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About the MUST units, like the 45th Surgical Hospital,
Tay Ninh, Vietnam.

Special Units

MUST-equipped surgical hospitals were operated for several years, in Vietnam with mixed success. These, units consisted of
three basic elements, each of which could be airlifted and dispatched by truck or helicopter. The expandable surgical element
was a self-contained, rigid-panel shelter with accordion sides. The air-inflatable ward element was a double-walled fabric
shelter providing a free-space area for ward facilities. The utility element or power package contained a multifuel gas turbine
engine which supplied electric power for air-conditioning, refrigeration, air heating and circulation, water heating and pumping,
air pressure for the inflatable elements, and compressed air or suction. In addition, other expandables were, used for central
materiel supply, laboratory, X-ray, pharmacy, dental, and kitchen facilities.

By 20 October 1966, personnel and MUST equipment of the 45th Surgical Hospital had all arrived in-country. Work was
begun on ground preparation and construction of quarters and a mess a few miles west of Tay Ninh. The utility packs and
operating rooms and central materiel expandables had been moved next to the site when it was hit by mortars on 4 November
and its commander, Major Gary P. Wratten, MC, was killed.

Two days later the hospital was ordered to become operational as soon as possible to support Operation ATTLEBORO, then
in progress northeast of Tay Ninh. An emergency surgical capability and a 20-

patient Holding capacity was completed on 8 November. The rest of the hospital was ready to open on 11 November when
three more mortar attacks delayed operations until 13 November when the hospital received its first casualties.

Lieutenant Colonel (later Colonel) Thornas G, Nelson, MC, MUST professional consultant to The Surgeon General, reported
in 1967 that, during, the early period of its operation, the 45th Surgical Hospital operated as a true forward surgical hospital;
that is, patients were, not held for, followup surgery or prolonged treatment.

Commenting on the relationship between helicopter evacuation and the employment of a forward surgical hospital, he continued:

As was true of other hospitals in Vietnam, patients were moved directly from the battlefield either to a clearing station or a nearby hospital. . . .
Most patients arrived at the hospital within 10 minutes of pickup, and some of these were in such critical condition, usually from internal
bleeding or respiratory problems, that further evacuation even by helicopter would likely have been fatal. . . .

Patients were moved from the helicopter pad directly into the preoperative and resuscitation shelter where they were met by the surgical team
on-call and the registrar section to initiate resuscitation and medical records. Patients were nearly always admitted in groups of from three to ten,
and surgical priorities were established as blood administration and other stabilizing measures were employed and X-ray and laboratory
determinations obtained.

The performance of the 45th Surgical Hospital led to the accelerated deployment of MUST equipment for three additional
surgical hospitals in 1967: the 3d, 18th, and 22d. In 1968, the, 95th Evacuation Hospital was temporarily supplemented with
some, MUST equipment until the construction of a fixed facility was completed. The 2d Surgical Hospital arrived in Vietnam in
1965 and had a long history of distinguished service before becoming the last unit to be equipped with MUST in January 1969.
Meanwhile the Marine Corps was also using MUST equipment.

All medical facilities were vulnerable to enemy attack. On 4 and 11 November 1966, the 45th Surgical Hospital was subjected
to mortar attacks. The 3d Surgical Hospital underwent a 15-minute mortar barrage on 24 July 1967, with direct hits on the
bachelor officers' quarters and the MUST maintenance hut. Near misses caused extensive damage to practically all inflatable
elements. No patients were wounded, although 18 members of the hospital staff received minor wounds. During 1968, the 3d
Surgical Hospital underwent 13 attacks which resulted in damage to the hospital area. On 5 and 6 March the hospital suffered
extensive damage from mortar and recoilless rifle fire. The headquarters and chapel were completely flattened; the dental clinic,
X-ray, laboratory, medical library, medical supply building, and nurses' quarters were all damaged. The intensive care ward and
postoperative ward were heavily damaged or destroyed. During this 2-day period, no patients were wounded, although three,
staff members received minor fragment wounds. Repairs were completed quickly and the hospital remained operational

Until mid-1968, most field-army-level medical facilities, including MUST units, were not mobile. The 45th and 3d Surgical
Hospitals remained stationary after the initial emplacement of MUST equipment. Billets, messhalls, and storage areas were
constructed to support the units. Revetments were raised around all inflatable MU'ST components to make them less vulnerable
during attacks. Difficulties, in relocating the 18th and 22d Surgical Hospitals earlier in 1968 demonstrated the need to retain
mobility. Thus, late in 1968, the USARV surgeon instituted a policy that two MUST surgical hospitals would retain all
equipment necessary to be completely mobile and that drills would be held frequently to keep hospital personnel, trained to
displace, move, and emplace their hospitals rapidly. The 2d and 18th Surgical Hospitals were designated as "mobile" MUST's.

While MUST equipment was an important addition to the inventory of Medical Department assets, it was not used in
accordance with doctrine. Its "transportable" attribute was not exploited. Because hospitals supported operations from fixed
locations, emphasis was placed on the selection of a hospital site in a reasonably secure area.
Proximity to tactical operations was a consideration only in the sense that the hospital had to be within reasonable air-evacuation time and distance.
Hospitals had to be moved only when major tactical forces shifted to open new areas of operations,
such as, for example, the large-scale buildup of U.S. Army forces in I CTZ during 1968.
MUST equipment was a link in such hospital relocations. Pending the construction of fixed facilities in new areas,
MUST hospitals provided the controlled environment and the, other resources needed for high-quality patient care. As
air-conditioned fixed hospitals were completed, the need for MUST equipment diminished. In late 1969, the MUST equipment
was withdrawn from the 3d, 18th, and 22d Surgical Hospitals, leaving only two hospitals so equipped. The 3d and 18th
Surgical Hospitals were re-established in semipermanent facilities and the 22d Surgical Hospital redeployed to the continental
United States. The 2d, and 45th Hospitals were closed out in 1970.

The convalescent center. During the visit of The Surgeon General, Lieutenant General Leonard D. Heaton, to Vietnam in early
November 1965, General Westmoreland strongly recommended that a convalescent center be established in Vietnam, as soon
as possible. Malaria was increasing among U.S. forces, and too many patients suffering from malaria or hepatitis were being
evacuated out of the country because they could not be hospitalized and returned to duty within the USARV 30-day evacuation
policy. General Heaton accepted this recommendation and directed that a convalescent center be established.

The 6th Convalescent Center was activated on 29 November 1965, deployed to Vietnam during March and April 1966, and
received its first patients on 15 May. The center was located at Cam Ranh Bay, adjacent to the South China Sea. Its mission
was to provide convalescent care for medical and surgical patients, including combat wounded. After a year of operation,
approximately 7,500 patients had been admitted to the center from all areas of the country. The patient census averaged more
than a thousand a month, with malaria constituting 50 to 65 percent of all admissions, Other admissions included hepatitis
patients and those requiring longer periods of postoperative, care than 30 days. Approximately 96 percent of all admissions
were returned to duty- during an average, month, the equivalent of one to two battalions.

The 45th Surgical Hospital (MUST) Special Unit

Picture From Jerry Leblanc of the 45th Surg.