EARLY MISSION IN THE MEKONG RIVER DELTA

The following is from notes transcribed from a 12 April 1964 Mission involving 1LT John B. Givhan, pilot, and CPT James W. Ralph, DUSTOFF flight surgeon.

John Givhan: I was flying a CH-21C ("Shawnee" or "Flying Banana") helicopter for a combat assault mission way down in the Delta. I was in the right seat (aircraft commander). Lt. Robert "Bo Thompson, was in the left seat (pilot). We had gone into a landing zone and let troops off. We went in flying contour because we were drawing heavy fire in the LZ.

On the way back out, at about 400 feet, a round or rounds, came through the cockpit; basically blasting through the calf of my right leg. I immediately lost a lot of blood. I remember taking my belt off to make a tourniquet and tied it around my leg. I didn't have the strength to do anything and I was dragged out of the cockpit by either the crew chief or gunner.

I remember vividly, in an H-21 that if your head is toward the rear of the helicopter, your head is downhill from your body. I looked out of my right eye and saw a stream of blood flowing past my eye and I thought then that I'm in a bunch of trouble. I don't remember much after that until the helicopter actually made contact with the ground.

I later learned that Bo Thompson had been wounded by shrapnel in one of his arms and had to "crash land" the helicopter. At least no one was hurt in that landing, which was in a rice paddy somewhere near where we drew the fire.

The first distinct thing I remember was Bo leaning over me as they were taking me off the H-21, and he was saying, "John, you're going to make it." And I believed him; I know that had something to do with me living. I don't remember being put on another helicopter, but I do remember someone saying they were going to give me a morphine syrette. They gave me two, but that did not stop the pain, which was unbearable.

I don't remember much until I was off-loaded from what I believe was a UH-1 (Huey) helicopter at Can Tho and the sunlight hitting me in the eyes and the heat and the shock as well. And I remember someone holding an umbrella over me to shield me from the sun. At this point I came in contact with Doc Ralph. Doc later told me there were four or five things that happened that were "miracles" that had to do with me living - any one of which not happening could have made the difference between life and death.

"Doc" Ralph: I arrived in Vietnam in October 1963. The coup to overthrow Ngo Dinh Diem, who was a bit of a dictator, occurred on November 1st. After the coup, I was introduced to some Vietnamese generals by Dr. Van Van Cua, who was the senior medical officer for the Vietnamese paratroopers, later Division Surgeon for the Vietnamese Airborne Division, and eventually mayor of Saigon.

Bac Si (Doctor) Cua, took me to a victory party that the Vietnamese generals who had staged the coup were throwing. Two of the Vietnamese generals I met were Brigadier General Lam Van Phat, commander of the Vietnamese 7th Division and later Minister of the Interior, and Major General Cao Van Vien, commander of the Airborne Division and eventually Chief of Staff of the Vietnamese Armed Forces. I also met the flamboyant Marshall Nguyen Cao Ky, commander of the Vietnamese Air Force.

I had already flown a number of combat medical evacuation missions by that time, mostly for wounded Vietnamese soldiers. I was very much involved in the Medevac business and realized that the usual process of flying wounded into Tan Son Nhut airfield and then transporting them by ground ambulance for a one- to two-hour trip through downtown Saigon to the old Metropole Hotel (which had become the U.S. Naval Hospital in the Cholon section of downtown Saigon) was a ridiculous waste of time that could be fatal to the seriously wounded.

There was a police soccer field in downtown Cholon that could accommodate a UH-1B Medevac helicopter bringing in wounded. I thought this would be the best landing site, so I asked the Vietnamese generals if this would be possible, and they said yes; Bac Si Cua had told them of my involvement with medevac missions to rescue Vietnamese wounded.

There had been a policy under Diem that there could be no aircraft flights over the city of Saigon, including Cholon, because he was afraid of coup attempts and attacks by rebel aircraft against the Presidential Palace. One coup against Diem a few years previously had been essentially a success, but he had double-crossed the coup leaders, and he knew there would be no deals the next time. But Diem was no longer in the picture and the Vietnamese generals agreed it was a good idea to use the Cholon police soccer field to take our wounded directly to the hospital by helicopter.

I presented this proposal to the office of the J-5 at MACV headquarters, and an American colonel said, "No, it cant be done because the Vietnamese won't allow it." I then took it to the Support Group, which later became U.S. Army Support Command and eventually U.S. Army Vietnam (USARV), headquarters. Brig. General Joseph W. Stilwell, Jr. (son of Gen. "Vinegar Joe" Stilwell of World War II China-Burma-India theater fame; we called the son "Cider Joe"), was the commanding general at the time, and I was his "family Doc." General Stilwell thought it was a good idea.

