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slight variations between division and non-division troops for oral surgery, thoracic surgery, genitourinary surgery, and plastic surgery. The highest proportions are concentrated in orthopedic surgery and general surgery of the extremities. In terms of nonbattle admissions, with operations per 1,000 average strength per year, disease admissions with an operation rate of 52 per 1,000 exceed those for nonbattle injury of 36 per 1,000 per year. For disease, the non-division troops are highest with a rate, of 58 per 1,000 per year compared to 46 per 1,000 for divisions. On the other hand, the nonbattle injury admissions with operations show the highest annual rate (40 per 1,000) among the division troops with non-divisions amounting to only 32 per 1,000. Table 79.- Admissions for disease with surgical operations, annual rates, and
percent distribution, by type of surgery and type of unit, U.S. Army, Korea, July 1950-December 1953
87 Table 80.- Admissions for nonbattle injury with surgical operations, annual rates,
and percent distribution, by type of surgery and type of unit, U.S. Army, Korea, July 1950-December 1953
|
Age | Little Switch | Big switch | Total |
19 Years or less |
7
|
35
|
42
|
20-24 years |
97
|
1,971
|
2,068
|
25-29 years |
24
|
955
|
979
|
30-34 years |
10
|
403
|
413
|
35-39years |
5
|
152
|
157
|
40-44 years |
3
|
46
|
49
|
46-49 years |
1
|
15
|
16
|
50-54 years. |
0
|
3
|
3
|
Not stated |
0
|
5
|
5
|
Total |
147
|
3,585
|
3,732
|
Table 83 shows that almost all (145) of those included in Little Switch and slightly less than two-thirds (61.5 percent) of those included in Big Switch were identified as ever having been wounded. When the distribution by anatomical location of wound is compared with all nonfatal wounded for U.S. Army, Korea (table 45), and with wounded evacuees received in continental United States from Japan-Korea, (table 71.), there were slightly higher proportions of head wounds and chest, abdomen, and back wounds among the exchanged prisoners and a slightly lower proportion of extremity wounds. These ratios were 18.2 percent and 16.0 percent, for head, face and neck among the total wounded and the evacuee wounded, respectively, compared to 21.8 percent for head wounds among repatriated prisoners of war. The thoracoabdominal region showed 15.4 percent and 15.7 percent, respectively, for the two former distributions compared to 16.7 percent for the chest, abdomen, and back combined among the repatriated prisoners. Extremity wounds were 66.3 percent and 68.1 percent, respectively, for the first two distributions and only 61.5 percent for the repatriated prisoners of war who had been wounded.
There were 618 cases (17 percent) of those repatriated for whom survey medical records were received which recorded a surgical operation while, in captivity (table 84). Only 11 (2 percent) had a major amputation, although the majority of amputees were exchanged in Operation Little Switch where 11 percent with surgical operation involved a major amputation, of one or both extremities. Minor amputations of fingers or toes were involved in 9 percent of the surgical operations and 1.8 percent of the operations involved the removal of foreign bodies. The majority of cases with surgical operation in both POW exchanges involved "other types not stated."
The results of intensive physical examinations of the U.S. military repatriated prisoners of war are shown in tables 85-89. Four-fifths of all repatriated prisoners were in good mental health and morale, and only 18 percent suffered from psychiatric conditions upon examination (table, 85). The largest proportion (7 percent) were diagnosed as psychoneurotic, with character and behavior disorders second at 6 percent. Only 1 percent of all returned prisoners were classified as being psychotic.
Results of physical examinations of the eyes, lips, and mouth are presented in table 86. Almost 90 percent of all the repatriated prisoners showed no abnormalities involving these anatomical areas, although the proportion was less for those exchanged during Operation Little Switch. Of those with eye
Table 82.- Average weight lost by body build at capture and by weeks in captivity, U.S. military repatriated prisoners of war, Korea
Prisoners of war with weight loss |
Operation Little Switch | Operation Big Switch | ||
Cases with weight loss |
Average pounds lost |
Cases with weight loss |
Average pounds lost |
|
Body build at capture |
136
|
24.16
|
3,404
|
21.89
|
Slender |
36
|
20.61
|
561
|
17.92
|
Medium |
78
|
23.76
|
2,314
|
21.03
|
Heavy |
22
|
31.41
|
514
|
29.40
|
Obese |
--
|
--
|
15
|
45.53
|
Weeks in captivity |
136
|
24.16
|
3,404
|
21.89
|
0-9 |
11
|
22.36
|
121
|
20.21
|
10-19 |
3
|
33.67
|
40
|
17.35
|
20-29 |
12
|
22.00
|
40
|
19.95
|
30-49 |
6
|
29.50
|
115
|
24.46
|
50-99 |
17
|
20.88
|
282
|
23.39
|
100-199 |
87
|
24.63
|
2,803
|
21.98
|
Not reported |
--
|
--
|
--
|
14.67
|
89
Table 83.- Number and percent of wounded in action by anatomical location of wound, U.S. military repatriated prisoners of war, Korea
Anatomical location | Total | Operation Little Switch | Operation Big Switch | |||
Number | % | Number | % | Number | % | |
All body regions |
2,351
|
100.0
|
145
|
100.0
|
2,206
|
100.0
|
Head |
512
|
21.8
|
29
|
20.0
|
483
|
21.9
|
Chest |
95
|
4.0
|
13
|
8.9
|
82
|
3.7
|
Abdomen |
42
|
1.8
|
3
|
2.1
|
39
|
1.8
|
Back |
257
|
10.9
|
11
|
7.6
|
246
|
11.1
|
Extremities |
1,445
|
61.5
|
89
|
61.4
|
1,356
|
61.5
|
conditions noted, conjunctival changes showed the highest relative proportions. Gingivitis, bleeding, had the highest, proportional ratio for lip and mouth conditions, with no other diagnosis showing any appreciable amount in total. During Operation Little Switch, however, atrophy-papilla of tongue was the leading mouth condition diagnosed, amounting to one-third of the conditions found and representing a ratio of 8 percent of all the prisoners exchanged during Operation Little Switch.
