Chapter VII
Hospitalization and Evacuation

			Page
Evacuation of Casualties, Transport Capacities			1
Evacuation, Standing Operating Procedure			2-14
Evacuation, Battalion Phase, Chart			15
Evacuation, Regimental Phase, Chart			16
Evacuation, Division Phase, Chart			17
Evacuations and Replacements, Chart			18
Battle Casualties, Assault of Island Fortresses			19

Evacuation of Casualties
Capacities of Transport.--The following table gives the average capacities of the various types of transport used to move sick and injured men.
Vehicle	Men
	Sitting	Recumbent	Average
Ambulance, air	16	10	13
Ambulance, animal-drawn	8	4	6
Ambulance, motor	10	4	6
Ambulance, cross-country	6	4	5
Truck, 11/2-ton	10	4	5
Truck, 21/2-ton	16	6	7

Evacuation Afloat

21. General:

    1. Evacuation from shore in landing area:

       The plan for this evacuation service will depend upon the number and relative locations of the landing beaches if there is more than one, which will usually be the case, as well as upon the number and locations of the troop and hospital ships in the landing area in relation to the shore. Widely separated or detached landing beaches require separate allotment to them of the necessary hospital ships, ambulance boats, personnel, and material for evacuation from shore to ship. Hospital ships at anchorage in the lan ding area are comparable to evacuation hospitals receiving patients from front line divisions in normal land operations.l Beach heads are comparable to division hospital stations, and the boats plying between shore and hospital ships correspond to the Army ambulance companies in the Army scheme of evacuation.

    2. Evacuation facilities afloat:

       For evacuation from shore to ship the following means are employed.

       1. Small boats returning to ships from landing troops: The use of these boats in the initial stages of a landing operation for transporting wounded from shore to ship is uncertain and dependent on the military situation. They cannot be thus employed until the essential combatant troops and their equipment have been put ashore. Until the landing is secured, all other activities must yield to this paramount necessity. Thereafter, perhaps later in the first day's attack, these boats on their return trips to ships may carry casualties, preferably slightly wounded. While being thus used, these boats are not entitled to fly the Red Cross flag nor to the protective provisions of the Geneva Convention.

       2. Ambulance boats: These are motorboats of varying size and design assigned to the operative control of the Navy force surgeon. They fly the Red Cross flag and may be used only for the transportation of casualties, medical personnel, and medical matériel. When thus marked and employed, they are entitled to the protective provisions of the Geneva Convention. The joint medical plan should provide a reasonable number of these boats of approved patient capacity, design, and speed. They should be used primarily for the transportation of seriously wounded cases to hospital ships.

       3. Lighters and barges: Each of these, capable of carrying a large number of wounded on litters or stretchers, should be added to the ambulance boat service in the landing area, to the extent of the requirements, as rapidly as they can be made available after combatant troops and their equipment have been put ashore.

       4. Motor launch for the Navy force surgeon: A swift motor launch at the exclusive disposition of the Navy force surgeon and his staff assistants is highly desirable for the efficient administration of the naval evacuation service in the landing area. The assignment should be made before arrival in the operations area.

Note: Ship's boats generally are not well adapted for use as ambulance boats, especially those below the 40-foot motor launch (class B boat). The 50-foot motor launch (class A boat), except for its too low speed, is fairly satisfactory for this purpose. Loaded Army litters can be stowed in the class A and B boats as shown below:
Army Litter

	On bottom			Second tier (across thwarts)			Total
50-foot launch		12			12			24
40-foot launch		6			8			14

3. Development of shore-to-ship evacuation:

   As a rule, during the initial stages of a landing attack, comparatively few casualties can be removed from beaches. Although the landing of combat troops and matériel must have first consideration, it is highly desirable to have ambulance boats provided for the evacuation of the seriously wounded direct to hospital ships. In any event it is the responsibility of the Naval force surgeon to organize and develop his evacuation service step by step as rapidly as the situation permits; and the detailed plan should provide for the rapid organization of systematic evacuation from shore to ship.

