George Thompson, M.A., M.F.A.
Adjunct Associate Professor
Historian
History and Philosophy of Medicine
The University of Kansas Medical Center

The medical units closest to the combat zone staffed by physicians and enlisted men were found in the army's infantry divisions. These men were identified as Medical Department personnel on duty with division troops. Their purpose was to provide medical care for the division's infantry and artillery regiments, machine gun and mortar battalions, engineers, signals and train units.

Each medical unit varied in size, but the largest and most significant were the infantry regiment's aid station that was staffed by 4-7 officers and 31-43 enlisted men. It would be these men who provided the first level of professionally directed care for the regiment's sick and wounded.

However, it was found that the reorganization of the infantry regiments in August 1918 required that the men of the Regimental Aid Station be dispersed in order to better support the regiment's infantry battalions. This resulted in the creation of three Battalion Aid Stations. Each station supported four infantry companies by locating the station to the rear of the battalion and by placing two Medical Corps enlisted men with each company to man a Company Aid Post. These eight men were trained and supervised by the physician assigned to the battalion aid station.

The Company Aid Post was sited in a sheltered location very near the front line if the unit was garrisoning a trench system. However, if the company was out of its protected position making an assault or in retreat the post would move and establish a succession of posts to provide emergency medical care.

Shell hold where first-adi was administered, 7th Artillery Regiment, 1st Divsion, Sereviller, France, July 5, 1918

It was expected that the initial treatment of a man's wound(s) began with his own application of his first-aid dressing to his wound. To do this each man was provided with two gauze bandages (4"x84"), two gauze compresses (3 ½" x 3 ½ "), two safety pins and was instructed on how to apply the dressing by one of the physicians assigned to his battalion. 

The purposes of this dressing was to protect the wound from further trauma, prevent loss of blood, and reduce the possibility of secondary infection and to give the man some physical and psychological comfort.

However, he may not have been able to care for himself. If so the dressing may have been applied by a comrade but more likely by the Company Aid Post personnel, who were trained in how to apply field dressings, control hemorrhage, splint fractures and to protect the wounded from gas.

About 40% of the wounded were able to walk to the rear. The remainder would need to be carried by regimental stretcher bearers to the next level of care which was the Battalion Aid Station where they would be seen by the battalion's medical officer. The locating, marking, gathering and directing of the sick and wounded to the next level of care would have been an important patient management task performed by the two men assigned to the Company Aid Post.

First aid in trench window

The Battalion Aid Station was centrally located at 500 to 1000 yards behind the infantry companies in a building, dugout or specially constructed shelter. Its location was carefully selected because it had to be easily reached from the front by foot and on a road, if possible, to allow ambulances to pick up the patients for transport to their next level of care.

An aid station's site could be anything from a hasty shelter to set of above or below ground rooms constructed over time that could treat from 12 to 30 patients for their injuries, project them from further harm, hold them for evacuation, plus store medical supplies for the station and company aid posts.

Aid station, 315th Infantry, 79th Division, Bois de Consenvoye, France, November 8, 1918

The Battalion Aid Station was staffed by one medical officer, four to six medical corps enlisted men, two runners and one or more stretcher bearer squads.

The treatment the wounded received was limited to physician directed emergency care such as:

• Controlling hemorrhage
• Application or readjustment of field dressings and splints
• Administration of the anti-tetanus serum and morphine for pain
• Treatment for gas injuries
• Anti-shock treatments such as warmth, hot food and drinks

Adjusting improved splint on a litter patient, Broussey, April 20, 1918

The first step in a long process of sorting the sick and wounded began here with the filling out of the patient's field card that noted whether he was:

• Very slightly wounded but able to return to the line
• Slightly wounded and requires evacuation
• Seriously wounded
• Patient with fractures
• Severely wounded with attendant shock
• Gassed patient
• Psychoneurotic
• Sick

If the patient was slightly wounded or not seriously sick he would be retained whereas the rest were evacuated. The slightly wounded to be evacuated, seriously wounded and those with fractures were likely to receive the attentions of the physician whose examination led to personal or directed treatments such as:

• Painting around the wound with iodine
• Injection of 500 units of the anti-tetanus serum
• One-fourth grain of morphine for pain to slightly to seriously wounded
• Control of hemorrhage through ligature, hemostats or a tourniquet
• Immobilization of fractures with the Thomas Splint
• Shock treatment such as blankets, warming table and hot drinks

Regimental aid station, 28th Infantry, 1st Division, near Cantigny, May 28, 1918

Given that the aid station could not provide surgical procedures; retain patients for any length of time; were subject to enemy artillery fire; and were constantly receiving new patients it was essential to evacuate their patients as soon as possible. This was especially important due to the risk that the wounded could develop a life, or limb, threatening gas-gangrene infection if he did not receive a surgical intervention within 12 hours of his wounding.

Administering a hot drink to a shock case

A timely evacuation was a challenge due to the weather, terrain, enemy fire, how to move the patient and the patient's condition. Weather and terrain were variables that could not be controlled. The threat from enemy fire could be mitigated by a night evacuation.

The means of evacuation, by stretcher bearers, wheeled stretcher cart or ambulance and preparing the patient for movement were variables that the station's staff focused on. The physician directed treatment was designed to stabilize the man and prepare him for his next level of care at the division dressing station or field hospital if it was near. At the same time the stabilizing treatment was given the staff coordinated his evacuation with the personnel of the next level of care: the ambulance company and its dressing station.

Battalion aid station, 101st Infantry, 26th Division, Bois de la Voisogne, France, May 31, 1918

Sources:

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)