LST(H) Landing Ship, Tank (Casualty Evacuation)

The LST proved to be a remarkably versatile ship. Thirty-eight LST's were converted to serve as small hospital ships. They supplemented the many standard LST's which removed casualties from the beach following the landing of their cargo of tanks and vehicles. For example, on D-Day, LST's brought 41,035 wounded men back across the English Channel from the Normandy beaches. During World War II amphibious operations, and in subsequent landings at Inchon, Korea, "grey hull" tank landing ships (LST) were converted into an important component of the medical care system - the LST(H) Landing Ship, Tank (Casualty Evacuation). Modified for surgical support of limited scope, these ships were primarily used by forward surgical teams to stabilize the wounded.

The LST(H) provided immediate medical care facilities, evacuating over 40,000 casualties from Normandy alone. Other LSTs were converted to mini-aircraft carriers and actually launched fixed wing reconnaissance aircraft from their modified decks. This mission flexibility remains a hallmark of amphibious ships today. During World War II amphibious operations, and in subsequent landings at Inchon, Korea, "grey hull" tank landing ships (LST) were converted into an important component of the medical care system - the LST(H).Modified for surgical support of limited scope, these ships were primarily used by forward surgical teams to stabilize the wounded. Given the intensity of the warfare and the shortage of true hospital ships, LST(H)s became essential in providing quick, early, lifesaving treatment for the combat wounded in forward locations. In operational settings where larger hospital transports were available, the transports were often withdrawn at nightfall due to lack of air cover.

Hospital ships were very active during World War II. They were marked with Geneva Convention protective symbols and theoretically immune from enemy fire. In 1943, landing ship tanks (LSTs) used to haul assault troops were modified to evacuate and treat wounded personnel in the Pacific and beaches in Africa. Approximately 150 folding army cots were placed in each LST to establish a ward. Casualties were evacuated to the LST using smaller vessels called DUKWs. Casualties were later evacuated from the LST to a hospital ship. Despite early doubts, the system worked quite well. LSTs were controlled by the U.S. Navy. LSTs were not considered "immune" targets under the Geneva Convention and could be fired upon by the enemy.

In general, the plan for an amphibious assault was to have one or more LST's, especially equipped as hospital ships, support the landing until the beach was secure and the evacuation hospital was established. Each LST then acted as all evacuation hospital ship. These LST's received patients during daylight hours, pulled offshore at dusk, and remained at sea during the night. They had U.S. Navy surgical teams. These teams consisted rarely of well-trained surgeons. Colonel McGowan would advise augmenting the staffs of these LST hospitals with well-trained surgeons from the Army to do the surgery on these ships. An ophthalmologist and a neurosurgeon were required in the surgical team. On Luzon, in the XI Corps action (Zig Zag Pass, Bataan, Corregidor), there was no trained ophthalmic surgeon. Close cooperation between the Medical Corps of the Army and the Navy in amphibious warfare was vital. Only thoroughly trained personnel should be entrusted with the receiving and disposition of casualties. On many landings, the LST's were storage places for units of whole blood. The stored, refrigerated blood should have been packed by plan, with a medical officer responsible for its care, screening, and distribution. Too often, blood was distributed haphazardly throughout a convoy and was difficult to locate.

Each evacuation control LST was recognizable by a large white "H" painted amidships on both sides. They are located 300 yards directly seaward of their corresponding TransDiv control vessels. They fly an oversize VICTOR flag and display a GREEN light at night. They have pontoon barges alongside and stand out 1,200 yards ahead of the LST formation.

At Iwo Jima, the chain of evacuation of casualties included 4 LST(H)'s or evacuation control LST's, specially equipped with medical personnel and supplies and designated to make preliminary "screening" examinations of casualties and distribute them equally among the transports and hospital ships. One LST(H) was available for each of the invasion beaches, making two for each Marine division. All ships, LVT or DUKW, that evacuated wounded from beaches were to proceed to their respective evacuation control LST(H). Those casualties unable to endure the trip to a transport or hospital ship were to be transferred immediately to an LST(H) for treatment, while less seriously wounded patients were unloaded onto a barge alongside the LST(H) and then transferred to LCVP's for further transfer to transport or hospital ship. Aboard each LST(H) were 4 surgeons and 27 corpsmen, increased on arrival at the objective by the transfer of one beach party medical section (1 medical officer and 8 corpsmen) from an APA, giving each LST(H) 5 surgeons and 35 corpsmen. At all times these beach party medical sections were on call by the Transport Squadron Commander.

