Mobile hospitals, Surgical teams, X-ray trucks, Sterilizers and more!

US Ambulance, circa WWI, holds 4 men!

How do you best save wounded men if:

1. they are sometimes carried by 4-6 stretcher bearers for 1 mile or more before getting to ambulance

2. they must travel over muddy, shell-warped lanes for 3 to 5 miles back of line to get to a sterilized operating room

3. only at night, lest the enemy see the ambulance line during the daylight and bomb them

4. in ambulances that hold either four or eight

5. with only barest field dressings on utterly horrific head, chest and intestinal areas

6. with limited morphine pills

7. not enough front line surgeons

8. who have limited facilities (surgical supplies, no needles, no ether, no nurses, orderlies only...)

The United States Army Medical Corps answered these challenges by creating mobile hospital units. These teams of expert surgeons, nurses and orderlies formed 7-member teams who volunteered to go directly in back of the front lines of Doughboys.

US Army Mobile X-Ray truck, WWI

These men and women were screened to be the most professional, stable, healthy individuals who had proven their resilience and talents in the first months that Americans had gone abroad. Then, as the need for medical teams to be much closer to the wounded became vital, mobile surgical units were created.

Composed of one surgeon, one assistant, two nurses, one nurse anesthetist and two orderlies, this team would receive a wounded man and immediately operate on him.

To ensure that this occurred within minutes, the mobile unit also consisted of admitting officers who were trained in triage, x-ray technicians and ambulance drivers who took the post-op patients and transported them farther down the line to another mobile unit or a larger facility, also mobile, called an evacuation hospital.

Want to read about one in action in the Meuse-Argonne in November 1918 during the Big Push?
Read HEROIC MEASURES, out now.
In there, you see how the main character, Gwen Spencer from Scranton Pennsylvania joins a mobile surgical unit and survives the rigorous PUSH in The Great War.

A group of trucks in a mobile unit would pull into a clearing and go to work!
This was their configuration.

Even men of the ambulance units had to pause to line up and get a bath! Note that water had
"to be carried several blocks an coal is scarce. Rambillard, France, Oct. 23, 1918

First aid to American wounded soldiers, where, when, how

     A wounded soldier passed through many posts as he was removed from the front. Some of these travels took, sadly, days. Stories abound of men left on the ground in rain, snow and sleet as medical teams walked among them to analyze the severity of their injuries and determine how quickly and where they might be evacuated for treatment. Many men waited close behind the front lines, hearing the sound of the guns, bombs and airplane strikes that hurt them and their fellow soldiers even as they lay wounded. In fact, many doctors and nurses lamented that had they been able to treat their patients sooner, the men would have had a higher rate of survival and faster recovery. (In fact, improving the immediacy of treatment for a wounded soldier was the foremost goal of medical response teams throughout the war by all combatants and was implemented and improved on in each succeeding war.)

     When a soldier was wounded, he was assisted to the first aid station, dressing station or casualty clearing station by his pals or by stretcher bearers. (These first stops along the route backward from a front lines had many names and saw many variations, depending on numbers of medical teams, type of equipment and surgical and nursing specialists available. Triage was a function at each stage back of the line.) But before he got to such a station, the solider had in his possession a field dressing. (I have not yet found a U.S. field dressing picture. If anyone knows of one, I would heartily appreciate the url.)
    Here, courtesy of the British site, The Warwicks 1914-1918 (http://thewarwicks1418.com), I show you their First Field Dressing, FFD and their description:

Courtesy of and Copyright to  http://thewarwicks1418.com

"First Field Dressing (FFD) and Iodine ampoule carried on Active Service inside the lower right of the jacket."

Applied by the soldier himself or by those near him (if capable), this dressing consisted of iodine, the only easily packaged and affordable antiseptic/cleansing agent at the time. Penicillin was not yet used as a means to kill bacteria. Morphine was not readily available at the front lines, only backward of the line.

French church opened as ward used by Field Hospital #1, 2nd Division, June 16, 1918

   The next receiving station was a more intensive care unit. This post was a Mobile Hospital unit, literally moving by truck to one to four miles in back of an active front. This included a surgical team of doctors, nurses, and nurses assistants (what we would call orderlies) and/or stretcher bearers who were generally able-bodied types to carry wounded men. This mobile unit team, in the case of American facilities, assessed soldiers and divided them according to type of wound or disability. A team of doctors and nurses assessed each soldier and sent him either to surgery (in order of severity of wounds and operability), to a mental health receiving station or to a hospital treating only those with diseases. (These divisions were not rigorously applied because not all facilities were available in each sector. And at the end of the war, as fighting and casualties increased especially during the last Big Push from September 1918 through November 1918, dividing became nigh unto impossible.)

Nurse cleansing U.S. Marine's eyes of mustard gas during battle of Belleau Wood, June 1918

This mobile unit moved by truck, motorized or horse drawn, lived in tents and operated in tents. Their patients recuperated in tents, as well. Those who recovered to a stage where they could be transported farther back of the line were taken by ambulance. At this point, they went to a larger recuperative facility far back of the line in what the Americans called a Base Hospital.

Mobile Hospital #2, loaded and prepared for change of location. Carries sterilizers.

At the Base Hospital, the wounded were reassessed for fitness for duty. Some were returned to the front. Many received physical therapy by rehabilitation aides, or re-aids as they became known. Most were sent on down the line toward ports and ships home.

