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Casualty Evacuation Helicopters: Re-evaluating the Role of the 'Dustoff' in the Vietnam War

Originally published by Vietnam magazine. Published Online: June 12, 2006 
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Within the general evolution of the art of war, the conflict in Vietnam was notable for several novel and important features that were destined to become irreversible. Among these were such things as the helicopter gunship, the electronic battlefield and even the hush-hush array of satellite-based surveillance assets. All of these are powerful tactical factors that we today seem to take pretty much for granted, to the extent that from our present perspective, a generation later, we may overlook the significance of their original development. We tend to forget that a large number of the key elements of modern warfare were totally new in 1965, and that it was the Vietnam War that first allowed them to be explored and deployed under the stresses of real and mortal combat.

From the viewpoint of troops on the ground in Vietnam, the innovation that made by far the greatest impact was not directly tactical at all, but actually medical in nature. This was the casualty evacuation helicopter, or "dustoff," which could whisk a wounded man to a well-equipped aid station within minutes, and from there to a base hospital within a few hours. One Vietnam infantry veteran told me: "The troops in my own unit always felt that if we were not killed outright if we were hit, the odds of surviving were in our favor. This added greatly to the confidence factor in any situation."

In historical terms, it represented still another advance in the speed of casualty evacuation and in the treatment of shock, which had significantly improved since the Napoleonic Wars. Until then, unless one was a high-ranking officer, wounded soldiers were not removed from the field until after the battle was over. In 1792, however, French surgeon Dominique Jean Larrey began to develop horse-drawn, two-wheeled "flying ambulances" for the swift removal of casualties–primarily to prevent their being slaughtered by the enemy–and he soon discovered that the earlier they were treated, the better their chances of recovery. Even after that fundamentally critical innovation, some 44 percent of the soldiers wounded during the American Civil War failed to survive, but by 1918 the British died-of-wounds figure was down to around 8 percent. In World War II it was 4.5 percent for U.S. troops, and in Vietnam it was as low as 2.6 percent.

Each successive improvement in medevac procedures brought a concrete tactical advantage in terms of troop morale, and in Vietnam the process was brought to practically the highest level it could possibly attain. There was also a political advantage for the U.S. government to take unprecedented care of its conscripted soldiers and lavish upon them a degree of medical succor that had been unknown in any previous war. Fewer losses meant more support back home.

The dustoff, however, did not come cheap. First, it involved a heavy cost in rear-echelon personnel, as well as some long-term cash payouts. More convalescents in the hospital, surviving for longer, meant that more doctors and nurses were needed to look after them, after which more veterans' pensions had to be found. It is a sad fact that the average wounded soldier costs the taxpayer many more dollars than a soldier killed in action, however differently we may rate the psychic or moral costs. Second, the helicopters themselves represented a particularly significant drain on a precious tactical resource.

We must recall that 1965 came only 11 years after the entire French empire had been able to deploy a grand total of only seven helicopters in the Southeast Asia theater. The United States would eventually deploy something like 4,000. But even then the average time available for flying might be only about 10 percent, since as much as 90 percent of any chopper's time had to be devoted to maintenance tasks. Hence, on average, only something like 400 helicopters were reliably available at any moment to cover all the requirements of the U.S. forces in-country, as well as of the ARVN and of the many political and civilian agencies.

If we break this down still further, it is not difficult to understand that only some 70 to 80 helicopters might be available for military use within each corps area. This might translate into only one or two dozen per division. Lifting a single infantry company might normally require some 16 to 20 helicopters, depending on fuel load. Those choppers were supplemented by the necessary accompaniment of gunships, command ships and associated heavy-lift support–or indeed the continuing routine requirement for logistic backup throughout the Army. So by definition, there can rarely have been very many surplus helicopters available for medevac purposes. As Lt. Gen. Harold G. Moore (then the lieutenant colonel commanding the lead battalion) later reported on the start of the November 1965 Ia Drang battle, "my main concern focused on the fact that we would have only sixteen Huey slicks to ferry the battalion into the assault area….What that meant was that fewer than eighty men–not even one full company–would hit the landing zone in the first wave…." (In the face of three whole enemy battalions!)

Then again, in December 1969, Lieutenant Michael Lee Lanning experienced a nerve-wracking wait when only three helicopters could be made available to lift his company out of the scene of a bloody battle. "We would have to be extracted in three separate lifts," he recalled. "Turnaround time between each sortie would be about thirty minutes. That meant that before the last group could be picked up, any lingering dinks would have an hour to plan an attack on the remaining eighteen men." All in all, we must conclude that despite the apparently plentiful supply of helicopters available to the U.S. forces in Vietnam, they were still always a relatively rare resource that needed to be managed and husbanded very carefully.

