Patient amputee participating in the gymnastics phase of the reconditioning program, U.S. Army Air Forces Thomas M. England General Hospital, Atlantic City, NJ, during WW II. By 1945, the hospital had more than 2,800 patients, and had evolved into the largest hospital in the United States specializing in amputations and neurosurgery. The hospital was closed 30 June 1946.
Description of Echelon V Medical Treatment in WW II
Echelon V is the final level of medical services for a casualty. The facilities consist of the zone of the interior, continental United States-based hospitals that can provide the most specialized and long-term care possible, in addition to all the types of medical care found at lower echelons. Care was medical and surgical for restorative, convalescent, and rehabilitative services to the sick or injured soldier, provided by military, Department of Veterans Affairs, or civilian hospitals. This phase could include a period of minimal care and increasing physical activity necessary to restore patients to functional health and allow their return to duty or useful life as a civilian. Artifical limbs with related rehabilitation and training were provided at Echelon V.
Casualties were evacuated to Echelon V facilities from the communications zone, normally from the field or general hospitals of Echelon IV. A patient returned from an overseas theater during World War II would receive care in:
One of sixty-six named general hospitals
One of the numerous station hospitals or convalescent centers
Veterans Administration facilities
As a general rule, a patient would be evacuated to the United States when:
His injuries required an extremely long convalescent period
Equipment or facili1ities were not available to treat the injuries in theater
His injuries would result in being medically discharged upon recovery
Seriously wounded or ill soldiers could require months or possibly years of prolonged and specialized treatment. Such patients would therefore not stay long at the Echelon IV general hospital, but were sent home to the United States as quickly as possible. Upon boarding the hospital ship or plane, according to the availability of transportation and the urgency of the case, the casualty entered the fifth and final echelon of the chain of evacuation. In a typical case, perhaps two weeks after being severely wounded on the battlefield, the casualty was admitted to Walter Reed Army Hospital in Washington, DC, or to one of the other hospitals, if possible to be closer to his home. The patient remained there until cured, or until treatment options were exhausted.
Role of the Veterans Administration
By 1940, the Veterans Administration (VA) was both a respected member of the medical community and a designated "defense agency." VA recommendations for the physical examination of draft registrants were followed. VA also became a leader in emphasizing mental health as an important factor in overall physical health, based on their experience with WW I veterans.
During World War II, many of Veterans Administration's physicians, dentists, nurses and administrative people were called or volunteered for military service. To replace these employees, VA reduced minimum age and physical requirements for jobs. Women were hired for jobs previously filled only by men. This drain on VA hospital staffs came at the same time as a rapid increase in the number of veterans needing immediate medical treatment.
In 1943, Congress granted WW II veterans the same eligiblity for benefits as WW I veterans. Previously, WW II veterans were only eligible for care for compensable service connected disabilities. The new act provided care if a veteran couldn't afford it and there were available beds. The Disabled Veterans' Rehabilitation Act of 1943 established a vocational rehabilitation program for disabled World War II veterans under which the VA provided 621,000 disabled World War II veterans with job training.
After WW II demobilization, there were 15.2 million veterans of whom 11.3 million were from WW II. Waiting lists for VA admission grew. Beds were increased at existing hospitals and construction projects were expedited. The Army Corps of Engineers built 44 hospitals for veterans, supplementing those built by VA.
Amputees returning from World War II at first found difficulty obtaining artificial limbs. Congress authorized the VA to fill this need. The VA's experience in assisting thousands of veterans led it to become a world leader in the development of prosthetic devices.
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, 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, and 3) other U.S. military and Veterans Administration documentation.
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