What is the Glasgow Coma Scale?

Often times on television and in movies, you’ll hear a medical character exclaim, “His GCS is 5!” or some other variation. What is this score? What does it mean for the patient?

The Glasgow Coma Scale (GCS scale) is one way to gauge the significance of brain injury. There are three components to the measurement. Eye Opening. Verbal Response. Best Motor Response. In general, the highest score is 15. The lowest score is 3. You can be dead and still score a 3 so the higher the score the better.

Eye opening looks at four components and each is given a score:
4: The patient opens their eyes spontaneously.
3: The patient opens their eyes after being spoken or shouted to.
2: The patient opens their eyes to a painful stimulus.
1: No eye opening at all.

Verbal response looks at five components:
5: The patient knows person, time and place.
4: The patient can speak but is not oriented.
3: Speaks unintelligibly.
2: Moaning.
1: No verbal response.

Best motor response looks at six components:
6: The patient can obey a two part request such as touch your nose and then your shoulder.
5: The patient moves to push away a stimulus. For instance, if I’m starting an IV in your left hand, you take your right hand to push it away. This is called localizing pain and the patient usually needs to move across their midline or above their clavicle (if the stimulus is placed to the head) to score here.
4:  Pulls extremity away from pain.
3: Abnormal flexion.  Also referred to as decorticate posturing.
2: Abnormal extension. Also referred to as decerebrate posturing.
1. No motor response.

Initially, we might look at the overall score to determine whether or not a patient needs to be placed on a breathing machine. Generally, a score equal or less than eight is used as a cut off point. The lower the initial score, the more likely the patient will be intubated. Over the long term, the GCS can be used to trend improving or worsening neurological status.

Have you ever heard this scale used on television or in a movie?

This Is US: Jack’s Needless Death

This television episode caused more people to reach out to me over any other. This Is Us has been building up to Jack’s death for eighteen months. It needed to be big. It needed to be dramatic. Can you tell I’ve been watching the show? It was really none of those and medically— well, just weird to be honest.

If you haven’t watched the episode then don’t read this post because it will reveal his cause of death . . . like right now.

Jack’s ultimate demise? A heart attack called the widow maker caused by the stress of the fire.

Jack is in intense smoke and heat for several minutes. He emerges and is first checked by EMS. He is being given oxygen and a dressing to his arm for “2nd degree burns”. The EMS person says she can’t treat the burn and he is seemingly refusing transport, but she does encourage him to be seen. Also, giving oxygen is correct, but it is not the right type of mask. A note on burns. Burns will evolve over the next several days so you don’t really know how severe a burn will be for a while.

Jack does eventually go to the hospital to get his burns checked. The doctor is initially giving him instructions on burn care.  The doctor says, “I’d like your heart rate to come down.” and glances at the monitor— which doesn’t have any readings on it. No waveforms. No numbers. He then says, “There’s soot in your airway so we’ll have to run some tests. The swelling is minor.”

That’s about it. The doctor tells Jack he basically dodged a bullet and seems none too concerned about his potential airway damage.

Just as I mentioned above, airway burns from smoke inhalation are similar to skin burns in that they evolve over time. Smoke inhalation and the potential for upper airway swelling is taken very seriously. There is a nice overview here. At the very least, there should be discussion of admitting Jack to the hospital. As quoted from the article, “Studies have shown that initial evaluation is not a good predictor of the airway obstruction that may ensue later secondary to rapidly progressing edema.” If there is concern about significant injury to the airway then the patient is electively intubated until the airway injury heals. It’s VERY difficult to intubate someone with a lot of airway swelling.

Shortly after this consultation, Rebecca decides to make a phone call and get a candy bar from the vending machine. In that, perhaps under two-three minutes passage of time, Jack codes and dies. Even though she is just outside the ER nurses station, she never hears a code being called. Doesn’t see the commotion.

The doctor approaches her and says, “One of complications of smoke inhalation is that it puts a terrible stress on the lungs and therefore the heart. Your husband went into cardiac arrest. It was catastrophic and I’m afraid we lost him . . . Mrs. Pearson, your husband has died.”

