Formal U.S. military assistance to the Republic of Vietnam may be traced to the signing of the Pentalateral Agreement in 1950, a multinational Mutual Defense Assistance Treaty for Indochina, The, American contribution to the defense of the Southeast Asian sovereignties was nominal for several years thereafter, as reflected by the fact that at no time during the next decade did US military personnel in Vietnam number more than 1,000, Most of the US support effort took the form of materiel and supplies, distributed to the South Vietnamese government through MAAGV (Military Assistance Advisory Group, Vietnam), a small logistics and training organization. However, in November 1961, mounting support by North Vietnam of guerrilla activities in the South led President John F. Kennedy to conclude that, if the South Vietnamese democracy were to be preserved, a much larger commitment of US military personnel in support of the RVNAF (Republic, of Vietnam Armed Forces) would be required.

The consequences of the President's decision were immediately manifest. By the end of 1961, the number of US military personnel in Vietnam had quadrupled. Slightly more than 4,000 men were assigned as military advisers to the RVNAF, to staff officers at MAAGV headquarters, or to a rapidly increasing number of support units. With the arrival of additional Special Forces and logistical detachments in the first 2 in months of 1962, the magnitude of the US military role in Vietnam became clear. To provide centralized command and control for these growing combat advisory and support forces, USMACV (US Military Assistance Command, Vietnam), a joint command under CINCPAC (Commander in Chief, Pacific), was officially established on 8 February 1962. Named as the first COMUSMACV (Commander, US Military Assistance Command, Vietnam) was Lieutenant General Paul D. Harkins, whose grade was indicative, of the strength of the, expanding American commitment.

Closely related to the buildup of American combat, combat advisory, and support forces was the development of the US medical service structure in Vietnam. Based on anticipated troop lists, initial medical support requirements were set in December 1961, shortly after President Kennedy's decision to increase the level of American support to the RVNAF. These requirements included one field hospital of 100-bed

4

capacity, with four attached medical detachments to provide specialty care hot to be totally dependent on the hospital for administration and logistics, and one helicopter ambulance detachment to provide evacuation capability to the treatment facility.

Over-all planning and guidance for the deployment of all incoming units became the responsibility of CINCPAC under the direction of the Joint Chiefs of Staff and the Department of Defense. Logistical support responsibility was subsequently isolated and delegated to USARYIS (US Army, Ryukyu Islands), a subordinate command of USARPAC (US Army, Pacific). Logistical support of the medical units committed to Vietnam would become a major responsibility of the USARYIS surgeon's headquarters.

The field hospital recommended for deployment in December 1961 was to become operational in April of the following year, In the interim, however, arriving Army units, primarily transportation companies, could not be left without any, form of medical service. During January and February 1962, three small medical detachments, each attached to a transportation company, disembarked in South Vietnam. Each provided, on air area basis, limited dispensary and general medical care, for the units to which they were attached, as well as for all other US personnel in their area.

To coordinate, logistical and administrative support for the increasing number of US Army personnel and units, USARYIS Support Group (Provisional) was established. On 24 February 1962, its medical section, comprised of one plans and operations officer and a chief clerk, both temporarily reassigned from the medical section of the 9th Logistical Command in Thailand, initiated medical activities in Vietnam. Through March, the medical section concentrated on assessing the capabilities of Army medical units in Vietnam, recommending to USARPAC through USARYIS headquarters that preventive medicine and veterinary food inspection detachments be sent from the United States to the theater of operations. Those requirements were subsequently corroborated by Major General Achilles L. Tynes, MC, USARPAC chief, surgeon and Colonel Thomas P. Caito, MSC, chief of his plans and operations division during a prolonged visit both made to Southeast Asia between 30 March and 1 May 1962.

However, the medical section would not see the fruition of its efforts as a staff office of the USARYIS Support Group (Provisional) headquarters, On 1 April 1962, the temporary USARYIS Support Group was redesignated USASGV (US Army Support Group, Vietnam), and placed under the command and control of General Harkins as

5

COMUSMACV. The mission of the USASGV medical section was now clarified: to advise the USASGV commander and his staff on matters pertaining to the medical, dental, and veterinary services of the command, and to supervise all technical aspects of those services.

Less than 3 weeks later, on 18 April 1962, the 8th Field Hospital became operational at Nha Trang, assuming responsibility for the hospitalization of all authorized US military personnel, dependents, and civilians living or stationed in, Vietnam, A second responsibility allotted the 8th Field Hospital was that it act as a central medical supply point for all Army medical units in Vietnam, a duty for which the facility was ill-prepared and grossly understaffed.

Concurrently, the, hospital commander, Lieutenant Colonel Carl A. Fischer, MC, became also the USASGV surgeon, staff adviser to the Commanding Officer, USASGV, on all Army medical activities in Vietnam. (Chart 1) As surgeon, Colonel Fischer also headed the USASGV medical section, now expanded to include one Medical Service Corps officer acting as chief of section and two enlisted men. Physically separated by some 200 miles from USASGV headquarters, Colonel Fischer made frequent trips from Nha Trang to Saigon to insure that all necessary action required of his medical section was accomplished, In addition, he had to utilize clerical personnel assigned to the 8th Field Hospital in performing those duties required of him as USASGV surgeon. Both arrangements proved unsatisfactory, prompting Colonel Fischer to request a change in the table of distribution based on AR 40-1; a change which, if approved, would have placed a full-time surgeon in USASGV headquarters, He further reported that, as of 31 December 1962, one of the major problems he faced as hospital commander was that of insufficient personnel in his headquarters section, leading to the absence of a "cohesive, balanced organization to accomplish the administrative and logistics burdens of attached units."

