Medical Air Evacuation in WWII – One Patient’s Journey
Flight nurse Lt. Georgie Taylor smiled at Private Hawkins, who was recovering from abdominal surgery due to a rifle wound. “We’ll be in Tunisia . . .”
He was too pale. Restless. His hand chilled her. Georgie leaned closer, her mind tingling with concern. “Are you all right?”
“Thirsty.” He rubbed his throat with white fingers.
She wrapped her hand around his wrist to measure his pulse—rapid as she feared. No doubt about it. He was going into shock, probably from postsurgical internal bleeding.
On Distant Shores, p. 55 (Wings of the Nightingale #2)
Before World War II, medical air evacuation was little but theory—by the end of the war, it was recognized as vital to patient care. I enjoyed following the development of air evacuation in my Wings of the Nightingale series, which featured three flight nurses based in the Mediterranean.
This blog series has discussed:.
General principles of air evacuation
The patient’s flight experience
Let’s follow my fictional patient, Private Hawkins. In the battle for Troina, Sicily in early August 1943, Hawkins is shot in the abdomen. Medics perform first aid and take him from the battlefield to the battalion aid station, where he’s stabilized. An ambulance carries him to a field or evacuation hospital, where he undergoes abdominal surgery. After he’s stabilized, an ambulance takes him to the airfield at Termini Imerese, Sicily, and a C-47 will fly him to the large US hospital complex at Mateur, Tunisia, since he will need a long recuperation. (Read more: Hospitalization in World War II—Evacuation of the Wounded)
At Termini he arrives at a tent hospital at the airfield. The flight surgeon evaluates the patients to decide which are good candidates for air evacuation. Due to high altitude and unpressurized aircraft cabins, the doctors prefer not to send patients with serious head injuries, sucking chest wounds, or severe anemia. Each combat theater has different policies on “neuropsychiatric” patients, but if they’re allowed, an extra technician attends these patients.
At the airfield holding unit, the physician briefs flight nurse Lt. Georgie Taylor on each patient. Georgie in turn orients the patients—most of whom have never flown—on what to expect. Private Hawkins wears an Emergency Medical Tag (EMT) which summarizes his condition and treatment. A large envelope with his medical records and X-rays rests beside him on the litter.
Loading the Plane
The surgical technician and medics from the holding unit carry the litter patients onto the plane. At the cargo door, Georgie checks the EMT against the list of patients on her flight manifest and directs the tech where to place each patient based on his medical needs.
The litters are clamped into aluminum racks along each side of the fuselage, stacked three litters high. Later versions of the C-47 will come equipped with lightweight web-strapping systems to hold litters. Hawkins is placed in the middle tier for easier access. Lower tiers are reserved for patients with heavy casts or needing more intense care.
After the patients are secured, the C-47 glides down the runway. When the plane levels off, the flight nurse and technician see to the patients’ needs. They record Hawkins’s “TPR” (temperature, pulse, and respiration) on the flight manifest, and check for signs of bleeding and infection.
The flight team also provides water and food if needed. They converse with the patients, a voice of calm for the anxious and of encouragement for the depressed. If no patients are on oxygen, the men are allowed to smoke.
The interior of the C-47 is poorly ventilated and heated, and becomes stifling in hot weather and frigid in colder climates or higher altitudes. Smells can become overwhelming, especially when burn patients are aboard or someone becomes airsick. Surprisingly, air sickness occurs in less than 1 percent of flights.
Georgie is trained to treat shock, hemorrhage, pain, air sickness, and other medical emergencies. When Private Hawkins goes into shock, Georgie and her technician administer plasma and oxygen to keep him alive.
When the C-47 lands at Mateur, Georgie and the technician unload the plane with the help of men on the ground. A trained flight team can unload a full plane in 5-10 minutes, which is crucial in case of crash landing or ditching in water.
Due to Private Hawkins’s condition, he is rushed to the shock ward to be prepared for surgery. He will recover.