After a few exchanges she goes to Jack’s room where there is a spotlight shining on his chest with a cursory ambu bag at the head of his bead . . . but no other equipment. I’m telling you in two minutes, a code has barely just begun and is never called so hastily . . . like ever. Later, explaining the event to Miguel, Rebecca says he had a widow maker’s heart attack.

The widow maker is a real term for a heart attack. It generally refers to occlusion of the left main coronary artery that feeds the left side of the heart. It is the same heart attack celebrity trainer Bob Harper had and survived. The reason the widow maker can be so devastating is that the left ventricle is the largest, strongest pumping chamber. If it dies . . . well, you’re hosed.

There would be no realistic way the doctors would know it was specifically this kind of heart attack as shown in the episode without an autopsy. Presumably, Jack went into one of the lethal heart rhythms, v-tach or v-fib, at the time of his code. In the time frame given on the show, the medical team would have barely started CPR and given the first line treatment which is electricity. A 12-lead ECG can be a strong diagnostic tool for this type of heart attack, but they never did one. Had they done that early on, they probably would have seen the changes.

Also, he would likely have some signs and symptoms. Chest pain. Nausea. Left arm pain. Sweating. Demonstrating these might make the scenario seem more believable. Having Rebecca witness the code would have been more dramatic.

Also, it would make more sense that he would suffer this cardiac event while he is actually under duress— such as during the rescue of the children and the dog.

The only way to truly know that this is the type of heart attack Jack suffered as presented in the show would be to conduct an autopsy.

This Is Us— thanks for killing off a beloved character in a totally lame way— at least from a medical standpoint.

Pharmacy in World War II: The Military

Sarah Sundin concludes her series today on WWII and the role of the pharmacist. Wasn’t the information amazing? You can find Part I and Part II by following the links.

Welcome back, Sarah!

While researching the military medical system for my World War II novels, I read about physicians and nurses, dentists and veterinarians. But where were the pharmacists? In the civilian world, the physician prescribes medication, the pharmacist purchases, compounds, and dispenses, and the patient or nurse administers. I discovered the wartime military system differed. As a pharmacist I was baffled and intrigued.

On February 14th, I discussed the role of the pharmacist in the 1940s. On February 16th, I described the local drug store and how its role changed during the war, and today I’ll review the rather shocking role—or lack thereof—of pharmacy and pharmacists in the US military.

Drug Distribution in the Military

In the US Army and Navy, outpatient prescriptions were filled at base or unit dispensaries, while inpatient orders were filled at hospital pharmacies. Both dispensaries and pharmacies were staffed by enlisted personnel—pharmacy technicians in the Army and pharmacist’s mates in the Navy—under the control of physicians. In 1936, the pre-war Army had forty graduate pharmacists serving as enlisted technicians.

Pharmacy technicians did not need any previous health care background or education. They went through a three-month program based on practical training rather than scientific understanding.

Medical Administrative Corps

For decades, pharmacy organizations had lobbied for a Pharmacy Corps with commissioned pharmacists. Indeed, most nations had similar corps. However, the US Army Medical Department was run by physicians. They thought of pharmacists in a condescending manner as businessmen rather than professionals, and they saw the drug distribution system as adequate.

The Medical Administrative Corps was formed in 1920 as a compromise. The MAC was responsible for administrative duties within the Medical Department, including medication procurement and distribution. In 1936, the MAC was permitted to commission sixteen pharmacists, with future appointments in the MAC restricted to graduate pharmacists.

The number of officers in the MAC increased during the war. In 1943 six hundred graduate pharmacists served as MAC officers—but none of them served as pharmacists.

Options for Pharmacists

Since most draft-age pharmacists had four-year bachelor’s degrees, they were eligible to serve as officers. While physicians, nurses, dentists, and veterinarians were commissioned as officers and placed in appropriate positions, no such guarantee was available for pharmacists.

Upon enlistment, pharmacists could apply for the Army Officer Candidate School, but upon graduation, they could be assigned anywhere. Pharmacists served as infantry officers, artillery officers, and in many other divisions. Even if they happened to be assigned to the MAC, as noted above, they did not practice their profession.

