New Zealand Medical Services in Middle East and Italy
LESSONS FROM INITIAL OPERATIONS IN ITALY
LESSONS FROM INITIAL OPERATIONS IN ITALY
Operations in Italy presented to the medical services a number of problems not met with in the more open country of Egypt and North Africa. The two ruling factors in the Sangro and Orsogna operations were the roads and the weather. These were the main factors to be considered in deciding the extent of surgical treatment to be given in forward areas, the type of transport required, the locations of ADSs, MDSs and CCSs, and the accommodation required for each.
The outstanding lesson learned was the need for elasticity in all branches of the medical services, and an attempt was made to provide this by reinforcing one medical unit by another. As occasion demanded, companies and sections were split so as to have the minimum of personnel necessary for efficiency at resuscitation posts, car posts, and dressing stations.
Normal methods had to be adapted to meet local conditions. The ADS had to be located well forward and in a building. The lower rooms with a big fireplace found in most houses were ideal for the purpose. In most cases a section only of a field ambulance company was required as an ADS. The rest of the company was located further back to act as a car and resuscitation post and reinforce the forward section when necessary. This rear section also provided bearer squads for evacuation of patients from RAPs.
Equipment for the forward section was taken up by bearers, jeeps, ambulance cars or mule transport, and consisted of full resuscitation equipment with blood, wet and dry plasma, instruments, steriliser, dressings, splints, medical comforts, 40 stretchers, 100 blankets, and 20 hot-water bottles. Replenishment by the usual channels was adequate, 7 Advanced Depot Medical Stores being located at Vasto.page 526
The companies of 4 Field Ambulance were organised in half-company sections for use with 4 Armoured Brigade, and this proved most successful.
The practice as regards MDSs was to have two field ambulances open in buildings: the forward one to sort all cases and treat battle casualties; the rear one to act as a reception station for sick and such casualties as occurred in rear areas. As the fighting moved ahead, the forward MDS took on the work of the reception station, and the reserve field ambulance opened further forward.
The forward MDS consisted of the usual two companies of the field ambulance, reinforced by 1 General Hospital surgical team, 2 NZ Field Transfusion Unit, two relief surgical teams from the reserve MDS (and, if necessary, from the field ambulance holding sick), a relief transfusion team from one of the other field ambulances, and one section from the Mobile Dental Unit. This forward medical centre was then capable of treating and, if necessary, holding all types of casualties. No limit was placed on the surgical work to be done at this MDS, the policy being to leave the decision to the OC of the unit, as the evacuation time to the CCS varied for each battle.
The primary function of the rear MDS was to sort out all cases of sickness, holding those who would be fit to return to their units within eight to ten days. However, there were always a few casualties from shelling, bombing, or mines in the rear areas and one competent surgical team had to be retained at this MDS. It was usual, too, for 102 Mobile VDTC to be attached to this MDS to treat venereal disease patients within the Division.
The reserve field ambulance provided relief surgical and resuscitation teams, medical officers, and drivers for jeeps, together with extra stretcher-bearers if required by the ADSs. The attachment of a transfusion team to 2 NZ FTU enabled extra transfusion orderlies to be trained to provide a reserve within the Division.
During the campaign 1 NZ Mobile CCS was under command of 2 NZ Division. This resulted in all cases from the Division passing through a regular evacuation channel, and allowed for continuity of treatment with benefit to the patients. This unit at first had the assistance of a surgical team from 3 NZ General Hospital and later of another from 8 British FSU.
The mobile shower section of 4 Field Hygiene Section worked continuously throughout the campaign, an average of over 450 troops receiving showers each day. A small unit such as this could be carried on one truck, and if one was available for each brigade group every man would be able to have a shower at least once a week. The natural inclination of the Italian to ignore even the most page 527 elementary sanitary principles added greatly to the work of 4 Field Hygiene Section itself.
In the past 1 Mobile Dental Unit had worked only when the Division was in reserve. From the start of the Italian campaign dental sections were attached to brigades and divisional troops throughout the Division. All troops were within easy reach of one of these sections and, as a result, were able to receive attention with a minimum period of absence from their units. It was found that, when the mobility of the Division in a campaign was fairly restricted, the dental condition of the Division would be satisfactorily maintained by this method, with the co-operation of all unit commanders.
It was found to be essential to use buildings to accommodate medical units during the winter months in Italy. School buildings, usually found in each town, were suitable for both MDSs and CCS, but careful reconnaissance and planning were necessary to make the best use of the existing buildings. It was advisable for these units to have accommodation for 200 patients but this was not always possible. If less accommodation was available, good evacuation facilities were desirable as a compensating factor.
In the buildings an absence of glass was universal following heavy shelling. Window-proofing by blankets was found to be both inefficient and wasteful. When a small supply of window-lite (pliable transparent material on a netting base) became available, it was most valuable. Temporary repairs to roofs were effected by the use of canvas covers until Italian labour could be obtained through the local Allied Military Government office to repair damaged tiles. Unit vehicles were equipped with penthouses, and adaptations of these proved very useful as offices, workshops, cookhouses, and dispensaries.
Heating was a major problem, but plentiful supplies of wood were available in most places and drum heaters with chimneys were built by units. The late arrival of kerosene heaters relieved a difficult situation. Difficulty was experienced with the primus stoves which were relied on so much in the field ambulances. Constant wear and tear was experienced and repairs and supplies, especially of spare parts, were a difficulty.