AUGUST 13, 2024
Originally published by our sister publication Anesthesiology News
Known as the largest amphibious attack in military history, D-Day, June 6, 1944, marks the invasion of Normandy beaches by over 150,000 Allied troops during World War II. This historic date, which turned the tide against German Nazi forces, was the culmination of years of intricate planning, including the often-overlooked significant medical preparation. Surgeons in the United States, Britain, and Canada needed to be equipped to
Originally published by our sister publication Anesthesiology News
Known as the largest amphibious attack in military history, D-Day, June 6, 1944, marks the invasion of Normandy beaches by over 150,000 Allied troops during World War II. This historic date, which turned the tide against German Nazi forces, was the culmination of years of intricate planning, including the often-overlooked significant medical preparation. Surgeons in the United States, Britain, and Canada needed to be equipped to care for the anticipated grave injuries.
In commemoration of the 80th anniversary of D-Day, Leo Gordon, MD, FACS, a professor of surgery at Cedar-Sinai Hospital and an affiliate faculty member in the Cedars-Sinai History of Medicine Program in California, gave a presentation at Cedars-Sinai on June 6, 2024 on how American medicine prepared for this landing.
The overwhelming number of injuries and deaths as a result of the attack on Pearl Harbor on December 7, 1941, made it clear there was a great need for more doctors, nurses and front-line combat medics. One major step in preparation for war was the restructuring of U.S. medical education. In all 247 medical schools existing at the time, the traditional four-year medical education was replaced with the 9-9-9 plan, abbreviating one year to nine months to produce more doctors for the Allied war effort.
“The 9-9-9 plan sped up medical school graduations and even went into getting high school students interested in engaging with medicine–we didn’t know the number of casualties, we didn’t know how long the war was going to last,” Gordon said during the presentation.
This contraction of medical education also extended to internships and residencies. The one-year internship was shortened to nine months, and all residencies were limited to two years regardless of specialty. Upon completion of the internship or residency, 50% of graduates were assigned to the army, and the other 50% served local communities.
In 1942, the American College of Surgeons changed their entire educational program to emphasize teaching surgeons how to treat traumatic injuries. “There were no lectures on innovative research, the lectures were limited to the treatment of war wounds, advanced wound care, the treatment of burns and fractures, and evacuation procedures,” Gordon said. “The American College of Surgeons essentially became a travelling road show, with war preparedness as their theme.”
To assist the surgeons in administering military medicine, the Bolton Act of 1943 was passed to train nurses tuition-free for military, as well as civilian, roles during wartime in 24 to 30 months. “As a result, obviously, with the war effort and this free education, the number of qualified nurses increased exponentially,” Gordon said. More than 59,000 nurses served in the Army Nurse Corps during World War II, in comparison to just 12,000 prior to Pearl Harbor.
While surgeons and nurses were prepared to care for injured soldiers in army hospitals, combat medics, many of whom were conscientious objectors that received just three months of training, were the first point of contact for wounded soldiers on the beach. “If you’re injured, you would have at your disposal wonder drugs and advanced surgical techniques, but someone had to give you immediate care, and that somebody was the combat medic,” Gordon said during his talk. Their treatment was quick, consisting of splinting, stopping bleeding, administering morphine, using plasma transfusions to support shock, and evacuating patients to higher levels of care.
General Dwight D. Eisenhower addressing U.S. Army paratroopers June 5, 1944, the day before the D-Day invasion.
The innovative chain of evacuation, designed to efficiently transport the wounded from the front lines to hospitals, during World War II involved a stepwise plan of increasingly sophisticated care: the combat medic, to the aid hospital, to the field hospital, to the convalescent hospital, where soldiers would either remain or be sent back to action. Once stabilized, patients would be evacuated to England via airplane or hospital ship if needed. “Air evacuation was a new and innovative method for evacuating the injured for the D-Day landings,” Gordon said.
Another essential step was preparing large stores of penicillin and plasma. Plasma supports blood vessels from collapsing, as it maintains blood pressure and circulation, and is thus highly effective in treating shock. Penicillin, which was initially challenging to mass produce, was known as the war’s “miracle drug,” curing infections and saving millions of lives.
“It’s hard to get our mind around the fact that just as much money, effort and manpower went into the mass production of penicillin as went into the Manhattan Project,” Gordon said.
The innovations in medical care in preparation for D-Day, from developing a chain of evacuation for injuries to reconfiguring medical education, led to important advances in the U.S. that continued after the war. These included the widespread use and production of penicillin, advancements in blood storage and transfusion medicine, surgical management of abdominal thoracic and vascular injuries, immense growth of the Veterans Administration and increased pay and rank for surgeons that joined the army. In addition, there was an increased awareness about the neuropsychiatric effects of warfare leading to a better understanding and treatment of what is now known as PTSD.
After seeing the strides made with funding during the war, the government began to put greater financial emphasis on medical research. “Government involvement in research didn’t happen a lot prior to World War II, but the public knew that if the government pumped funds into medical research in the future as it did for the war, we were going to discover some things,” Gordon said.
Although the medical planning for D-Day occurred over 80 years ago, Gordon believes we should continue learning from this enormous preparation to address mass casualties. “We should take that planning and apply it to other mass casualty situations – natural disasters, terrorism, and mass trauma. Preparations should be ongoing,” Gordon said in an email interview.
Additionally, despite the fact that surgical history is no longer covered in many medical school curricula, “a working knowledge of medical history engenders a respect for medical innovation,” according to Gordon. “There is a fascinating, nearly a spellbinding story behind every medical intervention and discovery that enhances daily practice. Such knowledge makes any healthcare worker feel part of a greater effort–part of a 2500-year attempt at relief of human suffering.”
To access the program, send an e-mail request to LeoGordonMD@gmail.com.
By Anna Tsioulias
