War Surgery and Medicine
FORWARD SURGERY IN 2 NZEF: BY CAMPAIGNS
FORWARD SURGERY IN 2 NZEF: BY CAMPAIGNS
Greece: In Greece comparatively little forward surgery was carried out by our medical units. During the early stages of the fighting our casualties were dealt with by ⅔ Australian CCS and 24 British CCS, and then sent on either to 1 NZ General Hospital at Farsala or to 26 British General Hospital at Athens. At the Thermopylae line 5 MDS did some operating at the Greek Hospital.
Crete: Forward surgery was carried out to some extent by 5 MDS in Crete and also by 7 British General Hospital, and by our surgical team attached to 7 General Hospital and later to 189 British Field Ambulance, cases being referred back from the Field Ambulances.
Second Libyan Campaign: The Mobile Surgical Unit did a considerable amount of surgery, including abdomens and heads. A certain amount was also done by the MDS of the Field Ambulances. The L of C1 units were a considerable distance back and evacuation was always difficult, and was impossible for ten days after the MDS area had been captured by the enemy. The shortage of water created serious difficulties and hardships, as did shortage of plasma and crystalloids. Evacuation of cases after operation over long stretches of rough desert militated against the recovery of serious cases, and few abdominal cases survived the ordeal.
Pre-Alamein: The organisation of forward surgery had been developed and FSUs and FTUs were available for attachment to both Field Ambulances and CCSs. The 2nd NZEF now had a well-equipped CCS, buttressed by the excellent equipment of the MSU. The first New Zealand surgical team was attached to the active MDS, and British FSUs were also attached to our forward medical page 82 units. The Blood Transfusion Service was operating well with blood freely available. The FSUs were well equipped, some even with specially constructed mobile operating vans. The lines of evacuation were short and both road and rail, as well as some air, transport were available.
Alamein: For this battle there was a well-planned organisation. A cluster of Field Ambulances was operating around Alamein itself, two being placed underground and others on the sea coast and alongside the rail and road. With these were FSUs and FTUs. Our own active MDS was alongside the railway and had attached to it our own FSU and FTU and received cases from active ADSs. First page 83 priority cases were dealt with, including abdominals. Further back at Gharbaniyat were a group of CCSs, including our own CCS as well as a British and Australian and Indian CCS. These were sited on a road inland to the main coastal road, with a British Field Ambulance stationed in front of them to sort out the cases, treat and evacuate to the Base the lighter cases, and distribute the heavier cases and those requiring surgical treatment in an ordered plan to the different CCSs. Our CCS did not restrict its work to our own personnel, but took its turn in the more or less even distribution of the casualties as they came along the medical route of evacuation. With the MDS it was different as our ADSs evacuated our own cases directly to our MDS.
Field Ambulances were protected in some cases by underground dressing stations and the CCSs by the digging in and dispersal of tents. The tents were officially supposed to be 100 yards apart, and the distance was such that ambulances were used at times to carry patients in the hospital area.
From the CCS evacuation was arranged by motor ambulance to Alexandria, where many cases were referred for primary surgery in rush periods; by train to the Delta and Canal for cases not requiring any urgent treatment and those already operated on; and by plane for special cases, such as head cases, to special centres in Cairo. By that time it had been learnt that air transport was unsuitable for all seriously ill cases except heads, and especially unsuitable for abdomens for at least a week following operation.page 84
A list of operations undertaken by a single operating team during the first fortnight of this period was:
|Nature of Injury||Total Cases||Percentage|
|Compound Fractures of Limbs||61||37.5|
|Wounds of joints||12||7.5|
|Shell wounds of soft parts||19||12.0|
|Abdominal (including three abdominothoracic and 15 non-penetrating)||40||24.5|
|Clinical gas gangrene||4||2.4|
Our own CCS dealt with 2203 battle casualties and 2928 other cases, a total of 5131 cases, with 41 deaths, in the period 1 October to 31 December 1942.
The Advance to Mareth: Casualties were slight during this period, largely consisting of mine wounds from the minefields and the scattered mines placed all along the route by the Germans. The forward operating units leapfrogged each other during the rapid advance, and a team from the NZ CCS was attached to one of these units, 151 British Light Field Ambulance. As our advance continued our Air Force got much the upper hand and wide dispersal of the medical units became unnecessary. Air transport was developed markedly at this period, and forward landing grounds were set up close behind the advancing troops. A section of a field ambulance was detached for duty at each landing strip. Air evacuation became the most efficient and the regular method, though the train was pushed through to Tobruk and was used for evacuation of casualties.
