New Zealand Medical Services in Middle East and Italy
Medical Arrangements for Sangro Crossing
Medical Arrangements for Sangro Crossing
For the initial main attack by 2 NZ Division in the Italian campaign special medical arrangements had to be made.
The operation envisaged was a type of warfare completely new to 2 NZ Division. In earlier campaigns the field ambulances had almost invariably been able to collect patients from the RAPs by ambulance car. In the Sangro crossing, however, the regimental medical officers with their staffs and equipment were to move forward on foot; and between the RAPs and 5 and 6 ADSs on the lateral road on the south bank of the Sangro, there would be a swiftly flowing ice-cold river, fordable only with considerable difficulty even in the most favourable places.
The general plan called for a crossing on foot in several places on a two-brigade front, the seizing of a fairly extensive bridgehead, up to several miles in depth, and when this was achieved, the building of two temporary bridges over which would pass the supporting arms and essential vehicles. Thus, even with complete success, several hours would elapse before ambulance cars could collect from the RAPs.
The regimental and ADS medical officers conferred to discuss the extreme difficulties expected. For one thing, it was certain that there would be casualties before bridges could be erected and ambulance cars could get through. It was decided that while the collection of casualties forward of the RAPs would follow the usual practice, using regimental stretcher-bearers augmented, when possible, by jeeps, evacuation from RAP to ADS would have to be by a combination of hand and mechanical carriage. The RMOs had to be prepared to hold their casualties at the RAPs for a rather longer time than was customary, and the ADSs had to be prepared to treat patients more shocked than usual owing to the longer lapse of time and the cold, wet conditions.
It would not be practicable to run ambulance cars nearer to the Sangro during the infantry crossing, and the establishment of a bridgehead on the northern side, than to the Strada Sangritada, a road running parallel to and about a mile from the south bank of the river. Along this road, opposite the assault area, were the battalions of 5 and 6 Infantry Brigades, and on the evening of the operation a car post with two four-wheel-drive ambulance cars and one jeep fitted with a two-stretcher frame would be established at each battalion RAP. Two ADS stretcher squads and four squads page 507 recruited from battalion B Echelons were detailed to cross the river with each RMO to carry back men wounded prior to and during the actual river-crossing. The ADS bearers were also to be prepared to carry back across the river to the car posts, at any time, any casualty whose chances of survival would, in the opinion of the medical officer, be endangered by an enforced wait at the RAP for the completion of the bridges and the arrival of the ambulance cars.
The ADS area was in sight of the German positions and was frequently shelled. No Red Cross signs were displayed as it was thought that they would give away positions of troops and indicate the point selected for the river-crossing. At the ADS were large quantities of blood and plasma for the treatment of shock and a plentiful supply of ambulances for evacuation to 4 MDS, which was very suitably situated at Atessa, 5 miles away.
At 7.30 p.m. on 27 November the ADS stretcher-bearers went up to the battalion positions. Two and a half hours later they moved forward in pitch darkness with the files of infantrymen, squelching through the mud and wading across the icy streams of the Sangro riverbed. The main stream was waist-deep, with a swift, powerful current. Struggling with the stretchers and almost paralysed by the cold, the men managed to keep their feet only with difficulty.
The battalions reached the northern bank and waited in silence until 2.45 a.m. on 28 November, when the artillery barrage opened and the infantry advanced to the attack. The MOs and stretcher-bearers followed up and established the RAPs in suitable farm buildings. The teams attached to 25 Battalion RAP found themselves approaching the crest of the low hills that rose from the bank of the river. Coming under shell and machine-gun fire, they were compelled to move back down the slopes. The other RAPs also experienced shelling near their positions.
The men from the ADS worked with the RAP personnel, treating casualties brought in by the regimental stretcher-bearers, until about 4.30 a.m., when the battalions were nearing their final objectives. They then assisted in the search for casualties left lying in the wake of the advance, and collected a number of wounded reported to be lying in minefields to the rear of 26 Battalion RAP. It was nerve-racking work, each man treading with involuntary but futile caution in the darkness. Only one man of the Medical Corps was unfortunate enough to tread on a mine. He died in 1 NZ CCS a week later.
Throughout the night engineers had worked on the construction of two bridges, a Bailey bridge for 5 Brigade and a pontoon bridge on the 6 Brigade sector. At 8.10 a.m. on 28 November the pontoon bridge received a direct hit which destroyed one span, killed nine page 508 men and wounded several more. It was then subjected to continuous, accurate shellfire that made further progress impossible. The Bailey bridge was completed and had to suffice for both brigades, constituting a disheartening bottleneck. For the casualties accumulating at the RAPs the delay was serious. As the morning wore on it seemed that some of the more urgent cases would have to be carried back across the river, an operation that might have ended in disaster.