By the, end of December, the number of detachments offering area medical coverage for US forces, all obtaining their, medical supplies through the 8th Field Hospital, had doubled. (Map 1) An even greater strain on the resources, of that facility was created by attached units . two medical laboratories, three specialized surgical detachments, one segmented helicopter ambulance detachment, one dental detachment, one veterinary detachment, and one engineer detachment. While the veterinary detachment was headquartered in Saigon, all other units were totally dependent on the 8th Field Hospital, for administration and logistics. The dual problems thus engendered- medical staffs too small to handle the administrative tasks demanded of them, and the physical separation of the USASGV surgeon from his medical section- would continue to plague the commanding officer of the 8th Field Hospital and his successors during the next 3 years.

6-7

8

Although the opening of a Navy dispensary in Saigon in 1963 removed that city, as well as III and IV CTZ's (corps tactical zones) to the south, from the hospitalization, responsibilities of the 8th Field Hospital, increasing numbers of casualties more than offset that relief. In the same year, USASGV was again redesignated, becoming USASCV (US Army Support Command, Vietnam). Now removed from his direct command, General Harkins as COMUSMACV retained operational control over the lower headquarters, As the senior Army officer in Vietnam, however, he remained the Army component commander, while the Commanding General, USASCV, became deputy Army component commander. No benefits accrued to the USASCV medical section, however, and it remained understaffed and physically separated from the commanding officer of the 8th Field Hospital.

The Army medical structure in Vietnam remained essentially unchanged in 1964. The USASCV surgeon's medical section increased by one enlisted man; and while a dental surgeon, preventive medicine officer, and veterinarian were added to his staff, they too served in dual capacities and could contribute little to a reduction in the medical section's workload.

NOTES TO CHART 1

a) Before the arrival of the 8th Field Hospital, administrative and logistical support for all Army medical units in Vietnam had been coordinated through the Office of the Surgeon, Headquarters, United States Military Assistance Command, Vietnam..

b) USASCV was the acronym for the Army component headquarters in Vietnam from March 1963 through June 1965. Before 1963, that headquarters had been known as the USARYIS Support Group (Provisional) and, after 1 April 1962, as USASGV (United States Army Support, Group, Vietnam).

c) The staff structure of the Office, of the Surgeon, Headquarters, MACV, as of 31 December 1964.

d) The staff structure of the USASCV Medical Section as of 31 December 1964.

e) The principal duty of the USASCV Dental surgeon was Commanding Officer, 36th Medical Detachment (Dental Service), the command and control element for dental units.

f) The principal duty of the USASCV Veterinary Officer was Commanding Officer, 4th Medical Detachment (Veterinary Food Inspection), the command and control element for veterinary units.

g) The principal duty of the USASCV Preventive Medicine Office, was Commanding Officer, 20th Preventive Medicine Unit, the command and control element for preventive medicine units.

h) The principal duty of the USASCV Surgeon was Commanding Officer, 8th Field Hospital, the senior medical organization and highest level headquarters for all nondivisional medical units in Vietnam.

i) The plans and operating officer acting, as chief of section, as well as the enlisted personnel under him, had originally constituted the Medical Section of the 9th Logistical Command, Thailand, whence they had been reassigned for temporary duty to South Vietnam.

Sources: (1) Medical Activities Report, Office of the Surgeon, Headquarters, Military Assistance Command, Vietnam, 1964. (2) Army Medical Service Activities Report, Medical Section, United States Army Support Command, Vietnam, 1964. (3) Army Medical Service Activities Report, Office of the Surgeon, Headquarters, United States Army, Vietnam, 1965.

9

Two American destroyers were attacked by North Vietnamese PT-boats on 2 and 4 August, 1964, prompting the Gulf of Tonkin resolution. That action taken by Congress would lead to the direct commitment of the first major US combat units in Vietnam. It would thrust General William C. Westmoreland, who had replaced General Harkins as

10

COMUSMACV shortly after the consolidation of MAAGV and USMACV headquarters in June 1964, into a position of international prominence; and it would be he who would supervise the massive buildup of US forces in Vietnam over the next 4 years.

Medical Command Versus Logistical Command

As early as 1962, General Harkins had, recognized the need for a centralized logistics organization in support of US forces in South Vietnam. Again in 1964, COMUSMACV had recommended that a logistical command be promptly introduced in-country. Later in the year, the organization of that command was authorized, with responsibility for over-all joint logistical planning to reside in, USMACV headquarters. The decision stipulated that support should be conducted on an area basis for all common supply and service activities, which in practice meant that the Army was to provide common-item support within II, III, and IV CTZ, plus any portion of I Corps in which major Army forces were deployed.

The doctrinal framework which justified the creation of a logistical command in Vietnam, was COSTAR II, the second of two studies on combat service support of the Army. One of the outgrowths of the study was the directive that, when a field army was constituted, all logistical support was to be, provided by FASCOM, a field army support command. Nondivisional medical service was placed under the Army support command.

