at forward and rear airdromes; care of the casualties in flight; and the maintenance of medical records of all casualties.

An Air Evacuation Transport Squadron was to be stationed at each airdrome used for formal air evacuation and would be responsible for the coordination of activities of Air Force with Ground Force personnel. It determined the number of planes available and the time of arrival; supervised loading and unloading of aircraft; determined classification priority of casualties; furnished medical care in flight; maintained medical records; and effected liaison with the various agencies responsible for air evacuation. Patients were given three priority ratings: Priority I, patients who required expert nursing care in flight (litter patients); Priority II, patients who required minor nursing care in flight (litter and walking); and Priority III, patients who required no nursing attention in flight (walking). Transport-type aircraft equipped with litter racks or litter strap installations were to be used. The forward supply of litters, blankets, and splints would be maintained by the Surgeon, First U. S. Army, at evacuation airdromes. The rear supply of these materials was to be maintained by the Surgeon, SOS. In emergencies, depending upon the military situation, this equipment would be shipped to forward airdromes by air transport. It was understood that air evacuation, notwithstanding advantages claimed for it, was dependent upon the degree of air superiority, the tactical situation, and the weather. These limitations necessarily made air evacuation ancillary to road, rail, and sea.

In an evaluation study of air evacuation for the period ending 23 July 1944, Maj. Gen. A. W. Kenner, Chief Medical Officer, SHAEF, reported that a total of 55,674 American casualties was evacuated from the Continent to the United Kingdom during this period, of which 18,415 were evacuated by air and 37,259 by water. The average number of casualties evacuated daily by air was 418, while for water it was 785. The percentage of the total casualties evacuated by air was 33.07. 172 He called attention to three major controllable factors which determined the number of casualties evacuated by air: the staff policy of limiting evacuation to returning freight-carrying aircraft; the restriction on the use of tactical airfields by transport aircraft; and the reception facilities in the United Kingdom. In addition to the controllable factors, there were weather conditions and the limited facilities of the holding units on the Continent which had to be considered. On the basis of reception facilities in the United Kingdom, he concluded that daily air evacuation for American casualties could be increased 500 percent, and recommended that air evacuation facilities be made available

for the evacuation of the majority of the casualties from the Continent to the United Kingdom. This recommendation was approved by G-4 and by the Chief Administrative Officer. The facilities, however, were not immediately forthcoming, as will be seen later.173

By the latter part of August the armies had moved forward at such a rapid rate that the landing fields for cargo aircraft were as far removed from the forward areas as were the railroads. Taking cognizance of this situation, General Hawley, on 21 August 1944, initiated action to provide an air strip behind each Army for evacuation planes and to secure C-47 aircraft for evacuation of casualties from these strips. He stated that oral agreements had been made with the Ninth Air Force Commander for Communications Zone engineers to construct the air strips under his supervision. The recommendations of General Hawley were submitted to the Chief Administrative Officer through G-4, with the request that airfields on the Continent now being used to support US armies, or to be used in the future by cargo planes, be available for casualty evacuation; and that a general policy be established which would make available at least 20 percent of the cargo planes landing on these fields for evacuation of casualties. He approved recommendations that C-47 aircraft be made available for air evacuation. While the Chief, Movements and Transportation Branch, G-4, approved the recommendations he stated that the implementation of the recommendation rested with the 12th Army Group and the Ninth Air Force. General Kenner, the Chief Medical Officer, SHAEF, referred the recommendations of the Chief Administrative Officer.1

On 30 August 1944, General Hawley, summarizing the evacuation situation for General Kenner,175 stated that sufficient motor ambulances were not available in France to evacuate all casualties, and, besides, the distances involved would make the use of motor ambulances extremely detrimental to the casualties, resulting in loss of life for many of them. There were no locomotives available in France for hospital trains, and even if such vehicles were available, the disrupted railroad system made the use of hospital trains impractical for distances over 100 miles. It was estimated, in fact, that it would take at least 48 hours for a hospital train from the Paris Area to reach the coast. For these reasons, General Hawley concluded that evacuation by air was the only "proper" method. His reasons for the unreliability of air evacuation to this date are quoted in full: 176

(a) The medical service has been unable to effect a liaison with the Air Forces which is effective. There are so many echelons of command involved that it takes more than a week merely to make contacts.

(b) Evacuation of casualties by air has no priority at all. Except upon one or two occasions, it has been impossible to evacuate casualties by air unless supplies were being carried forward by air. Consequently, evacuation is completely dependent upon supply. Where there is no supply by air, there is no evacuation by air.

(c) Evacuation by air is interrupted at such times as tactical operations by air are contemplated.

(d) All planes engaged in air evacuation are based in the U. K. Consequently, air evacuation depends not alone on the weather in France, but also upon the weather in the U. K. There have been, and will be, times when flying is impossible in the U. K., but quite possible in France. However, no evacuation within France is possible at such times.

General Spaatz, meanwhile, had as a possible solution proposed to the Supreme Allied Commander that responsibility for air evacuation be transferred from the Commanding General, Ninth Air Force, and Commanding General, IX Troop Carrier Command, to the administrative control of USSTAF. On 8 September 1944 this responsibility passed from the Commanding General, Ninth Air Force, to the Commanding General, USSTAF. To remedy the shortcomings in the air evacuation system, General Hawley recommended that air evacuation be given a definite status; that air evacuation be made a separate mission which would not be entirely dependent upon resupply by air; that sufficient aircraft be made available and based in France for evacuation there when weather conditions prohibited evacuation to the United Kingdom; and that a chain of communications be established in which the Chief Surgeon, ETO, could inform the responsible commander in the Air Forces of the necessary requirements.17 It was further recommended that a modification of air staff policy be made which would permit empty aircraft, in cases of emergency, to proceed to the Continent for the sole purpose of air evacuation.178 Affirmative action was taken on all but the latter request, as will be shown below. 179

177

On 2 September, General Grow had requested that General Kenner initiate action which would make available at all times at least fifty C-47 aircraft for use in evacuating casualties. This limited number of planes, he believed, would not be a factor in tactical operations and the air evacuation program would not therefore be dependent upon tactical requirements for planes which normally would receive first priority. These planes could be used for resupply in the usual manner. General Kenner, following the recommendation of General Grow, initiated action for a certain number of C-47's to be placed under the immediate control of the Medical Department, and organized as an air medical unit.180 Assistant Chief of Staff, G-4, while agreeing that the formation of an air medical squadron would greatly facilitate air evacuation, could not determine a source of the required planes.181