The dustoff suffered from a particular difficulty that has been common to all front-line ambulances throughout history. It was designed to rescue wounded soldiers from as near as possible to the time and place they were wounded–which by definition would add up to an especially dangerous situation. The dustoff had to fly right into the heart of the battle zone and pluck out shocked, suffering, bleeding and badly damaged combatants who might still be under heavy fire. Yet the medical crew also had to make sure that they themselves managed to survive such fire, so that their rescued casualty could be removed safely to an aid station in the rear.

That made for some urgent personal dilemmas. As one crewman recalled in Moore and Joseph C. Galloway's We Were Soldiers Once…and Young: "The NVA were in the wood line shooting at the helicopter. The medevac pilot kind of froze up on us and was having trouble setting the ship down. We never did come to a complete hover. All aboard had to dive out on the ground from about six feet up in the air. We ran in a crouch."

On some occasions the infantry had particularly bad experiences with dustoff crews. William Shucart reported of the Ia Drang battle: "We were trying to get the medevac ships to come in but they would not. A couple of Huey slicks came down but we were taking fire and the medevacs wouldn't come. When you are taking fire is precisely when you need medevac. I don't know where those guys got their great reputations. I was totally dismayed with the medevac guys. The Huey slick crews were terrific."

Obviously, there was always a serious conflict of interest inherent in the whole business of medevac. On one side, the dustoff crews had to ignore the tactical dangers and go in regardless, and in fact many of them were often among the bravest men to be found anywhere in the military. Yet, on the other hand, they had to carefully calculate their risks and make sure that conditions were relatively safe, or at least safe enough. Otherwise, they would be certain to lose the wounded men they were evacuating as well as their own lives.

Lanning's account of a conversation between him and a pilot was perhaps not atypical: "I held [the wounded and delirious Staff Sgt.] Blyman with one arm and reached for the handset to talk to the medevac pilot with the other.

'Listen,' I said, 'I need a hook and a cable.'

"'What's the situation?' he asked.

"I told him we were receiving sporadic fire, knowing ahead of time what his reaction would be. 'No way,' he answered. 'I can't hover that long under fire.'

"'Listen,' I said again, 'we've got a man hit in the knee. He's gone crazy. I've got to get him out of here now! We'll put down all the supporting fire we can.'

"The pilot must have heard the urgency in my voice, because after a slight pause he said, 'Okay. Pop smoke. Let's give it a try.'"

In that instance, the dustoff chopper did receive some hits. But the extraction was successful and the members of the medevac team were recommended for medals.

It was essential for medevac helicopters to drop their extraction hooks at safe sites, or more normally they would need to find a viable and secure LZ–which was often even more difficult in overgrown jungle terrain, in marginal weather or close to the enemy. The quickest way to lose a helicopter was to land it under heavy close-range fire. So it was understood, as Philip Caputo memorably remarked, that "happiness is a cold landing zone." The dustoff pilots became renowned for their courage in placing themselves and their ships in harm's way, but there was always a fine line to be drawn between an acceptable risk and a suicidal one.

Quite apart from enemy action, even the basic physical and administrative preconditions for a medevac mission were often daunting. Such problems persisted from the start to the finish of the war. In War Zone D during July 1965, General John J. Tolson recalled that 173rd Airborne Brigade members "found that they had to go to unusual lengths to clear new landing zones for medical evacuation." One company of the 1st Battalion (Airborne), 503rd Infantry, tried to clear an LZ with 100 pounds of C-4 explosives, but the GIs could make little impression on the trees. In July 1969, the 1st Battalion, 3rd Infantry, accidentally dropped a massive mahogany tree across its LZ, and the men needed a whole day to clear it away. Then again in Laos, in March 1972, according to Tolson, "even single-ship re-supply and medical evacuation missions had to be planned and conducted as a complete combat operation. This entailed a separate fire plan, allocation of escorting armed helicopters, and contingency plans for securing downed crews and aircraft." Such operations were by no means easy or instant, as might casually be assumed by the armchair strategist.

The sheer complexity of organizing many of the dustoff missions leads us on to the final price that had to be paid for them, which was surely by far the most serious and costly of all. In a nutshell, medevac often distorted the tactical shape of battles, because it was normally given priority over every other type of mission. As F.J. West put it in Small Unit Action in Vietnam, care for the wounded, and even retrieving the bodies of the dead, became a mission "more sacred than life itself." Strict attention to these considerations became elevated into a vital point of honor, as well as a precondition for high morale both among soldiers in the field and (albeit less directly) among the civilian population back home.

