This year marks the 100th Anniversary of the United States entry into World War I. In the history of the world the war to end all wars is considered a significant turning point in history. There were lessons that were learned and mistakes that were made that paved the road to a future global war. Scholars look back at World War I and discuss the failure of the Treaty of Versailles or the use of chemical weapons changing how future wars would be fought. One of the most overlooked topics (until recently) that has not received extensive research and discussion was the role that medicine played in the war and the impact that it had on combat medicine and civilian medicine.
During this war we see the foundation set for military medicine and we see the impact that Stretcher Bearers and Ambulance Drivers had on patient care. It was during this war that people realised that you needed first responders out on the battlefield to begin treatment immediately to keep them alive so that the patient could get to the next level of care. Unfortunately, that lesson was learned in the combat theater and was not given serious thought prior to going to the battlefield.
Today, military medicine is very progressive and the lessons learned in a combat theater are shared with other practitioners and in the last 50 years EMS has benefited from it. When WWI began, military medicine had not seen any changes since the Civil War. When the United States entered in 1917, the Army did not have an established Medical Corps. The Army was left to learn from what the British and French had learned 3 years prior to U.S. entry into the war. The system that the Americans would copy is by having care being given to casualties on the battlefield. Care would begin with the wounded receiving care from a Stretcher Bearer and then moving the wounded to an Ambulance. This concept of providing early care to the wounded gets its first test during World War I.
The Stretcher Bearer has much in common with today’s Emergency Medical Technicians and Paramedics. A Bearer would go over the top of the trenches into a dangerous environment unarmed with a medical bag in hope of sustaining the casualty until they could get them to the next level of care. Bearers would work in teams of 4-6 and would often have to carry a casualty miles through thick mud. These long carries were so long and both carriers and the casualty had experience so much that many bearers felt that they had been
passing over a life long friend to the ambulance rather than a patient. Some Stretcher Bearers faced sniper fire and would stay by their casualty protecting waiting long periods of time before they could move their patient on to the next level of care.
A Bearer could always be recognized from his hands. The wooden stretcher handles did not always do well in the harsh elements in Europe. The wood would splinter and was rough causing handlers to have hands that were calloused and splintered. Bearers were seen by Medical Officers as men that could make a difference in patient care on the battlefield. Many doctors saw to it that Stretcher Bearers and Ambulance drivers received ongoing first aid training. Other officers such as Chaplains kept a close eye on Stretcher Bearers and made sure that the overworked responders get sleep when exhausted.
Stretcher Bearers were not the only medical personnel exhausted on the front line. Once a Bearer removed a casualty from no-man’s land a patient would then continue their journey to a Casualty Clearing Station via Ambulance. Ambulance drivers would often have to navigate their way to makeshift field hospitals while encountering rough terrain, enemy fire, and patients screaming in agony.
When a patient made it to a Casualty Clearing Station they would be reassessed and decisions were made if the patient needed to be brought to another level of care or treated at the Casualty Clearing Station. In the first industrialized war of the 1900s nations did not place enough emphasis on patient care.
Many of the ideas born on the battlefield during WWI are still being used today on the modern battlefield and in EMS. The Thomas Splint was used to stabilize femur fractures and is still being used today. When used it dramatically reduced the mortality rate. At clearing stations doctors began to use X-Ray machines to locate bullet wounds and shrapnel in patients. Doctors were also learning new ways of treating contagious diseases, burns, and tissue damage. The lessons learned in Clearing Stations were used to train first responders on the battlefield.
Military Medicine to Civilian EMS
Many of the common procedures used in EMS can be traced back to World War I. However; it was not until the mid-1950s when physicians began to ask why lessons learned for emergency medical treatment and transportation during war could not be applied to civilian use. Drs. J.D. “Deke” Farrington and Sam Banks used these combat lessons to develop a trauma training program for the Chicago Fire Department. This program later developed into an EMT course.
Recently some of the combat medical treatments that are applicable to civilian EMS are the use of tourniquets, hemostatic agents such as Quick Clot, and Chest Decompression. The concept of
making sure people on the frontline have the necessary equipment to treat injuries has emerged in Law Enforcement. Soldiers, Marines, Airmen, and Sailors that operate in a combat theater carry an (IFAK) Independent First Aid Kit on their Flak Jackets including tourniquets, Israeli bandages, and other trauma dressings. Many law enforcement officers nationwide carry tourniquets or a modified version of the IFAK.
The U.S. military continues to identify better means of providing care to combat casualties. EMS can now learn from these experiences to improve the capability of the EMT and paramedic so they can provide better EMS care to our citizens. When we look at the initial care provided to patients in combat or in the civilian world when help is called for the initial treatment begins with a courageous responder showing up with a medical and using their training and experience to get the patient to the next level of care. That concept of giving an individual some medical training and then sending them out into combat over one hundred years ago to save lives has not changed. In the future, EMS will continue to benefit from what is learned in combat because unfortunately, war is good for medicine.