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

In 1918 the staff of the Medical Department observed the method used by the French Army for patient management called Triage. This technique was quickly recognized as an effective way for front line medical personnel to sort, classify and distribute the sick and wounded.

Triage, 42d Division, near Suippes, France, July 17, 1918

The unit assigned to implement the method was the Field Hospital Section, the largest medical unit in the infantry division’s Sanitary Train. The section was comprised of four identical field hospitals that were staffed by a total of 25 officers and 337 men. Each hospital could accommodate 216 patients and was designed to be mobile so as to be in contact with the medical units it supported.

Field Hospital No. 13, near Vendeuil-Caply, July 2, 1918

In early to mid-1918 the static combat zone allowed these four hospitals to be grouped for greater efficiency. They were positioned at 6 to 8 miles from the front on a road network that linked them to the Ambulance Section’s Dressing Stations and to medical treatment further to the rear such as the Evacuation Hospital.

Field Hospitals No. 314 and No. 315, 79th Division, at Ferme Notre Dame de Eparges, Mueuse

The notion of deploying four hospitals to perform the same role changed in May 1918 when the 1st Infantry Division’s Field Hospital Section at the Battle of Cantigny experimented by assigning each hospital a specific type of patient such as the:

• Wounded and gassed
• Sick
• Skin or venereal diseases

The fourth hospital was to be the medical reserve and a convalescent camp. At the same time the concept of Triage was being developed by designating its role to the hospital receiving the wounded and gassed.

This idea of assigning a type of patient to each field hospital was quickly adopted by the other medical units operating at the infantry division level. In practice, however, each division’s Field Hospital Section was free to designate what worked best for them, especially the mission for the Triage.

Triage operated by the 77th Division, La Chalade, September 28, 1918

An illustration of how the Triage operated with the other field hospitals and the ambulance companies is illustrated in the deployment of the 82nd Infantry Division’s Sanitary Train in September 1918 for the St. Mihiel offensive. At the start of the operation Field Hospital 328 was designated as the division’s Triage and was located at Dieulouard. It remained at that location throughout the battle and began receiving casualties eight hours after the start of the offensive on September 12th. At Millery, further south, Field Hospital 325 was designated to receive the sick, the 326th the gassed and the 327th the seriously wounded.

This illustration also indicates the preferred site for the division’s field hospitals. Although each had tents for shelter the preferred location was in a village. The site was likely to have intact buildings that would provide better shelter, a water supply, sources of fuel and perhaps electricity. This semi-permanent setting of grouped hospitals allowed the units to also share a portable sterilizer, mobile x-ray van and medical lab.

Church at Benzu-leGeury, France, used as a ward for wounded by Field Hospital No. 1, 2d Division, June 16, 1918

The Field Hospital Section was the last point for a man to receive treatment from an infantry division’s medical unit. However, upon arrival and treatment at one of these hospitals it did not mean the patient would be evacuated to the next level of treatment such as an evacuation or a base hospital. If a patient did not require prolonged care and was likely to recover within 14 days he was retained at one of the hospitals designated for his medical condition.

Unloading severely wounded at Field Hospital No. 28, Varennes Meuse, October 2, 1918

This decision illustrates the value of Triage as a method to sort, classify and determine who should be evacuated and to where and who should not be transported to the next level of care. If a patient could recover within the specified days then his contribution to the infantry division would be retained.

An example that illustrates this is the diagnosis of men classified as a potential ‘war neurosis’ case. At the Triage these patients would be examined by the division psychiatrist to determine the cause and severity of their condition. The six categories used were:

• Shell fright
• Gas fright
• Hysteria
• Mental and or physical fatigue
• Malingering
• Cowardice

This examination, classification and recommended treatment led to 65% of the cases seen at the division level to be retained and 35% to be evacuated to a neurological hospital.

The sorting, classification and distributing done at a Triage required a skilled team to determine who was transportable and who needed to be retained until they were ready to be moved. Ideally the team had a thorough knowledge of medicine, surgery and human nature. Their evaluations had to be complete and unhurried but quick enough to prevent congestion caused by the arrival of new patients.

Sorting Wounded

The essential sorting and classifications at the Triage focused on identifying those who were wounded, gassed or were medical cases and within these three who were transportable and who were not. In some triage units the mission was to sort and distribute to the nearest hospitals according to the medical diagnosis. In others there was a continuation of emergency medical care but with more sophisticated treatment as compared to that received at the Ambulance Company Dressing Stations.

The treatment for shock was a top priority whether given at the Triage or at the field hospital for the wounded and consisted of:

• Removal of wet clothing
• Warming through blankets, stoves and specially designed warming tables
• Hot drinks and food
• Morphine for pain
• Adjustment of splints and bandages to reduce pain
• Intravenous saline solution
• Blood transfusion from matched donors

However, prior to receiving treatment for shock the patient would have been seen in the receiving department of the Triage or hospital for the wounded. His condition would determine whether he would be routed to the dressing, shock or operating departments. If treatment for shock was required he would be held there until his condition permitted either evacuation or treatment by the operating department’s team.

Slightly wounded awaiting readjustment of dressings, Field Hospital No. 28, October 2, 1918

The operating team’s procedures focused on the control of hemorrhage and adjusting fractures and if time permitted the removal of foreign bodies and the debridement of the wound. All surgical work was intended not to be definitive but rather to prepare the patient for evacuation to a rear area hospital where more definitive work could be done.

At the hospital designated for the treatment of gas injuries the patient’s clothes were removed and he was bathed to remove possible contamination followed by an appropriate treatment for the cause of his injury by a gas designed to irritate the lungs or blister the skin.

Medical treatment as described at this level of physician directed care was constrained by the reality that only essential emergency procedures could be performed. It was imperative that this lifesaving care be matched by the need to maintain the best patient management system possible. Therefore, the medical mission for the staff of the Sanitary Train’s Ambulance Section and Field Hospital Section was to first save lives and then to prepare their patients for the their next level of treatment at the Evacuation Hospital.

Evacuating wounded by truck from Field Hospital No. 15, near Montreuil, France, June 7, 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)