matters not otherwise covered.
f. Other medical details. — No change (when applicable) .
66
Appendix n
CHECK LIST OF COMPLETE UNIT PLAN
1. SITUATION. — This paragraph is a resume of the situation
as it affects the operations of the unit. It sets forth the
premises upon which the plan is based. These may in-
clude —
a. So much of the information of the enemy as affects the
operations erf the unit.
b. The decision and general plan of the next higher com-
mander.
c. Supplemental decisions of the commander (or responsi-
ble staff officers) that affect the operations of the
unit.
&. The conclusions arrived at in the analysis of the ele-
ments of the medical situation. (Sea par. 116.)
2. DECISION. — This is the decision of the unit commander
arrived at after an estimate of the situation. <See
par. 14.)
3. ALLOTMENT OP TASKS. — In a separate subparagraph
each task required by the decision is allotted to a sub-
ordinate unit or agency. What each, subordinate unit
is to do must always be stated clearly. When and why
it is to be done may be stated; but how it is to be done
should be left to the subordinate commander, unless
there be a compelling reason to limit his discretion.
4. -SUPPLY AND ADMINISTRATION.
a. Supply. — The plan for the procurement of supplies of
all classes, and their distribution to subordinate units.
Arrangements for rationing of units not provided with
kitchen facilities.
b. Administration. — Special instructions to the unit staff;
special reports and returns required; special instruc-
tions regarding the administration of patients.
5. COMMUNICATIONS. — Command posts and plan for
maintaining communications within the unit.
67
Appendix III
COMBAT ORDERS FOB MEDICAL UNITS
■ 1. Written Field Order. — a. Situation. — War between Blue
and Red has been going on for some time. Hie Blue 1st Divi-
sion has been engaged with Red forces on previous occasions,
and Red organization, armament, and other military char-
acteristics are well known to this division.
A Red force has been concentrating in the vicinity of Har-
risburg, Pa, The Blue 1st Division, marched north from Bal-
timore, Md., May 13, 1940.
Normal march dispositions were made of the 1st Medical
Regiment during this march, and standing operating pro-
cedures have been established for medical service in normal
situations. At 4:00 AM May 15, the division field order for
the occupation of a defensive position was issued.
b. The order.
Maps: Gen Map, Gettysburg (1925), 1 inch=5 mi. U. S. Geol
Surv Map, 1:62,500 Westminster auadrangle,' with situa-
tion overlay herewith (Annex No. 1).
1. a. A hostile force, estimated to be a corps of two divisions
and corps troops, is marching south in three columns
on the general axis: CARLISLE (355-795 ) — BALTI-
MORE (gen map). Leading elements of this force
bivouacked last night on the general line: KAST BER-
LIN (370-760) — HAMPTON (365-760) —BIGLERVILLE
(345-760) (gen map). No hostile combat aviation has
been reported.
b. The 1st Div (rein) will organize and defend the position
shown in Annex No. 1. Formation: brigs abreast. Inf.
and arty elements will be in position by 11:00 AM 15
May. The present adv gd will outpost the position. The
1st Sq, 1st Cav, is in contact with the enemy.
No restrictions on reconnaissance.
1st Medical Regiment,
WOODENSBURG, Md,
15 May 1940; 9:30 AM.
68
REFERENCE DATA
The det, 1st Med Regt, now atchd to the adv gd, will be
atchd to the outpost when march conditions cease.
Evacuation by army, commencing 7:00 PM, 15 May.
The 701st Surg Hosp (motorized) will arrive in WOOD-
ENSBURG at 11:30 PM, 15 May.
2. This regt will support the div in the defense of the position.
3. a. The 1st Bn (less Co B) will establish coll stas in sup-
port of the 1st and 2d Brig combat teams. It will es-
tablish liaison with the medical service of the outpost
and be prepared to assist in the evacuation of the
outpost.
b. The 3d Bn (less Co G) , committing only one company
initially, will establish a clr sta at HAMPSTEAD (386-
722) (Geol Surv map). (See par. 4a.)
C. The 2d Bn (less Co F) will evacuate the coll stas estab-
lished by the 1st Bn. The CO, 2d Bn, will select the
ambulance routes, and inform this CP of his selec-
tions without delay.
d. Co G, when notified of the opening of the new clr sta
at HAMPSTEAD, will prepare to close the clr sta now
operating at PIKESVJLLE (395-690) (gen map).
e- The elements of Cos B and F, when relieved from at-
tachment to the outpost, will proceed without delay
to HAMPSTEAD and report to their respective com-
panies.