If a pharmacist wanted to compound and dispense medication, his only option was to serve as an enlisted technician, with pay and privileges far below that of an officer.

Fight for a Pharmacy Corps

The American Pharmaceutical Association (APhA) renewed the legislative battle for a commissioned Pharmacy Corps. While the Surgeon General’s office argued that “Army pharmacy was simpler than civilian practice. The department’s three-month pharmacy technician course was sufficient preparation. There was little compounding. Since medications were furnished in tablet form, ‘any intelligent boy can read the label’” (1).

These arguments did not sit well with pharmacists—or with the general public. Dr. Evert Kendig of the APhA argued that “Army pharmacy technicians were given responsibility beyond that legally permissible in civilian life even as the Army misused its professional pharmacists” (1). Several incidents were reported of prescriptions improperly filled by technicians and of blatant physician prescribing errors that would have been caught by a pharmacist. Public opinion tipped the scale, and on July 12, 1943, President Roosevelt signed legislation authorizing the formation of the Pharmacy Corps.

Pharmacy Corps

The Pharmacy Corps was authorized to commission seventy-two pharmacists. However, the military moved slowly. In January 1944, after receiving 900 applications and conducting two-day written examinations, physical examinations, and interviews, twelve officers were commissioned. By January 1945, the Pharmacy Corps had only commissioned eighteen pharmacists. The other officers’ slots were filled by former MAC officers.

The drug distribution system did not change by the end of the war, but the formation of the Pharmacy Corps laid the groundwork for post-war reforms.

Resources:

  1. Ginn, Richard VN. The History of the US Army Medical Service Corps. Washington DC: Center for Military History, 1997. (Accessed February 6, 2011 at http://history.amedd.army.mil/booksdocs/HistoryofUSArmyMSC/msc.html).
  2. Worthen, Dennis B. Pharmacy in World War II. New York: Pharmaceutical Products Press, 2004.

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Sarah Sundin is the author of the Waves of Freedom series (Through Waters Deep, 2015, Anchor in the Storm, 2016, and When Tides Turn, March 2017), the Wings of the Nightingale series, and the Wings of Glory series, all from Revell. In addition she has a novella in Where Treetops Glisten (WaterBrook).

Her novel Through Waters Deep was a 2016 Carol Award Finalist, won the 2016 INSPY Award, and was named to Booklist’s “101 Best Romance Novels of the Last 10 Years.” Her novella “I’ll Be Home for Christmas” in Where Treetops Glisten was a finalist for the 2015 Carol Award. In 2014, On Distant Shores was a double finalist for the Golden Scroll Awards from both AWSA and the Christian Authors Network. In 2011, Sarah received the Writer of the Year Award at the Mount Hermon Christian Writers Conference.

A mother of three, Sarah lives in northern California, works on-call as a hospital pharmacist, and teaches Sunday school and women’s Bible studies. She enjoys speaking to community, church, and writers’ groups, and has been well received.

Pharmacy in World War II: The Drug Store

We’re continuing with Sarah Sundin’s series on the role of the pharmacist in WWII. You can find her first post here.

Welcome back, Sarah!

In the 1940s, the local drug store was more than just a place to get prescriptions filled and pick up toothpaste—it was a gathering place. If you’re writing a novel set during World War II, it helps to have an understanding of this institution.

As a pharmacist, I found much about my profession has changed, but some things have not—a personal concern for patients, the difficult balance between health care and business, and the struggle to gain respect in the physician-dominated health care world. On February 14th, I discussed the role of the pharmacist in the 1940s, today I’ll describe the local drug store and how its role changed during the war, and on February 18th,  I’ll review the rather shocking role—or lack thereof—of pharmacy and pharmacists in the US military.

Welcome to the Corner Drug Store—1939

Perkins’ Drugs stands on the corner of Main Street and Elm, where it’s stood all your life. Large glass windows boast ads for proprietary medications and candy, and a neon mortar-and-pestle blinks at you. When you open the door, bells jangle. The drug store is open seven days a week, sixteen hours a day, so you know it’ll always be there for you. To your right, old-timers and teenagers sit at the soda fountain on green vinyl stools, discussing politics and the high school football game. The soda jerk waves at you.