The juxtaposition of two events (the decision of the joint Chiefs of Staff to establish a centralized logistical command in Vietnam and the Gulf of Tonkin aftermath) made it only a matter of time before the US Army would assume responsibility in South Vietnam for the distribution of supply items common to all military services, as well as for those used only by the Army,

On 1 April 1965, Headquarters, 1st Logistical Command, a field army support command and control element, was activated. In accordance with the policy of centralized logistical direction, four geographic support areas (roughly corresponding to CTZ's) were directly subordinated to that command. The 8th Field Hospital was removed from the direct command of USASCV headquarters and subordinated to the 1st Logistical Command. As senior medical officer in Vietnam, the hospital commander, Lieutenant Colonel (later Colonel) James W. Blunt, MC, now assumed a third hat: 1st Logistical Command surgeon and director of the command's medical section.

When Colonel Blunt activated the 1st Logistical Command medical section on 1 April, he was made responsible for providing the commander and his staff with necessary assistance and advice on all aspects of non-

11

divisional medical support, to include veterinary and dental service, and medical supply. That proved an impossible task, since he remained both USASCV surgeon and commanding officer of the 8th Field Hospital. Colonel Blunt's dilemma was partially resolved with the interim appointment of a more junior Medical Corps officer, Major (later Lieutenant Colonel) Stuart A. Chamblin, Jr., as the 1st Logistical Command surgeon on 12 May. However, far more important changes in the structure of the Army medical service in Vietnam were imminent and would, for a time, reduce if not eliminate the problems faced by preceding commanding officers of the field hospital,

Consistent with current concepts, the USARPAC chief surgeon noted in his 1965 Annual Medical Activities Report: "Medical Service is an Army or area wide service, and, as such, all medical support capability should be consolidated under one Medical Command." Prompting that statement were the recognized criticality of professional medical personnel, the unique characteristics of medical supply and maintenance, the constant demand for strong and effective preventive medicine and veterinary, food inspection programs, and the requirement for medical support to be immediately responsive to the needs of the commander. A field hospital was completely unsuitable as a control element for a medical command encompassing units, scattered through three CTZs. Consequently, the 58th Medical Battalion was assigned to the 1st Logistical Command on 29 May, assuming command and control over nondivisional Army medical units in Vietnam. The battalion's commanding officer, Lieutenant Colonel (later Colonel) Edward S. Bres, Jr., MC, was simultaneously appointed 1st Logistical Command surgeon and director of its small organic medical planning staff.

With the appointment of Colonel Bres as 1st, Logistical Command surgeon, the commanding officer of the 8th Field Hospital once again wore only two hats. However, the need for a full-time surgeon in the Army component headquarters had not diminished, but rather had become more pressing. The Department of the Army finally concurred in the oft-repeated demands of earlier USASCV surgeons, and on 29 June, authorized a table of distribution change adding a full-time surgeon, an administrative officer, and an additional enlisted man to the USASCV medical section, Ten days later, Lieutenant Colonel (later Colonel) Ralph E. Conant, MC, became the USASCV surgeon. Assigned no duties other than surgeon, he retained that post when USASCV was redesignated USARV (US Army, Vietnam), on 20 July 1965.

The scope, of the medical advisory effort at the field army level increased with the establishment of USARV as the highest command and control headquarters for all US Army units in Vietnam. Reorganized in structure and expanded in size, the USASCV medical section was renamed the Office of the Surgeon, Headquarters, USARV. Staff super-

12

vision of a medical service supporting Army logistical operations had ceased to be a responsibility of the medical section when the 1st Logistical Command's medical section was activated. But on 20 July, that loss was more than offset with the assumption of staff responsibility for the health services of the entire Army medical structure in Vietnam, including unit, division, and army level medical service. Specifically, the USARV surgeon was given the mission of planning all USARV medical service, to be correlated at USARV headquarters with troop concentrations, logistical support areas, and the concept of tactical operations, Additional duties included preparing and coordinating broad medical policies, recommending assignments for medical personnel within USARV, maintaining medical records and statistics, and furnishing professional consultants to the command.

In the meantime, the 1st Logistical Command surgeon was coordinating the deployment and day-to-day operations of nondivisional medical units in Vietnam, units increasing in numbers from 11 in April to 60 by early fall, Just as the 8th Field Hospital had earlier proved inadequate as a command and control element, so now was Headquarters, 58th Medical Battalion, too small to handle the increasing volume of logistical, administrative, and support functions demanded by subordinate headquarters. On 18 August, Lieutenant Colonel Conant was replaced as USARV surgeon by Colonel Samuel C. Gallup, MC. On 25 October, the recently promoted Colonel Conant in turn replaced Colonel Bres as 1st Logistical Command surgeon. The reason for the replacement of Colonel Bres was soon apparent, for with the activation of the 43d Medical Group on 1 November, the 58th Medical Battalion ceased to be the senior army level medical unit in Vietnam. (Chart 2) Colonel Conant was the commanding officer of that medical group,

Although a subordinate medical headquarters, the 58th Medical Battalion continued to exercise major command and control responsibilities through 17 March 1966. The 43d Medical Group assumed the nondivisional medical service mission in II CTZ, and also exercised command and operational control over all nondivisional medical maintenance, laboratory, and helicopter units in Vietnam. The 58th Medical Battalion remained the command and control, element for nondivisional units in III and IV CTZs, and for all preventive, medicine, dental, and veterinary units, until the 68th Medical Group became operational on 18 March 1966.