/. Cos B and F (less elements atchd to the outpost) will
proceed to HAMPSTEAD and there await orders in
reserve, prepared to move on 15 minutes' notice. The
movement to HAMPSTEAD will be directed by the
CO, Co P.
x- (1) The 2d Bn will transport all foot elements of the
1st Bn into positions.
(2) All movements into positions will commence at
11:30 AM, 15 May.
(3) All units will be in position with necessary stations
established and ready to operate by 3:00 PM, 15
May.
(4) Bn comdrs will report without delay the exact loca-
tions of their stations.
69
MEDICAL FIELD MANUAL
(5) Parking of vehicles on the BALTIMORE AND HAN-
OVER ROAD is prohibited.
(6) The use of the following roads by med vehicles is
prohibited:
(fl> Road: ALESIA (388-732) —MILLERS
(386-730) ;
<t>) Road: BECKLEYSVILLE (393-727) —
ALB AN TOWN (390-727); (all Geol
Burv map).
4. a. The Hq and Serv Co, moving with the 3d Bn, will
proceed to HAMPSTEAD and establish sta in the
vicinity of the clr sta thereat.
b. Army medical depot: BALTIMORE.
c. Distribution of all classes of supplies: standing operat-
ing procedure.
5. CPs: 1st Med Regt: WOODENSBURG, closing 12:45 PM,
15 May.
HAMPSTEAD, opening 12:30 PM, 15
May.
1st Bn: Vicinity of GREENMOUNT (385-725) (Geol
Surv map), to open not later than 1:30 PM,
15 May.
2d Bn: Vicinity of GREENMOUNT, to open not
later than 1:30 PM, 15 May.
3d Bn: HAMPSTEAD, to open not later than 1:30
PM, 15 May.
Official:
JOHN C. DOE,
Col, 1st Med Regt,
Commanding.
RICHARD C. ROE,
Capt, 1st Med Regt,
S-3.
Annex No. 1 : Overlay of situation (omitted) .
Distribution: A.
■ 2. Spoken Field Ordbbs, — a. Dictated field order. — (1)
Situation. — In compliance with Field Orders No. 45, 1st Medi-
cal Regiment (see par. 1, app. Ill), Company C has been
directed by the battalion commander to support the 2d
Brigade combat team with its collecting station located In
70
REFERENCE DATA
the general vicinity of Alesia (388-732). The commanding,
officer of the 2d Battalion directed Company s to evacuate
the collecting station(s) of Company C,
After arriving in Alesia with his company, completing his
reconnaissance, and conferring with the commanding officer
of Company E> the commanding officer of Company C as-
sembles his platoon commanders and issues the following oral
field order:
(2) Order. — Follow me on your maps. We are now at the
southwestern exit of the village of Alesia. That direction
(pointing) is north. This street (pointing) runs almost due
northeast. Note the high hills to the northeast; just beyond
them lies the stream known as Gunpowder Falls.
Copy this order as I give it, placing as much of it on your
maps as possible,
A hostile force, estimated to be a corps of two divisions with
corps troops, is approaching this area from the north. No
hostile combat aviation has been reported. It is estimated
by the brigade staff that no attack can be made against this
sector of our position before daylight tomorrow.
This division is organizing and will defend a position along
the general line: Gunpowder Falls, 1-i.neboro, Dug Hill Ridge.
Formation: Brigades abreast, with the 2d Brigade on the
right. The boundary between brigades is as follows: West-
em Maryland Railroad from Greenmount to Millers, thence
the highway north through crossroads to road junction
712, thence along the eastern, slopes of the hiDs to Blackroek,
and thence north along the stream to the vicinity of road
junction 781 — all to the 2d Brigade.
The position is outposted, and our cavalry is in contact with
the enemy.
The 2d Brigade will defend its sector with regiments
abreast, the 4th Infantry on the right. Boundary between
regiments: the highway from ^Jesia to Roller and thence
along Muddy Creek, all to the 3rd :;'nfantry. The brigade is
organizing and occupying that part of its sector :?rom its left
boundary to Roller; and is organizing an extension £rom
Holler to Rockdale. After, the organization of the extension
is completed, the brigade reserve will be withdrawn into the
valley along the railroad just southwest of where we are
71
MEDICAL FIELD MANUAL
standing (pointing) . One battalion of the 4th Infantry is
to go to division reserve at the same time.
Company E will evacuate our collecting station, and will
also operate advanced ambulance shuttles.
This company will support the 2d Brigade combat team
initially with one collecting station established in Alesia.
The 1st platoon will establish the collecting station in that
church (pointing) . Liaison agents •will be dispatched at once
to establish contact with aid stations. Liaison will be estab-
lished at once with the medical service of the outpost.
