The Chain of Evacuation

With the anniversary of the Battle of Passchendaele falling last week, we began a series of blogs counting the cost of war, told through the story of one of James Pegrum’s (one of our builders) ancestors, Private Wilfred Pegrum of the 25th Machine Gun Corps (Infantry). In doing so, we are exploring the possible events following his wounding in the final days of the battle and more broadly looking at those involved in caring for the casualties of the war.

The Field Ambulance

Medical units, which were often provided by detachments for infantry, artillery and other units, were managed by the Royal Army Medical Corps (RAMC). At the outbreak of the war there were around 9,000 Warrant Officers and Men in the RAMC, however by 1918 it had grown to number around 113,000. The Corps was assisted in its work by voluntary help from the British Red Cross, St John’s Ambulance, the Friends Ambulance Unit, the Voluntary Aid Detachments and hundreds of private and charitable ventures. Many of the Corps’ members and those of the voluntary organisations were conscientious objector or pacifists, who while unwilling to take a life themselves, would risk their own to save those of others.

The ferocity of the war coupled with the need to maintain high levels of sanitation in an otherwise fetid environment led to many changes in the way medical affairs were handled. One significant change arose from the vast numbers of casualties the war creating, which meant that it was impossible for surgeons to evaluate and practice successfully on the front lines. It was recognised that a man’s chances of survival depended on how quickly his wound could be treated and therefore the ability to efficiently and rapidly move casualties away from the front was required. For this reason the system known as the Chain of Evacuation was established. Each section of the chain, which included Regimental Aid Posts, Field Ambulances, Casualty Clearing Stations and hospitals, had its own role, with the ultimate aim of dealing effectively with all medical matters and making sure the army remained an effective fighting force.

In our model we show Wilfred’s journey through the Chain of Evacuation, with him now in the care of his regiment’s Field Ambulance. Field Ambulances were mobile front-line medical units for treating the wounded before they were transferred to a Casualty Clearing Station and then onto a hospital. They comprised stretcher-bearers, an operating tent, tented wards, nursing orderlies, cookhouse, washrooms and a horse drawn or motor ambulance. Here, Men would be assessed, labelled with information about their injury and treatments and be prioritized in a procedure known as triage. This would be the final stage of the Chain for many men, their wounds so severe that morphia and other pain killing drugs was the only treatment.

Our model is based on this photo of a Field Ambulance near Ovillers, Somme, in September 1916. Imperial War Museum copyright image Q1098

While the RAMC was not a fighting force, its members were subjected to the full horror of war. They performed their duties unarmed and in the process lost no less than 6,873 personnel. Even to this day, the Commonwealth War Graves Commission is still adding names to their roll of honour.

Throughout this project, James has asked his two sons to think about what might have happened to their ancestor, following his wounding at Passchendale. They continue the story:

Jon (age 12)

Somewhere close to Passchendaele. Wilfred has been transported onto a horse cart ambulance made of oak, which takes him on his way for much needed care.  At this moment he was unconscious, but not yet dead.

Toby  (age 9)

​Somewhere close to Passchendaele. Suddenly solider 899 saw the horse cart ambulance "Look!" he shouted. The soldiers boarded Wilfred onto the cart, pulled by fluffy, beautiful horses. 

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