This year, we commemorate the 80th anniversary of the end of World War II.
While much has been written about the roles of US Navy and Army noncombatant hospital ships used during the war, the lifesaving services of medically augmented, grey-hulled amphibious warships, also known as Landing Ship Tanks (LSTs) is less well known.
Large, and difficult to maneuver, LSTs were flat-bottomed combatant vessels approximately 50 feet wide by 328 feet long, with high vertical sides, specifically designed to support amphibious operations. While their crews typically referred to them as “large slow targets,” LSTs were perhaps the most versatile naval vessels of WW II.
The LST closed logistical gaps during amphibious operations in Europe (including Anzio and Normandy) and the island-hopping campaigns in the Pacific.1 Not only did these vessels bring troops, tanks, and other war material ashore, LSTs became critically important casualty evacuation and treatment platforms. Very quickly it was realized by Allied forces that LSTs augmented with surgical capability were needed to provide lifesaving, far-forward surgical care during amphibious operations.
US Ship LST-464
Beginning in 1943, the US Navy began adapting LSTs into designated medical ships. Among the first to hold this designation was USS LST-464. In June 1943, while assigned to the Seventh Amphibious Force in the Pacific Theater of Operations (PTO), it was refitted to provide much needed combat casualty care and other medical capabilities and redesignated as a combatant vessel with hospital capabilities, LST(H)-464 (see Figure 1 above).
In addition to the 60 hospital bunk beds (organized in triple tiers) and four “surgical beds” for the most severely injured casualties, the ship had an OR, a sterilizing room, dental office, laboratory, dressing room, and x-ray room.2 Later, an additional ward, sick officer quarters, outpatient spaces, and a formal medical stock room were established on the ship.2
The core staff included six medical officers and 35 hospital corpsmen. However, depending on the mission and location, additional medical officers and surgical teams (forerunners of today’s fleet surgical teams) augmented the ship’s roster of care providers. Over the course of its service in the PTO, the ship provided “the specialties of surgery, internal medicine, dermatology, urology, eye, ear, nose, and throat, neuropsychiatry, and anesthesia.”2,3
While supporting operations in New Guinea for nearly 15 months, LST (H)-464 served as both a station hospital and evacuation unit. She also supplied emergency medical supplies, combat personnel, and nonmedical stores such as fuel and fresh water to units in the region. Prior to her departure, LST(H)-464 was formally organized into the 7th Fleet Blood Bank for US Army and Navy personnel, collecting 809 pints of lifesaving whole blood.2
Leyte Gulf Campaign
Fought October 23–26, 1944, the Battle of Leyte Gulf was the largest naval battle of WWII. It was also the first time in the war that Imperial Japan employed suicide “kamikaze” planes against enemy targets. Despite Allied victory at Leyte Gulf, fighting did not end, nor did the risk of kamikaze attack.
November 12 was the most challenging day for 464’s medical team when 137 casualties were admitted from three ships attacked by kamikazes. On November 14, 125 patients were admitted.2
Unlike unarmed white-hulled hospital ships, gray LSTs did not display large red crosses which could function as potential targets for kamikaze planes. They did, however, have a protective armament. LST(H)-464 successfully fought off kamikaze attacks on November 17, 24, and 26.2
During the Philippines campaign and during “strenuous and unremitting” duty, caregivers aboard the LST(H)-464 treated 4,846 combat casualties. After depleting its stores of whole blood, an additional 1,500 pints of whole blood were obtained from US Army soldiers in the region. By April 1945, whole blood was regularly available in the PTO, and the ship no longer had to serve as a blood bank.2
Combat Casualty Care at Sea
From 1943 to 1945, the medical units supporting LST(H)-464 cared for 8,236 hospital inpatients, 15,271 “dispensary” outpatients, and performed 655 major operations and 381 minor operations; 75% of all major operations were performed under spinal anesthesia with procaine. When necessary, general endotracheal anesthesia was performed with nitrous oxide and ether using a Heidbrink anesthesia machine.2
Regional anesthesia was also used and “found very useful and safer than general anesthesia.” Intravenous (IV) sodium pentothal was frequently used for orthopaedic surgery and removal of shell fragments and other foreign bodies. Open extremity fractures were treated with closed reduction, locally placed sulfa drugs in the wound, and IV plasma and penicillin. Large soft-tissue wounds were also treated with local and IV antibiotics and plasma transfusions. Burn patients were resuscitated with plasma and wounds were treated with Vaseline and burn dressings.2
Patient Movement
During amphibious operations, LST(H)-464 would land on the beach, and open her bow doors to receive casualties.2 Casualty evacuation by helicopter did not occur routinely until the Korean War (1950–1953). As such, to receive casualties from other ships, patients were placed in rigid wire baskets called Stokes litters. This device was invented by future US Navy Surgeon General Charles Francis Stokes MD, FACS (1863–1931), after his experiences transporting casualties between ships during the Spanish-American War (1898).
While necessary, ship-to-ship patient movement was described as “slow, dangerous, and inadequate.”2 Patients were then transferred down ladders to the medical spaces,2 another challenging patient movement evolution (see Figure 2 on right).
Many unsung LST(H)s provided lifesaving damage control resuscitation and surgery on the war-torn beaches of Europe and the Pacific. During the battle of Normandy (June 1944), 16 LSTs were specially designated as “emergency hospitals,” evacuating more than 41,000 casualties.4 During the Battle of Iwo Jima (January–March 1944), four medically designated LST(H)s were used for receiving the war wounded, two for each US Marine division. At Iwo Jima, on D-Day alone, 2,230 casualties were evacuated by LST(H) between 9:00 am and 3:00 pm,5 or about six casualties per minute.
The spirit of these LSTs and their medical departments lives on in the modern US Navy’s nine Fleet Surgical Teams designed to augment amphibious warship medical departments and provide forward surgical in support of US Marine Corps amphibious operations.
