Lesson video

Hello, I'm Mr. Marchant, and I'll be your history teacher for today's lesson.

I'm really excited to have you joining me as we explore today's subject, and my number-one priority will be to help ensure that you can meet our lesson objective for today.

Welcome to today's lesson which is part of our Edexcel unit on "Medicine in Britain." By the end of today's lesson, you'll be able to explain the organisation of the Chain of Evacuation on the Western Front and the challenges the system faced.

There are two keywords which will help us navigate our way through today's lesson.

Those are evacuation and terrain.

Evacuation means to move people from a dangerous place to somewhere safer.

And terrain is a particular type of land.

Today's lesson will be split into three parts, and we'll begin by focusing on Caregivers on the Western Front.

To manage the significant number of casualties on the Western Front, the British Army relied upon a wide range of caregivers.

In particular, this included members of the Royal Army Medical Corps, or the RAMC, and many nurses from the Voluntary Aid Detachment, or VAD.

The Royal Army Medical Corps was the branch of the British Army responsible for providing medical care to soldiers.

In 1914, the RAMC had 20,000 personnel, including doctors, surgeons, stretcher bearers, and ambulance drivers.

On the Western Front, the RAMC worked alongside female nurses and Voluntary Aid Detachments, or VADs.

VAD units were made up of ordinary members of the public who volunteered to support the work of the RAMC.

When World War I broke out, there were 74,000 VAD members, two-thirds of whom were female.

Many VAD members worked as nurses, but volunteers also helped with a range of other jobs, such as cleaning, cooking, and driving ambulances.

So, thinking about what we've just heard, what branch of the British Army was responsible for providing medical services? Pause the video here and press play when you're ready to see the right answer.

Okay, well done to everybody who said the Royal Army Medical Corps, or the RAMC.

And which of the following statements is correct? Most members of the RAMC were women.

Most members of VADs were women.

Only women provided medical care on the Western Front.

Or, women were excluded from both the RAMC and VADs.

Pause the video here and press play when you're ready to see the right answer.

Okay, well done to everybody who said the correct answer was B.

Most members of VADs were women.

In fact, two-thirds of VAD members in 1914 were female.

When war broke out, both the RAMC and VADs were underprepared.

Few members of the RAMC or VADs had experience managing the type of wounds suffered by soldiers on the Western Front.

Similarly, there was a lack of experience in managing the mass casualties produced in battles on the Western Front.

Furthermore, medical officials had initially expected that most critical treatment could be provided in sterile hospital environments, some distance from the battlefield.

However, the severity of many wounds meant that it became important to perform many procedures closer to the frontline, which usually meant outside of the large hospitals established by the RAMC when the war began.

Nevertheless, the RAMC and VADs adapted well to the demands of the war.

To help manage mass casualties, more members were recruited.

For example, by the end of 1918, there were nearly 170,000 RAMC personnel.

Furthermore, the training provided to members of the RAMC and VADs was improved as they gained experience in providing effective medical services in a war zone.

For instance, when World War I began, stretcher bearers were only expected to have the physical strength to help carry wounded soldiers.

However, by the start of 1915, stretcher bearers began receiving medical training so they could also perform advanced first aid themselves.

In particular, it was expected that stretcher bearers should be able to stop bleeding in order to prevent wounded soldiers going into shock.

Okay, so let's make sure we have a secure understanding of everything we've just heard.

Where did the RAMC initially expect most critical medical procedures would be performed? Was it close to battlefields, in distant hospitals, in trenches, or on the frontline? Pause the video here and press play when you're ready to see the right answer.

Okay, well done to everybody who said the correct answer was B.

Initially, the RAMC expected that most critical medical procedures would be performed in distant hospitals.

And let's try another question.

This time, we have a statement which reads, the number of men working for the RAMC increased significantly during World War I.

But is that statement true or false? Pause the video here and press play when you're ready to see the right answer.

Okay, well done to everybody who said that that statement was true.

But we need to be able to justify our response.

So why is it that that original statement was correct? Pause the video here and press play when you're ready to check your answer.

Okay, well done to everybody who said, whereas just 20,000 men worked for the RAMC in 1914, it had nearly 170,000 personnel by 1918.

So, we're now in a good position to put all of our knowledge about caregivers on the Western Front into practise.

I want you to describe two ways in which the medical care provided by the RAMC and VADs improved during World War I.

You may refer to changes in staffing and training as part of your answer.

So pause the video here and press play when you're ready to reflect on your responses.

Okay, well done for all of your hard work on that task.

