Notes on Mobile Surgical Units in the Middle East, WWII Tactical and Technical Trends, No. 34: September 23, 1943 (Lone Sentry)

The following article is based on some observations relating to certain questions about the proper functioning of these units in the Middle East as published in the June 1943 issue of the Military Review, Command and General Staff School. The original source is given as the Journal of the Royal Army Medical Corps, January 1943.

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a. General

Mobile surgical units of all kinds should be flexible in themselves and should be handled freely and flexibly. They should be equally capable of working at the base hospitals or in the forward combat zone and they should be distributed according to the needs of the situation. If a particular corps is suffering heavy casualties, a dozen teams may be needed for a few days. At other times a couple of teams can easily cope with all the work. In very quiet times there will be very little work at all in the forward combat zone; at such times most teams will be better employed at the base. Should a battle be about to start it is easy enough to push forward a dozen teams in a couple of days. In battle each team can do general work as required.

b. The Question of After-Care

Is the team to care for its own patients, its own tentage and have other necessary equipment and personnel? One opinion is that the team should not be required to carry accommodation for patients. It means extra transport and work when the team's energies should be devoted solely to treatment of patients. It is thought that the team should be responsible for the immediate post-operative care of its patients and should have its own nursing orderlies trained to this work.

c. Personnel of Surgical Teams

There is room for two types of teams in the forward combat zone; the extremely mobile team running one table, and the rather less mobile team running two tables, but of more than twice the capacity and very economical in personnel and equipment.

d. What is the Ideal Theater Accommodation?

It is not safe to count on finding buildings. Should operations be done (1) in a tent; (2) in a pent-house built round a truck, or; (3) inside specially equipped trucks? The great advantage of operating within the vehicle is the speed of getting to work, and of packing up. The task of packing up is far more important. You may have plenty of time to pack up and "beat it" if the enemy is approaching. But the first warning may be a shell in the camp, and in that event five minutes may be all the time one has to get going. Tanks move fast! The trouble about the few units possessing actual operating trucks is that the vehicles are far too small. In one unit the anesthetist said that it was sometimes necessary to anesthetize the patient before he could be got inside the vehicle and placed on the table. Vehicles should be expandable so that the floor space can be quickly doubled. Such a vehicle, plus a similar vehicle fitted as a sterilizing truck, could be joined back to back. This arrangement would give space enough to run two tables at the same time.

The alternative to such mobile theaters may be the specially designed pent-house tent built round the truck. The truck itself does not require elaborate fittings. Such as there are should be made accessible from the outside so that, when the pent-house is erected round the truck, equipment and supplies are readily and easily available. There is an Australian mobile surgical unit truck which embodies certain good points on these lines. The main feature about the construction of the vehicle internally is that all the fittings, cupboards, shelves, etc., are made of metal or metal-covered ply-wood, combining lightness and slimness with great strength and freedom from warping.

Trailers are a mistake for they are the very devil on narrow roads and in the desert. On narrow roads they won't go around the bends and in the desert the bumps are always breaking the couplings.

e. Other Points Concerning Transport

It is very bad policy to overload vehicles. In bad country it is unsafe. If a vehicle is loaded to the roof, packing and unpacking take twice as long and, if a particular article is required in a hurry, it is always at the bottom of the pile.

Conclusions

If an ideal unit were to be designed, it is thought that the expandable trucks, one as an operating room, the other as a sterilizing room, and the two-table system with two surgeons would be best. And if that were not obtainable the single-team operating truck for the most advanced sporadic work and the two-table pent-house arrangement for the heavier work a little further to the rear would be most desirable.