Mareth: Special arrangements were made to cope with the peculiar position of the left-hook force which was built round 2 NZ Division. This force was out of contact with the rest of the force as its line of evacuation was in the hands of the enemy for some time. Special arrangements were therefore made to provide an adequate surgical set-up in the Field Ambulances. The NZ FSU and the light section of the CCS and the NZ FTU were attached to the active MDS. Evacuation by air was arranged, the airstrip being constructed by our ambulance personnel. When the road became available an evacuation ambulance convoy, previously got together by Brigadier Ardagh, was rushed up to bring back the less serious casualties.page 85
The CCSs were grouped at Medenine behind the coastal front, the NZ CCS being one of the two active units there, and one CCS was placed inland behind the outflanking force. From Medenine evacuation was by road to Tripoli with a staging area in between.
Mareth to Tunis: At Wadi Akarit grouping of CCSs was arranged as at Medenine. The grouping of CCSs was not carried out so well during the Eighth Army's later progress to Enfidaville. The CCSs moved separately, and behind Enfidaville the NZ MDS took over the great bulk of the forward surgery for some time as the CCS was too far behind at El Djem. Evacuation still took place by air, but at Sfax sea evacuation became possible. The layout of the medical units was stabilised, protection being effected largely by dispersal, though the gradual decrease of enemy air activity led to more efficient concentration of tentage.
The Sangro: During the early period of this long-drawn-out battle the greater part of the surgery was carried out in the MDS, and at one time nursing sisters were utilised by one of the MDSs which had established their unit in a building in a small village from which evacuation was difficult. Our CCS, with two others, was established in Vasto within reasonable distance of the line, but the bulk of the surgery was still carried out at the MDS. A special neurosurgical unit was available in a British CCS at Vasto. Evacuation from Vasto was by a rather bad road to railhead at Termoli, where two British CCSs were stationed.
Cassino: The NZ CCS was well placed at Presenzano on a good road and near enough to the line to make it the natural forward operating centre, only urgent cases being dealt with by our MDSs? Neurosurgery could be undertaken at an American Evacuation Hospital quite close to our CCS, and we availed ourselves of its excellent service. Road evacuation to our hospital at Caserta and British hospitals at Naples was satisfactory, and an ambulance sorting post was instituted at Capua to distribute the casualties to the different hospitals and special centres.
Florence: Our CCS was stationed at Siena well forward, but nevertheless our active MDS, with our New Zealand surgical unit attached, carried out a considerable amount of forward surgery, and the CCS suffered depletion of its surgical staff.
Evacuation was difficult as there was a long ambulance route to Lake Trasimene where air evacuation was carried out. British CCSs acted as staging posts half-way to Trasimene and also on the northern shore of the lake. Special centres of neurosurgery and facio-maxillary and opthalmology were arranged at one of the British units at Trasimene. An ambulance centre was arranged at the aerodrome to muster and tend the casualties.page 86
Rimini Battles: Here, for the only time in Italy when the Division was in action, our CCS was not functioning, and we supplied a surgical team to a Canadian CCS which was carrying out the forward surgery for our troops. A certain amount of this work was carried out in our MDSs. Evacuation was by road and also by air, as airstrips were constructed steadily as the line moved forward. Sea evacuation was also arranged from Ancona to Bari.
River Battles: Our CCS was now functioning satisfactorily in a large building at Forli, and the greater part of the major surgery was carried out there. The MDS carried out surgery on first-priority cases such as traumatic amputations and severe muscle wounds, and also in minor wounds. The abdominals were dealt with at the CCS. page 87 The trinity of neuro, ophthalmic, and facio-maxillary surgeons was functioning very satisfactorily in a small 400-bed British hospital at Riccione, and all special cases were sent there. Evacuation was by road and rail to Senigallia, where our 1 NZ General Hospital was established, British units acting as staging posts on the way. Air and sea evacuation was also available to our 3 NZ General Hospital at Bari. The arrangements were almost ideal.
The Advance to Trieste: Very little surgery was necessary during the rapid advance. A detachment of 2 NZ General Hospital was utilised at this period to reinforce the CCS. The CCS was first moved to north of Bologna, then to Mestre, near Venice, and finally to Udine. Evacuation was carried out by road to the railhead at Forli and later by air to our hospitals at Senigallia and Bari.
1 Line of Communications.