You pass clean shelves stocked full of proprietary medications, toiletries, cosmetics, hot water bottles, hair pins and curlers, stockings, cigarettes, candy, and bandages. You know where everything is—and if you can’t find it, Mr. Perkins or his staff will be sure to help you.

The owner, Mr. Perkins, is hard at work behind the prescription counter with good old Mr. Smith and Mr. Abernathy, that new young druggist Mr. Perkins hired last year. Mr. Perkins greets you by name, asks about your family, and takes your prescription. He has to mix an elixir for you. If you don’t want to wait, he’ll be happy to have his delivery boy bring it to your house. But you don’t mind waiting. You have a few items to purchase, and you’d love to sit down with a cherry Coke.

Welcome to the Corner Drug Store—1943

Perkins’ Drugs still stands at the corner of Main Street and Elm. Large glass windows boast Army and Navy recruitment posters and remind you that “Loose Lips Sink Ships.” The neon sign has been removed to meet blackout regulations. The store is open for fewer hours since Mr. Smith retired and Mr. Abernathy got drafted. Mr. Perkins hired Miss Freeman. Not many people are thrilled to have a “girl pharmacist,” but if Mr. Perkins trusts her, that’s good enough for you. Perkins’ Drugs and Quality Drugs on the other side of town alternate evening hours so the town’s needs are met.

A placard on the door reminds you that Perkins’ Drugs is authorized by the Office of Civilian Defense as a pharmaceutical unit, meaning the store will provide a kit of medications and supplies for the casualty station in case of enemy attack. You pray the town will never need it.

Bells jangle when you open the door. The soda fountain is closed. Mr. Perkins can’t buy metal replacement parts for the machine, the soda jerk is flying fighter planes over Germany, and sugar is too scarce a commodity.

A barrel stands by the door. You toss in five tin cans, washed, labels removed, tops and bottoms cut off, and flattened. Mrs. Perkins at the cash register thanks you.

You pass clean shelves with depleted stocks. Proprietary medications, cosmetics, toiletries, and medical supplies remain, but rubber hot water bottles, silk and nylon stockings, hair pins and curlers, candy, and cigarettes are in short stock—or unavailable. Most of the packaging has changed. Metal tins have been replaced by glass jars and cardboard boxes. You pick up a bottle of aspirin and a tube of toothpaste, double-checking that you brought your empty tube. Without that crumpled piece of tin, you couldn’t purchase a replacement. Tin is too dear.

At the prescription counter, Mr. Perkins greets you by name and asks about your family. Miss Freeman gives you a shy smile and you smile back. There’s a war on and women have a patriotic duty to do men’s work so men are free to fight. Mr. Perkins frowns at your prescription for an elixir. He’s used up his weekly quota of sugar, and his stock of alcohol and glycerin are running low. Would you mind capsules instead? Of course not. Mr. Perkins phones Dr. Weber and convinces him to change the prescription. Mr. Perkins can’t have the prescription delivered—he doesn’t qualify for extra gasoline and he couldn’t find a delivery boy to hire anyway.

You and Mr. Perkins discuss war news as he sets up a wooden block with little holes punched in it, then lines the pockets with empty capsule halves. He weighs powders on a scale, mixes them in a mortar, then fills the capsule shells. After he sets the capsule tops in place, he puts the capsules in an amber glass bottle with the familiar Perkins’ Drugs label.

You buy a few War Bonds. Your wages are higher than ever with the war on, and with all the shortages there’s nothing to buy. Besides, War Bonds are a solid financial investment and your patriotic duty. On a poster by the counter, a smiling pilot leans out of his plane and reminds you: “You buy ‘em. We’ll fly ‘em. Defense Bonds and Stamps.”

Mr. Perkins thanks you for your purchase, and you thank him for his service. War or no war, you know Perkins’ Drugs will always be there for you.

Resources

My main source was this excellent, comprehensive, and well-researched book: Worthen, Dennis B. Pharmacy in World War II. New York: Pharmaceutical Products Press, 2004.

http://www.lloydlibrary.org (Website of the Lloyd Library and Museum, which has many articles and resources on the history of pharmacy).

