Battlefield Medicine: Ambulance Section
George Thompson, M.A., M.F.A.
Adjunct Associate Professor
History and Philosophy of Medicine
The University of Kansas Medical Center
The sick and wounded after receiving emergency treatment from the medical corps personnel at the regimental, battalion or support unit level were evacuated to the next phase of physician directed care which was provided by the infantry division’s Sanitary Train. This 950 man unit consisted of a:
- Train Headquarters
- Ambulance Section
- Field Hospital Section
- Camp Infirmaries
- Divisional Medical Supply Unit
The word ‘train’ identifies units that were assigned to support the entire infantry division. There were four trains: Ammunition, Supply, Engineer and Sanitary. All of these were mobile and relied on their horse drawn and motor vehicles to perform their supporting roles.
The role of the Sanitary Train was to provide medical care for the entire division through its ambulance and field hospital sections and Camp Infirmaries.
The Ambulance Section consisted of a headquarters, one horse drawn and three motor ambulance companies. Their purpose was to transport men from the Battalion Aid Stations to the Field Hospital Section. If the travel time from collection points to the hospital was too long, leaving a man unattended, the Ambulance Sections set up intermediate points that allowed for a continuance of emergency medical care called Dressing Stations.
The section’s four companies possessed 12 horse drawn and 36 motor ambulances. By 1918 operational experience proved the motor ambulance to be reliable and effective for evacuating patients from near the front provided roads were not too damaged. The horse drawn ambulance company was held in reserve because although they could negotiate terrain that was impassable to motor vehicles they presented a large target, were slow and the horses tired quickly in contrast to motor vehicles.
The deployment of the 82nd Infantry Division’s Sanitary Train in September 1918 for the St. Mihiel offensive illustrates how the train’s units might be placed in order to support an offensive. At the start of the operation one motor ambulance company, AC 327 was placed at Dieulouard with Field Hospital 328. To the south of their position AC 325 and 328 were on alert and in reserve at Millery with the other three field hospitals, while AC 326 was further to the rear at Marbache.
As the battle progressed AC 327 was moved north to Blenod on September 7th and to Norray on September 16th. This shift of location illustrates the key mission for the ambulance company which was to maintain constant contact with the moving Battalion Aid Stations so as to evacuate their patients in a timely manner to the Sanitary Train’s field hospitals.
Ambulance Company 327, as with the other three ambulance companies, was divided into two sections. One operated the Dressing Station while the other collected, coordinated and moved patients from the battalions to the Dressing Station and then on to a field hospital. Because the combat zone was dangerous, evacuation from the front for the first 500 to 1000 yards was done on foot by the walking wounded or by litter bearer squads sent forward from the ambulance company.
The destination of the litter bearers was to a collecting point where vehicles could safely assemble for the purpose of loading patients.
The other section of the Ambulance Company manned the Dressing station that was 3,000 to 6,000 yards from the front. It was staffed by up to 5 officers and 25 men and was sited on a road, if possible, and housed in a dug out, cellar, building or tents.
The Sanitary Train could deploy up to four Dressing Stations but in practice it was one, if the division’s frontage was narrow, or more for a wider front and with one held in reserve. If the division was engaged in mobile warfare the Dressing Station might be divided in order to create an Advanced Dressing Station staffed by 1 officer and 15 men closer to the front at 1,500-2,000 yards while the Main Dressing Station with its larger staff was place further to the rear.
The medical mission of the Dressing Station was similar to the Battalion Aid Station’s in that it continued to provide emergency medical care such as:
- Arresting hemorrhage
- Inspecting and readjusting the patient’s dressings and splints
- Administering morphine and the anti-tetanus serum
- Treating for shock and gas injuries
At this level more sophisticated treatments than were possible at a Battalion Aid Station could be provided such as treatment for shock and gas or even surgical procedures to close aspirating chest wounds or the control hemorrhage through ligature or packing the wound.
Patient management was an important concern for the staff at this phase of care. The first evidence of this was the attention given to the design of a continuous system of evacuation by ambulances from the battlefield as performed by half of the Ambulance Company. The second was the continuation of stabilizing the patient at the Dressing Station for further evacuation and the first detailed classification of patients in order to direct them towards their future care.
The Dressing Station addressed these tasks by organizing itself into departments so as to efficiently manage their case load. These departments were:
- Receiving and forwarding
The creation of these departments indicates the first step toward placing patients, such as orthopedic and gas cases, with a staff that was experienced in treating these types of injuries.
The receiving and forwarding department was tasked to unload, sort and classify new patients. This was supervised by a medical officer who examined them and determined who should be returned to their unit, who needed immediate attention from the dressing, orthopedic or gas departments and who and when should be evacuated to the next level of care that would be the Triage operated by one of the Sanitary Train’s field hospitals.
Jaffin, Colonel Jonathan H. Medical support for the American Expeditionary Forces in France during the First World War (Fort Leavenworth 1990)
Volume VIII, Field Operations, The Medical Department of the United States Army in the World War (Washington, 1925)
Volume XI, Section I, General Surgery, The Medical Department of the United States Army in the World War (Washington, 1925)