AFMS Readiness and the Korean War Published July 27, 2021 By Dr. Joseph Frechette, Ph.D. Air Force Medical Service History Office FALLS CHURCH, Va. -- Each year on July 27th we recognize National Korean War Armistice Day, which marks the anniversary of the day in 1953 when hostilities during the Korean War came to an end. This provides a timely occasion for the Air Force Medical Service to reflect upon the challenges of readiness in the face of unexpected major operations. The AFMS was barely a year old when the war began on June 25, 1950, and it was far from ready for a major conflict. The strength of Air Force as a whole had declined in the year before the war, and every corps within the AFMS was well below the strength that the Office of the Surgeon General estimated necessary even for peacetime operations. At the moment of the initial North Korean invasion the Far East Air Forces Surgeon, Brig. Gen. Clyde L. Brothers, had fewer than 200 officers at his disposal in all corps and there were no Air Force hospitals in either Korea or Japan. More than half of all hospitalized Air Force personnel were actually cared for in Army facilities. The flight surgeons that were available were often inexperienced and almost all were assigned to multiple squadrons. Likewise, in the first months of the war insufficient personnel and communications, and the need for greater inter-service coordination, hampered the AFMS’s ability to provide the most effective aeromedical evacuation. As late as 1952 there were also shortages in field grade officers, with the majority of the medical groups of the Fifth Air Force commanded by captains. While the AFMS more than tripled in size to meet the needs of the conflict, Brothers also noted deficiencies in the accelerated training of new medics, particularly with regard to the treatment of ear, nose, and throat issues, field operations, and the medical aspects of personal aircrew equipment. Nevertheless, the AFMS grew and retooled in the face of the initial crisis. They made up for personnel shortfalls through recruiting and a national “doctor’s draft” that funneled civilian medical personnel into the military. By the end of 1951, the officer strength of the medical service had grown to just under 1,000, with the number of doctors and nurses increasing nearly sevenfold and the number of dentists was not far behind. In February 1951 the AFMS published its first aircrew effectiveness program to improve medical support to aircrews, and when flight surgeons were unavailable a system of assigning general duty physicians to squadrons proved successful. Over the course of the war, the Air Force went from 73 to 180 medical facilities around the world, including some small facilities in Korea and six large hospitals in Japan. By the war’s end about 80% of Air Force patients were cared for in Air Force facilities. Finally, aeromedical evacuation matured and came into its own, and by the end of 1950 air transport became the standard for casualty movement, which would greatly increase survival rates. By the end of the war, the Air Force’s 801st Medical Evacuation Squadron had moved more than 311,000 wounded or sick patients out of Korea, and the Military Air Transport Service had provided care for more than 43,000 evacuees on their way home to United States. The 801st MAES evacuated more than 4,700 Marine casualties from the 1st Marine Division’s withdrawal from Chosin Reservoir, with nearly 4,000 of those casualties being transported in a single day on December 5, 1950. For their gallantry and heroism, the 801st MAES was given the first Air Force Distinguished Unit Citation ever awarded in theater. Lessons learned in processing and staging patients for air movement back from the combat zone by the 801st Medical Air Evacuation Squadron were eventually incorporated into the organization of the new 6481st Aeromedical Evacuation Group in the spring of 1953. Innovation with the incorporation of helicopters into the AE system also led to improved service. The 3rd Air Rescue Squadron demonstrated the helicopter’s utility in bringing frontline casualties to mobile army surgical hospitals. Having demonstrated the efficiency and effectiveness of the system that ultimately evacuated most of the war’s casualties, a December 1953 Army-Air Force agreement finally formally recognized the Air Force’s responsibility even in forward areas. While one should not overstate the case, as unforeseeable chance and contingency will always present challenges to military organizations, the AFMS’s gains in Korea were hard won in the face of undeniable necessity. Thanks to improvements to the aeromedical evacuation system, along with advances in the use of antibiotics and updated surgical techniques, the casualty death rate in the Korean War was half of that experienced in WWII. The initial challenges and eventual successes are a reminder that readiness is not an academic exercise, but a deadly serious endeavor, the consequences of which can’t be measured.