Only 12 prisoners had malaria, all of whom were exchanged during Operation Big Switch. Six were diagnosed as falciparum, five as vivax, and one as malariae. The results of chest X-ray examinations (table 87) show more than 90 percent of the exchanged prisoners with no pathology. This proportion was smaller during Operation Little Switch, of course, because the very nature of the prisoners' condition qualified them for inclusion in the first exchange. In total, however, fewer than 2 percent of all prisoners had active tuberculosis and about equal proportions, or less, showed any other form of lung pathology.
Examination of the skin and body surface (table 88) showed 78 percent of all of the prisoners had no skin abnormality; in Operation Little Switch, however, only 48 percent were, free of any skin conditions. Of all prisoners with skin conditions, 56 percent had dermatophytosis, 8 percent had acne, and 6 percent had follicular hyperkeratosis. Of those with skin conditions who were exchanged during Operation Little Switch, 41 percent had follicular hyperkeratosis, 11 percent had dermatophytosis, and 10 percent had acne.
Stool cultures among prisoners exchanged during Little Switch showed shigella in seven cases and no pathogens in 127 cases; no reports were furnished for the remaining 13 who were exchanged. For Operation Big Switch, stool cultures produced shigella in 14 cases, salmonella in three cases, and no pathogens in 1,995 cases. No report was received for 1,120 cases, and 454 were stated as "other" unspecified. Table 89 presents the associated data on the results of stool examinations among repatriated prisoners of war. Two-fifths of all prisoners were found to harbor parasites. This figure was almost two-thirds for those exchanged during Operation Little Switch compared to 38 percent for Big Switch. The following various parasites were found: 59 percent ascaris, 8 percent amebae, and 7 percent hookworms. Twenty-five percent were not specified as to type. The only large proportional differences between the two prisoner exchanges were the higher ratios during Operation Little Switch for amebae (16 percent) and hookworms (11 percent) compared to 7 percent each for Operation Big Switch, and the lower proportion for ascaris (43 percent) compared to 61 percent among prisoners exchanged in Operation Big Switch.
Table 84.- Number and percent with surgical operations, U.S. military U.S. military repatriated prisoners of war, Korea
Surgical operation | Total | Operation Little Switch | Operation Big Switch | |||||
Number | % | Number | % | Number | % | |||
Total with surgery | 618 |
100.0
|
83
|
100.0
|
535
|
100.0
|
||
Amputation, major | 11 |
1.8
|
9
|
10.8
|
2
|
0.4
|
||
One lower extremity | 5 |
0.8
|
3
|
3.6
|
2
|
0.4
|
||
Both lower extremities | 3 |
0.5
|
3
|
3.6
|
--
|
--
|
||
One extremity, not stated | 3 |
0.5
|
3
|
3.6
|
--
|
--
|
||
Amputation, fingers or toes | 54 |
8.7
|
11
|
13.3
|
43
|
8.0
|
||
Removal of foreign body | 109 |
17.6
|
16
|
19.3
|
93
|
17.4
|
||
All other operations | 444 |
71.9
|
47 |
56.6
|
397
|
74.2 |
90
Table 85.- Number and percent of results of psychiatric examinations, medical survey of U.S. military repatriated prisoners of war, Korea
Results of examinations | Total | Operation Little Switch |
Operation Big Switch |
|||
Number | % | Number | % | Number | % | |
Total diagnoses |
3,743
|
100.0
|
147
|
100.0
|
3,596
|
100.0
|
Good mental health and morale |
3,073
|
82.1
|
120
|
81.7
|
2,953
|
82.1
|
Psychoses |
37
|
1.0
|
3
|
2.0
|
34
|
0.9
|
Psychoneuroses |
267
|
7.1
|
8
|
5.4
|
259
|
7.2
|
Character and behavior disorders |
219
|
5.8
|
7
|
4.8
|
212
|
5.9
|
Mental deficiency |
33
|
0.9
|
4
|
2.7
|
29
|
0.8
|
Transient personality disorders |
112
|
3.0
|
5
|
3.4
|
107
|
3.0
|
Other or not reported |
2
|
0.1
|
--
|
--
|
2
|
0.1
|
Table 86.- Number and percent of results of eye, lip, and mouth medical survey of U.S. military repatriated prisoners of war, Korea
Results of examinations | Total | Operation Little Switch |
Operation Big Switch |
|||
Number | % | Number | % | Number | % | |
Eye conditions | ||||||
Total diagnoses |
3,745
|
100.0
|
148
|
100.0
|
3,597
|
100.0
|
No abnormality found |
3,298
|
88.0
|
114
|
77.0
|
3,184
|
88.5
|
Scleral changes |
26
|
0.7
|
2
|
1.4
|
24
|
0.7
|
Corneal changes |
19
|
0.5
|
1
|
0.7
|
18
|
0.5
|
Conjunctival changes |
55
|
1.5
|
5
|
3.4
|
50
|
1.4
|
Other or not reported |
347
|
9.3
|
26
|
17.5
|
321
|
8.9
|
Lip and mouth conditions | ||||||
Total diagnoses |
3,764
|
100.0
|
154
|
100.0
|
3,610
|
100.0
|
No abnormality found |
3,315
|
88.0
|
Ill.
