European Front 1939-1940

 

SURGERY: establishment of debridement and delayed primary

suture as the surgery of choice for war wounds.

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The British Army entered the Second World War with a casualty evacuation system based on experience from the First World War (7).

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The scheme of evacuation published in the RAMC training manual continued to have the CCS as the point of convergence of all casualties (as shown in Figure 2 (8)). The CCS continued to be sited at the head of a railway line served by an Ambulance Train. It was a large unit, divided into a Heavy and Light section as organised at the end of World War 1 but without sufficient transport to move any element by itself.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Fig 2. Casualty Evacuation Chain 1935.

 

The period of active operations started on May 10 1940 when German forces attacked Holland and Belgium. From May 17 until the completion of the evacuation of British forces from Dunkirk, Cherbourg and western French ports, the British Army was in retreat. This caused commensurate disruption to the casualty evacuation plan. It was apparent that the equipment for the CCS was too heavy and too bulky. When the CCS was required to move, this was the time when the demand for transport across the Corps area was at its peak. Practically every CCS in this campaign lost a greater or lesser part of its equipment on its first move (9).

Western Desert 1940-1943

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The campaign in the Western Desert from 1940 until the battle of El Alamien in 1942 was a ‘yo-yo’ along the North African coastal strip. It was a battlefield of armoured manoeuvre warfare with extended lines of communication. By the end of 1941 it was evident that a unit had to be improvised that could carry out the duties of a CCS but without the logistic demands. The need for formally configured ‘surgical teams’ that could be moved to reinforce CCSs or exceptionally to divisional Main Dressing Stations (MDS) to form ‘advanced surgical centres’ was also identified. Whilst such an advanced unit could not replace the care provided by the CCS, there was no doubt that lives could be saved if the CCS was many miles further down the evacuation chain.

 

SURGERY: mobile field surgical teams to move between CCSs as reinforcements.

 

The medical plan for Operation Crusader in Libya in November 1941 gives an idea of the complexity of such an evacuation system.

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Mobile surgical teams were attached to the CCSs at the start of the operation ready to be pushed forward when needed. A mobile military hospital, modelled on the American hospital platoon, was allocated sufficient transport to be able to move independently.

 

Each CCS was provided with a platoon of 34 lorries from the Royal Army Service Corps for as long as they were mobile units. The plan for XIII Corps was described as ‘An advanced operating centre (HQ of an Indian field ambulance plus the light section from 2 Indian CCS) at Bir Mumin will serve Indian 4th Division. In the rear of New Zealand field ambulances will be a New Zealand mobile surgical team for emergency operative treatment in an advanced operating centre at Dar El Brug.

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Supporting this in the Bir Habata area will be an advanced operating centre consisting of the corps field ambulance, the light section of 14 CCS and 2 Field Transfusion Unit) (10)’. This scheme of evacuation is shown at Figure 3.

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The mobile, self-contained Field Surgical Teams were designed to be grouped and regrouped in an ever-changing pattern and could function with either the field ambulance MDS or the CCS depending upon the tactical situation. The determining factor was to ensure that the interval between wounding and primary surgery did not exceed 8 hours (for wound management, not arrest of bleeding (9).

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