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.

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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.

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