So I asked you to describe two ways in which the medical care provided by the RAMC and VADs improved during World War I.

And your answer may have included.

One way in which the medical care provided by the RAMC and VADs improved during World War I was through increased recruitment during the war.

Whereas there were 20,000 staff in the RAMC in 1914, there were nearly 170,000 RAMC personnel by 1918.

This made it easier to manage mass casualties on the Western Front.

Your answer may also have included.

Another way in which medical care improved during World War I was through increased training for all medical personnel.

For example, at the start of the war, stretcher bearers were only required to have the physical strength to help carry wounded soldiers.

However, from 1915 onwards, stretcher bearers also received training in advanced first aid so that they could manage problems, such as bleeding, themselves.

So really well done if your own responses look something like those models which we've just seen.

And so now we're ready to move on to the second part of our lesson for today where we're going to think about the Chain of Evacuation.

On the Western Front, it was critical to ensure an effective system of evacuation existed for wounded soldiers.

This system would ensure soldiers were moved away from the battlefield to locations where they could receive appropriate medical treatment.

This system was known as the Chain of Evacuation.

The Chain of Evacuation was made up of four main stages.

Firstly, soldiers would arrive at Regimental Aid Posts, otherwise known as RAPs.

They might then move on to Dressing Stations.

From there, some soldiers would be sent to Casualty Clearing Stations, otherwise known as CCSs.

And some soldiers might go further on towards Base Hospitals.

More complex treatment was provided as the stages progressed.

So in other words, the most complex treatments were provided at CCSs and Base Hospitals.

So, let's check our understanding of what we've just heard.

I want you to study the stages of the Chain of Evacuation shown in the flowchart on your screen.

Identify which stage of the Chain of Evacuation is missing.

Pause the video here and press play when you're ready to see the right answer.

Okay, well done to everybody who said the missing stage from our flowchart was Casualty Clearing Stations, or CCSs.

Regimental Aid Posts, or RAPs, were the closest part of the Chain of Evacuation to the frontline, often being located in trenches, although some RAPs were set up in locations as simple as a pit in the ground.

RAPs were staffed by a Regimental Medical Officer and a team of stretcher bearers and could provide immediate first aid to soldiers.

This included bandaging for wounds and providing morphine for pain relief so soldiers could return to fight.

If soldiers were suffering from wounds and injuries which required greater medical attention, it was necessary for them to move on for further treatment.

Dressing Stations were the next stage of the Chain of Evacuation.

These were based in various locations, including abandoned farmhouses, dugouts, and tents.

Dressing Stations were staffed by 10 Regimental Medical Officers and teams of stretcher bearers who could provide emergency first aid.

In theory, Dressing Stations could care for up to 150 patients for a week, but during major battles, they often faced overwhelming demand.

During the Third Battle of Ypres, one Dressing Station dealt with 1,000 casualties over just two days.

Soldiers suffering from more serious injuries, including those in need of surgery, were moved by ambulance to Casualty Clearing Stations.

Okay, so let's check our understanding of what we've just heard.

What stage of the Chain of Evacuation was most likely to be found in trenches? Was it Base Hospitals, Casualty Clearing Stations, Dressing Stations, or Regimental Aid Posts? Pause the video here and press play wen you're ready to see the right answer.

Okay, well done to everybody who said the correct answer was D.

Regimental Aid Posts were most likely to be found in trenches, as they were the smallest stage of the Chain of Evacuation and the closest to the frontline.

CCSs were located further away from the frontline to provide greater security against attacks.

Although CCSs were often set up in large tents rather than permanent buildings, they had a large staff of doctors, surgeons, and nurses, and were well equipped with operating theatres, wards, and sometimes even access to X-ray machines.

This all meant that they could treat more serious injuries, and it was at CCSs where operations on wounded soldiers were carried out most frequently.

While CCSs were larger than Dressing Stations, they could still become overwhelmed during major battles.

During the first three days of the Battle of the Somme, a single CCS received 4,500 casualties.

Base Hospitals made up the final stage of the Chain of Evacuation.

These hospitals were set up furthest from the frontline and close to the French or Belgian coast.

Base Hospitals provided a space where up to 2,500 wounded soldiers could be cared for.

As well as providing a space for patients to recover, Base Hospitals were also equipped with their own X-ray machines, labs, and operating theatres so that treatment begun in CCSs could be continued.

Some wounded men at Base Hospitals would return to the frontlines to fight once they had recovered.

Meanwhile, patients with serious wounds requiring extended treatment, known as Blighty wounds, would be sent back to hospitals in Britain.