PHOTO, J. Power. Copyright of Illustration: 
Fort Sam Houston Medical Museum, San Antonio, TX

Care of recruited nurses and how they were trained, stationed and provisioned

The need for nurses to assist doctors, dentists, medics, stretcher bearers and ambulance drivers was immediate after Congress declared war in April 1917.

Since at that time, the United States had a very small standing army, expanding the current base to a fighting force of more than 1 million meant the development of a huge and almost instant medical assistance group.

Furthermore, recruiting women meant an entirely separate set of arrangements for training, transport, domicile and services had to be built into the organization of a mobile fighting army, navy and marine corps. Providing our fighting forces and medical support unit with barracks—or some similar accommodations—required either appropriation of current homes, chateaux, public buildings such as hotels, etc., or building them.

In France, many donated the use of their homes and chateaux. Many towns and cities offered their public buildings, such as city halls or old factories. The result was that nurses, in particular, those back of the line, might sleep in very nice surroundings—and others find themselves in tents.
Here are a few examples:

Base Hospital #3, Vauclaire, France

Tents used by Evacuation Hospital #1

Accommodating one million men as well as approximately 40,000 medical professionals (including 22,00+ nurses was a huge task, necessary to care of the American fighting man. But it was also a difficult one, made more complex by the fact that women were still considered to be the "weaker sex." Separation of them from their male counterparts implied not only sequestered housing accommodations but also dining, bathing (if possible considering field conditions) and latrine facilities. In the early days of the American war effort, the women even had separate common rooms where they spent their off-duty hours. However, as the frequency and intensity of battles increased, many of these social constraints bowed to the need for efficient responses by medical personnel. As mobile units, immediately behind the lines, became overwhelmed with casualties and as allied hospital units (particularly the French) were destroyed in German advances, social strictures of separating women from the men fell.

Male officers mess, Vichy Hospital Center

What these nurses did not have was rank within the Army.

To quote the Army official history of nursing service (from http://www.army.mil/women/nurses.html ):
"Army nurses during World War I did not have officer status. They were not commissioned, but appointed into the ANC. Medics sometimes refused to accept nurses’ authority on the wards. After the war, Congress, to show their appreciation, gave nurses officer status by allotting them “Relative Rank,” meaning that an Army nurse first lieutenant, for example, received less pay and status than a male first lieutenant."

Other challenges of supply and demand caused controversy within the Nurse Corps command and among other leaders within the greater Army. The most vital need was, of course, to recruit as many qualified, well-trained nurses as possible as quickly as possible. When that number lagged behind quotas, the Army decided to recruit unqualified women to serve abroad. Many of these women worked in other professions or had none at all, joining out of national pride and compassion for wounded Americans. For these women, they were sent to training camps for what we would call a crash course in medical emergency care. Many of them had no idea how to use a hypodermic needle or change a dressing. To train many of these women quickly, the Army established its Army Nursing School and pushed through many aides toward the front.

Another controversial issue was the "separate but equal" status of African-Americans. Black men were enlisted as soldiers and Marines, but were assigned to units separate from white troops. This meant that they would also receive medical care apart from their white brothers in arms. Hence, black women who volunteered to join the nursing corps were also enlisted and served black combat units in "separate but equal" facilities.

Planning transport into France of soldiers and wounded from front lines to home

Photo Copyright, Jo-Ann Power.
Exhibit:
Fort Sam Houston Medical Museum,
San Antonio, Texas.

Transporting all Americans, both military personnel and medical staff, into France to the front lines was a huge logistical problem.
This is one reason why arrival of American fighting force levels took nearly a full year from the date of declaration of war.
The flow of personnel in presented one challenge. However removing wounded American soldiers from the A.E.F. front lines back through French countryside to base hospitals, rehabilitation sites, onward to the French Atlantic coast and home to the United States was an immensely more complex logistical challenge.
Planning routes was the first task, but in fact, the simplest. Drawing lines on a map seems easy, yet the best routes were not the ones which could be used. The front lines of British and French troops meant a southwest exit from American lines northeast and east of Paris was necessary. But huge problems existed.

Most American soldiers did not speak French. Secondly, they served in a terrain new to them.  Still more confounding was the fact that French rail lines were badly in need of repair and without synchronized gauges to lock one train route/system to another. (French trains transporting nurses from their embarkation point in St. Nazaire often stopped at the end of a line for hours awaiting the next train east. Nurses recount stories of waiting, tired, hungry and often bitterly cold.)
Here are a few pictures of the types of transport and machinery needed to ensure adequate transport home for wounded American soldiers.

Horse-drawn ambulance
Photo, Copyright Jo-Ann Power.
Exhibit: Fort Sam Houston Medical Museum,
San Antonio, Texas

Interior of motorized ambulance, U.S. Army Ambulance Service

Transport by boat and barge was also necessary. These, like ambulance trains, had nursing staff to aid wounded during their journey across country and on the Atlantic Ocean.

Hospital barge, stretcher bearers and nurse on board.

Interior of hospital train ward car, shown from attendant's compartment.

Nurses served as attendants on these transports because the nature of many soldiers' conditions were precarious. Doctors were needed at the front, as were male stretcher bearers. Nurses on board responded to the immediate needs of wounded men whose physical needs could change in an instant.

Here is the photograph of the interior of an operating room on board a hospital train.