Some of the Support Group colonels said it was not a good idea and got after me from taking it to MACV and even more so for talking to the Vietnamese in the first place. I was told by a colonel, who later became a major general, that we could not fly our wounded directly to the Cholon soccer field, but if Gen. Stilwell got hit, we should fly him directly to Cholon. We could not do it for anyone else because that would be against regulations.

I discussed this with Captain Paul Bloomquist, medevac pilot. He and I and an Air Force officer from Paris Radar Control set up a protocol for flying medevac helicopters directly into Cholon. Bloomquist was with the 57th Medical Detachment (Helicopter Ambulance), commanded by Major Charles Kelly, who laid the groundwork for what helicopter medevac became in Vietnam.

The 57th medics were the first helicopter ambulance unit in Vietnam and the first to use the call sign "Dust Off," which is still used by medevac units around the world. I was the 57th Medic's flight surgeon and the first flight surgeon to fly routinely with the 57th. Bloomquist was the Executive Officer of the 57th at that time.

We finally got approval; the Vietnamese approved our protocol immediately, but the Americans, in typical bureaucratic fashion took a while longer. However, we got approval to go directly to the Cholon police soccer field, which was near the U.S. Naval Hospital. Gen. Stilwell said that he was recommending Bloomquist, the Air Force radar guy, and me for the Joint Service Commendation Medal when it became obvious that this protocol we developed was saving lives. We never saw the medals.

Well, this kind of set the stage for John Givhan being flown in when he got wounded. We were already using the Cholon soccer field for any severe casualties who could not tolerate the long ground ambulance ride from Tan Son Nhut airfield through downtown Saigon. All we had at Tan Son Nhut was a small U.S. Air Force Dispensary, with a few beds for non-serious patients, and two small Army outpatient dispensaries, one of which was under my command.

I was also Battalion Surgeon for the 145th Combat Aviation Battalion. John's unit, the 120th Aviation Company, was under the 145th. When John was shot, he was transferred to a UH-1B medevac chopper and flown to Can Tho, located on the south bank of the massive Mekong river. There he was initially treated briefly by another medical officer who had put a tourniquet on his leg above the knee, a clamp that clamped only skin and not the bleeding vessel, and covered the wound with a huge abdominal dressing, which obscured the view. An IV had been started.

I was tending to some other casualties at Can Tho airfield while this was going on. I then went over to check out John and he looked very bad, so I decided that I had better go with him myself on the chopper to Saigon/Cholon.

As soon as the chopper lifted off and tipped forward, I saw blood pouring down the litter (stretcher), and I realized something was wrong. I pulled off the abdominal dressing that had been wrapped around his leg and saw immediately what the problem was.

The clamp was not doing anything useful, and the military strap-type tourniquet, positioned above the knee, had been improperly placed around the condyles (bulges) of the distal femur (thigh bone) and was not compressing the bleeding vessel, the popliteal artery. So the tourniquet was not doing its job. If the tourniquet had done its job, John would have lost his leg above the knee, as the circulation would have been cut off at that point.

I had to stop the bleeding immediately, because John was about out of blood by that time. I wanted to try to save his leg, if possible, but the main objective was to stop the bleeding. As a doctor, I have this arrangement: I treat; God heals. I figured that if I could stop the bleeding, the Lord would take from there. I'm sure that John Givhan, being raised a good Southern Baptist, understands that.

I took a big wad of gauze wrap and stuffed it into the large exit wound, which was on the back of the leg just below the knee. The entrance wound was smaller and on the anterior, or front, of the leg at about the same level. The exit wound was a huge gaping hole, about as big as your fist.

I knew there was going to be more damage than I could see at the time, because high velocity bullets do severe soft tissue damage as they smash through; the faster the bullet, the more extensive the damage. I thought John had been hit by a .50 caliber machine gun round, but later learned it might have been a round from a 12.7 mm automatic weapon used for antiaircraft fire that the North Vietnamese had just brought into South Vietnam.

John may have had the unfortunate distinction and dubious honor of being the first American hit with this new weapon. Even though the round had come through the fuselage of the helicopter, it still had plenty of velocity and horsepower when it hit John's leg, causing much tissue damage and tearing out the popliteal artery that comes down behind the knee and divides into two major arteries as continues down the leg.