Those with the most serious life-threatening injuries would also be evacuated to Britain for specialist care.

So, thinking about what we've heard, I want you to write the missing word from the following sentence.

During the first three days of the Battle of the Somme, a single blank received 4,500 casualties.

So what's the missing word? Pause the video here and press play when you're ready to see the right answer.

Okay, well done to everybody who said that the missing word was CCS.

During the first three days of the Battle of the Somme, a single CCS, or Casualty Clearing Station, received 4,500 casualties.

And what happened to soldiers with Blighty wounds? Was it that they were bandaged and returned to fight? That they remained at Base Hospitals until they recovered? Or that they were sent back to Britain for treatment? Pause the video here and press play when you're ready to see the right answer.

Okay, well done to everybody who said that the correct answer was C.

Soldiers with Blighty wounds were sent back to Britain for treatment.

And let's try one final question.

This time, we have a statement which reads, the most advanced medical treatment was provided in the earliest stages of the Chain of Evacuation.

But is that statement true or false? Pause the video here and press play when you're ready to see the right answer.

Okay, well done to everybody who said that that statement was false.

But we need to be able to justify our response.

So why was that original statement incorrect? Pause the video here and press play when you're ready to check your answer.

Okay, well done to everybody who said, surgeries were only carried out at CCSs and Base Hospitals, whereas RAPs and Dressing Stations focused on providing first aid.

So, we're now in a good position to put all of our knowledge about the Chain of Evacuation into practise.

I want you to study the descriptions in the table.

Identify which stage of the Chain of Evacuation each description refers to.

So pause the video here and press play when you're ready to reflect on your responses.

Okay, well done for all of your effort on that task.

So I asked you to identify which stage of the Chain of Evacuation each description in the table referred to.

And your answers should have included.

For our first description, that this stage was staffed by 10 Regimental Medical Officers and teams of stretcher bearers, you should have identified that that was talking about Dressing Stations.

For our second description, that this stage continued treatment begun in CCSs, you should have said that that was talking about Base Hospitals.

For our third description, that this stage had space to care for up to 2,500 patients, you should have identified that we were talking about Base Hospitals again.

For our fourth description, that this was the stage where most surgeries were performed, you should have identified that this was talking about CCSs.

And for our final description, that this was often located in trenches, you should have identified that that was referring to Regimental Aid Posts, or RAPs.

So really well done if you identified each of those descriptions correctly.

And now we're ready to move on to the third and final part of our lesson for today where we're going to think about Transport and the Chain of Evacuation.

The Chain of Evacuation relied upon effective methods of transportation for wounded soldiers as well as upon clearly established stages for treatment.

Stretcher bearers, ambulance waggons, and ambulance trains all therefore played an important part in the Chain of Evacuation.

Stretcher bearers worked in teams, usually, of four men, and were responsible for moving wounded men so they could receive treatment.

This included retrieving some wounded men from No Man's Land, a responsibility which could place stretcher bearers in considerable danger.

The safest time for stretcher bearers to work was at night, but they were also required to retrieve wounded men in the daytime and during battles when they could become victims of enemy snipers or explosive shells.

For instance, during the first few hours of the Battle of the Somme, so many stretcher bearers were killed that some Regimental Medical Officers refused to let their own teams of stretcher bearers leave their RAPs.

The terrain on the Western Front could also create challenges.

Mud, in particular, could slow stretch-bearer teams down significantly, as men often became weighed down by mud stuck to their uniforms and sometimes even sunk into it.

So, thinking about what we've just heard, where did stretcher bearers often retrieve wounded soldiers from? Was it Base Hospitals, Casualty Clearing Stations, or No Man's Land? Pause the video here and press play when you're ready to see the right answer.

Okay, well done to everybody who said that the correct answer was C.

Stretcher bearers often retrieved wounded soldiers from No Man's Land.

Speed was important on the Chain of Evacuation.

Many wounded men suffered from blood loss or infection, making it critical for them to receive medical care as soon as possible.

For this reason, use was also made of vehicles to transport wounded men along the Chain of Evacuation.

Ambulance waggons, which were sometimes horse drawn and at other times motorised, allowed larger groups of men to be transported at once and at speed, especially between Dressing Stations and Casualty Clearing Stations.

Motor ambulances provided a smoother ride for patients than horse-drawn waggons, which could avoid making wounded men's injuries worse.

However, motor ambulances often became stuck in mud, meaning that horse-drawn waggons remained in use during the war.

