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Episodes & Studies Volume 1

Casualty Clearing Station

Casualty Clearing Station

In Forli the Casualty Clearing Station was established in a former school building where conditions allowed more than the usual comfort. Here elaborate surgical treatment was carried out as near to the forward areas as was practicable for tactical reasons (usually within 12 to 15 miles), and here, too, was provided the necessary post-operative nursing until the patient was fit to be sent farther along the route of evacuation to a General Hospital. The aim was always to reduce the time-lag between the wounding of a soldier and his first surgical operation. On occasions wounded were sent on to a General Hospital from the Casualty Clearing Station by air.

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The Casualty Clearing Station was usually a tented hospital, specially equipped and staffed as a mobile unit. Mobility was of prime importance as the unit had to be ready to move to a fresh site at short notice, or it might have to set up in an open field. It was equipped to hold 300 patients, of whom about one-third could be nursed on beds and the remainder on stretchers. During a battle a Casualty Clearing Station might handle from 200 to 500 patients in 24 hours, with a high proportion of urgent major surgical operations. In active periods the staff was usually supplemented by Field Surgical units, a Field Transfusion unit with its blood bank, and sometimes by a British Mobile Laboratory as well.

As in the Main Dressing Station, the standard practice was to set up the tented wards along a semi-circular road running from the entrance to the exit of the field. First came the reception tent, then the pre-operation ward, with an X-ray tent attached, followed by two to four tented operating theatres and finally some seven or eight tented wards. Each of these wards held 25 patients on beds, or 35 on stretchers. Conveniently arranged about this group were the special departments, medical stores and dispensary, ordnance stores, cookhouses, and mobile lighting sets for the theatres and wards. It was possible to establish the Casualty Clearing Station, pitch tents, and equip wards and theatres ready to function, within six hours from the time of arrival on the site.

During an action the ambulances would arrive from the Main Dressing Station in a steady stream, one moving in to take the place of another as it pulled out, sometimes two unloading at once. Stretcher-bearers brought the patients into the reception tent. One, perhaps, had his eyes and head bandaged. Another might be very still, with the envelope tied to his battle dress clearly marked ‘Abdominal’; he would be passed on immediately to the resuscitation and pre-operation ward. Here his stretcher was placed on trestles.* He was stripped of his clothing, bloodstained and mud-soiled as it was, washed and put into pyjamas. The extent of his injury was carefully estimated, and he was listed in order of priority for operation. In the meantime, the transfusion officer injected warmed blood so that the patient would be in the best condition to stand the operation.

When a patient was taken into one of the operating theatres the anaesthetist gave him an injection of pentothal in the inner vein of the elbow, followed if necessary by an inhalation anaesthetic. The surgeon would call for instruments and begin the operation. His assistant tried to anticipate his wishes, while orderlies held limbs, attended to the steriliser, obtained swabs or anything else demanded by the surgeon. When the excision of the wound was completed it was treated with penicillin and one of the sulphonamide drugs. Damaged limbs were usually encased in plaster and, the operation completed, the patient was carried to one of the tented wards. Here he came under the care of a nursing sister and six orderlies.

The Casualty Clearing Station had on its staff eight nursing sisters of the New Zealand Army Nursing Service who lived and moved with the unit. They provided the high standard of nursing necessary in serious post-operative cases, especially with abdominal wounds. Their presence alone so soon after a soldier had been wounded had a seemingly magical influence on his recovery.

As a surgical centre in the form of a well-found hospital unit within a short distance of the fighting line, the Casualty Clearing Station was a vital link in the chain of medical services. The page 29 work of the surgeons was greatly helped by blood transfusion and by two great life-saving discoveries, the sulphonamide drugs and penicillin, which gave the wounded soldier of the Second World War a much better chance of survival than in the First World War. Speed in evacuation, care in handling, constant supervision and correct treatment during the first few fateful hours from the time a soldier was wounded until he was operated on at the Casualty Clearing Station meant, in many cases, the difference between life and death, or between complete recovery and chronic invalidism.

* * *

‘On Boxing Day I was on the road again—this time in an ambulance of the NZ Motor Ambulance Convoy section—to 1 NZ General Hospital on the sea-coast at Senigallia, seventy miles away. The atmosphere in the General Hospital was a great help to morale and I felt 100 per cent better as soon as I was between the sheets. However, I had no sooner settled down than a medical officer came and after examination prescribed another two bottles of blood for me. I did not like having the blood transfusion but I always felt much better and stronger afterwards.

‘December the 28th saw me back in the operating theatre again, and this time my leg was stitched up and two rubber tubes were inserted in my stump. I then started another course of penicillin injections, which were no doubt the direct cause of my stump healing so quickly, but I was not sorry when the sister said that the course was finished.

‘Here I must put in a good word for the nursing sisters I found in the New Zealand hospitals. They were an excellent group and I always had a feeling of safety and security when they were around. The treatment and attention I received at 1 NZ General Hospital was thorough and good all the time, and no praise is high enough for the nursing staffs—both sisters and voluntary aids.’

* Formerly a kerosene heater was placed under the stretchers and blankets were draped round the trestles, but the application of heat as a means of resuscitation was later discarded, the room being heated sufficiently to prevent undue chilling but no direct heat being applied to the patient.