22. Debarkation:

    The debarkation of Army medical units and equipment is carried out in accordance with Army debarkation tables.

23. Phases of Landing Operations:

    1. The dispositions and employment of the Army and Navy medical services conform to the three general phases of the landing operations in which, during the first phase, landings of combat teams on the assigned beaches are made and as rapidly as possible the attack on each beach is pushed with such reinforcements as are necessary or available until the beaches are secured from enemy light artillery fire. This requires as the objective for this phase the establishment of a line about 10,000 yards inland. The second phase consists of those further operations inland which secure the beaches from enemy medium artillery fire. This requires as the objective for this phase the establishment of a line at least 15,000 yards inland. The third phase includes the further land and air operations necessary to secure the objectives for which the landing was undertaken.

    2. Simultaneous landings are made by as many combat teams on as broad a front as the boat facilities will permit without undue dispersion.

24. Army Medical Service During First Phase:

    1. Medical detachments:

       The medical detachments of combat units debark with the organization to which attached. In a combat battalion, two first-aid men wearing Red Cross brassards and carrying as much dressing material as they can, board the landing boats with each company.

It is their duty to land with and follow their companies closely, and to render such assistance to the wounded as may be possible. The remainder of the battalion medical detachment will normally go ashore in the later subwave which lands the battalion headquarters, the battalion surgeon accompanying the battalion commander. Ordinarily, only such medical equipment and supplies as may be hand carried can be landed at this time. The men should, however, carry as many dressings, blankets, litters, and as much splinting material as practicable. The detachments' transport and heaviest equipment follow later. The battalion medical detachment of an infantry assault battalion establishes an aid station at or near the beach at the best available site, where the battalion casualties are collected and treated as in land attacks. As the battalion advances inland, the medical section follows it and establishes successive aid stations according to the situation. The procedure followed by the medical section of an infantry reserve battalion is basically the same as that for the medical troops attached to an assault battalion in the landing, as is also that of the medical sections of field artillery and combat engineer battalions.
2. Regimental sections:

   Regimental sections of regimental medical detachments will normally land with their own regimental headquarters and thereafter perform their duties in accordance with the normal practice in offensive operations. In some situations it may be necessary for the regimental section to take over temporarily a battalion aid station at the beach filled with wounded whom the battalion section has had to leave behind in order to follow its battalion.

3. Beach medical service:

   1. The Army beach medical service proper lands early as a section in the Army shore party and operates thereafter under the shore party commander. The duties of the evacuation officer in charge of this section are to:

      1. Organize and coordinate the Army medical service on the beach.

      2. Receive, sort, and classify, temporarily care for, and retain control of all casualties arriving at the beach; turn them over to the naval medical embarkation officer (par. 25) only as fast as the latter can dispose of them.

      3. Provide such shelter and protection for the casualties as are practicable.

      4. Establish and operate a medical supply point.

      5. Establish connections with other Army medical units on or near the beach.

      6. Assist in forwarding messages and supplies to medical units inland.

      7. Mark his station by the Red Cross and other identifying signs.

      8. Cooperate closely with the naval medical embarkation officer on his beach.

   2. Wounded may temporarily accumulate in large numbers on the beach. They must be segregated and the walking wounded rigidly controlled; especially must the latter be prevented from interfering with the activities of the beach party. Therefore, casualties ready for evacuation from the beach will be assembled at a location designated by the shore party commander, which should be located with due regard to suitable boat landings, cover from the enemy fire, location of the aid or collecting stations, and natural drift of the wounded. One or more such locations may be designated for each beach.

3. Medical personnel to assist the evacuation officer should come from the corps medical regiment or other medical unit of low debarking priority. This personnel must be adequate for the many duties of the evacuation section of the shore party, which include the movement of all litter cases collected at the beach to a point on the shore from which they will be loaded into boats by the naval medical embarkation officer's personnel. In emergency, the evacuation officer may have to furnish litter bearers temporarily to assist in loading boats. The initial evacuation section of the shore party landing in the landing combat team may of necessity be only a skeletonized group. In such cases its early reinforcement will be provided for.