Command by the Medical Brigade

In December 1965, Lieutenant General Leonard D. Heaton, The Surgeon General, and General Westmoreland decided to send a medical brigade to Vietnam. Agreement bad not been reached, however, on the

13

level at which the brigade should be assigned, A month earlier, The Surgeon, General visited Southeast Asia and, at that time, had concluded that the medical brigade should be made a major subordinate command of USARV headquarters, just as, were the aviation and military police brigades and the engineer command, Shortly thereafter, Colonel (later Major General) Spurgeon Neel, MC, USMACV surgeon, had prepared a memorandum for General Westmoreland recommending that the medical brigade could most effectively support Army personnel in Vietnam if placed under the direct supervision of the USARV surgeon. Pointing out that medical service is an air integrated function consisting of treatment, evacuation, and supply, Colonel Neel maintained that optimal medical service could only be, achieved if directed solely by professional medical personnel. The interposition of an intermediate, nonmedical headquarters between responsible commanders and their medical resources could only reduce the quality of medical care available, to troops. During the same interval, the USARPAC chief surgeon, Brigadier General (later Major General) Byron L. Steger, MC, had visited Vietnam and strongly recommended the release of medical service from logistical command and control.

The designated commanding officer of the medical brigade, Colonel (later Major General) James A. Wier, MC, nonetheless found that, upon his arrival in January, no decision as to the placement of his command had been made. Under the COSTAR II concept, medical service was visualized as a logistical service and, as such, belonged under FASCOM, the 1st Logistical Command. The FASCOM commanding general, Major General Charles W. Eifler, was unconvinced of the need for a medical brigade, preferring instead that medical groups be placed under the operational control of the commanding officers of each of his three area support commands. In that manner, General Eifler believed, all logistical support would be more responsive to the needs of, the commanders of the two Field Force headquarters, and the mission of FASCOM best accomplished,

Since existing doctrine, lent support to the position of General Eifler, Colonel Wier was made director of Medical Service and Supply on the General Staff of, the FASCOM commanding general on 26 January 1966. Colonel Conant, who had previously occupied that position, was to remain 1st Logistical Command surgeon until the arrival of the medical brigade. In a March briefing attended by Major General (later Lieutenant General) John Norton, Deputy Commanding General, USARV, and General Eifler, Colonel Wier made a final attempt to have the medical brigade assigned directly to USARV headquarters, but to no avail. He succeeded only in persuading all concerned that the senior, medical officer in Vietnam should be the USARV surgeon at the Army com-

14-15

16

ponent headquarters rather than the commanding officer of the medical brigade.

Thus, when the advance party of the 44th Medical Brigade, activated at Fort Sam Houston, Tex. on New Year's Day 1966, arrived in Vietnam on 18 March, it was assigned to the 1st Logistical Command. A Medical Brigade (Provisional) was established, consolidating in a single element command and control responsibility for medical units not organic to divisions and separate, brigades- responsibilities formerly divided between the 43d and 68th Medical Groups, As director of the

NOTES TO CHART 2

a) As indicated above, the 58th Medical Battalion, senior Army-level medical unit in Vietnam from 30 May 1965 to 31, October 1965, retained considerable command and control jurisdiction after the 43d Medical Group became operational, although it, was technically a subordinate unit of that group,

b) The 406th Mobile Medical Laboratory, based in Japan, was reorganized on 24 September 1963 to include a mobile laboratory unit attached to USASGV, Envisioned as a Pacific Command-wide laboratory service for all US military medical facilities, the 406th Mobile Medical Laboratory replaced and absorbed the personnel and equipment of the 7th Medical Laboratory, previously operative in Vietnam .Throughout the Vietnam conflict, the 406th Mobile Medical Laboratory remained under the command of USARJ (United States Army, Japan), While operating in Vietnam however, it was attached to and operationally controlled by various in-country medical headquarters.

c) Operational control of the 36th Medical Detachment (Dental Service), 4th Medical Detachment (Veterinary Food Inspection), and 20th Preventive Medicine, Unit was retained by the 1st Logistical command Surgeon.

d) The staff structure, of the Office of the Surgeon Headquarters, MACV, as of 31 December 1965. The consolidation of MAAGV and MACV Headquarters led to an expansion in the functions of the Office of the Surgeon, and culminated in the staff organization depleted above, The MACV Surgeon's Office changed little in subsequent years. Throughout the Vietnam conflict, Army medical staffs and headquarters were directed to coordinate their activities with the MACV Surgeon's Office, although the latter was riot an element in the command end control chain for Army medical Units.

e) The staff structure of the USARV Surgeon's Office as of 31 December 1965. The organizational structure was patterned after the reorganized USASCV Medical Section of 9-20 July 1965.

f) On 1 November 1965, a full-time USARV Dental Surgeon, with no additional duties, was the commanding officer of the 36th Medical Detachment, who had previously performed that, advisory function as an additional duty, continued to wear a, second hat as the 1st Logistical Command Dental Surgeon.

g) The commanding officer of the 4th Medical Detachment was also Veterinary Staff Officer in the Office of the Surgeon, USARV Headquarters, until that Advisory function was delegated to tower headquarters, the 44th Medical Brigade, in 1966.

h) Through 20 November 1965, the commanding officer of the 20th Preventive Medicine Unit served also as Preventive Medicine Officer on the staff of the USARV Surgeon. Thereafter, that position constituted a full-time assignment,

i) The staff structure of the 1st Logistical command Medical Directorate as of 31 December 1965. Emerging duplication in medical staff functions is reflected in the similarity between the organizations of the USARV Surgeon's Office and the Medical Directorate.

j) Before 26 January 1966, the Medical Director was also the 1st Logistical Command Surgeon. Both were additional duties performed by the commanding officer of the 43d Medical Group, who retained his second position as 1st Logistical Command Surgeon following the appointment of a full-time Medical Director on 26 January.