The 2d platoon will evacuate the aid stations of the 3d
Infantry and of the artillery located in its sector. The pla-
toon commander will submit recommendations for advanced
ambulance loading posts before 2:30 PM today.
The 3d platoon will remain in reserve initially, prepared to
support elements of the 4th Infantry either in the occupa-
tion of the extension or in a counterattack. The platoon
commander will submit recommendation^ for advanced am-
bulance loading posts in rear of the extension before 3:00 PM
today.
The use of the road between Alesia and Millers, which is
that road that you see there (pointing), and of the road
between Beckleysville and Albaniown, is prohibited.
The 1st and 3d platoons will mess at the collecting station.
Hot food in containers will be delivered to ambulance loading
posts for the 2d platoon.
The Company CP will be at the collecting station.
Any Questions?
It is now 1:10 PM.
Move out.
b. Oral field order. — (1) Situation. — Liaison agents have
returned to the CP of Company C with the exact locations
of all aid stations established in the brigade sector. The
commanding officer of the 2d Platoon of Company C, accom-
panied by the junior officer of Company E, has reconnoitered
all roads in the immediate rear of the position, obtained the
information secured by liaison agents, and made his recom-
mendations for the locations of advanced ambulance loading
posts. These recommendations have been approved. He
72
REFERENCE DATA
then assembles the section leaders of the 2d Platoon and issues
the following oral order:
(2) Order. — I have prepared these road sketches of this
area (issues road sketches to section leaders). We are in
Alesia. At that end of this street (pointing) , the road to the
right leads to Roller and you can see it as it winds around that
nose (pointing) . On this road about 300 yards from town is a
crossroads. At the crossroads the road to the left leads down
the valley, parallel to the Tailroad. About a mile northeast
of the crossroads this road crosses the railroad and shortly
afterward crosses a small stream. Find that place on your
sketches and mark it as the aid station of the 3d Battalion of
the 3d Infantry.
At the other end of this street (pointing) , the road to the
right runs immediately in rear of the position of the 3d
Infantry, on the average about 1,500 yards in rear of the
main line of resistance and, at several points, it crosses the
regimental reserve line. Just on top of that hill (pointing)
there is a road junction where a road leads to the. left, or
southwest. About 500 yards dawn this road to the left, at the
head of a draw, is the aid station of the 2d Battalion of the
3d Inf antay. Mark that point on your sketches.
Now, coming back to this main road out of Alesia that you
see there (pointing) , after it crosses that hill (pointing) it
dips down into a narrow valley and crosses a small stream.
This stream crossing is about a mile and a half Irom Alesia.
Downstream about 300 yards from the point where the road
crosses there is a stream junction. The aid station of the 1st
Battalion of the 3d Infantry is located at that stream junc-
tion. Mark that on your sketches.
There has been no change in the situation since I explained
it to you earlier in the afternoon.
One section of ambulances of 35 company has been detailed
to operate advanced ambulance shuttles in the sector of the
3d Infantry. That is the section, parked right across the
street (pointing). The ambulance commander has assigned
the leading three ambulances to the left shuttle and the rear
two to the right shuttle. Liaison agents will accompany the
litter bearer sections and guide them to aid stations.
2 shall take the first section and establish loading posts for
the aid stations of the 1st and 2d Battalions of the 3d Infan-
ts
MEDICAL HELD MANUAL
try. The first section will entruck in the three leading
ambulances.
The second section, less one corporal and three litter squads,
will entruck in the two rear ambulances and proceed on the
road leading down the valley there (pointing) to the aid sta-
tion of the 3d Battalion of the 3d Infantry. This section
will establish and operate an ambulance loading post as near
to this aid station as is practicable.
The three litter squads withdrawn from the 2d section,
commanded by the corporal, will remain here at the collecting
station awaiting orders.
Cooked food will be delivered at all ambulance loading
posts.
Send all messages for me to the collecting station.
Any questions?
It is now 2:45 PM.