Many wounded soldiers were also transported along the Chain of Evacuation by ambulance trains.

Some had built-in beds, whilst others had iron stands which stretchers could be loaded directly onto.

Some ambulance trains regularly carried over 400 men who were cared for by a team of nurses.

For the most part, ambulance trains were used to transport wounded men between Casualty Clearing Stations and Base Hospitals.

However, ambulance trains shared the same railway lines with other trains transporting soldiers, weapons, and supplies to the frontlines, and so they were given the lowest priority amongst these.

As a result, ambulance trains often faced significant delays as they waited in railway sidings for other trains to move by, often taking days to make a journey which could normally be completed in hours.

At times, ambulance trains also came under attack from enemy explosive shells, in particular, because they were sometimes confused for trains carrying British soldiers, supplies, and weapons to the frontline.

So, thinking about what we just heard, what type of terrain did motor ambulances often become stuck in? Was it dry, muddy, or wet terrain? Pause the video here and press play when you're ready to see the right answer.

Okay, well done to everybody who said the correct answer was B.

Motor ambulances, whilst they were quick and could offer a comfortable ride to wounded soldiers, often became stuck in muddy terrain.

And now we have a statement on the screen which says, evacuations by ambulance trains were usually very speedy.

But is that statement true or false? Pause the video here and press play when you're ready to see the right answer.

Okay, well done to everybody who said that that statement was false.

But we need to be able to justify our response.

So why is it that that original statement was not correct? Pause the video here and press play when you're ready to check your answer.

Okay, well done to everybody who said, ambulance trains had lower priority than other trains transporting soldiers, weapons, and supplies to the frontlines.

This led to significant delays which could make journeys take days instead of hours.

And so now we're in a good position to put all of our knowledge about transport and the Chain of Evacuation into practise.

I want you to study the extract.

It comes from the diary of Norman Fermor, who worked as a stretcher bearer during World War I.

In the extract, it says, "awful night Collecting Wounded Sort for hours in terrible conditions.

Shell Holes, Wire, mud and Water but I found my way through eventually.

Saturday 22nd, back I go to Tin Hut Post F.

Heavy Shelling Here.

The next day we were Shelled again." Using the extract and your own knowledge, explain two challenges faced when transporting wounded men on the Western Front.

So pause the video here and press play when you're ready to reflect on your responses.

Okay, well done for all of your hard work on that task.

So I asked you, using the extract and your own knowledge, to explain two challenges faced when transporting wounded men on the Western Front.

And your answer may have included.

One challenge faced when transporting wounded men on the Western Front was the local terrain.

For example, Norman Fermor, who worked as a stretcher bearer, wrote about the "terrible conditions" he had to work in, including "Shell Holes, Wire, mud and Water." These difficult conditions in the local terrain would have slowed down the work of stretcher bearers as they worked carefully around them.

In fact, the local terrain also affected other methods for transporting wounded soldiers.

For instance, muddy conditions often led to motor ambulances becoming completely stuck on the Western Front.

And your answer may also have included.

Another challenge faced when transporting wounded men on the Western Front was the danger posed by the enemy.

For example, Norman Fermor recorded that, whilst he was on one posting as a stretcher bearer, he faced "Heavy Shelling Here, the next day we were Shelled again." Indeed, there was considerable danger when retrieving men from No Man's Land during battles.

During the Battle of the Somme, so many stretcher bearers were killed in the opening hours that some Regimental Medical Officers refused to let their teams leave their RAPs.

At times, ambulance trains also came under shellfire, often because they were confused for trains carrying new soldiers or supplies to the frontline.

So, really well done if your own responses look something like those models we've just seen, especially if you were including quotes from the source and your own knowledge as part of your answer.

And so now, we've reached the end of today's lesson, which puts us in a good position to summarise our learning about the Chain of Evacuation on the Western Front.

We've seen that the RAMC and VADs helped provide medical care to wounded British soldiers on the Western Front.

The Chain of Evacuation was a system for moving wounded men to locations where they could receive appropriate medical care.

More advanced medical care, such as surgeries, was available in the later stages of the Chain of Evacuation at CCSs and Base Hospitals.

Stretcher bearers, ambulance waggons, and ambulance trains were all used to transport wounded men.

And the local terrain, enemy attacks, and organisational priorities could all make the evacuation of wounded men quite challenging.

So, really well done for all of your efforts during today's lesson.

It's been a pleasure to help guide you through our resources today, and I look forward to seeing you again in future as we continue to think about medicine in Britain and medical history on the Western Front.