It was right at the bifurcation or division that the bullet did its thing. The artery had been completely torn through and had retracted back into the shredded muscle of John's leg, but I was able to stop the bleeding by packing the gauze into the wound with my hands and holding it firmly in place with my thumbs jammed as high and tightly as I could manage.

We climbed to our usual cruising altitude of about 1,000 feet, but started coming under ground fire as we headed for Saigon, usually about a one-hour flight, maybe a little longer. The pilot started to climb to higher altitude to escape the ground fire. I realized that John was going to need all the oxygen he could get due to his severe blood loss. We had no oxygen on board to give him (not normally carried on Army medevac choppers at that time).

John could not have tolerated a flight at higher altitude. He was worse than pale, he was turning gray. He was trying to die and I was not about to let him. I never had a wounded man die while under my care in Vietnam, and John Givhan was not going to be the first if I could help it! Anyway, John could not tolerate the higher altitude, so I asked the pilot, MAJ Charles L. Kelly, to stay low. Instead of flying at two or three thousand feet, we flew the entire mission hugging the ground, usually 100 feet above the deck or lower, actually hopping over rows of trees and power lines. This allowed John to have the maximum amount of oxygen available under the circumstances. It was risky to fly this way, but it was definitely worth it MAJ Kelly did as much as anyone to save John's life.

We were pouring in all the IV fluids we could, we had two lines with saline and two lines with a synthetic colloidal suspension called Dextran, a plasma-expander that was supposed to simulate blood but had no oxygen-carrying capacity. We gave him whatever serum albumin we had, which wasn't very much as I had just scrounged some from a Special Forces medic earlier that day. We did not have any blood on board.

John was semiconscious part of the time at best. I would talk to him and ask questions, and he would occasionally mumble something in response, not always making sense. We gave him all the fluids we had on board and were just about to run out as we got to the Cholon soccer field. We had called ahead for blood, and they ran that in through all four IV lines as soon as we landed.

I'm not sure how much blood John lost, but they poured a lot in him at the Naval Hospital. I was told later that the cockpit of John's H-21 helicopter was covered with blood, on the windshield and instruments, everywhere, and Bo Thompson had to wipe off the windshield to see enough to fly.

The gauze packing got completely soaked and sort of collapsed into the wound, so I had to push another one in on top of it. I held the packing tightly in place the entire time except for brief periods when the medic would hold the packing to give my thumbs a rest. Those breaks had to be very brief because the medic was not able to hold tightly enough to stop the bleeding completely. During those brief breaks I would check the IV lines, check for pulse, as I was unable to register any blood pressure at all, even by palpation. I even checked his eyes for papillary reflexes a few times to be sure he was still alive, and then went back to holding the packing myself.

Direct pressure is often the most effective way to control bleeding. I learned that in the Boy Scouts, long before I ever went to medical school. John Givhan came the closest to dying of anyone I treated the entire time I was in Vietnam.

We had radioed ahead for O negative type blood to be ready for John. The hospital did have the universal donor type, O negative. John's dog tags said his type was O positive, but I did not want to take a chance that the dog tags were wrong. We could not take time to go through the usual typing and cross-matching of the blood, as would be expected in a more routine situation. John is O positive, so he had no problem with the transfusions. Actually, we asked for the ambulance that met us to have four units of blood, and we hooked blood up to each of the four IV lines in the ambulance.

I jumped into the ambulance with John, still holding his packing, which I did not release until we were in the operating room of the Naval Hospital and the surgeon could take over. We had made it! The Lord was with us! Now I could relax, but 1LT John B. Givhan had much more to go through that night.

There are several points that need emphasizing: for one thing, we were able to use the Cholon soccer field to fly John directly to the hospital. If we had to land at Tan Son Nhut outside Saigon and use a ground ambulance through evening rush hour, he would not have made it to the hospital alive. He did not have the extra one or two hours it would have taken for ground transport.

One ironic thing was that there was another flight surgeon stationed at Can Tho, whom I eventually replaced (after I left the 145th, I went to the 8th Field Hospital in Nha Trang for a month and then down to Can Tho), and there was a U.S. Public Health Service surgical team working at the Can Tho civilian hospital during the time John was wounded. One of the American doctors was a vascular surgeon who could have taken care of John at Can Tho and possibly could have saved John from amputation. The Can Tho flight surgeon did not tell us about the American surgical team, although he knew they were there at the time. One problem with military medicine in Vietnam was the failure to communicate and share resources; however, this was not unique to Vietnam.

