The First World War Medical Evacuation System, split from Re: A General Introduction to Researching

[Blackadder1916]

Part 13: Evacuation to Hospital

Michael, first let me thank you for the informative additions to The Regimental Rogue.  I have on more than one occasion used your site as reference material.  However, (now that the pleasantries are out of the way) I do find a minor fault with your description of some elements of the chain of evacuation on the above quoted page.

Particularly this portion suggests that the following medical "facilities" are separate medical "units".

Advanced Dressing Station: Medical units immediately behind the front lines which received wounded brought by stretcher, or walking wounded, and administered immediate care.

Field Ambulance (F.A.): A mobile unit equipped with horse-drawn or motorized ambulances which evacuated soldiers from the Advanced Dressing Station rearward.

Main Dressing Station: A stationary unit at which battlefield casualties received fresh wound dressings, and at which time they were formally recorded as having entered the medical system. (Before this they may not have remained in one location long enough to be documented, and staff was not deployed further forward specifically for this purpose. It was from the Main Dressing Stations that the Divisions were informed of evacuated casualties when men might not have been handled by their own Unit R.A.P. or Brigade F.A.)

Corps and Divisional Rest Areas: Maintained for the treatment of the sick and lightly wounded who did not require evacuation to England, until they were ready to return to their units.

All of these medical facilities were established by and operated by field ambulances, which were the brigade and divisional medical units.  While these stations were usually set-up by elements of an individual fd amb, sometimes elements of all the fd ambs within the division were combined to form a single MDS or DRS.  I made a cursory review of Macphail’s official history of the corps to confirm what he says about the organization and employment of a fd amb, but he makes no mention of ADS or MDS in Chapter 6.  However, this site about the RAMC during the Great War provides a good explanation about the tactical employment.  CAMC units were somewhat similarly organized, but there were minor differences as can be noted in the excerpt I included from Macphail book.

http://www.ramc-ww1.com/chain_of_evacuation.php

Field Ambulance. [Fd Amb or FA]

There was at least one (In the case of a Cavalry and some Infantry Field Ambulances), but normally two, Advanced Dressing Stations set up by the Field Ambulances. In a textbook situation, the Advance Dressing Station would be sited about 400 yards behind the RAPs, in tents where necessary, but preferable in large houses or schools, and the Main Dressing Stations sited roughly one-mile further back. In the Great War though this seldom was the norm.

The Field ambulance was the most forward of the RAMC units and the first line of documentation. There were three Field Ambulances attached to the 75 Infantry Divisions and others such as the 4 Mounted Divisions and Guards etc, and four attached to the 5 Cavalry Divisions, that was one Field Ambulance attached to every Brigade. In action two of these were forward and the other was held in the rear. When the Division was out of the line the Fd Ambs were allocated special tasks such as a scabies centre or for other ailments, a Divisional Rest Centre [DRS], or as a bath unit. If the latter it was usually sited in a Brewery where up to 50 men could be bathed at a time in the large Vats and local women were used for laundering and the repair of clothing and uniforms.

The team, which made up a Cavalry Field Ambulance, consisted of 6 Officers and 70 O/Rs RAMC working alongside 42 O/R’s from the Army Service Corps. Within an Infantry Field Ambulance, the team was 10 Officers and 182 O/Rs RAMC working alongside 49 O/Rs ASC etc. A Field Ambulance composed of a Headquarters Company [A coy] which formed the MDS, and two companies [B & C Coys] which deployed forward to form the two ADS's. Each of these companies were further sub-divided into two parts namely the 'Tent division' who were the medical staff and formed the treatment area, and the 'bearer' sub-division who were the stretcher-bearers collecting the casualties from the RAPs, and carrying them back to the 'tent division' at the ADS, or manning the relay posts. Each Company had horse-drawn ambulances and, perhaps, one or two motor ambulances.