|
7510
|
3,204
|
$817
|
Cyanosis |
5
|
0.1
|
1
|
0.7
|
4
|
0.1
|
Pallor |
11
|
0.3
|
1
|
0.7
|
10
|
0.3
|
Cheilosis |
27
|
0.7
|
2
|
1.3
|
25
|
0.7
|
Angular features |
18
|
0.5
|
5
|
3.2
|
13
|
0.4
|
Pellagrous glossitis |
3
|
0.1
|
2
|
1.3
|
1
|
0.0
|
Atrophy, papilla of tongue |
37
|
1.0
|
12
|
7.8
|
25
|
0.7
|
Gingivitis, bleeding |
89
|
2.4
|
8
|
5.2
|
81
|
2.2
|
Tonsillar exudate or membrane |
14
|
0.4
|
1
|
0.7
|
13
|
0.4
|
Other or not reported |
245
|
6.5
|
11
|
7.1
|
234
|
6.5
|
Table 87.- Number and percent of results of chest X-ray examinations, U.S. military repatriated prisoners of war, Korea
Results of examinations | Total | Operation Little Switch |
Operation Big switch |
|||
Number | % | Number | % | Number | % | |
Total diagnoses |
3,743
|
100.0
|
147
|
100.0
|
3,596
|
100.0
|
Negative results |
3,454
|
92.2
|
115
|
78.2
|
3,339
|
92.9
|
Active tuberculosis |
58
|
1.5
|
7
|
4.8
|
51
|
1.4
|
Arrested tuberculosis |
7
|
0.2
|
1
|
0.7
|
6
|
0.2
|
Other lung pathology |
70
|
1.9
|
9
|
6.1
|
61
|
1.7
|
Retained foreign body |
25
|
0.7
|
6
|
4.1
|
19
|
0.5
|
Other pathology |
93
|
2.5
|
9
|
6.1
|
84
|
2.3
|
Not reported |
36
|
1.0
|
--
|
--
|
36
|
1.0
|
91
Table 88.- Number and percent of results of skin examinations, medical survey of U.S. military repatriated prisoners of war, Korea
Results of examination | Total | Operation Little Switch |
Operation Big Switch |
|||
Number | % | Number | % | Number | % | |
No abnormality found |
2,903
|
77.7
|
71
|
48.3
|
2,832
|
79.0
|
Individuals with skin conditions |
827
|
22.2
|
76
|
51.7
|
751
|
20.9
|
Not reported |
2
|
0.1
|
--
|
--
|
2
|
0.1
|
Skin conditions found |
892
|
100.0
|
91
|
100.0
|
801
|
100.0
|
Follicular hyperkeratosis |
56
|
6.3
|
37
|
40.6
|
19
|
2.4
|
Petechia |
1
|
0.1
|
1
|
1.1
|
--
|
--
|
Purpura |
1
|
0.1
|
--
|
--
|
1
|
0.1
|
Pellagrous dermatitis |
1
|
0.1
|
--
|
--
|
1
|
0.1
|
Ulcers, extensive |
6
|
0.7
|
--
|
--
|
6
|
0.7
|
Dermatophytosis |
502
|
56.3
|
10
|
11.0
|
492
|
61.5
|
Acne, any form |
74
|
8.3
|
9
|
9.9
|
65
|
8.1
|
Other skin disorders, not specified |
251
|
28.1
|
34
|
37.4
|
217
|
27.1
|
It is possible to estimate bed requirements on the basis of a series of probability values for patients remaining in hospital, by type of patient, or to estimate various types of disposition from hospital, as a function of time after the day of admission to hospital. These patient remaining and disposition distributions are commonly referred to as "curves" although, in the mathematical sense, they are but collections of discrete probabilities. Although the general properties of remaining and disposition curves, in this connotation, are well documented beginning with Love's study (13) on World War I casualties and later by Beebe and DeBakey (14) on World War II data, full potential of this knowledge was never applied to the complete interplay of requirements for fixed versus nonfixed facilities overseas. Beebe and DeBakey recognized the importance of considering the characteristics of the entire system and emphasized its benefits when applied to estimating bed requirements in forward or combat areas occupied by held armies. Their approach essentially involved the summation of the daily values comprising the remaining curve to determine the total accumulation of patients through a stated number of days (usually the number of the days in the theater evacuation policy) reduced by that proportion evacuated from the army area or theater. This adjustment was determined by assuming a fixed number of hospital days in the army area for evacuees and the length of time in days for the latter adjustment was necessarily arbitrary. Although Beebe and DeBakey recognized that patients are evacuated over time in keeping with various probability distributions, nevertheless, to further simplify computational procedures, they assumed all patients were hospitalized for the same number of days before evacuation; that is, if the last day hospitalized in
Table 89.- Number and percent of results of stool examinations, medical survey of U.S. military repatriated prisoners of war, Korea
Results of examinations | Total | Operation Little Switch |
Operation Big Switch |
|||
Number | % | Number | % | Number | % | |
No parasite or not reported |
2,285
|
61.2
|
55
|
37.4
|
2,230
|
62.2
|
Individuals with parasites |
1,447
|
38.8
|
92
|
62.6
|
1,355
|
37.8
|
Parasites found |
1,733
|
100.0
|
137
|
100.0
|
1,596
|
100.0
|
Amebae |
141
|
8.1
|
22
|
16.1
|
119
|
7.5
|
Ascaris |
1,026
|
59.2
|
59
|
43.1
|
967
|
60.6
|
Hookworm |
124
|
7.2
|
15
|
10.9
|
109
|
6.8
|
Pinworm |
2
|
0.1
|
1
|
0.7
|
1
|
0.1
|
Tapeworm |
4
|
0.2
|
--
|
--
|
4
|
0.2
|
Other, not specified |
436
|
25.2
|
40
|
29.2
|
396
|
24.8
|
92
the army area was 6 days, then no patient was evacuated before or after 6 days of hospitalization. This approach was similar to that used at the time by the Army Medical Department for estimating fixed bed requirements, the assumption being that a constant time to evacuation for all patients was valid for all evacuation policies. Thus, estimates for fixed beds were based on patient accumulations through the number of days in the stated evacuation policy, with no differences occurring in either overseas theater or CONUS (continental United States) patient accumulation between evacuation policies, until the length of days in a stated evacuation policy was reached. One result of this method was to develop an accumulation factor, or accumulation of patients remaining, after any number of days which was identical for the same number of days, regardless of the length of the theater evacuation policy. For example, the theater accumulation factor was the same at 5, 10, or 20 days for a 30-day evacuation policy as it was for a 60-, 90-, or 120-day evacuation policy. Similarly, the theater factors at 30 or 60 days were, identical whether the evacuation policy was 60, 90, or 120 days (15). Beebe and DeBakey recognized this limitation and advanced their theory for evacuating all patients (who would eventually require evacuation) after a fixed number of hospital days. This latter period of time was referred to as the "evacuation schedule" and was to be restricted to an estimate of the number of days before patients became transportable. The selection of any number of days as a fixed period of hospitalization, however, produces the same effect through that number of days, regardless of how short the period of time considered.
