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.
* * *
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.
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.