Fig 9. Layout of a Corps Medical Area.

 

 

If possible the theatres and the wards should have been separated to remove the distraction of extraneous noise. Instruments were laid out on a ‘cafeteria’ basis with only those needed for a particular operation taken so as to reduce the volume of materiel for sterilisation. The post-operation ward was intended to be reserved for the most seriously wounded patients needing special care and attention. If every injury was sent there after an operation the unit would soon

become overcrowded and the nursing staff would be unable to devote proper time to the serious cases. An example of the layout of a CCS is shown at Figure 8 (16).

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LAYOUT OF MEDICAL UNIT:

reception, evacuation, resuscitation,

X-ray, surgery, post-operative ward,

general ward.

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Fig 8. CCS Tentage Layout.

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Whenever possible the policy of grouping CCSs that had been developed in World War 1 was followed, thereby creating a ‘Corps Medical centre’. This arrangement simplified the evacuation procedure as all casualties were sent to one place and their subsequent disposition was decided by a single reception process. This was all the more important where onward movement was by air as a single airfield might serve a number of medical units and casualties could not be allowed to build up awaiting movement on the airfield itself (19). In many cases the FDS was used as a filter to take light cases and sick, and to co-ordinate the evacuation of casualties who did not need admission to a CCS prior to onward evacuation. When 2 or more CCSs were grouped, admissions could be controlled either on a time basis or by the number of casualties admitted depending on the workload. An example of the layout of a Corps Medical Area is shown in Figure 9 (16).

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EVACUATION: grouping of CCSs

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Burma 1942-1945

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The environment over which the campaign in Burma was fought had as many extremes as anywhere in Europe and the Mediterranean.

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The mountain warfare of Eastern Assam, the open warfare of the Central Burmese Plain, the amphibious operations along the coast of Burma and the long-range penetration operations of the Chindit expeditions each presented their own challenges. Above all else it was a campaign characterised by greater distances than the Middle East where movement overland was a major feat of endurance. However, the availability of evacuation by air transformed the management of battle casualties (20).

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Jungle operations caused similar challenges to other campaigns whereby very small units might be operating some considerable time (duration of travel not distance) from the base. Infiltration of the enemy onto the lines of communication was frequent and so casualty evacuation by land involved the commitment of forces for the protection of the ambulance convoy. Thus Jungle Surgical Units were developed that were configured for man-portable movement.These could be attached to the ADS of a field ambulance (21,22) or even further forward with the bearer companies.

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A unit of about 25 holding beds was found to be most practical (6). Movement, casualty evacuation and re-supply of medical materiel was frequently by air and so all equipment had to be man-portable and as interchangeable as possible. The theatre and the holding area could be as primitive as stretchers supported on forked sticks with slit trenches for the casualties if the medical site came under fire. In spite of these limitations, many lives were saved when the alternative was a five day hand carry to a Base hospital or an uncertain wait for evacuation by air.

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SURGERY: specialist units may be

required for specific environments.

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Summary

 

The wide variety of environments during World War 2 in which military forces were committed led to the creation of a range of medical units that could be tailored to provide medical support to the fighting forces. The timeless challenge of providing surgical treatment as soon as possible after wounding associated with the relative complexity of hospital services and the immobility of serious post-operative cases remained.

 

The Hartgill committee broke from the single casualty ‘pipeline’ of the First World War by establishing the ADS as the focus for distribution of casualties to the different medical units on the basis of the clinical need of the casualty. This followed the concept described by Jolly.

Small, mobile surgical teams (FSU's) were developed to reinforce forward medical units to provide treatment for small numbers of casualties. Mobile resuscitation teams (FTU) were created to administer blood and intravenous fluids to the sickest casualties.

 

If larger numbers of casualties were expected, then larger medical units were required (CCS's). The CCS continued to be dependant on the transport services for movement. The FDS was created as a holding and nursing unit with the dual function of either hosting one or more FSU's or FTU's to create an advanced surgical centre, or to act as a holding centre for the minor sick or injured so as to limit the extent of their evacuation.

 

Finally, the aeroplane transformed the speed and efficiency of casualty evacuation from forward surgical units to rear hospitals in a similar manner to the transformation achieved by the motor ambulance in the First World War.

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