World War II European Guerrilla Hospitals - Special Operations ...
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6/20/2018
World War II European
Guerrilla Hospitals
Colonel (Ret.) Rocky Farr, M.D., M.P.H., M.S.S.
Associate Clinical Professor of Internal Medicine
Associate Clinical Professor of Pathology
Aerospace Medicine Specialist
Lake Erie College of Osteopathic Medicine-Bradenton FL
Office: 941 782 5680; Cell: 813 434 8010; wfarr@lecom.edu
UNCLASSIFIED
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UNCLASSIFIED
How to get a copy:
• Internet search for:
– JSOU & Press & Farr & Monograph
• http://jsou.libguides.com/ld.php?content_id=
37706446
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UNCONVENTIONAL WARFARE
• During Operation Enduring Freedom, the United
States worked alongside opposition forces in
Afghanistan to bring down the Taliban regime and
rid the country of al-Qaeda fighters. U.S. Special
Forces teamed up with the Northern Alliance in
Afghanistan to topple the Taliban's brutal hold on
the country and bring known terrorists to justice.
Within a few months of launching the campaign,
U.S.-led forces and Afghan opposition forces took
control of the Afghan capital of Kabul, along with
Kandahar, one of the country's largest cities.
UNCONVENTIONAL WARFARE
• SF have long employed the use of UW in
enemy territory. Unlike DA missions, which
are generally designed to be quick strikes,
UW operations can last months, even years.
This can help the Army prevent larger
conventional attacks. And because of deep
roots set up by these missions, other SF
tactics, like DA or SR, can be launched
quickly and seamlessly.
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American Army Doctrine
• “The reason the American Army does so well in
wartime is that war is chaos and the American
Army practices chaos on a daily basis.”
-Attributed to the Germans, c. 1944.
• “One of the serious problems in planning
against American doctrine is that the
American’s do not read their manuals nor do
they feel any obligations to follow their
doctrine.”
-Attributed to The Soviets, c. 1960.
Yugoslavia
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Yugoslavia
“…our operations were closely linked with
our wounded, who were always numerous,
so that it was not possible to avoid
encirclement….”
– Tito J. The Creation and Development Of The Yugoslav
Army. Belgrade, Yugoslavia: Central Political Department of
the Yugoslav Army; 1949.
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Colonel Doctor Djorđe Dragić
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Yugoslavia
“Under the conditions of GW the importance
of the human factor is also notably enhanced
because … partisan units are … replaced on
a voluntary basis. The attention to the
medical services … is therefore
understandable.”
– Dragić, Colonel Doctor Djorđe. Partisan
Hospitals of Yugoslavia. Belgrade; 1966.
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Yugoslavia
“An organized medical service & the presence
of medical workers in the units, & the care of
the sick & wounded in general is an
important moral-political factor which must
be taken into consideration. Care of the
wounded is also a positive factor where new
fighters coming into the ranks…are
concerned.”
– Dragić D. Partisan Hospitals of Yugoslavia. Belgrade; 1966.
UNCLASSIFIED
106/20/2018
Hospital Ward Rules
Underground Shelter Behavior
1. Male or Female Orderly Is in Charge
2. Wounded Must Obey All Orders
3. Only Open Entrance After Enemy
Withdrawal Notification Given
4. Wounded May Not Open Entrance
5. Wounded Can Not Leave Shelter
Without Permission
6. Orderly Entitled to Shoot Wounded on Spot
Colonel Dr. Djorđje Dragić
• 1. Care of the sick & wounded is one of the most
difficult problems & is often decisive in the
development of military operations
• Regular armies concentrate the sick & wounded
while partisans disperse them to protect them
• Most tended to on the move, cared by local
population, or in secret hospitals
116/20/2018
“Two days later I went away eastwards to another hospital.
This one had moved, on an average, every four nights,
carrying all its wounded with it.”
-Lindsay Rogers in Guerilla Surgeon.
A New Zealand surgeon’s wartime
experiences with the Yugoslav Partisans.
126/20/2018
France
136/20/2018
France
“ The individual guerrilla would perform his
battle duties with more ardor and spirit and
accept more risks if he knew that there was
medical support in case he became a
casualty.”
– Bank A. From OSS to Green Berets. The
Birth of Special Forces. Novato, California:
Presidio Press; 1986.
2010s
• Missions beyond just OEF/OIF’s rings
– 12 man teams, 2 medics, 0 docs (or less!)
– Less robust U.S. presence in a country
– Long way to anywhere and everywhere
– Long evacuation times
• “Where’s my golden hour?!?!?”
– More medicine, MVAs, less battle trauma
– 72+ hour holding skills?
– Third world, local medical support
– Prolonged Field Care
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2020s ……
• Back to our roots
– 12 man teams, 2 medics, 0 docs
– Only U.S. presence in a country
– Long way to surgery (local care vs. FSTs?)
– Long evacuation times
– More medicine, less trauma
– 72+ hour holding skills
• www.prolongedfieldcare.org
– Guerrilla Hospitals
The way ahead: (1)
• TCCC Medical Battle Drill must be owned by
Commander
• All School Houses should teach TCCC to All
• Formulize JTS for Peacetime
• JTS Needs all Data Sources
• RFI for quick, joint new medicine fielding
• FDA cooperation w/JTS & CoTCCC
• Nonstandard (“sterile”) med log for SOF
• Reinvigoration of UW training in SOF
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The way ahead: (2)
• Aggressive hunt for new technologies for
SOF Medicine
• Question the old medical normals (O2?)
