The U.S. military in World War II had an organized, structured system for evacuation and treatment of casualties that stretched from frontline foxholes to hospitals in the United States homeland, based on medical care echelons. Sick or wounded individuals would be transported from one echelon to another as rapidly and efficiently as possible, subject to conditions which often prevented optimal handling, to optimize their care and potential to return to duty. The ability of the American military system to provide medical aid and treatment to its personnel was a source of strength and increased morale, an important factor in ultimate victory.
The chain of casualty evacuation was built around five echelons, starting at the unit level. Sick and wounded from the unit areas of front line battalions, regiments and other units are brought to Echelon I and then evacuated from there as indicated by their medical condition and medical needs. Each echelon does only as much as necessary, either to return the casualty to duty or to safely evacuate the casualty to the next higher echelon.
Governing all WW II medical planning were a series of general doctrinal rules, most of which remained valid long after 1945:
Commanders of all echelons are responsible for the provision of adequate and proper medical care for all noneffectives [persons whose medical condition prevents them from performing their military duties] of their command;
Medical service is continuous;
Sick or injured individuals go no farther to the rear than their condition or the medical situation warrants;
Sorting of the fit from the unfit takes place at each medical installation in the chain of evacuation;
Casualties in the combat zone are collected at medical installations along the general axis of advance of the units to which they pertain;
Medical units must possess and retain tactical mobility to permit them to move to positions on the battlefield and enable them to move in support of combat elements;
Mobility of medical installations in the combat zone is dependent upon prompt and continuous evacuation by higher medical echelons;
The size of medical installations increases and the necessity and ability to move decreases the farther from the front lines these units are located;
Medical units must be disposed so as to render the greatest service to the greatest number.
Coordination of Medical Units in WW II
One problem with the medical organization used in World War II was the lack of an overall medical command and control headquarters at the third and fourth echelons of health-services
support -- a problem not completely and adequately addressed by the Medical Department until well into the 1960s.
In support of a typical corps was a separate medical battalion -- under the command of the corps commander and the technical supervision of the corps surgeon -- which provided second-echelon care to non-divisional units assigned or attached to the corps. Patients were evacuated from the corps' divisions and from its attached medical battalion by a medical group of the field army -- in this case, under the command of the army commander and the technical supervision of the army surgeon. The medical group also provided second-echelon health-services support to the units of the army operating in the corps area but not attached to the corps. The group evacuated patients to the evacuation hospitals of the field army, again under the command of the army commander and the technical supervision of his surgeon.
This meant that health-services support for the corps was provided, for the most part, by units not under the control of the corps. In turn, the medical groups evacuated casualties to hospitals not under their control -- hospitals that sometimes received patients from more than one corps. Close coordination by responsible officers, through communication and conferences on a continuing basis, was required to avoid disastrous results for the wounded.
Material on this page adapted from the U.S. Army Command and General Staff College (Ft. Leavenworth, KS) publication, "From the Roer to the Elbe with the 1st Medical Group: Medical Support of the Deliberate River Crossing", by Donald E. Hall.
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