This deficiency was later overcome by the present author as applied to fixed bed accumulation factors, with the introduction of a distinctive set of evacuation probabilities for certain specified evacuation policies. These evacuee "curves" were derived by relating the number of days spent in overseas theater hospitals before evacuation to the eventual total days hospitalized for patients, by type, ultimately discharged in continental United States. Using this methodology, it was also possible to subdivide the remaining curve based upon the theoretical limitations established by the criteria for each respective evacuation policy, as it related to those patients whose eventual final disposition exceeded these limitations. Using the same methodology, it was also possible to develop similar curves for each separate type of final disposition. By summation of various portions of the remaining, evacuation, and disposition curves and through appropriate computation of these sums, it is possible to derive accumulation-decumulation factors. These factors permit time-phased estimations of dispositions among a group of patients arising from constant daily, admissions up to a point in time, after which no further admissions occur. The accumulation-decumulation factors derived from World War II and Korean War experience are current doctrine (16) for estimating fixed bed requirements and patient dispositions, but, despite Beebe and DeBakey's foresight, no further effort had been made to apply similar techniques to the estimation of mobile bed nonfixed requirements. One reason, of course, was official policy which dictated requirements for nonfixed beds be based on a basis of allocation; that is, one 60-bed surgical and two 200-bed evacuation hospitals per each division supported.
The probability data for patients remaining, included in appendix C, are based on the disposition of
1950-53 wounded admissions in Korea, (table C-1) and on the dispositions of 1950-53 disease and nonbattle
injury admissions in all overseas areas (table C-2). These remaining figures are estimates of the
probabilities that any one patient will require a hospital bed anywhere (mobile, fixed, theater, or CONUS)
through the indicated number of day's after initial admission. These probabilities are called remaining
factors and are, as a matter of convenience, referred to as a remaining "curve." From the properties of
probability, it may be seen that summation of the remaining curve from day
one through day n yields the average duration of
hospitalization to date (day n) for patients admitted on day one. These sums are also called accumulation
factors for the expected numbers of patients (based on an admission of one per day) remaining in hospital
anywhere at the end of specified number of days. To adjust these total accumulations to account for
evacuations, evacuee factors must be utilized. The basic data for those factors are included in appendix
table C-3 for wounded patients and in table C-4 , for disease and nonbattle injury patients, for specified
evacuation policies.
93
Figure 13.- Accumulation and accumulation-decumulation of wounded hospital admissions, U.S. Army, Korea, 1950-53, converted to one patient per day.
94
These daily evacuation rates are based on the average number of days overseas before evacuation as reported on the individual evacuee report card (12) related to the total days of hospitalization to final disposition as reported on the individual medical record (4) for the same patient. These ratios have been fitted to the respective remaining probability curve based on the theoretical limitations which define the parameters for each separate evacuation policy. The evacuee factors developed from these data, therefore, are applicable only to those patients admitted overseas and to whom the eventual final disposition is either a disability separation, or, which exceeds a specified number of hospital days as stated by the respective evacuation policy.
Estimates of patient accumulations are usually made to coincide with certain specified periods of time. The intervals between these time-periods are referred to as periods of estimate and usually are of equal lengths of time. For planning purposes, the typical periods of estimate are stated in intervals of 30 days. For any period of estimate, however, and for any length of evacuation policy, it is possible to develop factors for estimating patient accumulation and disposition, based on the overall duration of stay anywhere and the duration of stay before evacuation. When a group of patients are accumulated from constant daily admissions up to a stated point in time and then decumulated through estimated dispositions over intervals of time, the resultant figures are referred to as accumulation-decumulation factors. Figure 13 provides a graphical description of both the accumulation and accumulation-decumulation process. A more complete description, however, is provided in appendix A.
The remaining curve essentially presents the probability of patients' remaining in hospital anywhere, as a function of time after the day of admission to hospital. Patients remaining, therefore, are but one of a set of distribution functions. Besides patients remaining, the various types of disposition overseas are duty, death, and evacuation. These various distributions apply to both field army and to COMMZ (Communications Zone) of overseas theaters. Theater evacuation to CONUS converts into a patient remaining category for overseas admissions hospitalized in CONUS, in addition to disability separations which are considered only at that echelon.
