New Zealand Medical Services in Middle East and Italy
Functioning of Medical Units
Functioning of Medical Units
The ADS: The most forward of the New Zealand medical units in the battle for Cassino was 6 ADS, which had gone with 6 Infantry Brigade to the north of Cassino, near Portella, on 22 February. At this location both battle casualties and sick were received from 6 Brigade and evacuated to 4 MDS, still sited near San Pietro Infine. The exposed positions of the infantry battalions resulted in a number of casualties from shelling before the actual offensive. As a general rule, patients from 24 and 25 Battalions were received from the RAPs under cover of darkness. In view of the exposed nature of the RAPs, the ambulance cars usually attached to the battalion RAPs were retained at the ADS and sent forward as required. The ADS was reached by a complicated system of tracks off the main road. A daylight trip in an ambulance car from the ADS to 4 MDS took about one and a half hours, and although part of the route lay in page 542 an exposed position it was considered safe for individual ambulances. As the mud increased six AFS cars with four-wheel drive were used to supplement evacuation from the ADS.
6 NZ Field Ambulance ADS Reception Tent, Cassino
At 6 ADS the operating tents were dug into the ground as the position was well within range of enemy artillery and mortar fire, though the Red Cross was being respected. Only a few casualties came through during the afternoon of the opening of the second attack on 15 March, but there was a steady stream in the evening and large numbers during the night.
Owing to a strong possibility that tanks might have to be sent up the ambulance track to reach Cassino instead of along Route 6, two surgical teams, 8 British FSU and 6 Field Ambulance's team, were attached to 6 ADS on 15 March to operate on urgent casualties. Their services were not actually required for this purpose as the ambulance track remained open throughout.
From the time the infantry moved forward at midday on 15 March there was a steady stream of casualties, although not as numerous, however, as the medical units were prepared for.
The construction of the bridge across the Rapido on the night of 17–18 March enabled casualties from Cassino to be brought out across it in a fairly direct line, thus obviating a long ambulance journey along the tracks north-east of Cassino through 6 ADS. This ADS itself moved on 18 March some 2 miles to the south to bring it nearer to the centre of operations. This position was again exposed and well within range of enemy artillery and mortar fire, but Red Cross flags were prominently displayed and were respected by the enemy. Shelling adjacent to the area was consistent but only two shells fell in the ADS area, these causing three casualties.
The surgical policy adopted at the ADS was to do as little as possible compatible with comfortable and immediate evacuation to the MDS. The function of the ADS was, therefore, primarily that of an ambulance-car post and a resuscitation post for serious cases. In certain cases it was considered necessary to apply Thomas splints under pentothal to ensure comfortable evacuation to the CCS via the MDS. (Another important function of 5 ADS was as a first-aid post to the various British, American, and New Zealand artillery units, of which there were many within a radius of 3 to 4 miles, and to casualties resulting from the numerous traffic accidents on Route 6.)
The MDS: The first casualties arrived at 4 MDS at 3 p.m. on 15 March from 6 ADS, and by midnight seventy-four casualties had been dealt with. Evacuation from the MDS was carried out by NZ page 543 Section MAC, which took New Zealand battle casualties to 1 Mobile CCS at Presenzano, all British troops to 7 British CCS (established 4 miles south of 1 Mobile CCS), and all Indian troops to 2 Indian CCS adjacent to 1 Mobile CCS. An arrangement was made whereby 6 Field Ambulance, which had opened an MDS 400 yards south of 4 Field Ambulance on Route 6, would deal with walking wounded cases when the flow of casualties commenced. For the relief of 1 Mobile CCS during periods of stress, these lightly wounded were to be evacuated direct to 2 NZ General Hospital at Caserta. The number of casualties was never such as to necessitate this and 6 MDS did not function at all.
On 16 March casualties admitted to 4 MDS totalled 78 New Zealanders and 12 British, almost all of them being sent straight on to the respective CCSs. Some of these came through 5 ADS, which was sited nearer Cassino along Route 6. The casualties on 17 March were of similar numbers—78 New Zealanders and 6 British.
From 18 March onwards there was increased enemy shelling of the rear areas. A steady stream of wounded continued to arrive at 4 MDS and the figures for 18 March were 90 New Zealanders and 7 British, and for 19 March 89 New Zealanders and 5 British. As cases were banking up at the CCS it was necessary for more surgery to be done at the MDS. As casualties from Cassino could not be evacuated in daylight, the staff of the MDS was kept busy at night and the operating theatre was in use almost all the night of 19–20 March and again the following night.
Casualties used to arrive at 4 MDS about 11 p.m. after being held in Cassino during the day, and this was often twelve to sixteen hours after wounding. The few abdominal cases which occurred were affected by this delay.
Field Transfusion Unit: This was attached to the active MDS and was invaluable in the resuscitation of the serious cases, both those operated on at the MDS and those sent on for operation at the CCS. For the worst cases transfusions were arranged to continue during the trip to the CCS, and special clamps had been made by the divisional workshops to fix the transfusion apparatus to the stretchers. During the four months December to March a total of 506 cases was dealt with. Of these, 239 were given an average of 2·2 pints of blood and 184 an average of 1·6 pints of plasma. There were only seven reactions, none of them severe. During March only 2·7 per cent of the blood was discarded. During the second quarter of 1944 the work diminished very much and only 74 patients were given an average of nearly 2 pints of blood, and 33 patients about an average of 2 ½ pints of plasma.page 544