From Passchendaele to Helmand: the medical legacies of the First World War

Dr Emily Mayhew is a military medical historian and the author of A Heavy Reckoning, War, Medicine and Survival in Afghanistan and beyond. Here she explains the medical innovations that can be attributed to the battles of the First World War.

Battle of Pilckem Ridge. Stretcher bearers struggle in mud up to their knees to carry a wounded man to safety near Boesinghe, 1 August 1917

Every time you see an ambulance or a paramedic rushing to treat the injured, whether to attend a single person in distress or large numbers of wounded from a violent attack on civilians, you are witnessing the most important medical legacy of the First World War. Before 1915, the concept of the “paramedic” — a person trained to give emergency medical care to people who are seriously ill or injured with the aim of stabilizing them before they are taken to hospital — did not exist in Britain. In 1914, British soldiers went to the Western Front without a capability that today’s service personnel take for granted: fighting alongside a trained paramedic.

The first battles on the Western Front caused thousands of terrible casualties who died quickly from their wounds. Like everyone else, the military medical authorities realised that the war was not going to be over by Christmas and that the key to saving more lives in the fighting to come was to give treatment as close to the point of wounding as possible. Although each battalion had its Regimental Medical Officer who was usually a GP or surgeon in civilian life, there were not nearly enough of them to make a difference where it really mattered, during the battle itself. So a specialist stretcher bearer corps was created. We all know the images of these teams of men emerging from trenches and shell craters under fire, covered in mud with their heavy wooden and canvas stretchers, strong and resolute enough to carry away a wounded soldier in some of the worst conditions ever seen in warfare.

But these photographs only tell a part of their extraordinary story. Before 1915, a medical degree was needed to learn the complex technique of haemorrhage control. After 1915, it was taught on a six-week course to volunteers for the stretcher bearer corps, who then practiced what they learned in No Mans Land for three more bloody years. By the time of Passchendaele, these bearer teams had become a new kind of expert on the battlefield, trained to control the bleeding, trauma and fractures caused by artillery bombardments, and to administer morphine to those screaming in agony. Only when they had stabilised the patient where they fell, no matter the storm of shrapnel around them, did bearers begin to carry them back to the aid post or the field hospital for the next stage of treatment. Death rates for the seriously wounded were halved. Stretcher bearers became the teachers, showing those with medical degrees how to pack as much kit as possible into their satchels to take into hell and come out carrying a survivor.

A century later, we take that expertise for granted. Paramedics now carry a whole trauma bay’s worth of specially designed equipment in their motorbike panniers or Bergan rucksacks that they can use to save a life on the ground. In Britain’s military, paramedics are known as Combat Medical Technicians. In Afghanistan, they treated their comrades where they fell, controlling bleeding, trauma and pain under fire or in shell holes created by Improvised Explosive Devices. From Passchendaele to Helmand to Manchester and beyond, this is an extraordinary legacy of skill, expertise and commitment to saving a life on the spot and keeping it saved, no matter what the journey.

Reserve Army Medical Services (AMS) members from 335 Medical Evacuation Regiment come together to test their skills in Germany.

Dr Emily Mayhew is the author of A Heavy Reckoning, War, Medicine and Survival in Afghanistan and beyond (Profile Wellcome 2017).

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