The shifting of patients remaining by echelon, as the remaining curve is subdivided, may be visualized from figure 14. That segment of the remaining curve (R) through point (fN ) indicates patients remaining anywhere through the number of days of the field army evacuation, policy (f). The curve Rf indicates the proportion who are remaining in field army nonfixed beds through the number of days of the field army evacuation policy (f). And the curve OA represents the proportion remaining in theater fixed beds, while the curve OB represents the proportion remaining in CONUS fixed beds through the same number of days (f). The segment of the remaining curve fN pN represents patients remaining anywhere, between the number of days of the field army evacuation policy (f) and the length of days of the theater evacuation policy (p). The curve Ap indicates the proportion who are remaining in theater fixed beds during this period while the curve BpN indicates the proportion in CONUS fixed beds. The balance of the remaining curve (pN Ri), following the number of days of the theater evacuation policy (p), represents only evacuee patients remaining in CONUS fixed beds. The respective proportions represented by curves OA and OpN are developed from patient evacuation curves for varying lengths of evacuation policy (see figure 15 for wounded patients) and can be applied either to the field army or to overseas. theaters, or to both.
Although accumulation-decumulation factors for the field army area can be derived for any number of days included in a field army evacuation policy (see appendix A), those selected for inclusion in table 90 are limited to policies ranging from 5 to 10 days. Since the same methodology applies to any overseas area, however, factors for the theater evacuation policies of 15, 20, and 30 days could apply equally as well to the field army area, if evacuation policies of these respective lengths were assigned to field armies in relatively fixed situations. However, for all mobile situations where the field army evacuation policy exceeds 9 days, the standardized factors for 10 days and over should apply. The reason is that, although patients may be transportable for evacuation within the theater, they
95
Figure 14.- Subdivisions of the remaining curve, by echelon of hospitalization.
96
Figure 15.- Percentage of wounded hospital admissions evacuated, by length of evacuation policy, U.S. Army, Korea, 1950-53.
97
Table 90.-Field Army accumulation-decumulation factors, by type of case, and
specified evacuation policies
[Based on hospital admission of one per day for 30 days, then decumulation]
Evacuation policy and period of estimate |
Admissions to hospital | |||||||
Wounded in action | Disease and nonbattle injury | |||||||
Evacuees | Duty | Death | Remaining | Evacuees | Duty | Death | Remaining | |
5-day: | ||||||||
1-30 |
25.25
|
0.98
|
0.32
|
3.45
|
22.17
|
5.72
|
0.03
|
2.08
|
31-60 |
3.33
|
0.10
|
0.02
|
0
|
1.49
|
0.58
|
0.01
|
0
|
Total |
28.58
|
1.08
|
0.34
|
0
|
23.66
|
6.30
|
0.04
|
0
|
6-day: | ||||||||
1-30 |
24.13
|
1.30
|
0.34
|
4.23
|
19.86
|
7.28
|
0.04
|
2.82
|
31-60 |
4.04
|
0.17
|
0.02
|
0
|
1.93
|
0.89
|
0
|
0
|
Total |
28.17
|
1.47
|
0.36
|
0
|
21.79
|
8.17
|
0.04
|
0
|
7-day: | ||||||||
1-30 |
22.97
|
1.64
|
0.36
|
5.13
|
17.78
|
8.63
|
0.04
|
3.55
|
31-60 |
4.86
|
0.25
|
0.02
|
0
|
2.31
|
1.24
|
0
|
0
|
Total |
27.73
|
1.89
|
0.38
|
0
|
20.09
|
9.86
|
0.04
|
0
|
8-day | ||||||||
1-30 |
21.90
|
1.91
|
0.37
|
5.82
|
15.80
|
10.02
|
0.04
|
3.55
|
31-60 |
5.45
|
0.34
|
0.03
|
0
|
2.48
|
1.66
|
0
|
0
|
Total |
27.35
|
2.25
|
0.40
|
0
|
18.28
|
11.68
|
0.04
|
0
|
9-day | ||||||||
1-30 |
21.00
|
2.18
|
0.38
|
6.44
|
14.06
|
11.13
|
0.05
|
4.76
|
31-60 |
5.98
|
0.43
|
0.03
|
0
|
2.70
|
2.06
|
0
|
0
|
Total |
26.98
|
2.61
|
0.41
|
0
|
16.76
|
13.19
|
0.05
|
0
|
10-day and over: | ||||||||
1-30 |
20.14
|
2.42
|
0.38
|
7.06
|
12.65
|
11.99
|
0.05
|
5.31
|
31-60 |
6.48
|
0.54
|
0.04
|
0
|
2.88
|
2.43
|
0
|
0
|
Total |
26.62
|
2.96
|
0.42
|
0
|
15.53
|
14.42
|
0.05
|
0
|
5- to 10-day: | ||||||||
1-30 |
25.25
|
0.98
|
0.32
|
3.45
|
22.17
|
5.72
|
0.03
|
2.08
|
31-60 |
3.10
|
0.32
|
0.03
|
0
|
0.98
|
1.09
|
0.01
|
0
|
Total |
28.35
|
1.30
|
0.35
|
0
|
23.15
|
6.81
|
0.04
|
0
|