Both the in-country comrades in arms and the Stateside relatives of conscripted teenagers had to be reassured that the United States would do everything possible to rescue its soldiers if they should be injured or in danger of falling into enemy hands. And the men also needed reassurance that, if the very worst befell them, their bodies would not simply be left to rot in a suppurating alien jungle. This approach was excellent in itself and in many ways supremely humane. However, the requirements of medevac frequently changed the planned evolution of battles, or even led to new engagements that had not been planned at all. It became a force that worked strongly against the freedom of tacticians to organize tactics.

The need to search for a viable LZ for helicopter medevac often distracted the unit fighting on the ground (which had by definition just suffered one or more injuries) from pursuing its battle against the enemy in front. There are numerous examples of this in eyewitness narratives. In essence, what often happened was that an infantry company would advance, come under fire, lose a few men, and then start looking for and securing a suitable LZ somewhere close to–or embarrassingly often, rather far from–its immediate rear.

Unless the unit was relatively lucky, this effort might involve at least a whole platoon, which would normally constitute the company commander's all-important tactical reserve. As soon as that platoon became unable to participate in the main battle, all further offensive movement beyond the front line would naturally become unthinkable, and the general battle plan would instantly dissolve.

Arranging this medevac effort would also take up a great deal of the company commander's attention when he should have been converting the firefight into an assault and exploitation. The overall result was that the whole company would freeze and abandon its forward movement.

The alternative would have been for the whole American company to press forward without detaching any significant part of its combat strength or diverting command energy into medevac-related tasks, so that it could finish mopping up the enemy before starting to worry about its own wounded. If this system had been generally adopted, it would certainly have increased the number of U.S. soldiers who later died of their wounds. Moreover, it would arguably not have secured any more decisive strategic result against the notoriously elusive VC and NVA. However, it was the "traditional military thing" to do in any firefight, and it would surely have increased the extent and scale of many tactical victories, at least at the local level.

That might have added up to either a good or a bad thing in itself. But the new doctrine that was actually put into effect (i.e., dropping everything in order to care for the wounded) did clearly indicate that a major, if not a seismic, change had suddenly taken place in the whole art of war.

Since 1973, the minimization of American casualties has become an increasingly prominent feature of all U.S. deployments overseas. Quite apart from the traumas of Tet, Hamburger Hill and the Mayaguez incident, the need for economy in lives lost in limited wars was underlined in the public consciousness by some sharply unpalatable losses in both Beirut and Grenada in 1983, and even in the otherwise triumphant Gulf War of 1991. In 1994, the entire American peace-keeping operation in Somalia was called off after 18 U.S. soldiers had been killed in a single botched assault against one of the country's warlords, Mohammed Farah Aidid. In more recent times, the often very violent U.S. interventions in such places as the Balkans, the Sudan and Afghanistan have always been predicated upon a demand for, and an expectation of, absolutely minimal U.S. casualties. This has normally meant the use of air power or cruise missiles rather than of troops on the ground. Or if ground troops have been deployed, they have come to be very carefully protected and husbanded. Today we even seem to have reached a situation in which the dustoff itself has become almost obsolete, for the simple reason that there seem to be so few U.S. casualties to medevac. Against this scenario we should remember that, although care for the wounded in Vietnam might often have caused a battle to be prematurely curtailed, there were also many occasions on which rescue missions for the missing or dead actually produced an escalation of the fighting. Perhaps the most spectacular example was the saga of Bat 21, a Douglas EB-66 aircraft that was shot down in 1972 in a part of the DMZ that happened to be occupied by an entire NVA division. A major 12-day battle was fought to rescue the one crew member known to have survived, and additional aircraft and helicopters were lost in the process.

More prosaic, but perhaps rather more typical, was the five-day fight for the body of Lieutenant Bill Little in November 1969. It started as a platoon action but grew until it involved two companies of the 2nd Battalion, 3rd Infantry, 10 armored vehicles and a large weight of air- and artillery-delivered ordnance. Lieutenant Little had been killed while he was trying to medevac the pointman of his recon platoon, but the rest of the platoon had then been unable to retrieve the body and had called in Charlie Company to help. The attackers encountered a strong bunker complex and were repulsed, necessitating dustoff evacuation of their own wounded. At this point, an insulting enemy voice broke into the battalion radio net to taunt the would-be rescuers, saying: "We have your lieutenant. Come and get him."