4. It is highly important that the sorting, classification, and grouping of patients by the Army evacuation officer is done carefully and systematically. This assists the naval medical embarkation officer materially, permits greater economy in the use of boats and decreases later the secondary transfers from ship to ship.
4. Medical regiment divisional (or medical battalion, triangular division)

   1. Collecting companies: If conditions permit, the personnel of collecting companies land later during the first day's attack, taking with them such matériel as can be hand carried. Litter bearers of collecting companies move out to make contact with regimental and battalion aid stations and evacuate casualties from them to the beach. Other collecting companies personnel establish an initial collecting station near the beach. As the beach head is enlarged, collecting companies advance their collecting station inland, maintaining contact with the medical detachments in their zone of action. The transport and heavy equipment of collecting companies can be landed only after boats and simple docking facilities have become available for this use.

   2. Ambulance companies: The personnel of ambulance companies normally follow soon after the collecting companies. If casualties are heavy and the attainment of the first objective slow, the personnel of those companies should be used as litter bearers to assist in evacuating casualties to the medical stations on or near the beaches. In some situations it may be impossible to land the ambulances until the end of the first phase.

   3. Hospital companies: These companies usually cannot establish hospital stations ashore until the landed forces have gained beach heads at least 4 or 5 miles deep. Local topography may sometimes permit earlier establishment of these stations. If such is the case and if boat transportation to shore is available, advantage should be taken of such favorable circumstances to provide these facilities on shore for the care of casualties. Patients in hospital stations will be classified and held until called for by the army evacuation officer. In opening the initial hospital station after landing, the hospital company may take over the patients and the site of a collecting station near the beach, the collecting company opening a new station further inland. When companies of two or more battalions of a medical regiment are operating on a beach, a commanding officer will be designated and a command post established for the control of such elements.

   4. Medical regiment headquarters and headquarters and service companies: These companies may be expected to land with corresponding echelons of the division headquarters. The division surgeon, however, should establish an advanced command post when the division command post is opened on shore.

5. By the end of the first phase, part of the medical regiment of the divisions should be ashore. Operating collecting stations, an ambulance service, and perhaps a hospital station near the beach. A medical supply point and dump will be in operation near the beach for the supply of medical units ashore.

Note: Medical organization of a Marine Corps brigade consists of four medical companies, each composed of a headquarters section, collection section, hospital section, and service section. These medical companies land and operate in accordance with the brigade medical plan.

25. Navy Medical Service During First Phase

    1. Navy Force Surgeon:

       With the launching of the initial landing attack, the Navy force surgeon's office becomes the nerve center of the combined activities of the two medical services. The Army force surgeon must maintain close contact with the Navy force surgeon. This is easily done if both are embarked in the same ship. It is necessary that the Navy force surgeon receive prompt and frequent reports of the casualty situation on each landing beach. This will be done normally through signal communication from beach parties. A board in his office should show the bed capacity of each hospital ship in the landing area as well as that of troop ships previously prepared and staffed to receive slightly wounded from shore. On another board the evacuation officer of his staff keeps the current bed occupancy status of each receiving ship. This measure is of prime importance, since by means of it the actual bed situation throughout the fleet is known with approximate accuracy at all times, and boats returning from shore with patients are routed accordingly. Report of casualties and bed status are rendered to the Army and Navy Staffs periodically; hourly, if called for.

    2. Beach medical service:

       1. The naval evacuation service on a beach forms a section in the beach master's organization. The skeleton of this section, at least, should accompany the beach master in the first boat group and be reinforced to full requirements at the earliest opportunity thereafter. The task of the naval medical evacuation officer is to organize and operate the service of evacuation from the beach. His activities include:

          1. Establishment and marking with the Red Cross flag and other necessary identifying signs, an evacuation station at a site approved by the beach master.

