Critical Care Medicine - List
http://www.pitt.edu/~crippen/

RULES OF COMBAT

• If the enemy is in range, so are you.

• Incoming fire has the right of way.

• Don't look conspicuous; it draws fire.

• The easy way is always mined.

• Try to look unimportant; they may be low on ammo.

• Professionals are predictable; it's the amatuers that are dangerous.

• The enemy invariably attacks on one of two occasions, when you are ready for them, when you are not ready for them.

• Teamwork is essential; it gives the enemy someone else to shoot at.

• If you can't remember , the claymore is pointed at you.

• If your attack is going well, you have walked into an ambush.

• Don't draw fire; it irritates the people around you.

• The only thing more accurate than incoming enemy fire is incoming friendly fire.

• When the pin is pulled, Mr. Grenade is no longer our friend.

• If it's stupid but works, it is not stupid.

• When in doubt, empty the magazine.

• Never share a fox hole with anyone braver than you.

• Anything you do can get you shot; including doing nothing.

• Make it too tough for the enemy to get in and you can't get out.

• Mines are equal opportunity weapons.

• A purple Heart just proves that you were smart enough to think of a plan, stupid enough to try it, and lucky enough to live through it.

• Don't ever be the first; don't ever be the last; and don't ever volunteer to do anything.

• Five-second fuses only last three seconds.

Comment from David Crippen:

I have not heard these rules reiterated in almost 30 years, but I can assure you they are each only too true and when they were presented in Vietnam, there was considerably less humor attached to them. Seemingly small deviations from these maxims carried harsh and unpleasant penalties. A little history and a personal note:

In 1967 around Tet and following a number of fairly big offensives, the Army ran out of gun fodder and the draft began in earnest.. This was about the time advisors formulated the opinion that the United States could still win a war of attrition with Asians, a position which Macnamara and Dean Rusk tried to absolve after their retirement, presumably to facilitate their immortal souls into something other than the deepest pit in Hell they both deserved.

Be that as it may, one day there was a Jeep waiting for me at the end of the sidewalk after my grade point average dropped below a C minus (dammed economics course.......still don't understand it). After some preliminary behavior conditioning I arrived in Vietnam early in 1968 as a PFC field paramedic. I mention this only to provide the background as your observer and storyteller.

Since this was an unpopular war, to say the least, creative attempts to avoid the draft were very fashionable. Some very interesting medical problems surfaced at pre-induction physical exams, especially from rich kids who had access to sympathetic physician friends of fathers, those with sudden listening disorders and especially those arriving with shirt skirts and black fishnet stockings. I think some physician assigned to examining potential recruits from 1965-70 could write a VERY interesting book on the subject.

One of the more resourceful diversions was to apply for conscientious objector status. Since this had a religious connotation, the Army could not dismiss it outright so they tried to divert the diversion by involutions of red tape and paperwork. Among other impedimenta, it was necessary to prove that the potential deferee had formal religious upbringing (not joining a church the week before induction). This religiosity had to be steeped in the belief that all killing was fundamentally, morally wrong, not just during provincial political-economic squabbles.

This kind of lifelong religious indoctrination is pretty difficult to come by, especially on quick demand. A few hardy souls fled to Canada....most slipped back later. A few Quakers got out of Vietnam, but they all got drafted anyway into non-combatant sections. The agnostics then attempted to convince the Feds that it was possible to be a conscientious objector on the basis of non sectarian beliefs. This was a lot harder to do, since the applicant had to present volumes more proof of a nebulous and abstract nature to support their beliefs. A lot were graduate students in philosophy, but most were ordinary college types who held strong feelings about shooting their fellow hominids, especially those with the irritating tendency to shoot back.

So, it happened that a lot of would-be conscientious objectors followed or were pushed by the gently guiding hand across the pond to the big shootin' match just behind the rising sun. Most just gave up and got it over with, one way or the other. A few hard cases attempted to push the envelope after it had been delivered. This is the story of one such hard case.

Roland (not his real name) was fresh off the boat, pasty white New York City complexion, royally pissed off and ready to give someone a hard time. He stewed for a week during the hot weather acclimatization period and was duly sent to the boonies for field duty as a rifleman. Our story starts the day before his first foray into the field on a search and destroy mission.

Now, back in those days it happened that survival in the bush depended a great deal on an individual's ability to read, learn and navigate complex lessons quickly. First, it was necessary first to figure out that all previous "training" the Army offered was misleading, ineffectual and a direct lead-in to death or dismemberment if taken at face value. There are no guidebooks in a conflict where you can't tell friend from foe, even with a scorecard. Following that revelation, it was then necessary to figure out the RIGHT things to do with little or no prompting. The first month in the field was the big breakpoint. Those with slow wits, trusting souls, and the occasional bad luck fluke got eliminated from the gene pool quickly, leaving the wily and suspicious to carry on. Surviving a mistake was a gift from God. Making the same mistake twice proved you unworthy of God's grace.

Roland marched into the platoon leader's tent on arrival and announced that he had no intention of carrying a rifle, much less using it. He was a university trained intellectual and he had very profound and deeply held opinions about war in general and killing his fellow hominids in particular, none of whom he had any bad feelings for. He had tried valiantly to get non-combatant status and had been foiled at every turn by an uncaring, arrogant military whose only interested in him was as gun fodder. He had told them all during the appeal process that he didn't have any intention of carrying a firearm, much less using it even if put in combat. Now he was here and nothing had changed. He was prepared for reprisal, jail, torture and death.........but under no circumstances would he carry a weapon. And that was that. Plop went the M-16 on the desk.

The Lieutenant looked at Roland....looked at the M-16........looked back at Roland, shrugged and told Roland that this was only an apparent problem. He had no interest whatsoever whether Roland carried an M-16 or an olive branch or a dry martini...........but Roland was to be standing tall at 0400 for an insertion into a thickly ICU infested area for a looksee, and, of course, to kill everything walking, crawling, undulating or squirming. He then exhorted Roland to have a nice day and dismissed him.

True to form, 0400 found Roland standing tall, bright eyed, bushytailed and ready for action..........sans weapon. At 0405 Roland entered a non-stop express elevator right past ladies lingerie, camping equipment, sundries direct to the Twilight Zone............and ejected into a arena he never dreamed of in his wildest imagination. Sometime during that day, Roland came to the proverbial crossroads and made a deal with a God he never believed in, confronting insane reactions to an insane world, emerging different man. Next trip to the zone found Roland laden with rifle, ammo, flares, grenades, sidearm and a custom survival kit of his own design. Roland survived Vietnam and came home to a productive life.

It has been said that a large portion of the American young healthy male gene pool was lost between 1960 and 1973 in Vietnam. I submit that this is only partially true. Allowing for a universally applied bad luck component, at least some of that gene pool were culled out because they were congenital non-survivors. Those who did survive, did so because they were able to put together an expedient endurance strategy that worked. Like a fast video game, those who excel at it do so because they can react quickly effectively to speculative landmarks and clues on the fly. Those who couldn't found that the speed of the game exceeded their ability to keep up with it.

Don't flame me for insensitivity. Insensitivity is a natural, appropriate reaction to an insane world, and pragmatism is it's right arm. Which is the greater tragedy, to forfeit life in the name of ideals, or forfeit ideals in order to survive to have ideals. This question becomes decidedly less than academic when individuals get into the clinch. Occasionally someone asks me if I believe in God. You bet I do, and not because I'm hedging my bets from Pascal's Wager. Perspectives on the existence of God become very lifelike when you make deals with God on an hourly basis and see the outcome of those deals.