However, at 10.30 a.m., the first ambulance car appeared at the 26 Battalion RAP, and the mere sight of one load of casualties leaving for the ADS seemed to make the situation less desperate. After another long wait ambulance cars and jeeps began to arrive at all three RAPs. The stretcher-bearers carried on searching for wounded. A stretcher-bearer from 24 Battalion used a cart to bring back wounded along the road and was not sniped at because he had a Red Cross flag up. Finally, their work finished, the bearers from the ADS made their way back to their company by twos and threes, helping walking wounded across the river en route.
At 4 MDS at Atessa 131 battle casualties were admitted on 28 November, and of these 110 were evacuated to the CCS. A surgical team from 6 Field Ambulance was temporarily attached to relieve in the operating theatres during rush periods. On the next two days, as 2 NZ Division exploited its bridgehead across the Sangro, the battle casualties admitted amounted to eighty.
On 1 December B Companies of 4 Field Ambulance, 5 Field Ambulance, and 6 Field Ambulance all crossed the Sangro to establish ADSs in their respective brigade areas, 4 Armoured Brigade having now joined in the attack. A car post was established by A Company 6 Field Ambulance on the south side of the Bailey bridge. Evacuation to the RAPs and ADSs was by Bren carrier and jeep and from the ADSs to the car post was by four-wheel-drive ambulance cars (including ten AFS cars). From there two-wheel-drive cars could be used on the road. Forward of the ADSs stretcher-carrying jeeps, with frames made in 2 NZ Division workshops to the direction of ADMS 2 NZ Division, were used. Colonel King had seen similar fittings at an Indian MDS. They were most successful, and arrangements were put in hand to issue them on the scale of two to each battalion and regiment and three to each field ambulance. Stretcher-jeeps were jeeps fitted with steel frames to enable them to carry two stretcher patients, thus solving the problem of bringing wounded out over difficult ground where an ambulance car could not manoeuvre. The stretcher frames were made to lie along the back of the jeep so that the heads of the stretchers were just behind the back seat, while the feet of the stretchers over-hung the rear of the jeep by about four feet. These jeeps gave one the impression that the ride for the page 509 patient would be rough, but, by careful driving and slow travel, it compared favourably with most types of ambulances, the only difference being that the patients were exposed to the weather. This was later rectified by erecting a canvas canopy. Because it was fitted with four-wheel drive, was fast and manoeuvrable and capable of operating under all conditions in almost any type of country, the jeep was chosen for this work and proved itself on many occasions later in Italy.
It was decided to bring two NZANS sisters from 1 Mobile CCS forward to Atessa to assist in nursing the serious abdominal cases, whose condition was aggravated by the incidence of post-operative pneumonia in practically all cases and for whom the highest possible standard of nursing was necessary. The sisters took up their duties in 4 MDS in the civil hospital on 1 December. This was the first time nursing sisters had worked as far forward in a battle area. Their presence quickly transformed the work of the MDS and they were of especial value in the nursing of the abdominal cases.
On 2 December B Company 6 Field Ambulance moved into the three-storied building in Castelfrentano, not long after 24 Battalion had cleared the town. On 3 December the RMOs of 24 and 25 Battalions worked in adjoining rooms of the same RAP, after the RMO of 25 Battalion had been mortared out of his position farther up the road. For a while there was a large number of wounded, mostly from 25 Battalion, to deal with, but they were all speedily evacuated. There were fewer casualties next day but a notable incident was when a stretcher-bearer, Private Williams,1 of 24 Battalion went out to a wounded man lying only 200 yards from the German lines and stayed with him all day, until he was carried back in the evening by a stretcher party. As ADS to 6 Infantry Brigade, B Company admitted sixty-one patients on 3 December and evacuated them to the staging post south of the Sangro. The staging post reduced to three to four hours the return trip of the ambulance cars to the ADS. There was enemy shelling on 4 December but few casualties resulted. The next day heavy rain flooded the approaches to the Bailey bridge across the river and washed away the pontoon bridge. Casualties were sent as far as 4 ADS on the north side of the river and held there until the following day when the river could be crossed, though a few of the serious cases were taken across by hand carry.
When 6 Field Ambulance moved forward to Castelfrentano on 14 December and established an MDS in the schoolhouse, 1 General Hospital surgical team, 2 FTU, and 127 Paratroop Field Ambulance surgical team were transferred from 4 Field Ambulance to this unit. The nursing sisters did not proceed to Castelfrentano, but a special male nursing team of one NCO and two orderlies was sent forward from 1 Mobile CCS to the MDS to assist in the nursing of serious cases. For the attack across the Orsogna–Ortona road on 15 December, B Company 5 Field Ambulance left Castelfrentano on 14 December and established a resuscitation post on Sfasciata ridge. Here blood, wet and dry plasma, were available as well as surgical instruments and appliances sufficient for emergency operations. There was only a small staff, including two medical officers. There were no complete ADSs forward of the MDS and most casualties from the attack went direct from the RAPs to the MDS, although some passed through the resuscitation centre. In this action the evacuation of wounded from 21 and 23 Battalions was very slow and difficult and hand carriage was necessary. There was a blood bank at the resuscitation post and blood transfusions helped to save the lives of some of the more seriously wounded. Jeeps were used wherever possible and the car post was changed to shorten the carry.