          2. Establishing and maintaining close contact with the Army evacuation officer of the shore party.

          3. Reception of casualties from the Army evacuation officer and loading them into boats according to their classification for movement to designated receiving ships.

          4. Keeping the Navy force surgeon informed of the casualty situation on his beach through naval signal communication on the beach and by messages transmitted by naval personnel in boats carrying casualties from shore to ship.

          5. Forwarding to the Army evacuation officer messages and supplies received by him for the Army medical service ashore.

2. If casualties are collecting in large numbers on the beach in the early stages of the attack, naval medical embarkation officers must be alert to take advantage of any opportunities to send as many of them as practicable to ships by returning boats. This is generally desirable although there may have to a ship-to-ship transfer of these cases later.
3. Evacuation at end of first phase:

   By the end of the first phase, evacuation from shore should have progressed ot the use of a considerable number of improvised ambulance boats (previously used in landing combat elements) now provided with medical personnel and equipment from hospital ships or transports for the emergency treatment of casualties en route; perhaps a few regular ambulance boats entitled to fly the Red Cross flag; and organized ambulance boat service to most of the beaches; and the delivering of all casualties from beach evacuation stations to designated ships.

26. Army Medical Service During Second Phase.

    During this phase, any remaining elements of the divisional medical regiments (medical battalion, triangular division), including transport, are landed and in positions and missions similar to those assigned them in offensive land operations.

    1. Corps medical regiment:

       By the end of this phase, the corps medical regiment may be expected to have landed and relieved the divisional medical regiments of their functions at the beaches, allowing these elements to move forward in support of the action of the division.

    2. Medical supply:

       The medical supply service for the troops ashore is further developed in this phase; the medical supply point at the beaches is more systematically organized, supplies in the medical dump built up, and depleted stocks of the medical units inland replenished.

27. Naval Medical Service During the Second Phase:

    By the end of this phase, the naval medical service should have succeeded in developing and systematizing the evacuation from shore and at the receiving end; that is, in the fleet itself. This it is enabled to do through:

    1. Increased number of landing boats available for the use of the medical services.

    2. Inauguration of a regular ambulance boat service to the more important beaches.

    3. Docking facilities, though limited, at important beaches.

    4. Use of a small number of barges and lighters now made available to the medical services, whereby wounded can be removed from a beach more expeditiously, comfortably, and in much greater numbers.

    5. Fewer transfers of patients from ship to ship. If casualties are heavy, evacuation from shore in the early stages of the landing is more or less an emergency measure and patients are brought in many instances to whatever ship may be most practicable for the boat carrying them. As communication from the beaches becomes will established, and hence the numbers and classification of casualties on each beach reach the Navy force surgeon with some regularity, delivery of casualties can be made to ships according to patients' classification and ships' vacant beds. This favorable developed proceeds in like proportion with the increasing facilities noted in (a) to (d) above.

28. Army Medical Service During Third Phase:

    1. Surgical hospitals generally may be landed and established early in this phase. their use to the extent of their limited bed capacity is of distinct advantage to the most seriously wounded.

    2. Evacuation hospitals, comparativley large units, should not be landed and established until a slufficient advance inland has been made to afford them suitable choice location and reasonable assurance that they will not become involved in local reverses to our forces.

    3. General and station hospitals in which definitive treatment is carried out cannot be opened until a secure oversea base has been established. If general hospitals them must be built, at least 4 months will probably be required for their erection and equipment. It may be possible to convert existing buildings to general hospital use in much less time. The oversea expeditionary plan may or may not contemplate the establishment of general hospitals in the occupied territory.

    4. Army medical laboratories (mobile) will be landed as early in the third phase as their use becomes practicable and necessary.

    5. Army medical depots will be established ashore at such time and points as conform to the supply plan of the expeditionary forces after a b ase has been secured.

29. Navy Medical Service During Third Phase:

    1. In this phase the navla medical service may be expected to have at its disposition sufficient boats of suitable types ot enable it to perfect shore to ship evacuation. Evacuation from some beaches will probalby have ceased and the other beaches have been provided with adequate wharf and docking facilities. Hospital ships may be reloacted at anchorage to shorten the average trip from beach to ship.