are not necessarily transportable for evacuation out of theater within the same number of days for the respective longer evacuation policies. Usually, one might expect the field army area to operate under a 5- or 6-day evacuation policy and the overseas theater to operate under the 15-, 20-, 30-day, or longer, theater evacuation policies. Tables 90 and 91 present the various remaining and disposition factors for wounded and disease and nonbattle injury, respectively, based on an accumulation of one admission per day for 30 days (period of estimate) and subsequent decumulation, by type of disposition, to zero. Since patients are accumulated through 30 days, there are patients accumulated and remaining in hospital at day 30 for each of the short evacuation policies. However, patients are decumulated to zero through some form of disposition by day (d+p-1) which would be day 34 where the evacuation policy (p) was 5 days and the period of estimate (d) was 30 days. For evacuation, policies longer than the number of days in the period of estimate (p>d), patients accumulated through 30 days could theoretically remain up to 59 days for duty under a 30-day evacuation policy, approaching zero at 60 days; remain up to 89 days for duty under a 60-day evacuation, policy, approaching zero at 90 days; remain up to 119 days for duty under a 90-day evacuation policy, approaching zero at 120 days; and so forth. Since these factors are based on patients remaining and
98
Table 91.- Theater accumulation-decumulation factors, by type of case, and
specified evacuation policies
[Based on hospital admission of one per day for 30 days, then decumulation]
Evacuation policy and period of estimate |
Admissions to hospital | ||||||||
Wounded in action | Disease and nonbattle injury | ||||||||
Evacuees | Duty | Death | Remaining | Evacuees | Duty | Death | Remaining | ||
15-day: | |||||||||
1-30 |
16.71
|
3.36
|
0.40
|
9.53
|
7.94
|
14.53
|
0.05
|
7.48
|
|
31-60 |
8.32
|
1.16
|
0.05
|
0
|
3.41
|
4.07
|
0
|
0
|
|
Total |
25.03
|
4.52
|
0.45
|
0
|
11.35
|
18.60
|
0.05
|
0
|
|
20-day: | |||||||||
1-30 |
13.83
|
4.08
|
0.41
|
11.68
|
5.38
|
15.65
|
0.05
|
8.92
|
|
31-60 |
9.51
|
2.11
|
0.06
|
0
|
3.43
|
5.49
|
0
|
0
|
|
Total |
23.34
|
6.19
|
0.47
|
0
|
8.81
|
21.14
|
0.05
|
0
|
|
30-day: | |||||||||
1-30 |
9.87
|
4.66
|
0.41
|
15.06
|
2.91
|
16.19
|
0.05
|
10.85
|
|
31-60 |
10.40
|
4.59
|
0.07
|
0
|
3.22
|
7.62
|
0.01
|
0
|
|
Total |
20.27
|
9.25
|
0.48
|
0
|
6.13
|
23.81
|
0.06
|
0
|
|
60-day: | |||||||||
1-30 |
4.42
|
4.66
|
0.41
|
20.51
|
0.76
|
16.19
|
0.05
|
13.00
|
|
31-60 |
7.44
|
8.56
|
0.08
|
4.43
|
1.73
|
9.59
|
0.01
|
1.67
|
|
61-90 |
1.34
|
3.09
|
0
|
0
|
0.42
|
1.25
|
0
|
0
|
|
Total |
13.20
|
16.31
|
0.49
|
0
|
2.91
|
27.03
|
0.06
|
0
|
|
90-day: | |||||||||
1-30 |
2.73
|
4.66
|
0.41
|
22.20
|
0.34
|
16.19
|
0.05
|
13.42
|
|
31-60 |
5.03
|
8.56
|
0.08
|
8.53
|
0.86
|
9.59
|
0.01
|
2.96
|
|
61-90 |
1.59
|
5.09
|
0.02
|
1.83
|
0.41
|
1.97
|
0
|
0.58
|
|
91-120 |
0.32
|
1.50
|
0.01
|
0
|
0.08
|
0.50
|
0
|
0
|
|
Total |
9.67
|
19.81
|
0.52
|
0
|
1.70
|
28.25
|
0.06
|
0
|
|
120-day | |||||||||
1-30 |
2.06
|
4.66
|
0.41
|
22.87
|
0.23
|
16.19
|
0.05
|
13.53
|
|
31-60 |
3.90
|
8.56
|
0.08
|
10.33
|
0.56
|
9.59
|
0.01
|
3.37
|
|
61-90 |
1.33
|
5.09
|
0.02
|
3.89
|
0.26
|
1.97
|
0
|
1.14
|
|
91-120 |
0.43
|
2.56
|
0.01
|
0.89
|
0.08
|
0.81
|
0
|
0.25
|
|
121-150 |
0.10
|
0.79
|
0
|
0
|
0.02
|
0.23
|
0
|
0
|
|
Total |
7.82
|
21.66
|
0.52
|
0
|
1.15
|
28.79
|
0.06
|
0
|
|
15- to 30-day | |||||||||
1-30 |
16.71
|
3.36
|
0.40
|
9.53
|
7.94
|
14.53
|
0.05
|
7.48
|
|
31-60 |
6.74
|
2.73
|
0.06
|
0
|
1.84
|
5.64
|
0
|
0
|
|
Total |
23.45
|
6.09
|
0.46
|
0
|
9.78
|
20.17
|
0.05
|
0
|
|
20- to 60-day | |||||||||
1-30 |
13.83
|
4.08
|
0.41
|
11.68
|
5.38
|
15.65
|
0.05
|
8.92
|
|
31-60 |
4.56
|
4.90
|
0.07
|
2.15
|
0.92
|
7.25
|
0
|
0.75
|
|
61-90 |
0.82
|
1.33
|
0
|
0
|
0.22
|
0.53
|
0
|
0
|
|
Total |
19.21
|
10.31
|
0.48
|
0
|
6.52
|
23.43
|
0.05
|
0
|
|
30- to 60-day: | |||||||||
1-30 |
9.87
|
4.66
|
0.41
|
15.06
|
2.91
|
16.19
|
0.05
|
10.85
|
|
31-60 |
5.74
|
6.63
|
0.08
|
2.61
|
1.23
|
8.65
|
0.01
|
0.96
|
|
61-90 |
1.03
|
1.58
|
0
|
0
|
0.30
|
0.66
|
0
|
0
|
|
Total |
16.64
|
12.87
|
0.49
|
0
|
4.44
|
25.50
|
0.06
|
0
|
99
Table 92.- Accumulation-decumulation factors for wounded patients by echelon, for
a 5-day Army and 30-day theater evacuation policy
[Based on hospital admission of one per day for 30 days, then decumulation]
Echelon | Evacuation policy |
Evacuees | Duty | Death | Remaining accumulation- decumulation |
Total |
1-30 days of estimate: | ||||||
Theater |
30-day
|
9.87
|
4.66
|
0.41
|
15.06
|
30.00
|
Army |
5-day
|
(25.25)
|
0.98
|
0.32
|
3.45
|
30.00
|
COMMZ |
--
|
9.87
|
3.68
|
0.09
|
11.61
|
25.25
|
30-60 days of estimate: | ||||||
Theater |
30-day
|
10.40
|
4.59
|
0.07
|
0
|
15.06
|
Army |
5-day
|
(3.33)
|
0.10
|
0.02
|
0
|
3.45
|
COMMZ |
--
|
10.40
|
4.49
|
0.05
|
0
|
11.61
|
patient dispositions at all U.S. Army hospitals worldwide for an admission originating overseas, and the theater evacuation policy includes all hospital days lost in theater, it is possible to obtain factors for COMMZ fixed bed requirements for those patients admitted in and evacuated from the field army area, by subtraction from the respective overseas theater factors. For example, under a 5-day field army evacuation policy (f=5) and a 30-day theater evacuation policy (p=30), based on one admission per day through day 30-then none, the COMMZ factors for patients wounded in tire field army area taken from tables (90 and 91 are shown in table 92.
