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The establishment of a Field Ambulance |
In no way should modern readers confuse this with our current-day usage of the word Ambulance (meaning the vehicle). A Field Ambulance was a unit, not a vehicle. It was a mobile army medical unit.
Each infantry Division had 3 Field Ambulances, each of which was divided into 3 Sections. In turn, those Sections had Stretcher Bearer and Tented subsections. The Field Ambulance was composed of 10 officers and 224 men, as shown below.
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A Section 65 in total |
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B and C Sections 128 in total |
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Attached |
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As with all other units, the Field Ambulances relied heavily on horses for transport, and had an establishment of 14 riding and 52 draught and pack horses. They worked the 23 wagons, 3 water carts, 3 forage carts, 6 GS wagons, 10 ambulance wagons, and the cooks wagon. The Ambulance also had a single bicycle. Neither officers or men carried weapons or ammunition.
Each unit also included 7 motor ambulances. A workshop to maintain them was added to the Division, although in 1916 it was absorbed in the Supply Column.
A Sanitary Section ( consisting of a Lieutenant or Second-Lieutenant, 2 Sergeants, 2 Corporals, 20 Privates and 1 batman) was added to the Division in early 1915. It's job was to maintain as far as possible clean water supplies, cooking facilities and billets. The Sanitary Sections came under Corps or Army control from March 1917 onwards.
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The role of the Field Ambulance |
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A chain of medical establishments stretching from the front-line positions back to hospitals in the United Kingdom, India and elsewhere was established wherever the British Army was deployed. Depending on the nature of the wound or sickness, a man requiring treatment may have by-passed some of the steps in the chain. The Field Ambulance played a very critical role, as it received men soon after they had received their wound. If it was possible, a wounded man would first be treated at a Regimental Aid Post, a small and often temporary position near or in the front lines. Here a Medical Officer with 2 orderlies and a number of stretcher bearers (from units of the Division) would carry out first-aid. This might be sufficient treatment to allow the man to carry on (in the event of superficial cuts for example), or in other cases be something to enable him to pass to the next stage, the Field Ambulance.
The Field Ambulance would attempt to treat the man, or again just do enough to ensure he could be passed back to the next point, the Casualty Clearing Station (CCS). The theoretical capacity of the Field Ambulance was 150 casualties, but in battle many would simply be overwhelmed by numbers. The Ambulance was responsible for a number of points along the evacuation chain for the casualty, from the Bearer Relay Posts up to 600 yards behind the Regimental Aid Posts, through the Advanced Dressing Station (ADS), to the Main Dressing Station (MDS). It also provided a Walking Wounded Collecting Station, as well as various rest areas and local sick rooms. The Ambulances would usually establish 1 ADS per Brigade, and 1 MDS for the Division.
The men of Field Ambulances saw the full horror of war casualties and often became them: the cemeteries on and behind the battlefields mark the location of many of them, and the men of the CCSs.
| The Regimental Aid Post |  click |
The medical support for the Army developed rapidly as the size of the army grew, and as the nature of the wounds, sickness and other ailments faced in this war became clear. The lessons learned in the early phases of the war included those concerning the need for speedy treatment of wounds. A casualty's chances of survival were much greater if he could be attended to quickly.
Front-line units, such as infantry battalions, were able to provide only the most superficial medical care. Located near the front line, often in a support or reserve trench, was a Regimental Aid Post, attended by the Battalion Medical Officer and his orderlies and stretcher bearers. A wounded man would either make his own way there if possible, or be carried there. The facilities were crude and often just sufficed to carry out light first aid, give the casualty a drink, or just pass him down the chain to the ADS. The RAPs were manned by troops of the infantry or other unit.
Casualties moving on to the ADS were moved by hand carriage, wheeled stretchers, trolley lines, etc as conditions permitted. From 1916, relay posts for stretcher bearers were established every 1000 yards or so. To avoid congestion, certain communication trenches were allocated for the removal of casualties.
Wounded men and survival
The Advanced Dressing Station
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Admissions of wounded men to Hospital, Western Front 1916 (Source: Official History) |
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Number of men |
% of total admitted |
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Died in hospital |
36,879 |
7.3% |
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Returned to duty after treatment |
169,842 |
33.6% |
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Evacuated to UK for further treatment |
290,461 |
57.5% |
The Field Ambulance attached to the infantry Brigade provided one or more Advanced Dressing Stations in reasonable proximity of the front lines. The ADS was better equipped than the RAP, but could still only provide limited medical treatment. Men's wounds could be dressed, and some emergency operations carried out. In times of heavy fighting, the ADS would be overwhelmed by the volume of casualties arriving. Often, wounded men had to lie in the open on stretchers for a considerable time. The wounded man would be passed on down the line to a CCS, often by the wagon transport of the Divisional Supply Column. Buses, charabancs, light and broad gauge railways were also used as conditions allowed.
In addition to the ADS, the Field Ambulance was also responsible for the stretcher bearer relay posts, walking wounded collecting stations, sick collecting stations and rest stations. A larger version of the ADS, the Main Dressing Station, was often provided for the Division.
Medical re-grading
The Casualty Clearing Stations
After a medical examination, a man would be reclassified into a service grade. These grades changed during the war, splintering into ever more-closely defined groups. The man would be assigned to a unit depending on his medical grade. The CCS was the first large, well-equipped medical facility that the wounded man would visit. It's role was to retain all serious cases that were unfit for further travel, treat and return slight cases, and evacuate all others. It was usually a tented camp, although in the static trench areas the accommodation would sometimes be huts.
CCS's were often grouped into clusters of two or three in a small area, usually a few miles behind the lines and on a railway line. A typical CCS could hold 1,000 casualties at any time, and each would admit 15-300 cases, in rotation. At peak times of battle, even the CCS's were overflowing. Serious operations, such as limb amputations, were carried out here. Some CCS's were specialist units, for nervous disorders, skin diseases, infectious diseases, certain types of wounds, etc. CCS's did not move location very often, and the transport infrastructure of railways usually dictated their location. Most casualties came away by rail, although motor ambulances and canal barges also carried casualties to Base Hospitals, or directly to a port of embarkation if the man had been identified as a Blighty case. (In 1916, 734,000 wounded men were evacuated from CCS's by train; another 17,000 by barge, on the Western Front alone. There were 4 ambulance trains in 1914, and 28 by July 1916). The serious nature of many wounds defied the medical facilities and skills of a CCS, and many CCS positions are today marked by large military cemeteries.
CCS's also catered for sick men. Generally, considering the conditions, the troops were kept in good health. Great care was taken in reporting sickness and infection, and early preventive measures were taken especially for Trench foot which was responsible for about 12% of casualties.
Once admitted to a Hospital, the soldier stood a reasonable chance of survival. More than half were evacuated to the UK from a General or Stationary Hospital for further treatment or convalescence.
The Stationary Hospitals, two per Division, could hold 400 casualties. The General Hospital could hold 1040 patients. They were located near the Army's principal bases at Boulogne, Le Havre, Rouen, Le Touquet and Etaples. The establishment of a General Hospital included 32 Medical Officers of the RAMC, 3 Chaplains, 73 female Nurses and 206 RAMC troops acting as orderlies, etc. The hospitals were enlarged in 1917, to as many as 2,500 beds.