    2. In this phase, in which the navy is beste equipped and organized to carry out is part of the evacuation service, the Army is gradually adding to its facilities for caring for its own casualties ashore. this augmentation continues until, of the Army is successful in its mission and general hospitalization in the occupied territory is contempatled, the Army will eventually hospitalize its casualties in its own establishments. If the Navy is then to continue evacuation for the Army to home ports or other bases, it will still evacuate that part of the Army's sick and wounded which have ceased to be military assets or whose recovery will be a matter of many months.

30. Medical Supply to Landing Beaches:

    1. In land operations it is difficult ot maintain an adequate supply of blankets, litters, and splinting material at advanced medical stations during combat in spite of the specific provisions made for an exchange of these items for every casualtyl carried to the rear. It is more difficult in joint landing operations. Both Army and Navy are involved in this supply to the landed medical units. All medical supplikes are on board ship when the attack is launched. Medical personnel landing early can take with them only very small quantities of these items. In the ealry stages of landing, blankets, litters, and splinting materials cannot be exchanged with any degree of certainty, as troop landing b oats, if sometimes used to remove wounded from the shore, may deliver their patients to ships not carrying medical supplies. Furthermore, the boats may not return directly to the beaches but go to another ship to take a boat load of troops ashore.

2. 1. Therefore, the supply of blankets, litters, and splinting and dressing materials on beaches by exchange cannot be relied upon. It is necessary that the joint medical plan make detailed provision for this supply during the landing oeprations, to include:

      1. That medical detachments landing take with them as many of these items as they cna man-handle.

      2. That a medical dump be establihsed promptly on each beach under the direction of the evacuation officer (shore party), with the necessary personnel to operate it.

      3. That boats in the ealry stages of the attack, landing supplies include some of these essential items of medical equipment.

      4. That as soon as ambulance boats are put into service, they build up, on their runs from ship to shore, as rapidly as possible and maintain ample reserves of blankets, litters, and splinting and dressing materials on each beach.

      5. That the naval medical embarkation officer (beach party) take all necessary action to facilitate this supply.

      6. That at the beach, exchange with litter bearers and ambulances bringing in casualties form inland be rigidly enforced.

   2. The measures given in (1) above apply especially to the critical first and second phases. Thereafter an organized and more extensive system of medical supply to the landed forces should be in operation.
3. 1. The Navy stretcher is designed for use on board ship. For the movement of large numbers of casualties from shore to ship it is unsatisfactory. Its employment for this purpose would further require the transfer of wounded from the Army litter to the Navy stretcher on the beach.

   2. In joint oversea expeditions it is desirable for the Navy to make the necessary adaptations (litter hoists, litter glideways, bunk straps, etc.) for the use of the Army litter in transferring army casualties from shore to ship.
30. Alternative Procedure in Sorting and Classifying Casualties:

    1. Ideally, the sorting and classification of sick and wounded is best carried out on shore, thus permitting boats carrying casualties to ships to be systematically and most economically employed, and at the same time reducing to the minimum the time taken and the discomforts to patients in the subsequent secondary evacuation from ship to ship. Practically, in confused and crowded condition of the beaches often occurring, the heavy inflow of wounded, the early scarcity and irregularity of casualty carrying boats, and the uncertainty of the particular ship to which any loaded boat will deliver its patients, shore sorting, as experience has shown, may be far from satisfactory.

    2. An alternative procedure is to anchor a hospital ship off each beach, designate it as a sorting station, and at the same time fill it to capacity with casualties requiring early operation and others which are to be evacuated to a home port, transferring the rest to other ships. When this soritng ship is filled with the proper cases it leaves and is replaced at anchorage by another hohspital ship. If occupioed beaches are close together one sorting ship may serve more than one beach. This method was used extensively by the British at Gallipoli in 1915.

