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New Zealand Medical Services in Middle East and Italy
The Work of a Forward Operating Centre
The Work of a Forward Operating Centre
The medical units responsible for this work were the MDSs of the field ambulances and the CCS. By the time of the Tunisian campaign the work had become highly organised and the staffs of the units fully trained in the different aspects of the work, so that large numbers of patients could be handled swiftly and efficiently. At the reception tent the cases were sorted and particulars taken, kits attended to, exchange of stretchers and blankets arranged with the ambulances, and the patient sent on to the pre-operation tent, to the wards, or to the evacuation tent. This work was greatly facilitated by prior sorting and information supplied by the ADS or MDS.
The pre-operation ward carried out all resuscitatory and other preliminary treatment, including washing the patients, the provision of clean clothing, and the checking and control of personal belongings. The patients were examined and decision made as to the urgency of operation and the resuscitation required. An FTU carried out the blood and plasma transfusions and a senior surgeon attended to the diagnosis, conferring with the transfusion officer concerning priority. At the CCS an X-ray plant was available, the types of cases normally X-rayed being:
| (a) |
Doubtful abdominal injuries. |
| (b) |
Head and spinal cases. |
| (c) |
Injuries involving joints, especially the knee. |
| (d) |
Doubtful fractures. |
Resuscitatory measures at that time were:
| 1. |
Blood, the main and generally the sole measure of importance. Generally two or three pints were given. |
| 2. |
Plasma was given to counter haemo-concentration in severe burn cases and also to supplement blood. |
| 3. |
Warm fluids given, such as tea, cocoa, etc. |
| 4. |
Morphia, when pain or restlessness was present. |
| 5. |
Warmth: excessive warmth had been found to be deleterious. Simple warming by blankets in a warmed tent was carried out. |
Types of cases selected for early operation:
| 1. |
Abdominals: The diagnosis depended on: (a) the site of the wound and probable course of the missile; (b) local signs of abdominal injury such as rigidity of the abdominal wall, lack of audible peristalsis, abdominal distension, dullness in the flanks or pelvis; (c) general signs—shock and distress, signs of internal bleeding (pallor and rapid thin pulse). X-ray was used in doubtful cases, especially when diaphragmatic and retro-peritoneal injuries were present. Bleeding was found to be responsible for the early and serious symptoms, and sometimes prevented full resuscitation and demanded urgent operation for its control. Peritonitis was a late development. |
| 2. |
Chest cases: The only cases which demanded operation were those with large chest wounds, open sucking wounds, and occasionally with bleeding from an intercostal artery. Only a pint of blood was generally given to chest cases. |
| 3. |
Head cases: All injuries involving the scalp, skull, or brain were operated on if the general condition was satisfactory. The severely shocked and sterterous cases were left till signs of recovery were present and operation was felt to be justified. |
| 4. |
Fractures of the long bones: The extent of the wounds of the soft parts determined the necessity and extent of the operative treatment, and vascular injury was of special importance. Splinting in any case was required and X-rays, if time allowed, were of value in certain cases, especially if any joint involvement was suspected. |
| 5. |
Vascular injuries: Injuries to large vessels as shown by a history of serious bleeding, a pale and shocked patient, dressings soaked in blood, limb swollen and tense, loss of pulsation in terminal vessels, demanded urgent operation to prevent further bleeding and also secondary haemorrhage later. |
| 6. |
Joint injuries: Although operation was often unnecessary, splinting was essential. page 455 |
| 7. |
Foot injuries: These were very common, largely due to mines, and amputation was often required. |
| 8. |
Facio-maxillary injuries: As a rule these did not require urgent surgery, but eye injuries might demand enucleation or removal of foreign bodies by the electro-magnet and dental splinting might be required for fractures of the jaw. |
| 9. |
Spine: Might require a suprapubic drainage. |
| 10. |
Large flesh wounds: especially of the buttock, thigh and calf, owing to their liability to anaerobic infection and vascular injury. |
The buttock wound was always suspect of associated intra-abdominal, rectal, or lower urinary tract injury.