Two hospital ships and one APH were designated to evacuate patients to Saipan, where 1,500 beds were available, and to Guam, where there were 3,500 beds. Air evacuation of casualties to the Marianas was to begin as soon as field facilities would permit. Experience gained in the Marianas campaign had emphasized the necessity of having the casualties screened by a qualified flight surgeon to insure proper selection of patients for evacuation by air. Medical personnel and adequate medical supplies and equipment were to be aboard each plane.

On D-day, 19 February 1945, 30 APA's, 12 AKA's, LSV Ozark, and 4 LST(H)'s were available for the evacuation of casualties. The general plan for sea evacuation provided that an LST(H) be stationed 500 to 2,000 yards off each of the 4 beaches and that all casualties be evacuated to one of these ships.

During the early phase of the assault, prior to the establishment of fully functioning shore evacuation stations, the primary duty of LST(H)'s, was to render emergency treatment and receive casualties at night. In previous operations, casualties had been known to ride all night in open boats before finding a ship to receive them. After shore evacuation stations were established, the main purpose of the LST(H) was to effect an equitable distribution of casualties to APA's and AH's.

The work performed by LST(H)'s can be appreciated by the following: LST(H) 931 was stationed approximately 400 yards offshore. A pontoon barge was tied alongside for receiving casualties. A Jacob's ladder led from the barge to the main deck of the LST. On the barge was a small covered area that served as a supply shack. A number of litter bearers, two medical officers, and a talker to communicate with the control tower of the ship were stationed on the barge. LCVP's, LCM's, and Amtracs bearing casualties, temporarily tied up alongside the barge while the medical officer on duty went aboard to examine the wounded. Casualties requiring immediate attention were taken aboard the barge, where emergency treatment was carried out. To load patients in need of immediate surgery aboard the LST(H) a metal frame accommodating 3 stretchers was lowered to the barge by a tractor crane mounted on the main deck, just aft of the cargo hatch. The patients were then brought up and lowered directly into the tank well through the cargo hatch, which was always open and was outlined by luminous painted lines to prevent accidents during blackouts.

About 220 patients could be cared for on the tank deck and another 150 to 175 in the troop quarters. Patients requiring an operation were moved from the tank deck through the open hatch forward to the operating room. The normal complement of an LST(H) was 4 medical officers and 26 corpsmen, but often this was insufficient. The use of LST(H)'s as evacuation control ships although representing an important step forward in the chain of evacuation, left much to be desired. Used for the transportation of LVT's to the target, they were converted for casualty handling only after these had been discharged and as a result, were often covered with dirt and grease when turned over to the medical department. The illumination on the tank deck was usually very poor and the medical facilities were unsatisfactory. The number of medical personnel assigned was insufficient to care for the large number of casualties, even when the staff worked day and night. On D-day, between 0900 and 1530, a total of 2,230 casualties were evacuated by LST(H)--an average of slightly less than 6 casualties per minute.

Dawn of Easter Sunday, 1 April 1945, disclosed an American fleet of 1,300 ships in the waters adjacent to Okinawa, poised for invasion. The 69th Field Hospital landed on 3 April 1945 and received its first casualties two days later. Until it was established, the divisions had evacuated their casualties immediately by LCVP's and DUKW's to one of eight LST(H)'s lying off the Hagushi beaches. Each hospital ship could take care of 200 patients and perform emergency surgery. By 16 April Army and Marine hospitals ashore had a capacity of 1,800 beds.

During U.S.Marine landings at Inchon in 1950, LST(H)s once again demonstrated their value in immediate medical support of combat operations. Concurrently, two United Nations hospital ships supplemented by five U.S. hospital vessels served as seaborne ambulances, and later as definitive-care platforms. Their original mission was to transport casualties to Japan, providing care en route, but Korean conditions made them far more valuable as rear-area hospitals. Some shuttled between Korean ports as mobile hospitals; others remained in port for considerable periods conducting clinics similar to those of land-based facilities. Patients were winched aboard from docks or from lighters and landed in helicopters.