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Medicine in the war zone

Colt's stretcher for narrow trenches, United Kingdom, 1915-1918

Colt's stretcher for narrow trenches, United Kingdom, 1915-1918

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Medicine in the war zone

How did army doctors and surgeons get to the wounded without risking their own lives? Medical treatment on the battlefield had to be organised. This presented a number of difficulties. In the 1500s soldiers were often left on the battlefield for two or three days until they died or their condition stabilised. Ambroise Paré was one of the first surgeons to initiate early treatment, sending men out to collect the wounded.

First World War triage: prioritising patients

One of the most important innovations in making decisions about how to treat soldiers wounded in battle is the system of triage. Under this system the wounded are divided into three groups. Soldiers who are only slightly injured are treated quickly and returned to the battlefield. The next group are those who need to be transported to hospital. The third group are those deemed to be beyond help and, when resources are limited, this group receives the least attention. The system began to be developed by the French surgeon Dominique Larrey during the Napoleonic Wars (1803-15) and became standard practice in the First World War (1914-18). Medical officers were stationed with the soldiers to look after them. If the soldiers were badly injured they would be removed from the front line by field ambulance to a casualty clearing station on the medical officer’s orders and from there to a hospital further down the ‘line’.

Transporting the wounded during wars

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Delays in treatment could mean the difference between life and death, so innovations in transport changed the nature of medical care during wartime. In battles that took place on foot or horseback, medical treatment had to be close to the battlefield and the wounded were vulnerable to further danger. Men had to be removed from the battlefield by stretchers. Historically ships were used to transfer the wounded to safer locations where a doctor could treat them, and hospital ships were developed on board in which the wounded could be treated. During the Napoleonic Wars Dominique Larrey developed ambulances drawn by horses to get wounded soldiers away from the battlefield. In the First World War motorised ambulances and trains made this a faster process.

Using flight to transport injured soldiers

The concept of the ‘golden hour’, that a patient must be treated within 60 minutes of multiple trauma, was attributed to data gathered by the French during the First World War. In the Second World War (1939-45) planes were used to move the severely wounded to hospitals. By the time of the Korean and Vietnam Wars, helicopters were used to move the wounded quickly back to medical units for treatment. During the Vietnam War it took 45 days for a seriously injured soldier to be returned to the United States. In the second Iraq War it took less than four days.

Moving medical equipment to the patients: an improvement in treatment

The time taken to treat soldiers was greatly reduced with the development of truly mobile medical equipment. In the First World War mobile X-ray units were used to locate bullets and shrapnel. In the Second World War motorised roaming surgical units meant that over three-fifths of the severely wounded could be operated on within 12 hours. By the Korean War (1950-53) surgeons at the mobile army surgical hospital (MASH) unit, could operate on soldiers within a few hours of them being injured. In the second Iraq conflict, which started in 2003, transportable heart lung machines, no bigger than a laptop computer, were being used by Allied forces.

Women and war

Historically, nurses have been distant from the front line. Women were less involved in the fighting and care of the wounded, although in Roman times women often travelled with their husbands and would look after them if they were wounded. Nuns nursed soldiers but they were not on the battlefield - they would care for those soldiers who made it to hospital. In the Crimean War (1853-56) Florence Nightingale and her nurses were far away from the fighting (unlike Mary Seacole). During the First World War nurses were closer to the front line than before. They gradually moved closer to the battlefield throughout the 20th century as nursing became a highly skilled profession.

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Bibliography

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