Named after the date these elite units were created, February 29, 1944, FOXY-29 medical augmentation units provided lifesaving forward surgical care to soldiers and marines on the beaches of Normandy during the Second World War (WWII).
A precursor to the US Navy’s modern fleet surgical teams, FOXY-29 units deployed on Landing Ship Tanks (LSTs) and were specifically designed to carry troops and materiel to support amphibious operations.
The origin of the American-designed LST can be traced back to November 4, 1941, when the British sent a dispatch to Washington, DC, requesting landing craft capable of carrying 500 tons of military cargo. The request was brought to the US Navy’s Bureau of Ships by Captain Edward L. Cochrane, and civilian naval architect John Niedermair is cited as having been tasked with sketching the designs for a ship with such capabilities.
Niedermair’s blueprints featured a ship that could cross the Atlantic yet also pump ballast tanks dry to land on beaches amidst amphibious operations and were specifically designed for use by the US Marine Corps (USMC). This initial design would ultimately become the famous LST of WWII.
The first LST, launched less than a year after the conception of its original design, was the product of a collaboration between the Bureau of Ships and the USMC (which had provided significant input into the design). These vessels would go on to become one of the most versatile, widely used, and strategically indispensable components of amphibious operations by Allied forces during WWII.1
Sitting at 328 feet long, 50 feet wide, with a minimum draft of only 3.8 feet, the LST could hold up to 1,900 tons of tanks and vehicles on its vehicular deck. These ships also included a sick bay, which represented the extent of medical capability for early LSTs.
Over the course of WWII, LSTs were fitted with varying equipment and medical teams, and some vessels were redesignated to better address the medical needs required by large-scale amphibious operations. By the Battle of Iwo Jima (January–March 1945), many LSTs participating in the invasion would be retrofitted with advanced medical and operative capabilities and redesignated as hospital ships—the LST(H).
To complement the newly retrofitted LST(H) vessels, the US Navy devised and implemented the FOXY-29 unit—a stopgap to address the anticipated increased casualty load for what was going to be the largest-known military amphibious invasion, which occurred in Normandy, France, on June 6, 1944. These lesser-known military units assigned to LSTs proved exceedingly capable at answering the call despite being equipped with limited supplies.
FOXY-29 Unit
More than 3,000 US Navy personnel would become part of the FOXY-29 program, and more than 2,300 naval medical personnel would be aboard LSTs at Normandy.2,3 Comprised of one or two doctors and 20–40 corpsmen, a single FOXY-29 unit would be assigned to an LST ahead of the upcoming invasion.
While composition varied modestly among FOXY-29 units, most units were composed of pharmacist mates—equivalent to modern-day hospital corpsmen—of varying rates and experience.4 The US Navy trained these special units at a small base in Lido Beach, New York. The units’ sole purpose was to organize and train personnel for this mission.
Many FOXY-29 physicians—commissioned officers—reported to Lido Beach having just finished their internship year with little to no prior military experience. Some of these physicians had their internships cut short by 3 months due to the pressing wartime efforts, limiting their postgraduate education as interns to only 9 months before being sent out to the fleet.5
Training at Lido Beach would last 5–6 weeks for FOXY-29 personnel. Enlisted personnel were issued carbines, and officers received Colt .45s, affirming the fact that unlike their medical counterparts aboard rearward white-hull hospital ships, FOXY-29 personnel would be in the fight.5
From a logistics standpoint, transporting wounded casualties from beachhead to ship before sailing back across the channel toward a higher echelon of care was not without challenge. While the bow doors of the LSTs were built to be able to onload and offload with relative ease, some LSTs would stay afloat for parts of the invasion, which necessitated other means of transporting casualties onto the ship.
DUKW amphibious trucks (D standing for the 1942 production year, U for utility, K for all-wheel drive, and W for tandem rear-axles); Landing Craft, Vehicle, Personnel (LCVP); and Landing Craft Tank (LCT)—small assault craft—were tasked with casualty evacuation on return trips after deploying troops and cargo on the beach, transporting the wounded back to LSTs offshore.
