The U.S. military, mobilizing its largest combat medical force since World War II, is struggling with outmoded medicines and equipment, supply shortages and transportation problems, according to military medical authorities in the Pentagon and Saudi Arabia.

The Defense Department is rushing more equipment, medicines and medical personnel to the Middle East in an effort to remedy the problems and prepare for the possibility of thousands of casualties in the event of prolonged war with Iraq, military officials said.

American authorities also have negotiated with several Mideast nations for use of civilian hospitals in the event U.S. combat medical facilities are overwhelmed. In addition, some civilian hospitals in the United States have been alerted that they may be used for wounded troops if war erupts, officials said.

While Defense Department authorities are attempting to speed modernization of desert medical facilities and the shipment of extra supplies and medicines, much of the equipment has not arrived in the region, frustrating many of the physicians and other medical personnel assigned to remote medical units.

Military doctors who are accustomed to working in some of the most sophisticated hospitals and clinics in the United States, and are now dispatched to front-line medical units in Saudi Arabia, complain that much of the equipment and medicine supplied by the military is years behind the latest medical advances and say their combat units lack some critical items and supplies.

"Would you send Marines into combat without their tanks?" asked one Navy physician assigned to a Marine Corps field hospital. "Why send us here without gear? Mothers don't want their kids to get second-rate care out here."

In response, Col. D.G. Tsoulos, the Army's chief surgeon in Saudi Arabia, said in a recent interview that "some fine-tuning" has been done and more is continuing.

U.S. medical authorities in the Middle East say that much of the equipment initially sent to the region was outdated and inadequate. Inflatable field hospitals purchased by the Army 10 years ago for use in combat arrived with "technology that was not the state of the art," Tsoulos acknowledged. He said the Army has spent the past several months refitting and modernizing field facilities.

Numerous Navy doctors assigned to field hospitals for front-line Marine infantry units said medicines provided by the military were sometimes 10 years behind the current generation of antibiotics and other medicines now in use in most American hospitals.

Physicians at one forward unit also complained that they were not provided the proper equipment for monitoring oxygen levels in the blood during surgery and modern devices for setting broken bones. Navy doctors at another Marine facility said they discovered serious supply shortages, noting that the plaster for casts arrived without the webbing needed to wrap damaged limbs.

Hampered by the bureaucracy of the mammoth military supply system, many of the physicians interviewed said they had written to their home hospitals asking them to ship equipment, supplies and medicine.

"I refuse to accept the term meatball surgery," said one front-line doctor. "We could have a higher salvage rate of lives if we were given the right equipment."

Physicians said, for instance, they were equipped with old X-ray machines and foot-pumped bellows for breathing oxygen into patients during surgery.

But some medical officials argued that the pace and scope of wartime medicine differs vastly from peacetime practice and that much of the high-technology equipment doctors use daily in their home hospitals is unnecessary in a combat environment.

"You can't set up a Walter Reed or a Bethesda in the middle of the Saudi desert," said the Army's Tsoulas, referring to the Army and Navy medical centers in Washington and suburban Maryland. He said the field facilities were "built to take care of wartime casualties and wartime diseases, not to do six-month diagnostic tests to find some funny little off-the-wall disease. What they're going to see will be obvious."

"Our mission is 'Stop and chop,' " said one doctor assigned to a forward-based mobile hospital unit, one of the few military physicians in Saudi Arabia who served in combat in Vietnam. "We stop the bleeding and chop off something we can't save. It's not particularly sophisticated."

Nevertheless, medical officials serving even at the more sophisticated facilities, such as the Navy's hospital ships, worry that they may be overwhelmed by casualties.

The military has refused to disclose the number of hospital beds it has established in the Middle East for possible combat that could involve 430,000 American forces and 250,000 Arab and other allied troops. Most other nations participating in the multinational force, with the exception of the British, have limited field medical facilities, and the U.S. military could be forced to absorb many of their wounded troops, American officials said.

Some military officials say that the Defense Department is planning to establish more than 20,000 field hospital beds in the region. The Army is providing each of its nine combat divisions with at least four field hospitals that can accommodate about 1,000 patients; the Navy is preparing at least 3,500 beds on its two hospital ships and at three large field hospitals; and the Air Force has sent numerous 50-bed air transportable hospital units to Saudi Arabia.

Many physicians say they are concerned that the military has not dedicated enough helicopters, trucks and field ambulances to accommodate the massive surge of casualties that could result from heavy-armor warfare in the desert.

"The helos belong to the guys with the bullets, not the guys with the bandages," said one Navy doctor assigned to a Marine field unit. "We have three ambulances, a hum-vee {jeep} and a pickup. We could take care of 14 people if all the ambulances were out in the field."

Senior medical authorities say that both air and ground transportation would be quickly diverted to medical evacuation once combat begins.

American military doctors say they have encountered problems and shortages in the medication needed even before combat begins. Because most of the medicine and supplies are oriented to combat wounds, doctors say they have been faced with shortages of aspirin and diarrhea medication for troops stationed in the desert.

Others say the long wait in the desert has given them valuable time to assess and reorganize the wartime provisions that have been stored in dusty containers awaiting eventual use.

"I had to break open eight boxes {of supplies} to find the sutures to put in three stitches on a patient," said one physician assigned to a Marine battalion. "Fortunately, it wasn't a serious wound."