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Sarah Sundin is the author of the Waves of Freedom series (Through Waters Deep, 2015, Anchor in the Storm, 2016, and When Tides Turn, March 2017), the Wings of the Nightingale series, and the Wings of Glory series, all from Revell. In addition she has a novella in Where Treetops Glisten (WaterBrook).

Her novel Through Waters Deep was a 2016 Carol Award Finalist, won the 2016 INSPY Award, and was named to Booklist’s “101 Best Romance Novels of the Last 10 Years.” Her novella “I’ll Be Home for Christmas” in Where Treetops Glisten was a finalist for the 2015 Carol Award. In 2014, On Distant Shores was a double finalist for the Golden Scroll Awards from both AWSA and the Christian Authors Network. In 2011, Sarah received the Writer of the Year Award at the Mount Hermon Christian Writers Conference.

A mother of three, Sarah lives in northern California, works on-call as a hospital pharmacist, and teaches Sunday school and women’s Bible studies. She enjoys speaking to community, church, and writers’ groups, and has been well received.

Pharmacy in World War II: The Pharmacist

I’m so pleased to have Sarah Sundin back. This week, she’ll be discussing the role of the pharmacist on several different fronts during WWII. I’ve found this information absolutely fascinating!

Welcome back, Sarah.

In the 1940s, the local drug store was more than just a place to get prescriptions filled and pick up toothpaste—it was a gathering place. If you’re writing a novel set during World War II, it helps to have an understanding of this institution.

As a pharmacist, I found much about my profession has changed, but some things have not—the personal concern for patients, the difficult balance between health care and business, and the struggle to gain respect in the physician-dominated health care world. Today I’ll discuss the role of the pharmacist in the 1940s.  On February 16th I’ll describe the local drug store and how its role changed during the war, and on February 18th, I’ll review the rather shocking role—or lack thereof—of pharmacy and pharmacists in the US military.

The Profession of Pharmacy in the 1940s

Although the term of druggist has been abandoned by the profession—please do not use it in your contemporary novels—in the 1940s, the terms of pharmacist and druggist were interchangeable. The 1940 US census counted over 80,000 pharmacists. The majority worked in retail pharmacy, with only 3000 working in hospitals. In fact, less than half of hospitals had a pharmacist on staff.

A cornerstone of pharmacy had always been compounding, the practice of mixing a prescription from raw ingredients. Pharmacists made creams, ointments, elixirs, suspensions, capsules, tablets, suppositories, and powder papers. Only pharmaceutical grade ingredients could be used, approved by the USP (United States Pharmacopoeia) or the NF (National Formulary). Every pharmacist owned a copy of the USP guide—the 11th Edition (1937) or 12th Edition (1942). The USP guide provides chemical data on each substance. By the 1940s, pharmacists compounded less—about 70 percent of prescriptions were filled with manufactured dosage forms.

In the 1940s, the pharmacist was a vital member of the community. Often viewed as more accessible than physicians, pharmacists were relied upon for health information and the treatment of minor ailments.

Education and Licensing

The first four-year Bachelor’s of Science degree in pharmacy was offered by Ohio State University in 1925. The four-year program became mandatory with the incoming class of 1932. The doctor of pharmacy (Pharm. D.) degree was first offered by the University of California, San Francisco in 1955, and did not become mandatory until 2000. Therefore, in World War II, pharmacists were addressed as “Mr.” or “Mrs.” or “Miss.”

In 1942, sixty-eight colleges of pharmacy operated in the United States. In addition to general education requirements, pharmacy students also studied pharmacy, pharmaceutical chemistry, pharmacognosy (deriving pharmaceuticals from raw substances, such as plants), pharmacology (the effect of a drug on the body), and business. To increase the chance that a student would finish his degree before being drafted, most colleges of pharmacy adopted a year-round, three-year program during the war.

Each state had its own licensing requirements and examinations, and there was no reciprocity between states. For example, a pharmacist licensed in California had to take a new set of examinations if he moved to Michigan.