From there, the newly repurposed ambulance ships would dock alongside the bulkheads of LSTs before loading casualties on a crane that could haul the wounded on Stokes litters aboard the larger ship. At that point, patients could be triaged by the FOXY-29 personnel who stayed aboard LSTs, before heading back across the English Channel.2,5,6
The capacity to manage casualties for each LST differed but was most impacted by whether or not the vessel had been purposefully retrofitted for casualty transport. Many LSTs prior to the invasion of France’s beaches had been fitted with three-tiered litters and rudimentary operative capability in the crew mess room for more advanced casualty transport capacity and stabilization of acute traumas, respectively.
Removable brackets were added to what would otherwise be used as part of the cargo haul to accommodate 147 additional litters to be used to transport the wounded, although some reports of casualty-converted LSTs note that the largest number of casualties carried in one trip was 260.6,7
Crew mess rooms were turned into makeshift ORs with the addition of a slop sink, an extra light, double electric outlet, and a foldable counter to house the ship’s portable sterilizer and associated trays. Additional stowage and bracket arms on the mess room bulkheads and newly mounted operative lights positioned over crew mess tables complemented the other renovations and formed the “MacGyvered” LST ORs.
Of the 144 LSTs assigned to the Normandy assault task force, 54 had been outfitted with these additional medical capabilities, and the remaining LSTs were to provide medical care with stock equipment and carrying capacity.6
Road to Normandy
The 3.8-foot minimum shallow draft of the LST that famously gave it its amphibious capabilities was not without consequence. Optimized for the shallow waters that define amphibious operations, the hull of the LST was poorly suited for the Atlantic crossing.
One FOXY-29 physician estimates that 95% of his shipboard crew was seasick during parts of the crossing. Medical personnel carried scopolamine and other motion sickness medicine for this purpose. Indeed, it was reported that the keelless LST would crest 40-foot waves and slide sideways, a supposedly exceedingly vertiginous sensation caused by its increased leeway and decreased tracking by virtue of design.2
High winds and chop would not be the only treacherous features of the Atlantic crossing. Lurking below the surface of the water, Unterseeboote, German U-boats, as well as surface E-boats—fast attack craft—were preparing to mount attacks on the crossing of Allied convoys.
On April 28, 1944, while Allied forces were practicing landings during Exercise Tiger, LSTs 507 and 531 were hit and sunk at the hands of nine E-boats that emerged out of the fog off Slapton Sands near the Devon coast. Estimated casualties from the two combined losses were 600–800 American servicemen. An estimated 13 more casualties resulted from damage to LST 289 attributed to friendly fire, which had its screws and rudders damaged and sustained a fire but otherwise remained seaworthy.5,8
For most who made it across the Atlantic, following the staging and preparation for the invasion of Normandy, came the crossing of the English Channel toward the beaches of occupied France. Not dissimilar to the Atlantic crossing, safe passage across the channel was not guaranteed.
Mines laid by various German vessels, combined with E-boats and Luftwaffe air raids would threaten convoys crossing the channel. While the surprise of the early D-Day convoys meant few threats from patrolling E-boats and air raids, American LSTs were susceptible to the mortal threat of mines in the crossings that followed. As such, LSTs traveled with minesweepers to dampen that risk.
