War always stimulates medical advances, and survival rates increased dramatically as the war went on. What was important was speed, and on the Western Front, once wounded men got into the chain of evacuation,… only 7.61 per cent died. Mud, Blood and Poppycock by Gordon Corrigan, published in 2003

In terms of numbers there were thirty-two [stretcher] bearers per 1,000 men, whose task was to deal with the… casualties during battle. Their orders were to take the less badly wounded. In the same spirit, the priority of movement in the trenches went first to ammunition, second to reinforcements, third to the wounded. In Death’s Men by Denis Winter, p.196, published in 1978

The Battle of the Somme… ‘is chiefly remarkable for the arrangements made for collecting the casualties… several improvements were introduced. The number of regimental stretched bearers per battalion was doubled; more accommodation and better shelter were provided for regimental aid posts and advanced dressing stations; a system of relay posts every 1,000 yards was established for stretcher bearers, and extensive use was made of buses, charabancs, light railways and general service transport. History of the Great War: Medical Services, p.147, published in 1931

The first call was the regimental aid post The first call was the regimental aid post. The post would be in a reserve trench dugout or shell hole, since shellfire so close to action precluded a tent or hut. Field dressings would be removed whenever possible… All would receive a morphia injection with a cross of indelible pencil on the forehead to warn the next treatment centre… a luggage label was attached to a tunic button to describe the case. In Death’s Men by Denis Winter, p.197, published in 1978

Into the tent are borne on stretchers or wearily stumbling, figures in khaki wrapped in blankets or coats, bandaged or splinted. All of them caked in mud or stiff with blood and dust and sweat. Labels of their injuries are attached. Many are white and cold and lie still. I have never seen such dreadful wounds… it is an extraordinary thing that in this charnel test of pain and misery, there was silence and no outward expression of complaint… even the badly wounded often asked for a smoke. RAMC doctor quoted in Death’s Men by Denis Winter, p.198, published in 1978

[The Field Ambulance] was a mobile medical unit, not a vehicle [The Field Ambulance] was a mobile medical unit, not a vehicle. Each British division had three such units, as well as a specialist medical sanitary unit. The Field Ambulances… established Main and Advanced (that is, forward) Dressing Stations where a casualty could receive further treatment and be got into a condition where he could be evacuated to a Casualty Clearing Station. Men who were ill or injured would also be sent to the Dressing Stations and in many cases returned to their unit after first aid or some primary care. There was no hard and fast rule regarding the location of a Dressing Station: existing buildings and underground dug-outs and bunkers were most common, simply because they afforded some protection from enemy shell fire and aerial attack. The Dressing Stations were generally manned by the Field Ambulances of the Royal Army Medical Corps. The Long, Long Trail, www.longlongtrail.co.uk

The Casualty Clearing Station (CCS) was the first large, well-equipped and static medical facility that the wounded man would visit. Its role was to retain all serious cases that were unfit for further travel; to treat and return slight cases to their unit; and evacuate all others to Base Hospitals. It was often a tented camp, although when possible the accommodation would be in 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 unit, for nervous disorders, skin diseases, infectious diseases, certain types of wounds, etc. The Long, Long Trail, www.longlongtrail.co.uk

The big push has started. For two days the convoys have been coming in The big push has started. For two days the convoys have been coming in. On the 9th we took in fifteen hundred in twenty-four hours. Every ward is full and the lines are crowded. Working day and night. The operating room starts at 08:30am, and four tables are going steadily till one o’clock next morning. I don’t know how the Op. room nurses stand it. 273 operations in four days. From the diary of Dr Henry Potter, 3rd Harvard Medical Unit, No.22 General Hospital, April 1917. Quoted in Lyn McDonald’s The Roses of No Man’s Land

Number evacuated by Ambulance Train Methods of evacuation from casualty clearing stations to base hospitals   Year Number evacuated by Ambulance Train Number evacuated by Ambulance barge Number evacuated by Motor Ambulance convoy Total 1914 85,327 - N/A 1915 383,810 4,156 387,986 1916 744,616 18,042 782,658 1917 1,035,903 10,112 30,196 1,079,301 1918 1,190, 761 21,451 22,645 1,234,857 Data taken from History of the Great War: Medical Services published in 1931

The ambulance train had its own permanent staff of doctors, nurses and orderlies, messes for medical staff, cookhouses to prepare food for staff and patients, and to provide a continuous supply of hot water for clinical purposes, a pharmacy, a stores wagon and a tiled, emergency operating theatre which could, in extreme circumstances, be used for procedures when the train was moving. A typical ambulance train had sixteen carriage and accommodated 400 patients in wards of thirty-six cots. The centre tier of cots could be folded up to take sitting cases on the bottom row. From Lifeline – A British Casualty Clearing Station on the Western Front 1918 by Iain Gordon, p.29

From the Casualty clearing station, the path of the most severely wounded led to the base hospital or England. Barge and rail replaced motor ambulance at this stage. Water was kept for the most serious cases in which any movement might be fatal… but the train was the standard mover. They fitted a complex timetable and could transport 1,000 men in thirty-six hours. In Death’s Men by Denis Winter, p.198, published in 1978

The Base Hospital was part of the casualty evacuation chain, further back from the front line than the Casualty Clearing Stations. They were manned by troops of the Royal Army Medical Corps, with attached Royal Engineers and men of the Army Service Corps. In the theatre of war in France and Flanders, the British hospitals were generally located near the coast. They needed to be close to a railway line, in order for casualties to arrive (although some also came by canal barge); they also needed to be near a port where men could be evacuated for longer-term treatment in Britain. The Long, Long Trail, www.longlongtrail.co.uk