Manpower Shortage

In a nation of 130 million, over 11 million would serve in the armed forces during the course of the war. This produced a manpower shortage on the home front, and pharmacy was not immune. As a class, pharmacists were not exempt from the draft, but local draft boards could declare individuals as “necessary men” if their enlistment would negatively affect the health of the community. During World War II between 10,000-14,000 pharmacists served in the military. Due to this loss, approximately 15 percent of drug stores closed during the war. The west coast was hard hit when all Japanese-American pharmacists were forcibly interned.

However, more opportunities opened for women as colleges and employers actively recruited them. While less than 5 percent of pharmacists in 1940 were female, the percentage of female pharmacy students rose above 15 percent during the war.

Effects of the War

Due to store closures, the average store filled 13 percent more prescriptions than before the war. This increase in workload was balanced by depletion of other goods due to rationing and shortages. In addition, citizens were encouraged to take better care of their health so they could contribute to the war effort, which led to an increase in physician visits. Overworked physicians dispensed fewer drugs from their offices and sent more patients to pharmacies. As a result, the average drug store enjoyed an 80 percent increase in sales during the war.

Pharmacists dealt with shortages of ingredients and medications. A serious shortage of quinine, used to treat malaria, led the military to collect the majority of the nation’s quinine stock. Also, shortages of alcohol, sugar, and glycerin taxed the ability of pharmacists to compound. Each pharmacy received a ration of ten pounds of sugar a week for compounding purposes.

Resources

My main source was this excellent, comprehensive, and well-researched book: Worthen, Dennis B. Pharmacy in World War II. New York: Pharmaceutical Products Press, 2004.

http://www.lloydlibrary.org (Website of the Lloyd Library and Museum, which has many articles and resources on the history of pharmacy).

United States Pharmacopoeial Convention. The Pharmacopoeia of the United States of America, Twelfth Edition. Easton PA: Mack Printing Company, 1 November 1942.
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Sarah Sundin is the author of the Waves of Freedom series (Through Waters Deep, 2015, Anchor in the Storm, 2016, and When Tides Turn, March 2017), the Wings of the Nightingale series, and the Wings of Glory series, all from Revell. In addition she has a novella in Where Treetops Glisten (WaterBrook).

Her novel Through Waters Deep was a 2016 Carol Award Finalist, won the 2016 INSPY Award, and was named to Booklist’s “101 Best Romance Novels of the Last 10 Years.” Her novella “I’ll Be Home for Christmas” in Where Treetops Glisten was a finalist for the 2015 Carol Award. In 2014, On Distant Shores was a double finalist for the Golden Scroll Awards from both AWSA and the Christian Authors Network. In 2011, Sarah received the Writer of the Year Award at the Mount Hermon Christian Writers Conference.

A mother of three, Sarah lives in northern California, works on-call as a hospital pharmacist, and teaches Sunday school and women’s Bible studies. She enjoys speaking to community, church, and writers’ groups, and has been well received.

Author Question: When Was Pregnancy Related Anemia Discovered?

Robin Asks:

I’m looking but I can’t find gestational anemia. I need to know if they would have diagnosed that in 1912 and what they might have called it. If it was diagnosed, what treatment might they have prescribed?

Jordyn Says:
blood-1813410_1920
First of all, I’ve never personally heard the term gestational anemia so I started my Google search with “when was anemia first discovered” and then started narrowing it down from there to pregnancy related anemia. I wasn’t having much luck on doing a basic Google search and decided to head over to Google books where I’ve had better luck with historical questions.

There, I found a book called An Antropology of Biomedicine and from that found the following information:

The discovery of the link between macrocytic anemia (a lack of red blood cells in which those that remain are swollen) and folate (a water-soluble form of vitamin B) was first made in India in 1928, when a British scientist Lucy Wills traveled to Bombay to work with “Mohammedan women” who were commonly found to have this particular form of anemia during pregnancy.

So, it looks like the discovery was made after your time frame, Robin.

Sarah Sundin: WWII US Army Hospitals Part 3/3

This is Sarah’s final installment on WWII Army Hospitals. I’d like to thank Sarah for all her hard work on these terrific posts. Click the links for Part I and Part II.

US Army Hospitals in World War II—Part 3

Ruth squatted beside his cot. “Have you ever flown before, Corporal?”