• SOF must have an organic surgical
capability/team just like in World War II.
• SOF Medicine & surgery in third world
countries may need to look more third world.
LESSONS LEARNED-GENERAL
• —All guerrilla forces need a medical capability
• —Guerrillas fight better if they have medics supporting them
• —Guerrilla fight better when they have dedicated evacuation
• —Casualties are tactical problems not just logistical problems
• —Casualty care requirements may drive the tactical plan
• —Guerrilla aid stations must be closer to the fighting than
conventional ones
• —Guerrillas frequently ignore minor wounds and illnesses, which can
lead ultimately to disability that is more serious and decreased unit
effectiveness
• —Use defense to gain time to evacuate
• —Sick and wounded decrease unit mobility and maneuver
• —Partisans prefer death to serious injury
• —Conventional forces concentrate casualties, guerillas disperse them
• —Treat casualties in route
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LESSONS LEARNED-
TACTICAL/OPERATIONAL (1)
• —Small groups of wounded are easier to move and/or hide
• —Never retreat from suitable positions in daylight
• —The dead should be evacuated. Families want them and it
keeps the enemy from doing a body count.
• —The auxiliary is the medics’ transport and manufacturing
sections
• —Use of civilian hospitals may mean capture by the police
• —Do raids against the enemy solely to obtain medical supplies
• —Restrict knowledge of overall medical plan to only a few
individuals
• —Divide patients into can be evacuation versus must be hidden
• —Develop various types of evacuation transportation platforms
LESONS
—
LEARNED—
TACTICAL/OPERATIONAL (2)
• —Women of the auxiliary make the best couriers
and drug transporters
• —Enemy checkpoint guards tend not to hassle little
old ladies
• —Induction of new guerrillas means medical exams and mass
treatment
• —Give knowledge of contact points only to evacuation
personnel, commanders, and medical officers.
• —Tell cache locations only to a few
• —Code any references to names and places
• —Give the key to the codes only on a need-to-know basis
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LESSONS LEARNED-
HOSPITAL/MEDICAL (1)
• —Underground dug out shelters are warmer in winter
• —Secret hospitals should be built of local materials that blend in
• —Appoint a person to oversee hospital camouflage and transport
• —Major surgery is possible even under the most difficult conditions
• —Guerrillas may not want American immunizations and drugs
• —As a guerrilla force grows bigger, surgical support becomes more required
• —Some cases need out of theater evacuation
• —Widely separate hospital wards by at least five hours on foot
• —Use only smokeless charcoal fires
• —If the situation is unsure issue dry food only-no cooking
• —Fell timber at least two hours on foot from the site of use
• —Disperse patients in danger areas
• —Forbid going outside of the hospital
• —Cache all medical supplies not required for daily use
• —Use well organized early warning systems
• —Use designated tactical units to provide hospital security
• —Prepare underground hideouts for patients early
• —Continuously update evacuation drills
• —Do weekly staff briefings on evacuation plans
• —Brief all new patients upon hospital arrival
• —Keep medical supplies packed in “go bags” at all times.
LESONS LEARNED-
HOSPITAL/MEDCIAL (2)
• —Admit sick and wounded only through secret contact points
• —Admit sick and wounded to hospital only at night
• —Transport sick and wounded blindfolded during the day.
• —The discharge net must be different from the admissions net.
• —Observe strict security during transport of patients
• —Observe strict security when collecting food
• —Heavily camouflage access roads, trails, and hospitals
• —Use code names for hospitals, villages, checkpoints, and landmarks
• —Avoid smoke from cooking during the day
• —Keep noise to a minimum during hospital construction
• —Forbid all to leave the premises without permission
• —Carefully select reliable medical staff personnel
• —Do not admit new patients during uncertain situations
• —Disperse less serious cases into small groups
• —Maintain absolute silence during the day
• —Encourage patients to sleep during the day
• —Change paths to and from the hospital to avoid making visible trails
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LESSONS LEARNED-
HOSPITAL/MEDICAL (3)
• —Cover windows on sunny days to avoid reflecting sunlight
• —Only perform outpatient treatment in clinics far removed from hospital
• —Only see patients requiring in-patient care in hospital
• —Ensure hospitals maintain close contact with nearest tactical unit
• —Use nearest tactical unit to get current intelligence
• —Use nearest tactical unit to provide protection during patient evacuation
• —Severely punish hospital rule violations
• —Keep rigid discipline
• —Only use hideouts once
• —Evacuation plans should include elimination of all traces of activity prior to abandonment of the area
• —Achieve mobility for evacuation by preparing equipment in one-man loads
• —Cache less mobile equipment
• —Destroy or hide material of intelligence value to the enemy
• —Police the area before departure
• —Eliminate all signs of the route of withdrawal
• —Rely on memory, do not write it down
• —Do not mark installations on maps or papers that are taken out of the base
• —Habitually memorize the location of installations and areas
• —Keep administrative records at minimum and cache
• —Destroy records that are of no further value
• —Pre-establishment of underground hideouts before combat operations is ideal
• —Create false trails and confuse enemy tracking dogs by using amputated parts
“SOF can not always bring
the Mayo Clinic to the
battlefield but it can strive to
make the Guerrilla Leader
happy.”
─Farr WD.
196/20/2018
Forest Brothers
• Search for video & Forest & Brothers
• https://www.youtube.com/watch?v=h5rQFp7FF9
c
“Guerrillas on the Amber Coast” by KV Tauras.
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