Other problems were the improper initial treatment by the first doctor (who was also stationed at Tan Son Nhut) who saw John and tried the tourniquet, which turned out to be useless due to improper placement, and a tourniquet was not the correct method of hemostasis (stopping bleeding) in John's particular case. The improperly placed clamp was another problem. With the artery having retracted, clamping was not really an option in John's case. The large abdominal pad had covered the wound, so it was impossible to determine the real extent of the damage. These were some of the things that could have contributed to John Givhan's premature demise.

The skilled flying of the 57th Medics pilots and the aircraft commander agreeing to fly at treetop level was a definite plus for John. Also, the pilots had flown into Cholon several times before and knew the most direct route. The Paris Control protocol worked perfectly for John. Things did go wrong and other things could have gone wrong for John. It seemed as if it was his time to die, but I got in the way. I've told him that the Lord just did not want him yet because he was too mean and needed many more years to mellow out before the Lord would put up with him. Besides, Martha needed a husband, and John A. and Endsley needed a Daddy, so it worked out okay all the way around. So you can blame John's presence in part to me and the 57th Medics DUSTOFF team.

One more problem facing John was that the Navy doctors thought John's leg was getting good blood flow after they repaired the damage (as much as they could under the circumstances) because his leg was warm. Unfortunately, this was not the case. John was transferred to Clark Air Base in the Philippines, where it was discovered that the warmth in John's lower leg was not from good blood supply, but was from tissue dying and getting infected. The surgeons at Clark did a prompt below-the-knee, or B-K, amputation of John's right lower leg. John told me later that he noticed a tremendous improvement in the way he felt after the infected lower leg was amputated; toxins from the dead tissue were making him very ill.

John: Last summer I ran into retired COL James B. Guthrie at the Selma Country Club at a golf tournament. He didn't know me at the time, but he heard on 12 April 1964 that a lieutenant from Selma has been wounded. Later he heard that it was a LT Givhan, and he knew of the Givhan family from the Selma area.

He went to the helicopter the next day or so, it having been sling-loaded back to Tan Son Nhut. He said it had 200 bullet holes in it, and the cockpit and cargo compartment were both coated with blood. The area of the cargo compartment where I had been lying was covered with blood "sludge"; I believe that's the word he used. That is certainly compatible with what I recall.

I remember going into that landing zone. We, the 120th Aviation Co., had ferried Vietnamese troops that morning to way down deep in the Delta, almost to the southern tip of Vietnam, far south of our usual area of operations.

We had never flown in that area before. This was because the 114th Aviation Co., stationed at Vinh Long, had an aircraft accident in which a UH-1B Huey helicopter had the tail boom separate in midair, killing everyone onboard as it crashed into the Mekong River. All the Hueys were grounded so the tail boom attachments could be checked. Also, ironically, Doc Ralph had signed the death certificates of that aircrew when their bodies were brought to Tan Son Nhut for identification.

That morning we ferried Vietnamese troops from Can Tho to an area near Ca Mau, to the landing zone where the fire fight was. We went to a little airstrip known as Ca Mau, deep south in the Delta and known to all aviators as bad, bad country, no man's land. I know I had a sense of foreboding as we sat there on the airstrip, eating some C-rations before we went on the actual mission I was wounded on, because we were told we were going in "contour." We also had a 20- to 25-knot wind because we on the peninsula of the lower south coast of Vietnam. Both pilots (Bo and myself) had to fight the controls going into the landing zone flying contour because of the crosswind. We had a terrific crosswind.

I remember when we got to about 600 yards from the LZ (landing zone), we started drawing heavy fire from enemy ground units behind rice paddy dikes. I saw something I never had seen before: Viet Cong soldiers running in the open toward us firing automatic weapons at us point blank. Then our gunners firing point blank back at them - so I knew it was bad news. I really don't know why, when we left the LZ, we were ordered to climb out to altitude. I thought that when we got to 400 feet altitude, we would make it. I was watching the altimeter and it was exactly at 400 feet that those rounds came through that hit me in the right leg.

Another interesting story: I always wore my helmet with sunglasses; I never used the visor (contrary to Doc Ralph's advice!), while Bo Thompson in the left seat always used his tinted visor and never wore sunglasses. When we got hit, Bo yelled over the intercom, "I'm blind!" I looked over at Bo and there was meat, blood, and flesh all over his visor - from my leg, obviously. I flipped his visor up and then he could see. I don't remember much after that except that it really hurts when you get shot! It's not like a John Wayne movie.