            “No, ma’am. A man’s meant to stay on the ground.”

            “How long did it take you to get to England?”

            “Almost two months, ma’am, zigzagging around them U-boats.”

            “Mm-hmm. Well, tonight you’ll have dinner in New York. You may change your mind about flying.”

a-memory-betweenIn my novel A Memory Between Us, the heroine becomes a flight nurse, pioneering medical air evacuation. If you’re writing a novel set during World War II, a soldier character may get sick or wounded, and you’ll need to understand how patients were evacuated from the battleground to the hospital and perhaps taken stateside.

In my first post,  I discussed the chain of evacuation. In my second post, I discussed more details about mobile and fixed hospitals, and today I’ll cover evacuation of the wounded.

Manual Transport

On the battleground, medics or fellow soldiers could manually carry a wounded man further to the rear for aid. Methods included the supporting carry (walking side-by-side), the arms carry, the saddleback carry (piggy-back), and the fireman’s carry.

Litter Transport

American litters were made of canvas stretched over aluminum or wood poles with stirrup-shaped feet to keep them off the ground. A litter could be carried by two people, but a litter squad consisted of four men, to rotate if traveling long distances and to assist over obstacles. Ideally, litter transport was only used for short distances, but in mountainous or forested or swampy terrain, litter transport was the only available means. Mules were often used in the Mediterranean Theater to carry litters in rocky, mountainous terrain.

Motor Transport

Ambulances were used to transport patients, usually from an aid, clearing, or collecting station to a field hospital, or for transport further to the rear. Ambulances could carry seven seated patients or four patients on litters.

Water Transport

Jeeps were often used, both on the battleground and to transport further to the rear. Rugged and maneuverable, jeeps could cover terrain inhospitable to ambulances. With litter brackets, a jeep could carry two patients. Armored divisions also used light tanks to transport their wounded.

During an amphibious landing, the best way to handle the wounded was to send them back on departing landing craft, which carried them to hospital ships off-shore. Patients could be removed from danger and transported quickly to get needed care.

Hospital ships were used offshore after an invasion to care for the wounded before field and evacuation hospitals could be set up. They also transported patients who needed long-term care to general hospitals further to the rear. Another use of hospital ships was to transport to the US any patients who needed long-term convalescent care or those who qualified for a medical discharge. They carried several hundred patients and delivered full medical care, but transport took a long time and carried the danger of enemy attack at sea.

Rail Transport

Hospital trains were used within theaters of operation to transport patients from one hospital to another. They were used in the continental US, Britain, continental Europe, India, and North Africa. They could carry several hundred patients with excellent medical care.

Air Transport

Medical air evacuation was new and revolutionary, but by the end of the war, it proved successful. Planes can traverse inhospitable terrain or dangerous seas—and quickly. At the front, the wounded were gathered at collecting stations at airfields. C-47 cargo planes carried 18-24 litter patients or a higher number of ambulatory patients further to the rear. A team consisting of a flight nurse and a surgical technician cared for the patients in flight. The larger C-54 cargo plane was used for trans-oceanic evacuation. Danger still existed, both from the inherent risks of flight and also because the planes carried cargo and couldn’t be marked with the Red Cross.

Resources for Research

Office of the Surgeon General. Medical Field Manual: Transportation of the Sick and Wounded. Washington, DC: US Government Printing Office, Feb. 21, 1941 (available free on-line at http://www.ibiblio.org/hyperwar/USA/ref/FM/index.html ). Please note the date—some of the material, especially about air evacuation, became quickly outdated.

For better information on air evacuation, please see:

Links, Mae Mills & Coleman, Hubert A. Medical Support of the Army Air Forces in World War II. Washington, D.C.: Office of the Surgeon General, USAF, 1955.
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sarahsundin2
Sarah Sundin is the author of the Wings of Glory series from Revell: A Distant Melody (March 2010), A Memory Between Us (September 2010), and Blue Skies Tomorrow (August 2011). She has a doctorate in pharmacy from UC San Francisco and works on-call as a hospital pharmacist.

***This content is reposted from December 17th, 2010.***