The NVA were thus using Bill Little's body as bait, and the U.S. response was eagerness to retrieve it, exactly as proffered. Without that taunt, there might not have been quite so strong a desire to assault the strongly fortified NVA area. But the action duly escalated, and a sustained air and artillery bombardment was laid upon the bunkers. After several delays, a combined attack finally was launched by both Bravo and Charlie companies, supported by what was (for Vietnam) an impressive array of armor. The whole area was then promptly evacuated by the NVA, who suffered fairly heavy losses for no further U.S. casualties. The body of Lieutenant Little was successfully recovered from its shallow grave, where it had been buried with all the respect due to a brave opponent. This action was certainly a tactical victory for the U.S. side, but it is important to remember that its inner structure had in many ways been shaped and determined not by deliberate tactical planning, but by the overriding urge to recover a single dead body.

According to the tenets of classical strategy, this sort of thing would seem to be complete nonsense. Why on earth should it matter whether a fallen American lieutenant was buried with honor in Vietnam by his enemies or in the cemetery at West Point by his family and friends? Why should the status of one body (or in other cases, of one wounded man) be allowed to change the whole course of a battle? In the 19th century, when life was cheap and few fallen warriors were even given marked graves, that sort of question would have been verging on the incomprehensible, if not the inconceivable. Even in World War II, where total U.S. losses were more than five times those suffered in Vietnam in about half the time span, it was still very much the exception, rather than the rule, for any special effort to be made to "save Private Ryan." We have to stop and wonder just why these matters should be viewed so differently today.

Perhaps the answer lies in the perceived importance of the cause being fought for. In Vietnam, most GIs tried to execute their mission as well and as efficiently as possible. Yet many still felt a deep contempt for the Vietnamese whom they were trying to defend, reinforced by a belief that American civilians neither understood nor supported the war. Without any loss of military professionalism, they found it difficult to work up any fierce commitment to the preservation of the Republic of Vietnam. At the same time, it was correspondingly easy to feel totally devoted to the lives and welfare of one's own comrades in arms. It therefore became natural to feel, as Lanning put it, that "the people (animals) of Vietnam are not worth one drop of American blood," or that even a spectacular tactical victory, in which dozens of enemy troops were killed, was "not worth nine lives."

There was thus apparently a type of unspoken multiplier at work, whereby it was subconsciously thought to be acceptable to lose one American life for every 10 or 20 of the enemy's, but any greater sacrifice than that was perceived as something of a defeat.

This line of reasoning was, of course, encouraged by the Pentagon's strategy based on attrition and the body count, in which it was just as important to minimize American deaths as it was to maximize the enemy's. Those two goals, however, often turned out to be incompatible, because rescuing one's own wounded of-ten meant that the battle against the enemy had to be broken off at a critical time, or diverted into an unplanned direction.

Paddy Griffith is one of Great Britain's most noted military historians, specializing in the evolution of battlefield tactics. For 16 years he was a senior lecturer in war studies at the Royal Military Academy, Sandhurst. For additional reading, see his Forward Into Battle: Fighting Tactics From Waterloo to Vietnam, and Airmobility 1961­71, by General John J. Tolson.

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4 Responses to “Casualty Evacuation Helicopters: Re-evaluating the Role of the 'Dustoff' in the Vietnam War”


  1. 1
    Jay W Shelly says:

    I read the article reevauating dustoff in veitnam. There was one comment about aA crew not responding to a call because it was to dangerous in the year I was with the 571st Med Det Dustoff. We never turned down a mission no matter what the conditions were. We low leveled in bad weather did every thing we could to save lifes. WE ARE REALLY THE FORGOTTEN FEW. Only 140 Helicopters were involved in Dustoff. And over 300 crewmembers were killed. The amount of wounded has never been tallied. The mortality rate for dustoff crew was 30% higher than any units in Vietnam So don't ever think these men didn't Pay the price for saving life.
    NO COMPROMISE
    NO RATIONALIZATION
    NO HESITATION
    FLY THE MISSION
    TO SAVE A LIFE

  2. 2
    Lynne Rominger says:

    My father was a Dustoff pilot in teh 45 Med Co, 7/68-7/69, and since his passing this past June, all I've heard from men who flew with him, crew chiefs, medics, co-pilots, Commanders is this: He never hesitated to take a mission; in fact, he "scarfed" up missions so much that they nicknamed him "Scarf." He flew in with no gunship cover into places we "weren't in." Everyone has said that he never refused to go in…and of the men that I know who served with my dad (and yes, I was a tot, in Fort Rucker and grew up knowing the pilots), they were all the bravest men EVER. They are heroes…under-rated heroes. They endured harrowing night hoists without gunship cover! I have to agree with Mr. Shelly. Especially because I know that my dad was always getting chewed out by the CO for going to missions that he didn't need to go to or shouldn't have gone to–all because my dad, like all Dustoff pilots and crew, couldn't stand the thought of anyone waiting for help and suffering.