Sources: (1) Medical Activities Report, Office of the Surgeon, Headquarters, Military Assistance Command, Vietnam, 1965. (2) Arms Medical Service Activities Report, Office of the surgeon, Headquarters, United States Army, Vietnam, 1965, 1966. (3) Army Medical Service Activities Report, Medical Section, Headquarters, 1st Logistical command, 1965. (4) Army Medical Service Activities Reports, Headquarters, 43d Medical Group 1965 and 1966. (5) Army Medical Service Activities Reports, Headquarters, 58th Medical Battalion, 1965 and 1966.

17

FASCOM medical section and designated commanding officer of the incoming brigade, Colonel Wier had paved the way for the assimilation of the Logistical Command's medical directorate personnel and functions into the Medical Brigade (Provisional).

The medical directorate was, at that time charged with an inclusive mission to develop, coordinate, and supervise medical plans and operations, medical supply and maintenance policies, medical statistics and records, professional medical and dental activities, preventive medicine, and medical regulating activities for all nondivisional medical units in Vietnam. Between 18 March and 1 May, when the 44th Medical Brigade became operational, the responsibility for the accomplishment of these functions was shifted from the directorate to the brigade. The number of personnel staffing the FASCOM medical section gradually diminished; some transferred to the Medical Brigade (Provisional), others rotated. By 1 May, the only personnel left in the medical directorate were the director and a FASCOM staff medical section consisting of two plans officers, one supply and maintenance officer, one medical noncommissioned officer, and two enlisted men. Five months later, the medical section had withered even further, and was thereafter maintained at Headquarters, 1st Logistical Command, for liaison purposes only. During its 6-week span, the Medical Brigade (Provisional) had served as a medium for transferring direct command and control of medical unit from the 1st Logistical Command to the 44th Medical Brigade.

From 1 May 1966 through 9 August 1967, when the most rapid buildup of US combat forces took, place in Vietnam, the 44th Medical Brigade remained subordinate to the 1st Logistical Command. As combat forces expanded, medical units and personnel grew proportionately; by 31 December 1966, units assigned to the medical brigade totaled 121, while assigned personnel increased from 3,187 on 1 May to 7,830 by the end of the year.

Units and individuals under the centralized control of the 44th Medical Brigade operated on a direct support/general support basis. Those providing countrywide or general support services, such as medical laboratories, supply depots, and preventive medicine units, were retained under the direct command of Headquarters, 44th Medical Brigade. Commanders, of these general support facilities frequently held two posts, acting as staff officers at brigade headquarters They were occasionally given a third hat as well, maintaining an office at USARV headquarters as staff advisers to the USARV surgeon.

Other units, particularly evacuation and treatment facilities, provided area or direct support, and as such would be subordinated to one of the medical groups. Groups were in turn assigned geographic areas of responsibility approximately equivalent to doctrinal Army corps areas,

18

and attached to one of three area support commands of the 1st Logistical Command for administration and logistics. Thus, when the 55th Medical Group became operational in June 1966, it was attached to the Qui Nhon Area Support Command, assuming control over nondivisional medical units in II CTZ North. The 43d Medical Group, previously responsible for medical service throughout II CTZ, retained that wider responsibility only for air evacuation. For all other aspects of nondivisional medical care, the 43d Medical Group was responsible only for II CTZ South, supported in its mission by the Nha Trang (later Cam Ranh Bay) Area Support Command. Headquarters, 68th Medical Group, remained the command and control element for units in III and IV CTZ, and was, along with Headquarters, 44th Medical Brigade, and all general support units, attached to the Saigon Area Support Command for administration and logistics. (Chart 3)

In his assigned area, the group commander would act as the support command surgeon, providing first-echelon, medical care, for nondivisional and nonaviation units, plus evacuation and second-echelon medical treatment for all US Army and other authorized personnel, Medical regulating within the CTZ would be controlled from his group headquarters, with all hospitalization and air ambulance units kept directly under group command. In most cases, however, a separate medical battalion headquarters would be used as the command element for ground ambulance, clearing, and dispensary units.

Had all medical command and control been vertically integrated, that system of area medical service might have been most efficient. However, the separation of administrative and logistical support from command, in conjunction with the existence of an intermediate, nonmedical headquarters between medical practitioners in the field and consultants in the USARV surgeon's office, created duplicative, overlapping, and confusing channels of communication. Administrative support was often confused with command responsibility, with actions of the former type following a communications channel from the support command directly to Headquarters, 1st Logistical Command, completely bypassing Headquarters, 44th Medical Brigade. The resultant lack of responsiveness to administrative problems on the part of the Commanding Officer, 44th Medical Brigade, an officer on the same command level as the commanding officers of each area support command, was inevitable, although difficult to explain to the, Commanding General, 1st Logistical Command.

Similarly, the inability of hospital and medical, group commanders to accomplish required personnel changes in their commands limited the effectiveness of medical service. Professional consultants assigned to the USARV surgeon's office, following visits, to treatment facilities, made recommendations directly to the USARV surgeon or brigade personnel

19

officer. Medical officers, on that basis, were subsequently transferred among installations and support areas, frequently without the foreknowledge, of affected hospital and medical group commanders.

