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New Zealand Medical Services in Middle East and Italy

Surgical Policy

Surgical Policy

The siting of the New Zealand divisional medical units during the battles at Cassino was in close relation to the main arterial road, Route 6. This enabled rapid and smooth evacuation of casualties to be carried out. The New Zealand CCS was very conveniently and safely sited at Presenzano, only about 15 miles from Cassino itself on a branch road between Route 6 and another main road (Route 85). Difficulties arose in evacuating casualties from the field to the RAPs and also from the RAPs themselves, but once these had been overcome rapid evacuation by motor ambulance was possible and the time to the CCS was only a little longer (30 minutes) than that to the MDS. There was, therefore, normally no need and no. excuse for the performance of major surgery at the MDS. The No. 1 General Hospital surgical team was attached to the CCS, which was at that time very well staffed, having in addition a British FSU and a British FTU as well as two bacteriological laboratories. The New Zealand FTU was attached to 4 MDS so as to be available for the resuscitation of serious cases before evacuation to the CCS. Casualties had to be held in the RAP to await evacuation by night and more resuscitation and splinting than usual had to be undertaken there. Fortunately, ample supplies of blood, as well as plasma, were available at the RAP as well as in the other medical posts. There was close liaison between the active MDS and the CCS, and at times the MDS undertook extra surgical work to relieve the pressure on the CCS and ensure early attention to the lighter cases. At that time it had been determined that early surgical attention was essential in wounds associated with serious muscle injury, and especially in traumatic amputation, and that satisfactory resuscitation was impossible by transfusion till the damaged tissue was removed. These cases were therefore dealt with at the MDS and transfusion given during and following operation. Schu-mine injuries were relatively common and many amputations were carried out at the MDS in these cases.

The abdominal and chest cases, as well as the large majority of other wounded men, were sent as quickly as possible to the CCS and were there dealt with by a well-qualified and ample staff. Three theatres were in operation, and there was a bed capacity of 300. Nursing sisters were available for work both in the operating theatre and in the wards. The value of giving ample time for the resuscitation of the severe cases, especially the abdomens, was demonstrated. This led to a new outlook in the treatment of these cases. Early in the war the idea predominant was that operative treatment in abdominal cases had to be carried out at the earliest possible moment, and certainly within six to eight hours. Every page 545 effort had been made to carry this out and abdominal cases had been placed in the first priority. This led to the performance of abdominal operations in the field ambulances and to the attachment of surgical teams, and later FSUs, to forward MDSs so as to have competent abdominal surgery available there. Now that it had been shown that extreme urgency was unnecessary and that the cases did much better if a longer period was devoted to resuscitation, and that the man died of shock and not of infection, the necessity for operating at the MDS stage no longer existed. The essentials to ensure recovery of abdominal cases had now been shown to be, first, the fullest possible resuscitation by means of blood, plasma, and rest; then surgical operation by the best available surgeon and anaesthetist, operating under satisfactory conditions; and finally, competent nursing, further resuscitation, and the holding of the patient at the operating centre till established recovery had taken place. The results obtained at our CCS at Presenzano completely established this opinion.