The Chain of Evacuation of The Royal Army Medical Corps
A man's chances of survival depended on how quickly his wound was treated. Modern warfare was now producing vast numbers of casualties requiring immediate treatment at the same time. This necessitated an efficient system that could immediately address a patient’s critical injuries close to the Front and then evacuate him to a medical unit in a safer zone. This network is known as the Medical Chain of evacuation or evacuation chain.
The secret of success in treating large numbers of casualties was rapid evacuation. “All through the chain of Medical Units from the Front to the Base the wounded man is kept the very minimum of time to attend to his wounds, and then he is moved on, and kept on moving, until he reaches either the Base or Home..... The reason for rapid evacuation is twofold. Firstly, it is very bad for morale if troops see wounded men lying about in large numbers; and, secondly, unless Medical Units are cleared they lose their mobility, and also cannot deal with a fresh influx of wounded that might come in quite unexpectedly - e.g. from a surprise counter-attack.” [Lt/Col T B Nicholls R.A.M.C. ‘Organization, Strategy and Tactics of The Army Medical Services in War’]
The rapid and successful evacuation of any casualties, whether on a battlefield or in civilian life, depends on three interdependent factors - time, space and transport.
Time involves how quickly wounds receive first aid so infection does not set into the wound, and/or the casualty does not bleed to death. It also involves how quickly the casualty can get to someone with specialized knowledge or with specialist equipment. Abdominal wounds, for example, need to be operated on within six hours in order for the patient to survive.
Transport involves what type of equipment can be used and/or is readily available to transport the casualty away from danger and to an appropriate medical facility. This process could involve the soldier walking or being transported on stretchers, horses, cars, trains, barges or ships.
Space involves what is happening in the immediate area such as: how close can emergency services get without becoming casualties themselves? What is topography and how does it help or hinder? Is there enough space to set up a large medical facility close by or is there only enough room for a small one?
With the above in mind, other factors had to be considered:
• Mobility: All medical field units needed to be able to move at a moments notice. This was essential to ensure the fighting units had medical support during an advance or retreat. The procedure for a significant advance was for each medical unit to move forward to one already up and running in front of them. Therefore, the Regimental Aid Post would move forward in line with the fighting soldiers. An Advanced Dressing Station would then move forward to a Regimental Aid Post. The Main Dressing Station would move forward to an Advanced Dressing Station. A Casualty Clearing Station would move forward to a Main Dressing Station, and a Stationary Hospital would move to fill the gap between the Casualty Clearing Stations and the General Hospitals near the ports. In a retreat the procedure would be same but in the opposite direction. This was achieved by a small ‘light section’ of each unit moving forward immediately. They would provide care for the serious cases still housed in the unit ahead who were unable to be moved. The rest of the unit would then evacuate less serious cases, then would close, pack up and move.
• Distances between medical units: Sometimes the nature or physical features of the area (due to unsuitable topography for motor transport, bad weather, or deteriorated land due to heavy shelling) prevented medical units from getting optimally close. In these situations Relay and/or Collecting Posts were set up where patients could be collected and transported by horse drawn ambulances. (These will be explained further in the Field Ambulance and Casualty Clearing Station sections)
• Overlapping areas: During a major offensive, the front Line might cover some 5 to 6 miles with many Corps/Brigades/Regiments involved, all of which would have had their own pre-allocated medical support. In situations where the areas of advance were narrow, it was inevitable that their medical support would overlap. In these cases medical units from different Divisions would either work together as one, or perhaps two or three different medical units would set up in one specific location.
• Co-Operation: It was imperative that the medical evacuation chain did not hinder the fighting troops going into action or prevent them from getting to their ammunition, and vise-versa. Also the Medical Services was reliant on other branches of the army to supply materials to build Dressing Stations, construct roads, railway sidings, and/or provide telephonic communications.
• Before the start of any major offensive the Directors and Assistant Directors of Medical Services (DMS and ADMS) who were appointed to oversee in the offensive held a conference to discuss all the above factors before setting up the evacuation chain for that sector.
Collecting Zone: Regimental Aid Posts and Field Ambulances
To be continued.....