Entruck your sections,
74
Index
Paragraphs Pages
Accumulation of patients In hospitals 83 59
Admission rate:
Average dally peacetime 57 41
fPormula "__ _ _ 47 37
Army, casualties in -------- ^ ^
Bed requirements 79-86 57
Case fatality rates 50 38
Casualties, battle:
Army 74 53
Classification _ _ 65 46
0>rps 73 si
Distribution:
Arm and service 66 48
producing agent ■_ 68 49
Within units 89 49
Evacuation 79-78 56
Infantry division 72 ' 51
Infantry regiment 71 50
Influence, type of action on 70 50
Rates, estimation 75 52
Causes, sickness and. Injury 55 40
Checl. lists:
Complete formal medical plan 23, App I 19, 65
Complete unit plan 23, App II 19,68
Chief medical officer 6 2
Classification, supplies 39 32
Climate, effect on siefcness 59 43
Combat orders, medical units 24-28, App III 20, 69
Columns:
Marching, road space occupied 33 25
Motor, time lengths 34 28
Command and staff 3 3
Credits, supply 43 35
Day of supply 42 34
Death rate 48 38
Decision, medical plan 14 13
Definitions:
Medical plans 15 13
Rate 44 36
Demobilization, estimation of hospital bed require-
ments in 86 63
Depot stocliages 43 35
Dispersion factor in hospital bed requirements 82 58
Distribution of casualties:
By producing agent 68 49
By transportation requirements 78 57
Duration, medical treatment 80 58
Estimation, hospital bed requirements:
In demobilization 86 63
In mobilization 85 62
Method 84 60
75
INDEX
Evacuation: Paragraphs Pages
Casualties 76-78 56
Policy 81 58
Fuel, motor 41 34
Headquarters, division and higher units 4 2
Hospitals, accumulation, of patients in 83 6S
Infantry casualties:
Division 72 51
Regiment 71 50
Influence, type of action, on casualties 70 50
Lubricants, motor 41 34
Marches, rates and lengths 35 29
Marching columns, road space occupied 33 25
Means, medical 12 12
Medical plan, check list of App I 65
Method, estimating hospital bed requirements 84 60
Mission, medical units . 10 6
Mobilization, estimation of hospital bed require-
ments In 85 63
Moving columns:
Foot and animal;
Average time lengths 34 28
Road space occupied 29 22
Motor:
Average time lengths 34 28
Koad space occupied 33 25
Nativity, troops, effect in siclmess 61 43
Noneffective rates 51 38
Orders, combat, medical units:
Examples App ni 69
Preparation 28 21
Purpose , 25 20
Scope 26 20
Types 27 20
Personnel, duty, transportation in motor vehicles- 32 24
Plans, medical:
Annex 20 15
Approval 19 15
Check lists , 23 19
Definitions 15 13
Preparation - 9, 18 8, 14
Purpose 16 13
Sanitary order 22 19
Satisfactory, characteristics of 17 14
Scope . 21 15
Preparation:
Combat orders 28 21
Medical plans 9, 18 8, 14
Producing agent, distribution of casualties by 63 49
Purpose, combat orders 2& 20
76
INDEX
Paragraphs Pages
Race, effect in sickness 60 42
Hallway car space requirements 36 29
Railway trains:
Requirements, medical units 38 31
Types — 37 go
Rates:
Admission _ 47 37
Case latality 50 33
Death. 48 3B
Formula _ _ _ 45 36
Marches 35 29
Noneffective 51 33
Time lactar In 48 36
Rations 40 33
Ratios :
Estimation,, provable casualty 75 53
Formula 53 39
Killed to wounded in action , 67 4g
Relations, command and stall of surgeon 7 4
Requirements:
Bed 79-86 67
Railway trains, medical units 38 31
Road spaces:
Foot and animal elements 38 32
Medical units 30 32
Motorized elements:
At halt 29 33
When moving 33 35
Sanitary order 23 IS
Scope:
Comftat) orders 26 30
Medical plan 16, 21 13, 15
Seasonal variation, sickness 53 41
Seasoning ol troops, relation to sickness 62 S3
Sickness and Injury:
Average peacetime dally admission rate 57 41
Causes 55 40
Climate, effect on 59 42
Nativity, effect on 31 43
Place of treatment 53 41
Race, efiect on 60 42
Seasoning of troops, effect on 62 43
Variation:
Range of from average experience 83 44
Seasonal 53 41
Situation, medical 11 9
Strength, medical requirement estimation 54 40
Supply:
Classification 39 32
Credits 43 35
Day or 43 34
Depot stockagea 13 3fi
Motor fuels and lubricants 41 34
Rations 40 33
INDEX
Paragraphs
Pages
("trim m ft.ti ri ftrtrii RtftflF FplntJnnH
7
Staff functions
6
a
Tiros factor in rates
46
36
nn
56
T'lwifi 1 avi rt^"Vk o w, iitt i f» /irtl urn via
OA
Jo
Trfl ti gpnfr^.fiti f>n t duty personnel-
32
24-
Transports, sick and wounded, capacities
76
56
Treatment:
Duration „ .._ _ __.
, eo
58
Place . _. . _ .
56
41
Troop movement - _ . ..
22
l^pes of combat orders, _
27, App in
20,69
Unit plan, check list
App II
63
Variation in slclsness:
. 63
44
Seasonal _ _. . — . . .
58
41
o
78