Casualties admitted to 6 MDS were, on 15 December, 172 and on 16 December, 115. Staff-Sergeant Burley1 was senior NCO in the field ambulance company establishing the forward ADS in the operations towards the Orsogna–Ortona road between 14 and 25 December. Owing to the difficulties and close nature of the country and determined enemy resistance, only a small resuscitation post could be established for the attacks of 15 and 24 December and evacuation of RAPs was by hand carriage over steep, exposed, and very muddy routes under enemy fire. Burley was forward of the skeleton ADS assisting and directing the stretcher-bearing, and on all occasions his coolness, decision, and example were an inspiration to those working under him and to the wounded they were carrying. He was awarded the Military Medal.
Before dawn on 24 December an attack was made by 21, 26, and 28 Battalions on Fontegrande ridge, west of the Orsogna–Ortona road. The state of the ground precluded any help from the armoured regiments. The country was broken and contained several steep-sided gullies covered with brush and with which the attacking troops were unfamiliar. By dawn both 21 and 26 Battalions were firmly astride Fontegrande ridge and the Maori Battalion, after suffering heavy losses, had wrested the vital road junction from the enemy.
The evacuation of the wounded presented quite a problem owing to the nature of the country and the difficult ground conditions. Because no suitable place could be found nearer the line, 26 Battalion RAP, for instance, was set up in a house about a mile from the Ortona road. This meant a long and tiring carry for stretcher-bearers. Some platoons could ill afford the number of men required to evacuate their own and enemy wounded, and some platoons were under close enemy observation. In all cases the medical orderlies and stretcher-bearers responded splendidly and, despite the heavy mortar fire, evacuated wounded as quickly as possible. They were assisted by a light fog which cloaked their movements.
Medical arrangements for the final attack on 24 December were the same as previously. There were 152 casualties admitted to 6 MDS that day. During these rush periods three surgical teams worked continuously at the MDS. Evacuations were made by road to 1 Mobile CCS at Vasto, 45 miles away. The road 2 miles from Castelfrentano was under direct observation from the enemy positions at Orsogna for about a mile and intermittent shelling caused frequent casualties in that area. The trip to Vasto took four to four and a half hours on 15 and 16 December but was later reduced to two and a half hours. The heavy section had joined the light section of the CCS at Vasto on 10 December.
The extremely wet weather and the difficult country covered in the Sangro operations necessitated a return to the use of large numbers of stretcher-bearing squads for whom there had not been much demand during the desert operations. It was found that at least six bearers were required for each stretcher. On Sfasciata ridge from 15 December onwards, 5 Field Ambulance resuscitation post called on large numbers of men, including bandsmen from the B Echelon formations of 5 Brigade, and later 4 Brigade, while 14 British Field Ambulance also gave assistance. Here all evacuations from the battalion RAPs were by hand carriage only. It was found that more blankets and stretchers were required than under normal conditions.
Stretcher-bearing jeeps took the casualties from the resuscitation post to the ambulance car post where four-wheel-drive ambulances waited. These included twelve cars of the AFS, whose work in Italy page 512 was up to the high standard which was customarily associated with this unit in the Western Desert. Without the service of the jeeps and four-wheel-drive ambulance cars, the time of evacuation to the MDS in many cases would have been increased threefold. The New Zealand Section MAC was posted to the Division for this campaign and provided a plentiful supply of ambulance cars for frequent and rapid evacuation of cases. The ADMS 2 NZ Division paid a tribute to the work of the stretcher-bearer squads and jeep drivers, who often worked for long periods under the most trying conditions.
In the static warfare that continued into January 1944 the positions of the medical units remained much the same, except that on 25 December, when 6 Infantry Brigade relieved 5 Infantry Brigade on the sector east of Orsogna, part of 6 ADS moved forward to establish a car post within 1000 yards of the battalion RAPs, with the remainder of the ADS taking over from 5 ADS on Sfasciata ridge the following day. Rain and snow on New Year's Eve levelled much of the tentage of the ADS to the ground, but all patients were held overnight at the car post, which was in a building. When 5 Brigade relieved 6 Brigade in the line on 2 January, 5 ADS took over again from 6 ADS. At Castelfrentano 5 Field Ambulance relieved 6 Field Ambulance on 7 January in the running of the MDS.
There was a change of commanders of 5 Field Ambulance on 14 December when Lieutenant-Colonel R. A. Elliott assumed command from Lieutenant-Colonel J. P. McQuilkin prior to the latter's return to New Zealand.