The Evacuation Chain

• Terms related to evacuation chain

  • Evacuation chain
  • Evacuation route
• The British Army on the Western Front developed a surprisingly sophisticated and efficient process for dealing with the wounded
• The priorities of the British Army's evacuation chain were: 1) to save lives, 2) to return soldiers to duty as soon as possible, and 3) to heal them as well as possible and discharge them from the Army
• Stage one of the evacuation chain

  Troops fighting at the front
• Types of wounds in World War One

  • GSWs (gunshot wounds)
  • Shrapnel wounds
  • Gas cuts
  • Stabs (lacerations)
  • Blast injuries
  • Illness and disease
• Soldiers' comrades would assist wounded soldiers until more permanent help arrived
• During attacks like the Battle of the Somme in 1916, soldiers were strictly forbidden to stop and help the wounded, being told to wait for the stretcher bearers
• Role of stretcher bearers

  Rescue wounded soldiers who could not move back themselves
• Stretcher bearers would rarely be deliberately targeted by either side in World War One and often helped wounded soldiers of the enemy
• Stretcher bearers faced great dangers such as long-range bullets, machine guns, and artillery while rescuing wounded soldiers
• Thomas splint was a crucial invention that helped stabilize patients with broken legs
• Stretcher bearers were sometimes conscientious objectors who transported the wounded to those who could treat them
• Role of the regimental Aid post (RAP)


  Dealing with minor wounds and returning as many men as possible back to the front line
• Role of the dressing station and field ambulance

  Dealing with wounded soldiers who needed further treatment beyond the regimental Aid post
• In ideal cases, dressing stations were in bunkers or abandoned buildings to offer protection from artillery
• Wounded men arrived at the dressing station on foot or were carried there by stretcher bearers
• The dressing station was staffed by medical officers, medical orderlies, and stretcher bearers of the Royal Army Medical Corps (RAMC)
• From 1915, nurses were occasionally present at dressing stations as well
• Field dressing station staff

  • 10 medical officers (MOS)
  • Medical orderlies
  • Stretcher bearers of the Royal Army Medical Corps (RAMC)
  • Nurses
• Vehicles used by the field ambulance

  • Ambulance wagons
• Field ambulance workers belong to a unit of the REMC called the field ambulance
• Field ambulance could treat up to 150 men theoretically, but more were usually treated during major battles
• A dressing station near Eep dealt with over 1,000 wounded between the 10th and 11th of August 1917 during the third battle of Eep
• Role of the dressing station and field ambulance

  Stabilize the condition of patients so they could be transferred to better medical facilities by horse or motor ambulance
• Diary entry by ESB Hamilton on the 19th of August 1916: '"The Dugout of the ads was awfully overcrowded both night and day and it was impossible to get it cleaned or aired. There was something like 800 people through here in about 30 hours a day before yesterday. This is far too much work for the Personnel of three offices and about 115 men. The result is a lot of men are done up and the others officers seedy and depressed."'
• Casualty clearing stations provided more permanent care by stabilizing the conditions of patients
• Casualty clearing stations were located at a sufficient distance from the front line to provide some safety from enemy fire but close enough to be easily accessible by ambulance wagons
• Casualty clearing stations often helped the most critically wounded, such as those with head or chest wounds
• Casualty clearing stations used a symbol to mark themselves out as hospitals to avoid being bombed by enemy bombers
• Some casualty clearing stations were unable to save every wounded man due to the severity of the wounds they were dealing with
• Observations of an orderly published in 1917: '"Muir was a lance corporal in the Royal Army Medical Corps and worked in a hospital in London at the end of the chain of evacuation. We order these meet each Convoy at the front door of the hospital. The walking cases of the first to arrive, many were either not ill enough or not badly wounded enough to need to be put on stretches in ambulances. They come from the station in Motor Cars supplied by the London ambulance column. The few minutes which the walking case spends in the receiving Hall are occupied in drinking a cup of cocoa and in having his particulars taken. Poor soul, he is very weary of giving his particulars. He's had to give them half a dozen times at least, particularly perhaps more since he left the front. Particulars in this case would be their individual details from the field dressing station, they wanted his particulars at the clearing station, on the train, on the steamer, on the next train, and now at this English Hospital."'
• Triage system


  Dividing wounded into three groups to determine who needs the most urgent treatment
• Wounded arrival at English Hospital

  1. Divided into three groups in a triage system to make more efficient decisions

  2. Categories: Walking wounded, Those in need of hospital treatment, Those with no chance of recovery
• Statistics relating to the casualty clearing station at the third battle of Eep or Passchendaele in 1917

  • 24 casualty clearing stations in each salient
  • 379 doctors and 502 nurses staffed the CCS
  • More than 200,000 casualties were treated
  • 30% of men admitted to the CCS required surgery
  • 3.7% of the men admitted died
• Base hospitals

  1. Located many miles from the front lines, close to the French and Belgian Coast

  2. Patients transported back to Britain

  3. Developed new and improved treatments for wounds

  4. Specialized in specific wound types

  5. Increased capacity during major offensives
• Hospital trains and steamships

  1. Transported men once treatment was complete

  2. Two options: Pass fit for Duty or sent to Britain for further treatment
• Mental trauma was studied separately from physical wounds
• Evacuation chain stages

  • Troops fighting at the front
  • Stretcher bearers
  • Regimental Aid post
  • Field ambulance and dressing stations
  • Casualty clearing stations
  • Base hospitals
• Evacuation chain was surprisingly effective at saving lives


  Returning men to Duty or helping them recover
• Evacuation chain helped prevent the Army from running out of men