Gulf War Air Power Survey

17

Other existing military post offices were located in Dhahran and Jeddah, Saudi Arabia. Contractor-staffed post offices were established in Tabuk, Khamis, and Taif, Saudi Arabia. Embassy or DOD-staffed postal operations were located in Pakistan, Jordan, Egypt, Sudan, Kenya, and the Seychelles Islands. The only aerial mail terminal in Saudi Arabia prior to the deployment was at the Dhahran Royal Saudi Air Base, a large warehouse to become the largest air mail operation in the world. Com­mercial air carrier mail routes were established at Riyadh and Jeddah, which reduced mail volume at Dhahran by 75 percent. Outside Saudi Arabia, the Air Force ran a military post office at the American Embassy in Cairo, Egypt. The Navy processed mail through Bahrain, while the Marine Corps set up mail operations in Al Jubail. Eventually, 203 mili­tary post offices were operating in Southwest Asia manned by more than 1,300 full-time postal specialists supporting half a million personnel in the theater.

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Chancing that DOD would eventually approve free mail, the U.S. Postal Service accepted and delivered free mail from Saudi Arabia, Unit­ed Arab Emirates, Oman, Bahraintwenty-nine days before the executive order was signed.¹¹⁹² The Secretary of Defense finally signed the executive order on 11 October 1990 and added the countries of Kuwait and Qatar.¹¹⁹³ By March 1991, free mail privileges were also authorized to members in Egypt, Israel, and portions of Turkey.¹¹⁹⁴ The costs associated with free mail, some $21 million, were absorbed by DOD.¹¹⁹⁵

Air-transportable hospitals were flown from Langley AFB, Virginia to Dhahran and became opera­tional within two days after arrival.

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However, the deploy­ment of reservists (and to a lesser extent active duty personnel) presented several clinical challenges. A number of mobilized reservists suffered from limiting or disqualifying dental and medical problems. In contrast, the preventive dental program for active duty troops avoided complica­tions upon deployment. Entitled dental care only during extended active duty, many Air Force reservists (later esti­mated to be at least twenty percent) needed extensive dental treatment before deployment. Enroute to the Gulf, many unit commanders request­ed U.S. Air Forces in Europe (USAFE) to screen their troops dentally and provide corrective treatment. Some of the reserve and active duty troops deployed with a variety of other disqualifying medical conditions.¹²⁰⁴
Furthermore, logistical shortfalls in the medical area appeared almost immediately. Generally, hospital table of allowances had never been tested in a long deployment,¹²⁰⁵ and deploying units in the United States assigned their flight surgeons only a minor role in predeployment prepa­rations. In addition, deployed hospitals found that they lacked equipment needed in the desert, such as spare air conditioning units, ice machines, and primary generators. Because of the oppressive desert heat, construc­tion of the hospitals caused an operational delay of a few days, even when units worked through the night.¹²⁰⁶ Critical logistical items, such as air conditioners, were obtained within a few weeks.
In spite of these initial problems, by the end of 1990, Tactical Air Command had readied many of its medical groups and air-transportable hospitals for war. By 18 January 1991, USAFE had also deployed an air-transportable hospital from Torrejon Air Base, Spain. On 19 December, medical personnel of the 4th Tactical Fighter Wing redeployed from Thumrait in southern Oman to Al Kharj, Saudi Arabia, about forty miles southeast of Riyadh. Lt. Gen. Charles A. Horner, CENTAF commander, then directed the Military Airlift Command to deploy medical personnel for the twenty‑five bed hospital at Thumrait. Military Airlift Command had never before been tasked to staff an air-transportable hospital.¹²⁰⁷ A summary of medical personnel is shown in Table 18.
Because air-transportable hospitals met only part of CENTAF For­ward's medical requirements, the CENTAF surgeon insisted on explor­ing the activation of a 250‑bed contingency hospital at Seeb, Oman. But the Tactical Air Command surgeon noted that Seeb, on the coast 20 miles west of Muscat, Oman, needed to improve its inadequate base infrastruc­ture and remedy significant shortfalls in medical supplies and equipment before it would be ready to treat serious battle casualties.

Table 18

Medical Manpower Summary

Location	Active Duty	Reserve Com­ponent	Total
Southwest Asia	2,342	2,526	4,868
Europe	3,874	3,019	6,893
CONUS	28,662	6,295	34,957

On 14 October 1990, CENTAF Forward dispatched a small ad­vance team to Seeb, Oman, to prepare for a contingency hospital in a hard-walled warehouse. Although the target date for full activation at Seeb was 15 November, it did not become fully operational until mid-January 1991, with medical staff from Scott U.S. Air Force Medical Center. Eventually, its staff merged with a collocated Army medical unit, the 365th Evacuation Hospital.¹²⁰⁸

The greatest demand for patient care arose in the first months of deployment, primarily due to the excess heat and rigors of field condi­tions in a hostile environment. In spite of the conditions, strict water and sanitary discipline kept the disease and nonbattle injury rates to one-half of the prewar predicted levels. This represented a major victory over the greatest casualty generator in military history. In the first few months, treatment of patients related mostly to dental problems, since they carried over from civilian life.¹²⁰⁹
Figure 16