Appendix
Illustrative Estimate of Hospital Ship Beds
for a Hypothetical Joint Oversea Expedition

1. General:

   The following estimates and computation of hospitalization afloat to accompany a hypothetical joint Army and Navy oversea expedition are meant to serve only as an illustraion of how the problem may be approached in the preparation of the medical plan. It represents a situation requiring a large number of beds in class A, class B, and class D hospital ships, but not as high a percentage of such beds as might be necessary in another situation.

   Note: For the purpose of this manual, class A hospital ships are those fully euqipped hopsital ships in commission in the Navy; class B hospital ships are those Navy hospital ships carried in the Navy Register, but not in commission in peacetime; class D hospital ships are those procured and converted and equipped as floating hospitals from commercial shipping and commissioned as hospital ships in the Navy.

   The fewer the class A and class B hospital ships available for use in a joint Army and Navy oversea expedition the earlier should estimates be made for the number of beds required afloat in the area of operation. This is necessary because class D hohspital ships must be procured, cxonverted, equipped, and manned prior to the expedition's departure form the port of embarkation.

   It should be noted that the divisoin of sick and wounded according to their seriousness, between class A and B ships, and class D ships, as made in this illustrative situation, will not be an arbitrary one in practice, provided the class D ships have been converted into modern and fully equipped hospital ships.

2. Principal Data on Which Estimates Were Based:

   a.	Enemy army forces believed to be available: Strong in numbers; in fighting qualities, and in armament and defense dispositions; skilled, stubborn, and reinforced resistance probable. Enemy naval resources available known to be much inferior to ours.
   b.	Army (and) Marine Corps expeditionary strength	40,000
   c.	Navy expeditionary strength	12,000
   d.	Operations area 8 days' fleet sailing time from port of embarkation and base.

3. Estimates:

   a.	Army sick en route to operations are hospitalized in their own transports (40,000+1,000x1.65.8 (days))	528
   	Navy sick en route hospitalized on their own ships: (12,000+1,000x1.65x8 (days))	158
   	Total expeditionary sick in hospital (on sick list) upon arrival in operations area	686

	Additional Army and Navy sick, hospitalized during first 7 days in operations area (686 sick and 7,500 battle casualties deducted from aggregate strength)	506
	Total expeditionary sick in hospital to include 7th day after arrival in operations area	1192
	Total expeditionary sick requiring evacuation to include 7th day in operations area. 10 percent	119
	15 percent of total Army strength being wounded patients, 80 percent of total battle casualties being wounded (initial H-hour to to include 7th day)	6,000
	One-third of wounded, serious, requiring class A and B hospital ship facilities	2,000
	One-third of wounded, less serious, requiring class D hospital ship facilities	2,000
	One-third of wounded retained ashore or in transports, as slightly wounded	2,000
	Total Army casualties and Navy sick requiring evacuation at end of 7th day in operations area	4,119
	Total hospital ship beds for Army and Marine Corps to accompany joint expeditionary force	5,000
b.	Twenty days may be assumed as required for hospital ships in the operations area to make the turn around and begin loading patients again in the landing area, the expeditionary fleet must be followed from the port of embarkation at close intervals by additional hospital ships. The minimum number for this purpose for the army forces (and Navy sick) are computed as follows:
	Army sick hospitalized 8th to 20th day in operations area: (31,978+1,000x1.65x13 (days))	686
	Navy sick (estimated) hospitalized in same period	251
	Total expeditionary sick hospitalized, 8th to 20th day	937
	Total expeditionary sick, occurring 8th to 20th day, requiring evacuation from operations area, 10 percent	94
	Additional 6 percent of remaining Army and Marine forces (31,603) in operations area being wounded patients, 8th to 20th day	1,896
	One-third of wounded, serious, requiring class A and B hospital ship facilities	632
	One-third of wounded, less serious, requiring class D hospital ship facilities	632

	One-third of wounded retained ashore or on transports, as slightly wounded	632
	Total Army casualties (and Navy sick) requiring removala from operations area, 8th to 20th day	1,358
	Total additional hospital ship beds to reach operations area prior to 20th day	1,300