  3. 3
    Boyd Wynne says:

    Response to two fellow Dustoff Aircraft Commanders-45th Med Co (Air Ambulance) RVN 1968-1969

    I have spent quite a bit of time digesting this and evaluating it with as little emotion as possible. Under the circumstances I believe that virtually all the Dustoff pilots I have known, in particularly the 45th, 57th, and 498th, I can’t remember a single AC refusing a mission due to the tactical situation. You must remember that Dustoff, unlike other missions, was a single ship mission. The Dustoff AC was in charge of the entire mission. We summoned and coordinated our gun cover, we organized the pickup site with the ground commander getting patient conditions, numbers, etc and we received the LZ situation directly from the ground unit with regard to enemy fire directions, type of fire (small/heavy automatic weapons, RPGs, mortars etc). With this information we were able to plan our route in and out, type of approach, and pass this on to our gun cover, the ground commander and our crew in the back so everybody knew what was going to happen and what was expected of them. At least in my situation there was an urgency attached to every mission and all I wanted to do was tip the balance in our favor of success. It might have taken a little longer to complete than we all might have wanted but at least we were generally successful.

    Sure, from time to time we were being second guessed and coerced into doing it “their” way but with experience, we knew a lie when we heard it. Most times it was a desperate plea by the ground unit or their C&C overhead to get their wounded out as soon as possible. But once they realized we were coming in no matter what, we would start getting actionable information. That crap about having to move to an LZ or cut one out of the jungle was nonsense. That’s why we had hoist ships and that bullshit about dustoff requiring a “safe” area to drop the hoist is just that-BS. I NEVER had a secure hoist mission.

    With regard to the availability of Dustoff aircraft assets , I’m sure you all remember the multiple field standby locations we manned-Quan Loi, Song Be, FSB Loc Ninh & Snuffy, Dong Tam, Phan Rang, Phan Thiet, Nui Dat and a multitude of other temporary daytime FSBs in support of on-going operations. Generally we were within 10-15 minutes of a pickup site, day or night. I can’t speak for the slicks or guns but during my second tour our ARA Snakes were on station every time called.

    Another thing, I never have nor ever will take anything away from the slick drivers. I could never have had the discipline to fly in formation into a hot LZ. Sure they did some medevacs. Generally they were going in and out of the LZ for insertion or resupply or had just completed and were available to do the mission. We must also remember our dustoff aircraft carried no armament-only the international red cross. (We did carry personal weapons-some more than others!) The slicks did some great things but that was our life every day and maybe we didn’t grow to really appreciate what our dustoff crews did until many years later.

    From the writings below it appears that their quandary was the dustoff mission stalled their advancement and closing with the enemy. In most of the hot LZs I went in to they had already closed with the enemy and that’s why I was there. I suppose they could have left the grunts there to die or not die and recover them after the contact was broken. How can you say there was too much in the way of treasure or resources given to the dustoff mission? When my ass was on the ground and hung out, I knew and believed someone would be coming in and get me out and they did. That was a comfort if there could be comfort in a situation like that.

    Yes, the individual soldier does matter, dead or alive. When my SF son was badly wounded several years ago in Afghanistan he did have to wait for dustoff but he said we were busy as hell killing savages so the wait didn’t seem as long as it was. Evidently there was some hesitancy on the part of the dustoff mission commander. Another war another era. Remember our motto from Charles Kelly “not until I have your wounded”. It still fits.
    Regards,
    Boyd
    Dustoff 27-the original one

  4. 4
    Andy says:

    One major flaw in historical fact within this writing is that the assumption is made that those who were tasked with the support mission of MEDEVAC during the Ia Drang battle were Dustoff. They, in fact, were not a Dustoff unit. It was an internal platoon of men and helicopters that belonged to 1st Cav who refused to land. A Dustoff unit is a dedicated medical evacuation unit, under the command and control of Medical Service Corps officers, tasked to conduct MEDEVAC support to a specified area. During Ia Drang, the 1st Cav command insisted on "fencing off" their area of operation from all outside support elements, to include Dustoff, and show that they could perform all helicopter support on their own as part of the test of Air Cav. They failed in this fact. Dustoff was NOT INCLUDED in the Ia Drang Battle.



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