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A very kind tweet from @greg_jenner has resurfaced, leading to a run of new followers. So, for Armisitce Day, and in the spirit of presenting my credentials, here is a thread on #ww1 British medical evacuations.
When a man was wounded in the front line, if he couldn't make his own way to the Regimental Aid Post (RAP) as walking wounded, his first encounter with the chain of evacuation would be the regimental stretcher bearer (RSB).
RSBs were not medical service personnel; they were members of the regiment, trained in arms, who volunteered (or were volunteered) to act as stretcher bearers under the authority of the Regimental Medical Officer (RMO).
The RMO was a member of the Royal Army Medical Corps (RAMC), attached to the regiment, and medically trained, as all RAMC officer had to hold professional medical qualifications.
The amount of training RSBs received depended on the concientiousness of the individual RMO. CK McKerrow, attached to the 10th Bttn Northumberland Fusiliers, took great pride in the work of his RSBs; JC Dunn, attached to the Royal Welch Fusliers, offered less training to his.
The first stop a wounded man would make would be the RAP where he would receive triage and treatment from the RMO and his orderly, an RAMC NCO. This meant basic identification of the wound and possibly rebandaging if there was time available. Image: Wellcome Library L0009419
From the RAP he would be collected by RAMC stretcher bearers from a Field Ambulance. These men were non-combatants with training in stretcher drill and some very basic first aid. They were not medical professionals, although many did develop levels of expertise during service.
The Field Ambulance was not a vehicle (those were horse-drawn ambulance waggons or, increasingly, motor ambulance cars), but rather an established military medical unit made up of 193 men divided into 3 sections.
Each section had 2 subsections: the bearer section made up of 36 men and the ‘tent’ section of 13-15 orderlies. Bearers carried while orderlies ran dressing stations and, behind the lines, divisional baths.
This structure was flexible, with sections combined and seconded as needed. Orderlies often worked as relief bearers or were seconded to Casualty Clearing Stations (CCS). Bearers carried men manually, on wheel stretchers, by light rail and, in desert, on camels.
The priority of Field Ambulances was evacuation. Dressing stations acted as staging posts for bearer relays and where men’s wounds could be rebandaged and blankets replaced. Medical intervention was minimal. Image: Stretcher cases awaiting transport near Arras, 1917; Q 6195, IWM.
Main dressing stations were sited on roads. From these, men were collected by motor ambulances of the Motor Ambulance Convoys (MAC) or of a volunteer unit such as the First Aid Nursing Yeomanry (FANY) or the Friends Ambulance Unit (FAU).
MACs formally a branch of the Royal Army Service Corps rather than the RAMC, although they had a small number of RAMC administrators attached for coordination purposes.
Ambulance car drivers were mechanics, not medical personnel; no medical personal travelled with a motor ambulance as standard, although orderlies sometimes did travel in one en route to a CCS.
Travel in motor ambulances was dark and uncomfortable, not to say dangerous. Lack of suspension meant that men’s wounds could reopen on bumpy roads, causing them to bleed out. Accidents were not uncommon on overcrowded, poorly maintained roads.
MACs took men to Casualty Clearing Stations. Known as field or clearing hospitals during the South African War, the units were renamed in 1915 to reaffirm their role as staging posts in the chain of evacuation rather than as sites of care.
Ironically, the stasis of trench warfare meant that, after their renaming, they became more static and were able to act more like hospitals, providing more medical intervention, including surgery, x-rays and blood transfusions. Image: Wellcome Libray, L0044173
Because of this, men could be discharged from CCSs to training depots or their units once sufficiently recovered. CCSs also contained moribund wards for men too badly injured for further treatment. The RAMC orderlies of served on these wards and acted as gravediggers.
CCSs were the farthest forward that female nurses served. These were the trained nurses of the Queen Alexandra’s Imperial Military Nursing Service and the Territorial Forces Nursing Service. Nellie Spindler, a QAIMNS with No. 44 CCS was killed at Passchandaele in July 1917.
CCSs were generally sited at railheads as the next stage of medical evacuation was by ambulance train. During the war, 31 trains were built for service on the continent. A further 20 were built for service in Britain.
Trains carried up to 500 passengers, either sitting or lying, as well as a staff of 50, including a Medical Officer, 3 nurses and orderlies. Trains could also be staffed by volunteers from the Red Cross, including the FAU. Image: Science Museum Group Collection
Trains took men to Base Hospitals at ports such as Boulogne and Le Havre. These were increasingly run by the Red Cross and were staffed by trained nurses and VADs overseen by RAMC medical officers.
Often sited in institutions including schools and religious houses, men could receive significant medical intervention and longer term care in Base Hospital. Image: Wellcome Images
After the early months of the war, if their wound was not a ‘Blighty’ wound, men were discharged to training camps before returning to their unit. Men with a 'Blighty' would be sent by hospital ship to Britain where they would be transported, to a military medical hospital.
Miltary hospitals were staffed by the RAMC, including RAMC orderlies not deemed fit enough for overseas service and those still undergoing training. Trained British Red Cross nurses served as Matrons, with VADs increasingly providing the female nursing staff.
While in hospital, men remained under military discipline and wore a uniform of ‘hosptial blues’. These were loathed; they never fitted properly and were considered infantilizing. They did not have pockets so men couldn’t carry money with them, to prevent them from drinking.
From military hospital men could either be discharged from the armed services or sent to an auxiliary hospital for convalescence. Auxilliary hospitals were set up in converted non-military buildings, such as the country houses volunteered by many owners.
They were run by the Red Cross, staffed by VADs under the authority of a trained Matron and overseen by an RAMC medical officers.
Some were luxurious, particularly those reserved for officers. Others were less so. Men at Glehow Hall in Leeds were housed in huts with open sides to allow them exposure to the health giving properties of fresh air – all year round. Image: Leodis
Men were also taken on excursions and entertained and supported by the local community. Such communities were able to see the damage inflicted by the war and to do their patriotic bit in supporting the war effort through caring for the wounded.
From auxiliary hospitals, men who were not discharged as unfit for service were sent to training depots. From there’re they might be reassigned to lighter duties due to decreased physical fitness or returned to their units, where they might be wounded or fall ill again.
If you have made it this far and still want to know more, my book, An Equal Burden: The Men of the Royal Army Medical Corps is available from Oxford University Press as an open access download. https://oxford.universitypressscholarship.com/view/10.1093/oso/9780198824169.001.0001/oso-9780198824169
Thank you for reading.
Thank you for reading.
