Emergency War Surgery NATO Handbook: Part III: General Considerations of Wound Management: Chapter XII: Sorting of Casualties

Past Experience

United States Department of Defense

In World War II, the lines of combat were relatively discrete and fixed, allowing the echelons of medical support to be structured and upgraded in a logical manner. The most seriously wounded casualty received care as close to the front as possible; those less seriously wounded and more transportable were moved to the more fixed installations in the rear. Battalion aid stations were generally situated about 500 yards behind the front. Triage was performed here and medical evacuation for further rearward evacuation was located here. The main thrust was to render the casualty transportable after all vital systems were evaluated. Airways were cleared, adequate ventilation assured, and accessible hemorrhages controlled. Dressings and splints were applied as necessary, fluid replacement initiated, and pain medication administered. Those with the most critical injuries were considered the first priority and were evacuated about one mile to the collecting station, where further lifesaving treatment was administered. Further to the rear (five `miles) at the division clearing station, casualties were once again triaged, and those with the highest priority injuries (urgent and immediate) were taken to the adjacent field hospital for immediate surgery. The remainder, who could better tolerate delay and further transport, continued on to general or evacuation hospitalization deeper within the rear area. The bulk of the extensive lifesaving procedures was provided at the forward hospital, where the wounded were operated upon, held until stable, and then transferred to the rear echelon hospitals.

By contrast, the Vietnam conflict consisted of sporadic small unit engagements which were widely dispersed geographically and seldom lasted more than six hours. Major battles, such as those fought at Hue and in the A Shau Valley, were measured in days, fought with mobile units, and accounted for the greatest number of mass casualty situations. Major medical support was not mobile and remained fixed within relatively secure centrally-located military compounds. Although labeled as semimobile, hospitals were generally Quonset-type structures, bolted to concrete slabs and provided with permanent electrical and plumbing connections. The inflatable "MUST" hospitals, while capable of mobility, required unacceptable levels of fuel for power generation and also became relatively fixed. Since the forward hospitals could not go forward to the casualty in those campaigns, the air ambulances went forward and brought the casualties to the hospitals. Fortunately, air superiority was never in doubt.

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Operational Medicine 2001

Health Care in Military Settings

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