To mitigate strafing runs by Luftwaffe air raids, LSTs floated barrage balloons attached to the ship deck and to one another with steel cables designed to disrupt and mitigate attacks from above.9
June 6, 1944
A total of 144 LSTs were estimated to have landed as part of the assault force during the invasion on D-Day. Of these, 106 LSTs were designated for casualty evacuation, 95 of which would undergo several trips across the channel to carry casualties, with 54 vessels having been purposefully retrofitted with extra litter racks and operative capability.3,6
LSTs converted for casualty evacuation received casualties in several different ways. The vessels that landed on the beachheads to unload vehicles and troops were able to receive patients through the bow ramps as well. However, LSTs at anchor and those unable to beach could load casualties brought by DUKWs, LCVPs, and LCTs using Stokes litters and double slings with deck cranes.6,7
Once aboard the casualty-carrying LSTs, FOXY-29 physicians, corpsmen, and US Army surgeons were hard at work triaging, stabilizing, and caring for Allied casualties and prisoners of war alike. Hospital corpsmen worked in rotating shifts—4 hours on, 4 hours off—once patients were stabilized. However, they were reported to have worked continuously through the day and night until D-Day plus 3.
Numerous amputations were performed in the officer’s wardroom and messing tables in crew quarters, requiring significant amounts of blood plasma and penicillin. Exploratory laparotomies, debridement of ophthalmologic injuries, suturing of scalp lacerations, as well as fixation and splinting of various fractures are documented procedures of medical teams aboard LST 307. Other LST reports note treating gas gangrene, and all reports note extensive use of penicillin in all patients.
While medical staff organization differed from unit to unit, the US Army surgeon and his two assisting technicians aboard the LST 307 performed all operations. The two FOXY-29 US Navy physicians administered anesthesia (sodium pentothal) and oversaw pre- and postoperative care, and enlisted personnel were responsible for administering stimulants, sedatives, intravenous fluids, charting, and other nursing duties.
Collaboration of FOXY-29 units with medical personnel of other branches and militaries was not uncommon. Reports from the LST 209 suggest the onboarding of a Royal Navy medical unit, consisting of three medical officers and 33 first-aid men before sailing for France’s beaches.
LSTs offloaded their casualties back to LCTs once they made it back across the channel and did not come into port to expedite patient disembarkment. By doing so, LSTs could unload up to 1,100 casualties in the span of 3 hours. Before returning to France, medically converted LSTs were resupplied at depots established at Southampton, Portland-Weymouth, and Brixham.6 Throughout the days and weeks following D-Day, LSTs transported more than 41,000 casualties from the beaches of occupied France back to the UK.3
Historical Significance
The advent and implementation of FOXY-29 units aboard LSTs represents an inflection point in the US Navy’s approach to medical support in combat operations.
Prior to WWII, medical personnel and equipment were limited to basic first aid with inadequate operative capability, if any at all, during initial amphibious, and casualty evacuation infrastructure from shore to shore was underdeveloped.
The decision to embed more advanced casualty care teams aboard LSTs for the invasion of Normandy reflected the recognition that large-scale assaults required increasingly advanced medical capability within close proximity to injured combatants. This shift departed from, yet complemented, the more traditional model of having rearward hospital ships and shore-based treatment facilities, establishing the principle that medical capability could, and should, follow maneuver elements.
FOXY-29s represented early, deliberate attempts by the US Navy to weave combat casualty care within the hull of assault vessels.
Improvised ORs fashioned from mess tables and wardrooms enabled Army surgeons, Navy physicians, and hospital corpsmen to conduct urgent procedures while the ship continued to sustain enemy fire. By performing transfusions, administering anesthesia, and operating while underway, FOXY-29 teams and their surgical personnel delivered critical care during the “golden hour.” While novel in amphibious operations, this concept contributed significantly to the success of medical care during D-Day and foreshadowed the doctrinal emphasis on en-route critical care that defines contemporary military medical evacuation algorithms.
The novel surgical capability aboard forward-operating craft was a functional precursor to the lineage that would later include US Navy fleet surgical teams embarked on modern amphibious warships, capable of landing troops by both air and sea.
While LSTs have long since been decommissioned, the ethos of FOXY-29 lives on today. The US Navy currently operates 22 amphibious warships equipped with modern ORs, hospital wards, and intensive care units, along with substantial supplies of packed red blood cells, frozen plasma, and walking blood bank capabilities—enabling robust forward surgical care anywhere in the world.
