Working Against Death

"I was up forward with the mortars when the ambush hit us," recalls the chunky Florida Negro. "There were Viet Cong everywhere--in the grass, in the trees and bushes, and in holes. The guy in front of me was killed. The guy behind the guy behind me was killed. There were all kinds of wounds--head, chest, abdomen, legs and arms. The captain and the sergeant major, they were killed. We formed a perimeter--really just a circle of people trying to protect themselves. "That's where I treated the wounded. I was just doing my job."

The Army understandably thinks that Staff Sergeant James Reid, 45, a World War II truck driver who was assigned to the Medical Corps, did more than just his job. His recommendation for a Silver Star notes that he kept on tending the wounded even after machine-gun fire chopped down a tree he was using for cover on that terrible night in the la Drang Valley. Of the 21 men whom Reid treated, only one died. Says Captain William Shucart of St. Louis, surgeon for the 1st Cavalry's 7th Regiment, 2nd Battalion: "I was pinned down elsewhere, and Reid treated the wounded strictly on his own. He gave blood and antibiotics and patched wounds--all that I or any other doctor could have done, and he did them darned near as well. He's an amazing, wonderful guy."

Jungle to Z.I. Behind the heroism of Medical Corpsman Reid and his buddies stretches an elaborate, efficient and increasingly swift chain of medical services--all the way from Dr. Shucart and his fellow surgeons in the jungle to "Z.I." (zone of the interior, meaning the U.S.). And the statistics of survival testify to the operation's success. In World War I, the fatality rate was 5.5% of the wounded; in World War II, 3.3%; in Korea, 2.7%. In Viet Nam, estimates Commander Almon C. Wilson, head of the 3rd Medical Battalion at Danang, it is below 2% .

Many factors have contributed to the reduction. But helicopter lifts are by far the biggest. After the high-grade first aid at the front line, there is always the helicopter that takes the wounded, whether American or South Vietnamese, on their next quick trip. Slow and bumpy ambulance rides have been virtual ly eliminated by the ungainly choppers that brave everything from bullets to a sheet of monsoon rain, day or night. "Man, that chopper's roar don't bother me a bit," said a young marine last week as he watched a noisy Huey land to pick up a wounded buddy. "Sounds more like angels singing." Whereas only 10% of the wounded were carried by copters in Korea, the ratio is up to 90% in Viet Nam, says Colonel Spurgeon Neel Jr., chief medic of the U.S. Military Assistance Command.

First copter stop may be either a MASH (mobile army surgical hospital) or the division unit. These are fairly close to the scene of action, and are used mainly for grave emergencies in which a ten-minute delay in starting treatment might mean death. Division hospitals average only about ten beds each, with four doctors. Each MASH has 60 beds, along with 80 medical personnel, including ten doctors. Behind these, in turn, are field hospitals and evacuation hospitals--all misnamed, judged by their current functions.* In South Viet Nam, there are now two U.S. MASH units and one Korean, three field and two evacuation hospitals, and the Navy's 3rd Medical Battalion.

Front & Back Surgery. One recent patient at the 85th Evacuation Hospital in Qui Nhon in the Central Highlands was a first lieutenant whose family does not yet know he has been wounded. Shot and partly paralyzed during a night action near Plei Me, the lieutenant propped himself against a tree and went on directing his platoon for half an hour before he felt himself blacking out. Then he turned over command to a sergeant. He lay in the field for an estimated seven hours. Then corpsmen and doctors got to him and gave blood, other intravenous fluids, a tetanus booster shot and antibiotics. A MedEvac helicopter (TIME, July 2) set down gently on the dangerous terrain, took the lieutenant aboard and deposited him only minutes later at the 85th Evac Hospital.

Entrance & Exit. The lieutenant needed all kinds of doctors, and the 85th had them all. Besides a platoon of general practitioners, it has six general surgeons, two neurosurgeons, two orthopedists, one thoracic and one urologic surgeon, two anesthesiologists, two internal-medicine specialists, two dentists and one psychiatrist; also 39 U.S. Army women nurses and 16 male nurses.

"We could see the entrance and exit of the bullet," says Captain Albert Dibbins of Melrose, Mass., "and the paralysis in the legs made it obvious that there was a spine injury."

Dr. Dibbins opened the patient's abdomen. The bullet had gone through the right kidney, but the wound was clean and would heal itself. The pancreas and duodenum were undamaged. A wound in the diaphragm was too far back to be treated; it would heal itself. So would the punctured lung: "It's so spongy that it acts like a self-sealing gas tank," explains Dr. Dibbins. He put a drainage tube in the lieutenant's chest, closed the abdominal incision and helped turn the patient over on his belly.

Next, Neurosurgeon Benjamin Blackett took over. He made an incision down the spine, found two fractured vertebrae, with bone chips up to a 1/2in. long broken from their tops and sides. Dr. Blackett removed the chips. But they did not explain the paralysis; so the doctor moved on to the exquisitely delicate job of "unroofing" three vertebrae, to expose the sensitive spinal cord. There, Blackett found what he was looking for: another bone chip, hardly bigger than a broken pencil point, was pressing against the cord. Insignificant as it seemed, it was enough to have caused the paralysis. Dr. Blackett left the vertebrae unroofed--the heavy back muscles would unite to give the spinal cord enough protection. Within a few days, the lieutenant regained partial feeling in his legs and was started on his way to the Z.I.