From the photos, it looks as if the patients are not secured by anything. What happens if they accidentally fall out? 😮
The litters were strapped in well, and I think it would take quite a bump to dislodge a person from a litter 🙂 The seated patients did have lap belts. But remember, seat belts in cars used to be an “upgrade,” and it wasn’t mandatory to wear them until the 1980s – very different safety standards in the past.
I have always felt such an “affinity” with Flight Nurses of this era, that I am thoroughly convinced I must have been one in my most recent “past life!” Providing, of course, such things happen. ?
I was gifted, at age 9, with my mother’s copies of the first 4 issues of the “Cherry Ames, *** Nurse” – the *** being “Student,” “Senior,” “Army,” “Flight,” etc… series of books – hers were 1st editions, encased in deep “Cherry Red” covers – which was a very popular series of fiction books, beginning during WWII. (Later editions printed in the 60’s, would have four color picture covers.) They were written by two different authors, the original being Helen Wells, starting during the early years of World War II, sort of as a Nursing focused mystery-solving fiction, along the same lines as Nancy Drew. It was written partly as a means of raising Nursing in the consciousness of those young preteen girls and young women who might consider taking it on as a profession. It was also a very influential series of nursing fiction, blended with an exciting mystery solving element, but based on the facts of the profession as they existed at that particular time. The circumstances of her education running parallel with those that existed during the times. There was even mention of the U.S. Cadet Nurse Corps towards the end of the “Senior Nurse” edition, at which point she was too close to graduation to participate, but her “little sister” in the school wasn’t too old in terms of her training, and was an active participant. That the actual program came in the summer of 1943 will give a timeline of when it was written.
The first several issues dealt with her adventures and misadventures through the three years of nursing school, then her enlistment in the Army Nurse Corps, training as an Army Nurse, her travel to England, through Europe AND the Pacific throughout the War, her training and adventures as a Flight Nurse (!), and, once the War ended, as a Veterans Administration Hospital nurse. Once she became a civilian again, then she continued to job-hop her way through and around the United States in numerous hospitals, and as such things as a Visiting Nurse Service Nurse in New York, as a dude ranch nurse out West, a Department Store Nurse(?), a cruise ship nurse, and even as far away as the diamond mine areas of “deepest, darkest Africa!” The last few, including as an office nurse for a pair of doctors, set in NYC, which ended the series in 1965, including the obligatory mystery, were all later – and easy – gifts as birthdays and Christmases came and went.
But, it was the most adventuristic set of the first four or five books, that took her through nursing school and the War that really got me going in that direction. I felt so much that this was something that wasn’t new for me – that it was something which I had already experienced, but was just being reawoken in me – that kept me deeply interested in nursing for many years.
I was privileged several years ago to be able to get a flight in an actual WWII era B-17, and I had made the same thing happen for my husband the year before (they are quite expensive, over $400 per person per flight!) He is also a kindred spirit in interest in WWII history and events, although he is more concerned with the military end than with the medical, as I am. But, we support each other in our mutual interests. The boarding and seating was something I can’t describe, knowing that so many others had done so under very different circumstances, so many years ago. But, it was the engines starting up, the taxiing and take off, and the actual flight that ran through me like an icy knife. I absolutely felt as though I had experienced this before, back when these planes were new. Yes, I’m aware that these planes were the heavy bombers of their day, not transport planes. But it was the sound, the vibrations of taxiing, the take off, the reminiscence of those feelings, that seemed so familiar. The flight itself was over much too quickly, and a “re-do” wasn’t possible. I got lots of pictures though.
And, I have read (and watched on “YouTube” anything and everything I have been able to locate on the era in terms of the civilian home front, both in America and Great Britain, as another passion of mine, and especially the activities and advances of the Nursing profession as it participated in the conflict. Yours will be a great pleasure to read, I’m already sure, based on what I’ve seen so far!
Thank you, Shari! I hope you enjoy my books!
I loved the Cherry Ames books when I was growing up, and I have a copy of “Flight Nurse” – such fun!
I also flew in a B-17 – it was a truly outstanding experience I’ll never forget.