The ADS did not normally have a holding capacity, but if it moved whilst handling casualties it could take it’s casualties with it. The object of the exercise was to collect the sick or wounded from the RAPs and provide sufficient treatment so again, the men could be returned to their units in the line where possible. Although these were better equipped they could still only provide limited medical treatment. If the casualty was not fit enough to be returned to his unit he was collected by horsed or motor transport by the bearer sub-division of the MDS.

The MDS did not at first have a surgical capacity, but did carry a surgeon’s roll of instruments and sterilisers for life saving operations only. It had a holding capacity of up to 1 week for the patient to be fit enough to return to their unit or be able to be transported back to the Casualty Clearing Station [CCS]. Later in the war fully equipped surgical teams were attached to the Field Ambulances, and urgent surgical interference could be performed to sustain life.

If the Line of Communication [LOC] from the front to the CCS's was a long journey, other Fd Amb's were placed along the way, and these served only to check dressings, taking a casualty off the ambulance for treatment only if necessary. There were also Field Ambulances on the lines of Communication between the CCS's and the General Hospitals if there was no rail link.

Official History of the Canadian Forces in the Great War: The Medical Services, 1925 (PDF Version, 4.2 MB)

. . . In 1901 a War Office committee recommended
that the functions of the bearer company and those of the
field hospital should be combined, and four years later
this recommendation was put into effect. The new unit
was the modern field ambulance. In the Canadian service
one was detailed to each brigade of infantry as divisional
troops; at a later date an additional unit as corps troops
was formed for corps purposes.

As now constituted a field ambulance consists of two
divisions, a bearer division comparable with the old bearer
company, and a tent division to perform the duties of the
former field hospital. These divisions are further divided
into three sections, each section being composed of one third
of the bearers and one-third of the tent division. An
ambulance will then consist of three small units which are
capable of performing the duties of bearers and of
hospital, having accommodation for 50 patients each or
150 in all. The arrangements for mounted troops are
slightly different, there being two sections instead of
three.3 The peculiar quality of a field ambulance is the
ease with which it can be resolved into its component
parts for any specific duty and assembled again when the
task is done.

In the British army the field ambulance as a rule served
an infantry brigade and all the other arms and services in
that group or area; in the American army the corresponding
unit known as a “section” served a division; in the French
army there was also a divisional group of bearers, known as
brancardier divisionnaire; but they had in addition 16
regimental bearers as the British had. Once a patient arrived
at the poste de secours he passed out of the medical service
and became a problem for the transport.

The personnel of a field ambulance is formed by 9
medical officers and 238 other ranks. Of the officers one is a
lieutenant-colonel; two are majors, and six captains. There is
in addition a quartermaster; a dental officer and a chaplain
are usually attached. The transport consists of 15 riding
horses, and 39 draught horses. The horse and motor drivers
to the number of 36 are technically attached from the army
service corps, but for all practical purposes they are part of
the formation.4

This transport is all first line, an integral part of the war
organization, and ready at all times to go into action. The
number of horse-drawn vehicles in the end became fixed at
sixteen, with three ambulance wagons added. Of these, three
were water carts, four limbered wagons, seven general
service wagons for technical stores and baggage, one
Maltese cart and one travelling kitchen. Four spare horses
were allowed. Seven motor ambulance cars were also
included in the establishment.

And some other sites discussing medical services in the Great War.

http://www.1914-1918.net/wounded.htm

  . . . In addition to the ADS, the Field Ambulance was also responsible for the stretcher bearer relay posts, walking wounded collecting stations, sick collecting stations and rest stations. A larger version of the ADS, the Main Dressing Station, was often provided for the Division. The next stop for most casualties was the CCS.

http://www.vlib.us/medical/ramc/ramc.htm

If this becomes a larger discussion, then perhaps a split to a new thread would be in order.