Vital Sorting. Though the Marine Corps has no separate medical service, and depends on the Navy's, it has the 3rd Medical Battalion, comprising four companies. At Danang is Company C, or "Charlie Med" to the gyrenes. "Back last summer," says Lieut. Commander Richard M. Escajeda, 36, chief surgeon and commander of Charlie Med, "we used to classify eight casualties as a mass casualty event. Then we rang a big metal ring--like a country fire alarm--and everybody reported to his station. Now things have changed so, we have to get 20 patients at once before we consider it a mass casualty."

In recent weeks as many as 160 wounded and ill marines have swamped Charlie Med's 13 physicians, five dentists and one oral surgeon in a single 48-hour period. "Then," says Dr. Escajeda, "when they come in with everything wrong with them, from missing limbs to multiple wounds, the most important person here is the triage officer."

Tough Decisions: Triage (pronounced tree-ahj) is French for "sorting," and because of the word's emotional overtones, most military medics prefer not to talk about it. But it is a process of sorting that works for the greatest good of the greatest number. The triage officer looks over the wounded and makes the vital, split-second decision as to which require immediate surgery, which can wait a few hours, and which need only more first aid. Sometimes he must also make the conscience-racking decision that a man is beyond help or hope, that it would be a waste of doctors' time, and therefore endanger others' lives, to work on him. Such cases have been rare in Viet Nam.

"The triage officer's pitfall," says Dr. Escajeda, "is to start helping in emergency cases. The good triage officer doesn't do that. Spending time doing the humanitarian thing for one patient who obviously needs help right now is fatal. Mass confusion results. Patients pile up, half the emergency cases don't get cared for, and the whole system breaks down."

At mass casualty times, all Charlie Med personnel work round the clock; they have done so for as long as 48 hours. Then, even the dentists quit their cavities and turn to as assistant surgeons, working not only in the mouth, but debriding (cleaning, by removing dead tissue) wounds in any part of the body. Enlisted marines inevitably have made this the basis for a wisecrack: "If you're gonna get wounded, be sure you get hurt real bad or you'll draw a dentist for your doctor."

Elapsed Time: 35 Minutes. There was no triage problem in the case of Marine Colonel Michael R. Yunck, 47. As operations officer of the First Marine Air Wing, Yunck had helped to plan Operation Harvest Moon; later he went out in a four-man armed "Huey" helicopter, directing fighter-bomber attacks south of Danang. He was about to call in a strike on a tiny, nameless hamlet when he looked down. His chopper was low enough for him to see women and children. It was also low enough for a Viet Cong machine gunner to sight in on the Huey. "I knew I couldn't call in a strike," said Yunck soon afterward. "And that was when I got the fifty caliber." Commented a surgeon: "He's going to lose his leg because he was too compassionate."

The slug tore through the Huey's door, smashed both bones in Yunck's left leg, and severed the main artery. A crewman tied a tourniquet below the knee, and the copilot sped the little chopper at 100 m.p.h. to a medical sorting and clearing unit only minutes away. There Yunck received morphine, blood and other intravenous fluids. Then he was flown' immediately to Charlie Med. Elapsed time: 35 minutes --five minutes to the clearing station, ten minutes there, 20 minutes to Danang. During the final flight Yunck continued to get blood by transfusion, and he was on the operating table for the unavoidable amputation within minutes of reaching Charlie Med.

Blood & Air. He had been kept alive by a copter and the second most important lifesaver in Viet Nam: a splendidly organized whole-blood program. Americans and some native residents in Okinawa, Japan and Korea are donating enough to make a generous supply constantly available--in November alone, 2,000 pints were flown in. Only half were used as whole blood, which deteriorates after three weeks. As Commander Wilson notes philosophically, "War is a study in waste," especially in dealing with an element as unpredictable as casualty numbers. But in fact, the unused blood is not really wasted: some units in Viet Nam are getting the equipment needed to separate and preserve the more durable plasma. And the Navy is planning to make a full field test of frozen whole blood in the near future.

A third vital factor in Viet Nam medicine is air conditioning of operating rooms, recovery rooms, and wards for the critically ill. In Viet Nam's two monsoon seasons, instruments rust and sterile dressings won't stay sterile in un-air-conditioned hospitals, but equipment is on the way and should soon reach the farthest-forward treatment units. The 1st Cavalry has even taken a "people pod," built to carry troops suspended from a helicopter, and converted it into a mobile hospital with two operating rooms, its own power supply, running water--and air conditioning. It will be helilifted by a CH-54 or "flying crane" right into the battlefield.

Emptying Beds. Ironically, the greatest insurance of adequate and immediate hospital care for the wounded in Viet Nam is the armed forces' ability to get them out of there. There are 1,600 military hospital beds "in country," but no man knows when these might be filled, leaving no room for a second wave of casualties. Reports come in daily to the Far East Joint Medical Regulating Office in Saigon, run by Major Robert M. Latham--how many "in-country" beds are occupied, how many beds are available at hospitals elsewhere in the western Pacific.

Usual procedure is to evacuate any man expected to need a bed for 15 days or more. But if the in-country count is high, Latham may decide to fly out some less severe cases to make room for a possible emergency. Every day or two, big Air Force hospital planes drop into Saigon and other airfields in South Viet Nam, pick up as many as 60 patients each, and fly them to Clark Field in the Philippines under the constant care of a doctor, nurses and corpsmen. "What we've done," says Colonel Neel, "is to bring management to the battlefield. It is no longer a matter of sending casualties to the rear and hoping there will be room for them. We make sure there is always room." And thanks to improvements in all sorts of equipment, surgical procedures and drugs, there is always better care.

*The nomenclature developed in an earlier age. Field hospitals are no longer in the field but in the rear areas (including Saigon) for headquarters personnel; evacuation hospitals receive men already evacuated from the field and treat them extensively.

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