4. Provisions of Medical Plan for Army Forces (and Navy Sick):

   a.	(1) Hospital ships to accompany expeditionary forces from port of embarkation:
   	Class A and B hospital ships with normal bed capacity	2,500
   	Class D hospital ships with normal bed capacity	2,500
   	Total hospital ship beds accompany expedition	5,000
   	(2) To arrive in landing area 6th day after the expeditionary fleet:
   	Class A or B hospital ships with normal bed capacity	450
   	Class D hospital ships with normal bed capacity of	450
   	(3) To arrive in operations are 12th day after the expeditionary fleet:
   	Class A or B hospital ships with normal bed capacity	450
   	Class D hospital ships with normal bed capacity of	450
   	Total second and third echelons	1,800
   	Aggregate hospital ship beds	6,800

   2. To the 6,800 hospital ship beds must be added such beds as are determined upon in the plan for the reception of the probable or the possible naval wounded.

   3. 1. In this example, no factor of safety has been provided for the numerous possibilities of unforseen changes in conditions or in the situation, which might increase the hospital ship bed requirements. No allowance has been made for prisoner-of-war casualties. It is only rearely possible to utilize at one time 100 percent of hospital be capacity.

      2. Ordinary prudence dictates that in the situation here assumed, a reserve of at least 10 percent of hospital ship beds be added. This reserve may initially be held, ready for sailing, at the port of embarkation.

      3. That the number of hospital beds provided for the situation indicated for ther first 28 days after sailing from the port of embarkation is conservative, is apparent from the fact that 1,916 of the sick and 2,632 of teh wounded, a total of 4,548, are held in landing area. A considerable percentage of the sick will have returned to duty by the end of this periodl, but of the wounded a majority will still be on a sick status, probalby in part on land and in part on ship board. These sick and wounded may exceed the Navy's hospital resources even after all transports which can possibly be spared for the purpose have been hastily and inadquately fitted out for their hospitalization.

4. As to the use of transports for the return to the home port of other base of those sick and wounded who in this hypothetical situation have been moved to hospital ships, it is to be recognized that both categories (those in class A and B and those in class D hospital ships) are of such a serious character as to require the medical and surgical care and the facilities of properly equipped hospital ships. History furnishes examples of deplorable and even scandalous instances of the movements of great numbers of the sick and wounded of such joint expeditions from the oeprations area to a distant base in entirely inadequately converted and medically equipped troop transports; and consequently attended by wholesale deprivations and unnecessary suffering. In the main such conditions are to be ascribed to the innitial failure to plan for and to provide as a part of the expeditionary shipping sufficient hospitalization afloat.

Evacuation, Battalion Phase

Evacuation, Regimental Phase

Evacuation, Divison Phase

Transient Center, Fleet Marine Force, Pacific
Procedure for Processing
Evacuation and Replacements

Battle Casualties -- Assault of Island Fortresses

	Total Blue Landing Forces Involved	Casualties			% of Total Blue Landing Forces That Are Casualties	Evacuation Time (Hrs.)
		Killed	Wounded	Total
Attu	*12,000	*600 30%	*1400 70%	*2000 100%	16.6%	24
Tarawa Atoll	*18,000	1056 29%	2557 71%	3613 100%	20.0%	***
Makin Atoll	6,600	66 26%	187 74%	254 100%	3.8%	6.0
Kwajalein Atoll Kwajalein Is.	21,342	177 15%	1037 85%	1214 100%	5.6%	5.0
Kwajalein Atoll Roi-Namur Is.	20,104	195 26%	545 74%	740 100%	3.6%	2.5
Eniwetok Atoll	*10,000	299 27%	786 73%	1085 100%	10.8%	***
Average for All Actions:		25.5%	74.5%	100%	10.0%	9.3
Notes: * To nearest round number. ** Final casualty report not yet in at this time. *** Undetermined as yet.

Table of Contents  *  Previous Chapter (6)