It will be noted that the total dispositions for COMMZ equal the number of evacuees received from the field army. Assuming constant daily admissions, these factors for wounded patients indicate the field army would require 3.45 times the number of daily wounded admissions plus dispersion in nonfixed beds for wounded patients; COMMZ would require 11.61 times the number of daily wounded admissions in the field army, plus dispersion, in fixed beds for field army wounded evacuees, plus 15.06 times the daily number of wounded patients initially admitted to COMMZ hospitals, plus dispersion. The same process can be repeated for DNBI patients to obtain total nonfixed as well as fixed bed requirements in an overseas theater of operations. To convert these factors into percentages per month, it is only necessary to multiply by 100 and to divide by 30. For example, the total wounded evacuated of 28.58 under a 5-day evacuation policy, converts to 95.27 percent, which may be read directly from the patients remaining column as shown in appendix table C-1 at day 5.
It is also possible to skip intermediate echelons of hospitalization by direct evacuation of any desired proportion of those patients who are identified as eventual evacuees from the skipped echelons. For example, if 60 percent of those patients scheduled for transfer to COMMZ (and who would later require evacuation to CONUS from COMMZ) were evacuated directly to CONUS from the Field Army, the figures shown in table 92 for COMMZ evacuees would be changed from 9.87 and 10.40 to 3.95 and 4.16, respectively, the latter two figures being 40 percent of the former two. The patients remaining figure of 11.61, as shown, changes to 6.79 and is derived by subtracting the respective smaller proportion requiring evacuation and the respective COMMZ duty and death dispositions (which are unchanged), by days of estimate, from the smaller proportions of evacuees received in COMMZ from the Field Army. These latter figures are computed by applying the desired percentage for direct evacuation (60 percent) to that proportion requiring eventual evacuation from COMMZ under a 30-day evacuation policy in this example. Table 91 indicates a total of 20.27 wounded require eventual evacuation under a 30-day evacuation policy; 60 percent of this figure shows a product of 12.16 for direct evacuation to CONUS. Since the Field Army is under a 5-day evacuation policy, the, figure of 12.16 direct evacuation must be scheduled out of theater at the rate of evacuation for the 5-day policy (see appendix A for evacuation where p<d) and, in this example, is 10.74 during the first period of estimate (1-30 days) and 1.42 during the second carryover (31-60 days). Under
100
Table 93.- CONUS accumulation-decumulation factors, by type of case, and specified
evacuation policies
[Based on hospital admission of one per day for 30 days, then decumulation]
Evacuation policy and period of estimate |
Admissions to hospital | |||||||
Wounded in action | Disease and nonbattle injury | |||||||
Duty | Death | Disability separation |
Remaining accumulation- decumulation |
Duty | Death | Disability separation |
Remaining accumulation- decumulation |
|
15-day: | ||||||||
1-30 |
1.30
|
0.01
|
0
|
15.40
|
1.66
|
0
|
0
|
6.28
|
31-60 |
7.40
|
0.03
|
0
|
16.29
|
5.52
|
0.01
|
0
|
4.16
|
61-90 |
5.09
|
0.01
|
0.01
|
11.18
|
1.97
|
0
|
0.02
|
2.17
|
20-day: | ||||||||
1-30 |
0.57
|
0.01
|
0
|
13.25
|
0.54
|
0
|
0
|
4.84
|
31-60 |
6.45
|
0.02
|
0
|
16.29
|
4.10
|
0.01
|
0
|
4.16
|
61-90 |
5.09
|
0.01
|
0.01
|
11.18
|
1.97
|
0
|
0.02
|
2.17
|
30-day: | ||||||||
1-30 |
0
|
0
|
0
|
9.87
|
0
|
0
|
0
|
2.91
|
31-60 |
3.97
|
0.01
|
0
|
16.29
|
1.97
|
0
|
0
|
4.16
|
61-90 |
5.09
|
0.01
|
0.01
|
11.18
|
1.97
|
0
|
0.02
|
2.17
|
60-day: | ||||||||
1-30 |
0
|
0
|
0
|
4.42
|
0
|
0
|
0
|
0.76
|
31-60 |
0
|
0
|
0
|
11.86
|
0
|
0
|
0
|
2.49
|
61-90 |
2.01
|
0
|
0.01
|
11.18
|
0.72
|
0
|
0.02
|
2.17
|
91-120 |
2.57
|
0
|
0.04
|
8.57
|
0.81
|
0
|
0.03
|
