In early August,1914, the British military and political establishment finally realised that the involvement of the British Army in the looming European War, in the form of the so-called British Expeditionary Force (BEF), was a virtual certainty. They also recognised that an element of the medical organisation of the British Army - the Royal Army Medical Corps (RAMC) - had to be an integral part of the BEF from the outset.

That the involvement of the RAMC in the BEF was an essential element in the plans for war, was largely due to the experience of the British Army in both the Crimean and Boer Wars. In both of these, then relatively recent, overseas conflicts, an almost willful neglect of the casualties of war had lead to the preventable deaths of thousands of soldiers from wounds and disease. This became a huge, largely avoidable, drain on the manpower resources of the Army.

This concern for the health of the British soldier, by both the military High Command and prominent politicians, was by no means an entirely a self-serving expedient to maintain the maximum number of serving soldiers as 'fit for duty'. It had also been realised that an important factor, then as now, in the maintenance of the morale of the soldier on active service, was the assurance that in the event of injury or disease, he, the soldier, would be cared for on the battlefield, and promptly evacuated for appropriate medical care and rehabilitation.

To achieve these laudable objectives, there needed to be, in addition to the static hospital units 'Behind-the-Lines', efficient mobile medical units that could move across the battlefield to bring medical care, succour and evacuation right up to the battle-lines proper.

In various planning exercises before 1914, such units had been created in principle and, although there was no established unit in existence at the outbreak of War, fully equipped medical units were quickly organised and left Folkestone with the BEF for France on the 12th August 1914.

The units were called Field Ambulances (FAs). However, these were complete medical units, and not merely a means of transportation as used in the current terminology.

The Organisational Structure of a BEF Field Ambulance in 1914.

The overall structure of a Field Ambulance on active service on the Western Front in 1914, is best described as having consisted of two elements: the place of the FA in the overall military structure of the BEF, and the organisation of the FA itself.

Each of the BEF's army divisions had three FAs assigned to it; one for each brigade. As the BEF was comprised of a total 5 of divisions numbered the 1st to the 5th and one extra brigade (the 19th), there were in total 16 FAs. The 1st Division had the 1st to 3rd FAs assigned to it, the 2nd Division, the 4th to 6th FAs and so on. The remaining Brigade - the 19th - was provided with the 19th FA.

The internal organisation of the FA comprised of three Sections designated A, B and C. Section A also dealt with administrative duties, whilst Sections B and C each had two sub-sections for the management of the unit's tents and its stretcher bearers.

Section A had a total complement of 65 RAMC officers and men, whilst Sections B and C had 64 each. In addition to these RAMC personnel, the FA had 41 NCO's and men seconded from the Army Service Corps to handle the establishment of 66 horses, 3 forage carts, 3 water carts, a general service wagon, 10 horse drawn ambulances and the cook's wagon. There was also a communal bicycle.

In 1914, most of the FAs were without motor transport, but as the war progressed an increasing number of these were supplied in the form of motor ambulances and transport vehicles. Maintenance of the motor vehicles was carried out by the ASC staff at an ASC workshop at divisional level,

The commander of the FA was a RAMC Lieutenant Colonel, a qualified medical doctor, who was also directly in charge of Section A. Sections B and C were commanded by an RAMC Captains or Lieutenants who, respectively, were also directly responsible for the Stretcher- bearers and tent sub-sections. They, too, were qualified medical doctors.

The overall establishment of an FA was 234 of which 10 were officers and 224 other ranks.

The FA's were identified by a flag-staff flying the Red Cross to alert the enemy troops, artillery spotters and reconnaissance aircraft, to the protected status of an FA. The Union Flag was also flown. In addition, the roofs of the tents, or buildings, being used by the FA were usually marked with the Red Cross, and large sheets displaying the Red Cross were often spread out on the ground within the FA compound.

The Role and modus operandi, and tasks of an FA.

In simple terms, the role of an FA was non-combattant, as recognised by the Geneva Convention of 1864, and concerned with: the recovery of casualties from the battlefield; their medical classification; the administration of emergency medical treatment and, when necessary, the expeditious forwarding of the casualties to the appropriate 'behind- the-lines' treatment and rehabilitation centres. Overall, about 50% of all the wounded treated by the FAs were serious enough to require repatriation to the UK for further treatment and rehabilitation - the so-called 'Blighty One'. Of all the wounded, about 60% returned to active duty; some men were wounded several times, on separate occasions, and served again.

The modus operandi of the FA was to establish, as close to the Front Line as feasible, Advance Dressing Stations (ADSs). From here, contact was made with the Regimental Medical Officers (RMOs) of the infantry battalions in the Front Line itself where the RMO, two RAMC orderlies and a variable number of regimental stretcher bearers - usually the Regimental bandsmen - had already established a Regimental Aid Post (RAP). This regimental team would retrieve the wounded from the Front Line, via the Bearer Relay Posts (BRPs), render first aid at the RAP and transfer all but the superficially injured back to the ADS on stretchers, or wheeled litters. The FA had a total of nine medical officers and it was their onerous responsibility, at the ADS, to carry out the process of tirage of the wounded.

Tirage was a process whereby a medical officer screened the wounded as they arrived at the ADS and separated them into three categories, i.e. A) the less seriously wounded, who could have their wounds dressed and be forwarded to behind-the-lines medical centres; B) the more seriously injured who required emergency, life-saving, treatment before and, perhaps, during evacuation, and C) the hopeless cases for whom nothing could be done except palliative care (often chloroform or morphine) to ease their suffering.

The ADS's were located as far forward as possible; often within rifle range of the enemy. Walking Wounded Collection Stations (WWCS) were also established by the FA to filter back these still mobile casualties. They also ensured that those who were fit to return to their post after treatment did so.

As the need arose, an Advance Dressing Station (ADS), and a Main Dressing Station (MDS) were also established by the FA respectively at the Brigade and Divisional level. There were no female nurses at the FA level.

The efficiency of this casualty relay system largely depended on the operational situation in the Front Line. When things were reasonably quiet, casualties could usually be evacuated from the battle-field by the FA and moved through the casualty clearance system to the Casualty Clearing Stations (CCS), located 'behind-the-lines', quite quickly and efficiently. The theoretical working capacity of a FA was 150 casualties at any one time. When there was heavy fighting, the system could be literally swamped with seriously wounded men. Clearance was far more difficult and, unfortunately, long delays occurred in the treatment and transportation of the wounded and the sick.

The recovery of the wounded from the battlefield was nearly always difficult and very hazardous. Generally, the wounded had to be man-handled for long distances on stretchers, or wheeled litters, over open ground under enemy fire, or through the congested and zig-zagging trenches. After an infantry attack on the enemy lines, many of the more seriously wounded were unable to make their way back to their own lines and were stranded in water-filled craters and shell-holes in No man's land, or left inextricably hanging on the enemy barbed wire. Many of their stretcher-bearer would-be rescuers were themselves wounded or killed during these recovery efforts. (The RAMC is the only unit in the British Army with two double-VCs). It was the contigencies of war, and chance, that largely determined who of the wounded would survive the experience and who would not.

The location of some of the war cemeteries on the Western Front mark the site of an early FA, being originated by them and supplemented by the war-dead from the surrounding battle-field in 1914 and those of later battles.

The utility of the FA having been proven in the increasingly static trench-based warfare of the Western Front in 1914, the numbers on active service continued to rise throughout the war, in step with the cumulative increase in troop numbers. FAs served in all the theatres of war. A total of 219 FAs were raised by Britain and the Commonwealth countries in the Great War.

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