War Surgery and Medicine
THE EQUIPMENT OF A FIELD OPERATING UNIT
THE EQUIPMENT OF A FIELD OPERATING UNIT
Field Surgical Unit
The equipment accumulated by the different units was generally quite ample and surgical instruments were simple in type. A pedicle clamp suitable for use in clamping the renal or splenic vessels, skull forceps such as a De Vilbis, malleable abdominal retractors and a strong rib spreader were found to be useful additions.
A suction apparatus of simple form, often made from a tyre pump, was found essential, and many different types were constructed. A lighting set proved of the greatest value, and several of the units utilised a very compact and efficient Italian lighting set. Although the unit was normally supplied with electric lighting from its mother unit, independent lighting was much to be preferred. Lighting by petrol or kerosene lamps was undesirable in the operating theatre when ether was being administered.
Main Dressing Station
This unit had an electric unit sufficient to provide light for all the main activities. A suction apparatus and the surgical instruments mentioned with regard to the FSU were also required by the MDS.
Our New Zealand Field Ambulances were equipped with extra surgical instruments and appliances both from Army and Red Cross sources to enable them to carry out forward surgery.
Casualty Clearing Station
This unit also had extra equipment supplied and had benefited greatly from the handing on of part of the elaborate equipment of the MSU. The light section in particular inherited a great part of the special equipment, including the special van and its fittings, a lighting set and powerful suction plant. It had sets of head and chest instruments as well as an extra supply for routine surgery.
Operating Theatres used for Forward Surgery
Tents were usually provided for this purpose. The most satisfactory tent utilised in the desert campaigns was the EPIP, and the combination of two of these tents, one to act as the actual theatre and the other to act as a shelter for patients awaiting operation and for storing the theatre supplies, was quite sufficient. Originally an RD tent was combined with an EPIP, but this was hardly large enough. As the fear of bombing receded, the operating tent was often joined on to the pre-operation or resuscitation tent.page 63
Each FSU had its own operating theatre acting independently of the theatre of the mother unit, so that if two FSUs were attached to an MDS there would be normally three theatre units, one being provided for the operating teams of the MDS.
PLAN OF OPERATING THEATRE, 5 NZ FIELD AMBULANCE, ITALY
For the operating theatre in Italy in a modified form either two IPP tents or two rooms were used. The staff consisted of:
1 Sergeant alternated as assistant to surgeon and in supervising the sterilisation and preparation of trays.
1 Corporal alternated as assistant to surgeon and in supervising the sterilisation and preparation of trays.
2 Orderlies who alternated as theatre assistant and steriliser orderly.
The CCS frequently had two theatres for its own personnel apart from those set up by the attached FS units. This independent working of the theatres made the spelling of personnel easily carried out. There were many other types of operating theatre utilised in the desert campaigns. There were elaborately equipped mobile van theatres presented by the Americans, and other less elaborate van theatres built by the Army in Egypt. Though mobile, most of these were somewhat cramped and proved unpopular. Tarpaulin page 64 penthouses attached to trucks were constructed, but they proved hot and more difficult to protect from sand. The ordinary hospital marquee was found to be less suitable. The hospital extending tent was excellent for large theatres, but was heavy and difficult to erect. For desert conditions, and generally when buildings were not available, the double EPIP tent proved the most satisfactory. The Germans provided a very satisfactory operating tent. Some were captured by us and at times used by our units. It should be possible for us to provide a special operating tent especially designed for forward operating work.
Autoclaves: A small autoclave was useful for the sterilisation of guards and dressings.
Sphygmomanometer: This was an essential apparatus for the estimation of shock.
Anaesthetics: Macintosh's apparatus proved excellent in forward surgery. Specialist anaesthetists often utilised modifications of Boyle's apparatus.
Extras: Electric lighting was normally provided, and standard lights were sometimes available. Arm boards, as extra attachments for the table, were excellent and simple, both for the giving of pentothal and also for blood transfusion. A kidney pillow was sometimes useful. Drums for sterile guards, and overalls, were much to be preferred to simple bags, though bags would do for sterile dressings and spare guards. An HP steriliser was essential in a busy CCS. There was great wear and tear on surgical instruments, especially Spencer Wells forceps, due to constant boiling.