Delivery of Medical Care on the Battlefield
Ambulance Section
Aid Station, First Division, Missy-aux-Bois
After receiving emergency care from the medical corps personnel at the battalion or regimental aid station, the sick and wounded were evacuated to the next phase of physician-directed care provided by the division's sanitary train. This 950 man unit consisted of:
- One headquarters
- One ambulance section that was comprised of a headquarters and four companies
- One Field hospital section that consisted of a headquarters and four field hospitals
- Eight camp infirmaries
- One divisional medical supply unit
The word ‘train’ is unique to the era. It identifies the support units assigned to an infantry division of which there four trains: ammunition, supply, engineer and sanitary. All used horse drawn wagons or motor vehicles in order to be mobile and to support the entire division’s personnel. The purpose of the sanitary train was to provide medical care to the division through its units.
The deployment of the 82nd Infantry Division’s Sanitary Train in September 1918 for the St. Mihiel offensive illustrates how a train’s units were placed in order to support the division. The map shows that at the start of the battle one unit, Ambulance Company 327 (AC 327) was placed at Dieulouard with Field Hospital 328. To the south of their position AC 325 and 328 were on alert and in reserve at Millery with the other three field hospitals, while AC 326 was further to the rear at Marbache. As the battle progressed AC 327 was moved north to Blenod on September 7th and to Norray on September 16th. The shift in locations illustrates how the ambulance company maintained contact with the moving battalion aid stations in order to provide a timely evacuation of patients to a field hospital.
The ambulance section’s four companies had a total of 48 ambulances that were distributed evenly among the four companies. One company was equipped with 12 horse drawn ambulances, while the other three had motor ambulances. By 1918 experience had proved that the motor ambulance was the most effective means to evacuate men from the front. This meant that the horse drawn company was held in reserve because although they could negotiate terrain that was impassable to motor vehicles they presented a large target, were slow and the horses quickly tired in contrast to motor vehicles.
Collecting point, 3rd Division, Nantillois, Muse
The ambulance company was divided into two sections. One operated the dressing station while the other collected, coordinated and moved patients from the battalions to the dressing station and then on to a field hospital. Because the combat zone was so dangerous, evacuation from the front for the first 500 to 1500 yards was on foot by either the walking wounded or by litter bearer squads sent forward from the ambulance company. The destination of the wounded was to a collecting point where vehicles could be safely assembled to load patients.The other section of the ambulance company manned a dressing station that was at about 300 yards form the battalion aid stations which would place it at about 800 to 1800 yards from the front line. It was staffed by up to 5 officers and 25 men and was sited on a road, if possible, and housed in a dug out, cellar, building or tents. The sanitary train could deploy up to four dressing stations but in practice it was one, if the division’s front was narrow or more if wider, while one was held in reserve. If the division was engaged in mobile warfare the dressing station might be divided in order to create an advanced dressing station staffed by 1 officer and 15 men closer to the front while the main dressing station with its larger staff was further to the rear.
Dressing Station, LahayvilleThe purpose of both dressing stations was similar to the battalion aid station in that it continued to provide emergency medical care such as:
- Arresting hemorrhage
- Inspecting and readjusting the patient’s dressings and splints
- Administering morphine and the anti-tetanus serum
- Treating for shock and gas injuries
At this level more sophisticated treatment could be carried out than was possible at a battalion aid station. This might include treatment for shock and gas or even surgical procedures such as closing an aspirating chest wound or controlling hemorrhage through ligature and packing the wound. Patient management was a primary concern for the staff at this phase of care. The first evidence of this was the attention given to the design of a continuous system of evacuation by ambulances from the battlefield as performed by the ambulance company. The second was the continuation of stabilizing the patient at the dressing station for further evacuation and the first attempt at the classification of patients in order to direct them to the right care.
Dressing Station, Ambulance Co 111, 28th Division, St Gilles
The dressing station addressed these tasks by organizing itself into departments so as to efficiently manage the care of patients through the following departments:
- Receiving and forwarding
- Dressing
- Orthopedics
- Gas
The creation of these departments indicates the first step toward placing patients requiring specialized expertise, such as orthopedic and gas cases, with a staff that had experience in treating these types of injuries. The receiving and forwarding department was tasked to unload, sort and classify new patients. It was supervised by a medical officer who examined them and determined who should be returned to their unit, who needed immediate attention from the dressing, orthopedic or gas departments and who and when should be evacuated to the next level of care that would be the ‘Triage’ operated by one of the sanitary train’s field hospitals.
Dressing Station, Lahayville
Sources for Ambulance Section
Jaffin, Colonel Jonathan H. Medical support for the American Expeditionary Forces in France during the First World War (Fort Leavenworth 1990)
Volume VIII, Field Operations, The Medical Department of the United States Army in the World War (Washington, 1925)
Volume XI, Section I, General Surgery, The Medical Department of the United States Army in the World War (Washington, 1925)