Duplication of Effort: Headquarters, 44th Medical Brigade, Versus the Office of the Surgeon, Headquarters, USARV

Much, if not, all of that confusion, could have been eliminated through a concise delineation of the responsibilities of Headquarters, 44th Medical Brigade, vis-a-vis the USARV surgeon's office. In theory, the former should have been responsible for the day-to-day operations of all nondivisional medical services in Vietnam; the latter, for long-range plans and operations. In reality, those functions could not be so easily segregated.

In addition to those responsibilities earlier transferred from the 1st Logistical Command medical directorate to the medical brigade, the duties of the brigade commander included all in-country communications among nondivisional medical units; the evaluation and dissemination of medical intelligence; and provision for the security of all medical forces assigned to the 1st Logistical Command.

The mission of the: USARV surgeon, originally less broad with respect to the operations of nondivisional medical service than that of the 1st Logistical Command surgeon, rapidly outpaced that of the commanding officer of the 44th Medical Brigade. On 10 June 1966, Colonel Wier became USARV surgeon, and command of the brigade was transferred to Colonel Ray L. Miller, MC. Exactly 5 months later, Colonel Wier received his first star. Although, when serving as brigade commander, he had expressed the desire, to reduce if not eliminate the USARV surgeon's office, Brigadier General Wier found it necessary to double the size of his office, staff over the next year. As US Army forces and their organic medical units expanded, so, of course, did the workload of the surgeon assigned to headquarters of the Army component. However, part of the growth in the USARV surgeon's office was the result of an increasing volume of paperwork, principally planning, accomplished at the Army level. Much of that planning was demanded of General Wier by G-3, Assistant Chief of Staff for Plans and Operations, Headquarters, USARV. Because of the time lag involved, General Wier found coordination with Headquarters, 44th Medical Brigade, difficult and was therefore unwillingly forced to increase the staff of his plans and operations division. Other responsibilities such as collecting and compiling medical statistics were added to his office during the year, and could not be delegated to lower headquarters. Professional activities and consultants had to remain at the Army level for, in addition to visit-

20-21

22

ing hospitals, they provided consultant services for organic medical units in divisions outside the purview of the 44th Medical Brigade.

The confusion in command and control, support, and coordination, that ensued was documented in a position paper prepared by General Wier in June 1967. Noting that the USARV surgeon was, not only the senior medical officer, but was also assisted by the most competent medical consultants in Vietnam, General Wier argued for the placement of the 44th Medical Brigade directly under headquarters, USARV. To do so would make the highest level of medical skill directly and immediately available to all medical units; a level of skill far beyond that available to the Commanding General, 1st Logistical Command, under the existing Organization. Advantages. resulting from the removal of the medical brigade and subordinate units from the intermediate logistics headquarters would be numerous: reinforcement of the medical service of tactical units could be more rapidly effected, and personnel economies could be realized through the realignment of duplicative staffs in higher and lower medical headquarters and through the elimination of the 1st

NOTES TO CHART 3

a) Deployment of medical groups as of 1 July 1966. When the 68th Medical Group became operational on 18 February 1966, it became, the higher headquarters for, and assumed the former command and control responsibilities of the 58th Medical Battalion. The 55th Medical Group became operational on 1 July 1966, assuming control over nondivisional medical units in the northern portion of II CTZ. The 43d Medical Group remained the command and control element for units in the southern portion of II CTZ. It acted in the same capacity for the 6th Convalescent Center, operational at Cam Ranh Bay since 16 May 1966, although doctrine specified that the facility be assigned directly to Headquarters, 44th Medical Brigade. All Medical Groups were further attached for administration and logistics to the headquarters of the various area support commands, subordinate commands of the 1st, Logistical Command.

b) On 1 August 1966, Headquarters, 9th Medical Laboratory became operational in Saigon. Thereafter, it rated as the control element for all medical laboratories in Vietnam, including, the 406th Medical Mobile laboratory.

c) Attached for administration, and logistics.

d) Upon becoming operational in Saigon on 27 December 1966, the 932d Medical Detachment (AI) became the command and control element for dental units in Vietnam.

e) The staff structure of the USARV Surgeon's Office as of 31 December 1966.

f) Until 9 March 1967, the Chief Nurse, USARV Surgeon's Office, also acted as Staff Nurse, Headquarters, 44th Medical Brigade from 9 March to 27 September, the latter position was occupied on a full-time basis by an ANC officer.

g) The staff structure of the 1st Logistical Command Medical Directorate as of 1 October 1966.

h) The primary duty of the 1st Logistical Command Medical Director was Commanding Officer, 44th Medical Brigade.

i) The staff structure, of Headquarters, 44th Medical Brigade, as of 31 December 1966. In general, the organization differed in structure from that of the Medical Brigade (Provisional) only in the addition of two officers to the Brigade commander's staff: (1) The Dietary Staff Adviser; and (2) the Staff Nurse.

j) On 6 June 1966, the Brigade Staff Veterinarian was appointed to additional duty as Veterinary Consultant to the USARV Surgeon.

k) The primary duty of the 44th Medical Brigade Dental Surgeon was commanding officer of the 932d Medical Detachment (Dental Service).

Sources: (1) Army Medical Service Activities Reports, Office, of the Surgeon, Headquarters, United States Army, Vietnam, 1965, 1966, and 1967, (2) Army Medical Service Activities Report, Headquarters, 44th Medical Brigade, 1966. (3) Interview, Brigadier General James A, Wier, MC, USARV Surgeon, and Captain Darrell G. McPherson, MSC, 17 June 1967.

