Medical Aspects of Chemical Warfare (2008) - The Black Vault

History of the Medical Management of Chemical Casualtiesexpertise were evacuated to the next echelon of care:the advanced dressing station. Litter-bearers who originallybrought in the casualties transported them fromaid posts to advanced dressing stations, or casualtieswere moved between the two echelons by motorizedor horse-drawn ambulances. 19Advanced Dressing StationsAdvanced dressing stations were set up at locationsaccessible by the regimental aid posts. Because theirlocations were further rearward (albeit still in artilleryrange), an advanced dressing station may have beenin a crypt or cellar of a building, such as a church orschool. The floor plan of the advanced dressing stationwas like an enlarged version of a regimental aidpost. Provisions were made for casualties that requiredincreased stabilization. Because they were in artilleryrange, additional care had to be taken to protect staffand patients from chemical attacks. At the advanceddressing station, casualties were further stabilized forcontinued transport, which was the responsibility ofsupporting echelons from the field ambulance headquartersor main dressing station. In the presence of ahigh influx of casualties, the walking wounded wereintercepted prior to their arrival at the advanced aidstation and sequestered in a holding area called a“divisional collecting post.” This collecting post wassupported by a field ambulance station. From there,casualties moved to a main dressing station, if needed.19Main Dressing StationsThe field ambulance headquarters formed the maindressing station, located outside of artillery range(thus defense against chemical artillery was not a majorconcern). Field ambulances were responsible fortransporting the sick and wounded from the advanceddressing stations to the main dressing stations. Casualtiesmight require an extended stay for treatment atthe main dressing station before further evacuationto the clearing stations. Evacuation at this level wascarried out by specially equipped motor ambulanceconvoys. Each motor ambulance car could carry sixor eight sitting or four reclining casualties. Unfortunately,chemical casualties in these ambulances wereexposed to heated carbon monoxide from the vehicle’sexhaust fumes. 19Casualty Clearing StationsCasualty clearing stations or railhead hospitalsserved as the final collecting zones. The casualtyclearing station’s primary function was to receiveand evacuate casualties to the distribution zone andthe stationary base hospitals. Casualty clearing stationsites needed adequate ingress for casualties andadequate egress for evacuation by rail, water, or road,and had to provide sufficient interim casualty medicalsupport. The casualty clearing station was obligated toact as a hospital only part of the time, depending onthe tactical situation. In some instances, the casualtysupport mission became so predominant that the term“clearing hospital” evolved. Although some clearingstations were only about 6 miles from the front, manywere fully functional as fixed hospitals with trainedfemale nurses (Figure 3-8), ordinary hospital beds,operating tables equipped with electric light, and thesame appliances and features found in the hospitals oflarge towns, such as radiograph equipment and clinicallaboratories. Dr Cushing visited one such hospital inBailleul, Belgium, and recorded Royal Army MedicalCorps casualty processing at a clearing station 2 weeksafter the first chemical attack (Exhibits 3-2 and 3-3). 14Base HospitalsCasualties were evacuated to the base hospital byrail (ambulance train), road (motor convoy), or water(hospital barge). A typical hospital train could carryabout 400 casualties. Evacuation by hospital bargewas extremely slow and restricted by the availabilityof navigable canals. Barges traveled only by daylight,at the rate of about 3 miles per hour, taking an average24 to 48 hours to complete an evacuation. The motorconvoy, preferred when speed was essential, was theprimary means of evacuation. 19The medical facilities to which casualties were sentwithin the distribution zone were also known as “gen-Fig. 3-8. A nurse irrigates the eyes of soldier who has aprobable mustard injury. It is now known that eye irrigationwould have provided only symptomatic relief because of therapidity with which mustard damages tissue.Reproduced from: Moore WE, Crussell J. US Official Picturesof the World War. Washington, DC: Pictorial Bureau; 1920.87