 

[Michael OLeary]

Blackadder, thank you for your comments.  As noted above I am trying to pitch the presentation of these pages to the lowest common denominator, a "Researching CEF Soldiers 101" of sorts for those who have no background in army or unit organizations, etc. One aspect I have noted in various forums' discussions about the Great War is that family researchers that do not yet have an understanding of the difference between "company", battalion" and "Brigade" are not helped by excessive detail when they just want to track the movements of a single soldier in their family. If I have offended by being overly simplistic, I apologize.  On the other hand, if you are able to condense those descriptions to 50 words or less and still meet the goal of "Researching CEF Soldiers 101" I'd be happy to consider using your versions.

Re: ADS & MDS: While the ADS and MDS may not be mentioned in McPhail, they are shown on a medical evacuation diagram in Tim Cook's "At The Sharp End", a reference that new researchers on the War are much more likely to possess.

Regards

Michael

 

[Blackadder1916]

I realize that you are trying to keep it to the lowest common denominator, however knowing that an ADS or MDS was operated by a field ambulance could (in my opinion) be helpful for someone researching the path that a soldier took as he was evacuated from the line.  I will admit that I haven't reviewed many WW1 medical records or paid much attention to how notations were recorded as to where specific treatment was performed on the patient.  However, it is possible that an entry could have been made as simply as "MDS at Agnez Les Dirisons" or "MDS at the Bricklands" and it could have meant the same MDS operated by 4 Canadian Field Ambulance near Amiens in 1918.  Alternately, an entry on a medical record may identify the treating unit simply as A, B,or C section of 4 F.A. and if it had occured shortly after 20 September 1915, it could have been in any one of three (rather dispersed) locations operating one dressing station and two rest stations.

Re: ADS & MDS: While the ADS and MDS may not be mentioned in McPhail, they are shown on a medical evacuation diagram in Tim Cook's "At The Sharp End", a reference that new researchers on the War are much more likely to
possess.

While Macphail may not mention it in "Chapter 6" which discusses the organiztion of the field ambulance, I'm sure the terms are used in other sections of his book.  As I said previously, I made only a "cursory" review; actually, I find Macphail to be sometimes disjointed in how he presented the subject.  Diagrams (even official ones contemporary to the war) showing the chain of evacuation will most often include ADS and MDS.  The terminology (and the same tactical employment) was maintained through the next war and Korea.  In actuality, only the terminology was changed for my first couple of postings to field ambulances - we referred to them as Evac Station (vice ADS) and Brigade Medical Station or BMS (vice MDS).

On the other hand, if you are able to condense those descriptions to 50 words or less and still meet the goal of "Researching CEF Soldiers 101" I'd be happy to consider using your versions.

I'll consider it.

 

[Michael OLeary]

I realize that you are trying to keep it to the lowest common denominator, however knowing that an ADS or MDS was operated by a field ambulance could (in my opinion) be helpful for someone researching the path that a soldier took as he was evacuated from the line.  I will admit that I haven't reviewed many WW1 medical records or paid much attention to how notations were recorded as to where specific treatment was performed on the patient.  However, it is possible that an entry could have been made as simply as "MDS at Agnez Les Dirisons" or "MDS at the Bricklands" and it could have meant the same MDS operated by 4 Canadian Field Ambulance near Amiens in 1918.  Alternately, an entry on a medical record may identify the treating unit simply as A, B,or C section of 4 F.A. and if it had occured shortly after 20 September 1915, it could have been in any one of three (rather dispersed) locations operating one dressing station and two rest stations.

Hospital admission cards in the files I have seen normally only list the general, stationary and convalescent hospitals.  Occasionally a Field Ambulance will be listed but I have yet to see any specific Dressing Station noted in the files I have reviewed. (I have about 60 individual files at hand, which is admittedly not a large sampling.)

I have attached as an example the hospital admission card from 734121 Pte AL Cross as an example showing Field Ambulance listings.

I'll consider it.

Thank you.

 

[Michael OLeary]

Further to my last; another item which might be found in CEF service records (but by no means all of them) is the Field Medical Card.  This document will identify the Field Ambulance and Casualty Clearing Station that teated and/or transported the soldier, but has no defined space for listing a Dressing Station.