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Logistical Command medical directorate. Perhaps most importantly, the centralized control of all Army medical assets in Vietnam would permit the most efficient use of critical, scarce resources. Their optimal utilization would be assured by vesting in the senior medical officer in Vietnam, the USARV surgeon, full command and control responsibility.

With the exception of G-1, Assistant Chief of Staff for Personnel, all members of the USARV General Staff concurred in General Wier's proposal. The lone demurral argued that placing the medical brigade directly under USARV headquarters would cause, the latter to become a support command, rather than the command and control headquarters for a true field army. General Wier's paper was returned without action, and before the proposal could be resubmitted, he returned to the United States, replaced as USARV surgeon by Brigadier General (later Major General) Glenn J. Collins, MC.

The effort to elevate the 44th Medical Brigade to the field-army level of command did not subside, and events of the first 2 weeks of General Collins' tour as USARV surgeon were to conspire to make that effort successful. As the result of decisions made elsewhere, space ceilings were placed on USARV in July 1967, bringing about a total reevaluation of the Army medical service in Vietnam. After a careful examination of the over-all Army medical support structure, the Office of the Surgeon concluded that, spaces could be deleted from the division medical service. To do so, however, would make it mandatory that the USARV surgeon have complete and direct control over all medical resources. Otherwise, the immediate reinforcement of divisional medical units could not be guaranteed.

On 2 August 1967, a final realignment study including these qualifications was presented by General Collins to the USARV General Staff. More explicit than the June proposal, it listed in detail both the advantages of assigning the 44th Medical Brigade directly to USARV, as well as the disadvantages of leaving the brigade directly under the 1st Logistical Command. Two points were, for the first time, emphasized: the reduction in delays in medical planning and, medical statistical reporting, and in implementing the recommendations of professional consultants; and the greater ease in the management of medical personnel to be realized by assigning the brigade directly to USARV headquarters.

Nondivisional Command and Staff Relationships: 1967-71

The need could no longer be denied. On 10 August 1967, the 44th Medical brigade was released from, the 1st Logistical Command and reassigned directly to USARV as a major subordinate unit. (Chart 4) The efforts of the last 2 years were rewarded; the arguments of

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General Heaton, General Steger, General Wier, General Collins, and Colonel Neel, validated. The Army medical service in Vietnam became in effect what it would become in later years in name- a unified medical command.

The Medical Brigade as a Major Subordinate Command of USARV Headquarters

General Collins assumed the dual role of Surgeon, USARV, and Commanding General, 44th Medical Brigade. Although technically excluded in the former capacity from operational control over nondivisional medical units, he was nonetheless able to exercise full command and control responsibilities in his other position as brigade Commander.

As USARV surgeon, General Collins and his staff were charged with five general responsibilities: to advise the USARV commander on all matters regarding the health of the command; exercise technical supervision over all medical activities of the command; plan to assure the availability of adequate medical support in the command; control the assignment and use of medical personnel in Vietnam; and manage medical supply and maintenance functions. As applied to nondivisional medical service, these were interpreted as responsibilities for medium- and long-range planning, the development of theater-wide medical planning factors, and the monitoring of coordination between the 44th Medical Brigade and supported units.

Meanwhile, Headquarters, 44th Medical Brigade, assumed responsibility for programs not originally envisioned for a field medical unit, in-

NOTES TO CHART 4

a) The maximum deployment of medical groups in Vietnam, a situation existing from 23 October 1967, when the 67th Medical Group became operational, to the 15 June 1969 deactivation of the 65th Medical Group. Originally headquartered in III CTZ, the 67th Medical Group relocated in I CTZ early in 1968,

b) The 522d Medical Detachment (AF) became operational on 10 April 1968, assuming control ever all Veterinary TOE units in Vietnam.

c) The 172d Preventive Medicine Unit became operational under reduced strength on 1 August 1968 It was not subordinated to the 20th Preventive Medicine Unit, but rather assigned directly to Headquarters, 44th Medical Brigade. Both the. 172d and 20th Preventive Medicine Units noted as control elements for preventive medicine detachments in Vietnam, the former for those operative in I and II N CTZ, the latter for units in II S, III and IV CTZ.

d) The staff structure of the USARV Surgeon's Office as of 31 December 1969.

e) The staff structure of Headquarters, 44th Medical Brigade as of 31 December 1968.

f) The Commanding General of the 44th Medical Brigade was also USARV Surgeon.

g) The 44th Medical Brigade Veterinary Officer was also USARV veterinarian.

h) The 44th Medical Brigade Dietary Staff Adviser performed additional duty as Dietetic Consultant in the USARV Surgeon's office.

i) The 44th Medical Brigade Dental Surgeon was also USARV Dental Surgeon.

j) The 44th Medical Brigade Preventive Medicine Officer was also USARV Preventive Medicine Officer.

k) The 44th Medical Brigade Chief Nurse was also Chief Nurse, USARV Surgeon's Office.

Sources: (1) Army Medical Service Activities Reports, Office of the Surgeon, Headquarters, United States Army, Vietnam, 1965, 1967, and 1969. (2) Army Medical Service Activities Report, Headquarters, 44th Medical Brigade, 1968.

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cluding an awards program, command maintenance inspections, and supervision of special services activities. Other responsibilities of the brigade commander and his staff were more limited than those of the USARV surgeon, including in-country medical regulating and the short-term planning of day-to-day operations involving army level medical support.