Disease and Non-Battle Injury Rates

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The excellent aviation infrastructure of most host nations resulted in a greater number of beddowns than could be supported with a fully staffed air-transportable hospital. Furthermore, squadrons deployed with more people than predicted, forcing the clinics to care for a base popula­tion sometimes as large as 1,200 personnel.
During the first month of the deployment, thirteen of seventeen beddown sites were supported only by squadron medical elements. This was due to CENTCOM-established deployment priorities, not a shortage of deployable hospitals. Airlift priorities often precluded air-transportable clinics from arriving concurrently with the squadron medical element, or else forced a downsizing of the clinic pallets. At ten of fourteen squad­ron medical element locations, the air-transportable clinic equipment packages arrived more than four days after the squadron medical element, and sometimes not at all.¹²¹⁰
Figure 17

Air-Transportable Hospital Locations

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To alleviate this problem, CENTAF established a squadron medical element support system soon after initial deployment; each beddown site was augmented with a bioenvironmental engineer and environmental health technicians. Accompanying them was a medical technician or general practitioner to provide flight surgeons time off and allow the squadron medical element to provide twenty-four‑hour coverage. Each in-theater squadron medical element was also assigned to an air‑transportable hospital for preventive medicine consultation, hospitaliza­tion, and resupply.

Medical support was generally adequate at isolated locations.¹²¹¹ Until the arrival of comprehensive medical resources, the early arriving squad­ron medical elements and air-transportable hospitals served as the primary sources of medical care for forward-deployed Air Force units, as well as units from other Services.
Activating U.S. Air Force Europe Contingency Support
Shortly after the deployment began, the European Command surgeon and component Service surgeons decided to rely primarily on preposi­tioned Air Force contingency hospitals to meet command require­ments for a 5,500-bed capability. The USAFE surgeon was tasked with providing 3,750 beds, and this was accomplished primarily by manning USAFE contingency hospitals. Also, a few fixed facilities were expanded, espe­cially the Wiesbaden, Germany, medical center. Four prepositioned contingency hospitals became operational: the 870th at RAF Little Rissington, 310th at RAF Nocton Hall, 317th at RAF Bicester, United Kingdom, as well as the 609th at Zweibrucken, Germany. Denmark also opened a contingency hospital at Holstebro. Bed capacities were in­creased at five preexisting medical facilities at Torrejon, Spain; Lakenheath and Upper Heyford, United Kingdom; Wiesbaden, Germany; and Incirlik, Turkey. USAFE received 6,892 medical personnel deployed from the United States. Most of these (3,874) were active duty.¹²¹²
These contingency hospitals took longer to activate than existing facilities and encountered several major problems in achieving full opera­tional readiness. Although Nocton Hall received ninety‑three percent of its total required staff, the hospital faced staffing shortages in certain

Figure 18

Hospital Support of the Gulf War

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specialties; not severe enough, however, to cause a problem during the Gulf War.¹²¹³

Although staffing levels did not present a problem at RAF Little Rissington and RAF Bicester, the staffs encountered other problems. At Little Rissington for example, laundry, electricity, water supply, sewage, communications, food services, and transportation would have been a prob­lem with a full patient load. RAF Bicester reported that it was totally unpre­pared to discharge its mission as the center for acute burn care pa­tients. Bicester's physical layout was also less than satisfactory, with the operating rooms housed separately from other key sections. Low rates of admission from the Gulf War relieved the hospitals from serious chal­leng­es.¹²¹⁴
A shortage of up‑to‑date medical supplies posed a major problem at all European contingency hospitals. At RAF Bicester, about 85 percent of the supplies were either outdated or deteriorating. The USAFE com­mander had recently placed a moratorium on replacement of outdated war reserve material, resulting in a large stock of useless supplies. The U.S. Army depot at Pirmasens, Germany, was eventually able to replenish the stocks.
A key obstacle that hampered USAFE's ability to make contingen­cy hospitals operational was the relatively low priority assigned medical supplies for airlift. In early December, the USAFE medical system was tasked with providing almost two-thirds of EUCOM beds needed for Gulf War casualties. These contingency hospitals did not become fully opera­tional until several weeks after the start of the air war. Even if all the Air Force beds were available at the outset of hostilities, it appeared doubtful that the European Command would have enough beds to handle the anticipated casualty flow for more than a few days. To make matters worse, host nation support was apparently not capable of providing sufficient help.¹²¹⁵
EUCOM and CENTCOM agreed that after the war began, EUCOM would initially provide only “flow‑thru support,” holding 80 percent of anticipat­ed patients in Europe no more than three days. After getting improved airlift support, the USAFE contingency hospital system was expected to achieve full operational capability within nine days after the war began. However, three hospitals were not operationally ready until 8 February, and a fourth, RAF Bicester United Kingdom, was not ready until 28 February 1991, after the ground war ended. Estimates of the number of patient evacuees to Europe soon exceeded the contingency hospital's capability, in effect forcing the entire system into a flow-through mode.¹²¹⁶
Although many of the supply, equipment, infrastruc­ture, and person­nel problems in the contingency hospitals had been resolved before the ground war in the Gulf started, the chief surgeons in Europe were wor­ried that contingency hospitals, aeromedical staging facilities, and the evacua­tion system would have difficulty accomplishing their missions. The USAFE surgeon was concerned that a major ground war might cause the CENTCOM commander to downgrade the airlift priority of medical items, especially aeromedical equipment, which was already in short supply. Three-fourths of the USAFE strategic aeromedical evacuation kits, which contained the basic supplies for transporting stable patients be­tween theaters, were incom­plete.¹²¹⁷ The aeromedical system was not fully pre­pared on the eve of the ground war.

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