1.33
|
90-day: | ||||||||
1-30 |
0
|
0
|
0
|
2.73
|
0
|
0
|
0
|
0.34
|
31-60 |
0
|
0
|
0
|
7.76
|
0
|
0
|
0
|
1.20
|
61-90 |
0
|
0
|
0.01
|
9.35
|
0
|
0
|
0.02
|
1.03
|
91-120 |
1.06
|
0
|
0.04
|
8.57
|
0.31
|
0
|
0.03
|
1.33
|
121-150 |
1.48
|
0
|
0.08
|
7.01
|
0.39
|
0.01
|
0.04
|
0.89
|
120-day: | ||||||||
1-30 |
0
|
0
|
0
|
2.06
|
0
|
0
|
0
|
0.23
|
31-60 |
0
|
0
|
0
|
5.96
|
0
|
0
|
0
|
0.79
|
61-90 |
0
|
0
|
0.01
|
7.28
|
0
|
0
|
0.02
|
1.03
|
91-120 |
0
|
0
|
0.04
|
7.67
|
0
|
0
|
0.03
|
1.08
|
121-150 |
0.68
|
0
|
0.08
|
7.01
|
0.16
|
0.01
|
0.04
|
0.89
|
All policies: | ||||||||
180 |
1.08
|
0
|
0.10
|
5.83
|
0.22
|
0
|
0.04
|
0.63
|
210 |
0.76
|
0
|
0.13
|
4.94
|
0.13
|
0.01
|
0.04
|
0.45
|
240 |
0.57
|
0
|
0.16
|
4.21
|
0.08
|
0
|
0.04
|
0.33
|
270 |
0.43
|
0
|
0.20
|
3.58
|
0.05
|
0.01
|
0.04
|
0.23
|
300 |
0.33
|
0
|
0.21
|
3.04
|
0.04
|
0
|
0.03
|
0.16
|
330 |
0.25
|
0
|
0.23
|
2.56
|
0.02
|
0
|
0.02
|
0.12
|
360 |
0.19
|
0
|
0.22
|
2.15
|
0.01
|
0
|
0.02
|
0.09
|
390 |
0.15
|
0
|
0.21
|
1.79
|
0.01
|
0
|
0.01
|
0.07
|
420 |
0.11
|
0
|
0.19
|
1.49
|
0.01
|
0
|
0.01
|
0.05
|
450 |
0.09
|
0
|
0.17
|
1.23
|
0
|
0
|
0.01
|
0.04
|
480 |
0.07
|
0
|
0.14
|
1.02
|
0
|
0
|
0.01
|
0.03
|
510 and over |
0.25
|
0
|
0.77
|
0
|
0
|
0
|
0.03
|
0
|
15- to 30-day: | ||||||||
31-60 |
5.83
|
0.02
|
0
|
16.29
|
3.95
|
0.01
|
0
|
4.16
|
61-90 |
5.09
|
0.01
|
0.01
|
11.18
|
1.97
|
0
|
0.02
|
2.17
|
20- to 60-day: | ||||||||
31-60 |
3.66
|
0.01
|
0
|
14.14
|
2.34
|
0.01
|
0
|
3.41
|
61-90 |
3.76
|
0.01
|
0.01
|
11.18
|
1.44
|
0
|
0.02
|
2.17
|
91-120 |
2.57
|
0
|
0.04
|
8.57
|
0.81
|
0
|
0.03
|
1.33
|
30- to 60-day: | ||||||||
31-60 |
1.93
|
0
|
0
|
13.68
|
0.94
|
0
|
0
|
3.20
|
61-90 |
3.51
|
0.01
|
0.01
|
11.18
|
1.31
|
0
|
0.02
|
2.17
|
91-120 |
2.57
|
0
|
0.04
|
8.57
|
0.81
|
0
|
0.03
|
1.33
|
this skip policy of 60 percent for wounded patients, COMMZ would receive 14.51 evacuees during the first period of estimate (25.25 as shown in table 92 less 10.74 direct evacuees to CONUS) and 1.91 during the second period (3.33 less 1.42). When the respective dispositions are subtracted (3.95 evacuees, 3.68 duty, and 0.09 death) from 14.51, the COMMZ remaining figure of 6.79 is derived. The subtraction of the second-period COMMZ dispositions (4.16 evacuees, 4.49 duty, and 0.05 death) from 1.91 second-period evacuees from Field Army added to the 6.79 COMMZ remaining figure, equals zero (0) remaining in COMM at the end of the second period.
101
Skipping routines may be applied in different proportions for different types of patients and also may be changed from one period of estimate to another. It is necessary to apply the desired proportion only to those patients on hand who will require eventual evacuation from the echelon of hospitalization to be skipped.
Patients, who are admitted overseas and whose estimated period of hospitalization to eventual final disposition exceeds the permissible length of time established by the respective theater evacuation policy, are evacuated to CONUS hospitals as soon as their condition permits and the means of transportation becomes available. Since the accumulation factors for CONUS simply represent the further extension of overseas theater evacuee factors, they are, therefore, applicable only to the respective daily number of overseas admissions which originate the requirements for fixed beds at the CONUS level of hospitalization. Table 93 presents these factors for wounded patients and DNBI patients, respectively, by length of theater evacuation policy for 30-day periods of estimate. It will be noted that patients accumulate in CONUS at different rates based on the respective length of the theater evacuation policy. Patient accumulations in CONUS reach a higher level under the shorter evacuation policies until the day of operations equals the length of a respective policy; thereafter, accumulations in CONUS are the same for any evacuation policy.
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