The similarity in functions performed by these two medical staffs produced both advantages and disadvantages. Personnel economies were, realized, and the degree of coordination between higher and lower headquarters enhanced, but considerable confusion remained as to the precise staff functions to be performed at each level, especially with respect to operational responsibilities.

In addition to the surgeon/brigade commander, the dental surgeon, chief nurse, veterinary, officer, preventive medicine officer, entomologist, dietitian, and aviation staff officer sat on both staffs, eliminating several duplicate slots. Further, personnel consultants on the USARV surgeon's staff now had direct access to medical treatment facilities of the brigade, contributing to improved relations between surgeons and medical commanders at all levels. The greater ease of coordination which these staffing arrangements permitted was heightened by the shift in location of brigade headquarters from Tan Son Nhut to Long Binh late in September 1967. The proximity of the two headquarters added materially to the freedom of communications between the two staffs. As General Neel, successor to General Collins as USARV surgeon/brigade commander, emphasized, good communications were essential to the success&% of army level medical service in Vietnam.

All forms of coordination between the two staffs were, not enhanced by the assignment of the medical brigade directly to USARV headquarters, however. In an attempt to delineate the proper role of S-3, Plans and Operations, the USARV Organization and Functions Manual was amended in December 1968, and the name of the USARV surgeon's Plans and Operations Division changed to the Plans, Programs, and Analysis Division. That abortive attempt to more precisely describe the division's functions created more confusion than order, and it reverted to the original designation the following year. In short, under the existing medical structure in Vietnam, no better description of proper staff functions could be made on the simple statement: the brigade staff were the operators; the surgeon's staff, the advisers and long-range planners. .

Establishment of the US Army Medical Command, Vietnam

Duplicative staff functions, the last major area of deficiency in the medical command and control structure in Vietnam, were, eliminated in 1970 with the creation of USAMEDCOMV (US Army Medical Com-

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mand, Vietnam) (provisional) . The previous year had been one of major reorganization, consolidation, and realignment of 44th Medical Brigade units. Headquarters, 55th Medical Group, had been deactivated on 15 June. The 43d Medical Group then assumed command and control over all 55th Medical Group units in II CTZ, but was itself scheduled for deactivation in the spring of 1970. When Headquarters, 43d Medical Group, was reduced to zero strength, the 67th Medical Group, which had become operational in October 1967 and had assumed command and control over nondivisional units in I CTZ, became the command and control element for medical units in II CTZ, as well throughout, the 68th Medical Group exercised responsibility for nondivisional medical service in III and IV CTZ

Reorganization and consolidation of medical staffs proceeded in tandem with that of field units. A review of functions performed by the USARV surgeon's office and the 44th Medical Brigade headquarters suggested that, if the two staffs were combined, duplication and overlap could be eliminated. Accordingly, Brigadier General David E. Thomas, MC, USARV surgeon/brigade commander, appointed a study group to determine the feasibility of such a, move. A lone admonition guided their study: that the prospective consolidation of staffs and functions result in no loss in the efficiency of medical service in Vietnam.

A basic organization and function for the unified medical, command was derived from the finding of the study group. The 44th Medical Brigade would be eliminated, with all command and control responsibilities absorbed by the medical command. The USARV surgeon would assume the role of Commanding General, USAMEDCOMV. Similarly, the Deputy Commander, USAMEDCOMV, would serve, as the USARV deputy surgeon. Manpower spaces would be eliminated in the offices of the USAMEDCOMV dental surgeon and veterinarian, officers who had formerly maintained staffs in both medical headquarters. In total, the study revealed that manpower could be reduced by 17 percent with no loss in functional efficiency through the proposed consolidation, of medical staffs. Based on these projected results, the study further recommended that, in the future, the dual function concept of the surgeon as commander of the major surbordinate medical unit, be retained, and considered on all levels as a method of reducing manpower requirements and achieving the best utilization of all scarce medical resources.

On 1 March 1970, Headquarters, 44th Medical Brigade, was consolidated with the USARV surgeon's office, forming the USAMEDCOMV (Provisional). (Chart 5) That command continues to provide field-army-level medical service throughout Vietnam. Most of the coordination and logistics problems associated with the Army medical structure, in Vietnam have been eliminated, and benefits have been achieved through a

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reorganization, that has resulted in a medical command structure curiously similar to that which prevailed before the buildup of US. combat forces. Duplication of efforts in the functional areas of command, including dental and veterinary control, administration, and plans and operations, has been eliminated. Manpower requirements have been reduced without degrading the efficiency of medical operations. More importantly, the responsiveness and flexibility of the command to changes in medical support requirements have improved, perhaps the ultimate test of the value of Army medical service in the theater of operations.

NOTES TO CHART 5

a) The deployment of Medical Groups in Vietnam has continued despite the reduction of zero personnel strength and equipment status of the 43d Medical Group on 7 February 1970.

b) Support areas in Vietnam are now referred to as Military Regions (MR) rather than Corps Tactical Zones (CTZ). The geographic regions thus specified are similar to, although not identical with, the CTZ's of earlier years.

c) The staff structure of Headquarters, Medical Command (Provisional) as of 1 March 1970.

Sources: (1) Army Medical Service Activities Reports, Office of the Surgeon, Headquarters, United States Army, Vietnam, 1965 and 1969. (2) Operational Report, Lessons Learned of the United States Army Medical Command, Vietnam (Provisional) for Period Ending 30 April 1970, Headquarters, United States Army Medical Command, Vietnam (Provisional), 15 May 1970.