Description of Echelon IV Medical Treatment in WW II
The fourth echelon of care corresponded to what was later called communications zone, or echelons above corps medical support. Care was provided in 1,000-bed or larger general
hospitals, usually grouped together in hospital centers, station hospitals, and convalescent centers. Most definitive or restorative surgery was performed at the fourth echelon. With an evacuation policy sometimes as long as 120 days, the fourth echelon of care was designed to return the maximum number of patients to duty within the theater.
Echelon IV Transport and Hospitals
After a day or two at an Echelon III evacuation hospital, or other Echelon III facility, with a fresh dressing on his wound and a new entry on his Emergency Medical Tag, a casualty would be moved by ambulance to a nearby railhead, port, or airstrip for evacuation to an Echelon IV facility by the mode of transport most convenient to the location. For example, in Italy, except for Anzio where all transportation was by water, transport would have been by hospital train, or by C-47 cargo plane rigged with litter racks to hold 18 or 20 non-ambulatory patients and staffed by personnel of a medical air evacuation transport squadron.
The numbered general hospitals in World War II had 1,000 to 2,000 beds, with many specialties represented on its staff and with equipment adequate for almost any situation it might be called upon to meet. A less difficult case might go to a station hospital, which would perform most of the functions of a general hospital -- indeed might be acting as a general hospital -- but would be smaller, with fewer specialists and less complete equipment. The World War II station hospital had anywhere from 25 to 900 beds. The station hospital normally served a post or garrison, referring its more serious cases to a general hospital. In all types of hospitals, medical cases usually outnumbered surgical.
Echelon IV Theater Evacuation Policy
In the Echelon IV hospital, the length of a casualty's stay and the surgery or medical care provided, was determined by the medical officers on the case within the theater evacuation policy. An evacuation policy establishes the number of days of hospitalization the theater medical authorities feel they can give to any one case, typically 90 days with a range of 30 to 120 days. This meant that if a patient admitted to a communications zone hospital would in the opinion of his doctors be fit for duty within the number of days of the evacuation policy, the patient would be retained and treated, being returned to his original unit or sent to a replacement center when he was recovered. If, on the other hand, the chances of his recovery within that time were remote or nonexistent, he would be sent to an Echelon V facility in the zone of the interior as soon as the patient could safely be moved so great a distance.
It was clearly to the advantage of a theater to have as long an evacuation policy as possible, because the longer the policy the more sick and wounded would be kept in the theater for future combat operations. The policy was determined by the availability of beds and of trained personnel in relation to the incidence of casualties due to battle wounds, injuries, and disease.
Material on this page adapted from 1) 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, and 2) U.S. Army Office of the Chief of Military History publication, "The Medical Department: Medical Service in the Mediterranean and Minor Theaters", by Charles M. Wiltse.
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