In the assault stage of the operation Field Ambulances landed with brigades and battalions as planned, and each beach group landed on D-day with a self-contained medical organisation comprising two Field Dressing Stations, two Field Surgical Units and a Field Transfusion Unit supplemented by small surgical teams.
With the exception of the right flank where the landings met opposition at LE HAMEL, field dressing stations were working and surgeons were performing operations in all the beach groups by H+90.
By D+2 it was possible to concentrate the Casualty Clearing Stations and the hospitals which began to arrive at the beach-head into three principal medical areas, HERMANVILLE, REVIERS and RYES.
By D+6 it was necessary to close down the area at HERMANVILLE to make way for the expansion of a neighbouring ammunition depot, and a new medical site was chosen at LA DELIVRANDE.
In the latter part of June a fourth area was developed near BAYEUX. The ﬁeld dressing stations within the corps were situated near the casualty clearing stations and attended to the lightly wounded, exhaustion cases and sick, leaving the CCS clear to handle major casualties.
The hospitals in the rear medical areas received casualties from the corps CCS.
Early in July BAYEUX developed into the main L of C hospital area, and when HQ L of C took over administrative command of the bridgehead on 13 July it also took over the REVIERS concentration of hospitals.
The RYES area was closed down, and when, in the meantime, First Canadian Army assumed responsibility for the LA DELIVRANDE group, there remained two main hospital areas.
For most of July the Second Army hospitals remained static and in the latter part of the month closed in readiness to move forward.
EVACUATION BY SEA AND AIR
Casualty Evacuation Posts were established on each of the three beach sectors on D-day but enemy shelling caused the CEP (Casualty Evacuation Point) on SWORD sector to close down after the first few days, and all its casualties for evacuation were sent to the CEP on MIKE beach. Later the evacuation of casualties was further simplified by concentrating the casualties in JIG and MIKE beaches. This central CEP at COURSEULLES was enlarged and formed out of two FDS, two FSU and one FTU. It had accommodation for 1,500 casualties and held cases until shipping and weather permitted evacuation.
Evacuation to UK was carried out by means of LSTs modified to carry stretcher cases, hospital carriers and medically manned LSTs for walking wounded. These were loaded initially off-shore by DUKWS specially allotted for medical purposes.
On D-day and D+1 the rough sea made evacuation difficult and if a decision had not been taken to beach the LSTs, the evacuation of casualties would have ceased and the CEPs would have been overcrowded.
The policy of using medically adapted LSTs, and setting aside DUKWS for medical purposes worked extremely satisfactorily; there were, however, misunderstandings and difficulties concerning the arrival of hospital carriers. Eventually it became routine for an officer of the CEP to meet the carriers in a DUKW and guide them to the proper anchorage.
By 26 July 38,581 casualties (including sick) had been evacuated to UK by sea.
Evacuation by air began on 13 June which was a week. earlier than had been anticipated in planning.
Air evacuation was more uncertain than sea evacuation because the airfields on which suitable aircraft arrived changed constantly and there was always uncertainty as to the number of aircraft available. The problem was also complicated because no facilities existed on the air strip for holding casualties. Consequently no preparations could be made for evacuation until the aircraft had landed, and in a congested beachhead it was not always possible to deliver casualties at the air strip on time.
The necessity for dual documentation was another factor which caused a heavy strain on fighting units.
On 18 June ,however, the whole evacuation scheme was centralised under 11 L of C.
A Medical Air Liaison officer was attached to 83 Group RAF, 81 General Hospital, and later, 77 General Hospital at REVIERS was made the principal collecting centre for casualties to be evacuated by air, and a single air strip was selected for evacuation purposes.
RAF Casualty Air Evacuation Units began to arrive at this time and assisted in holding casualties on the airfield until aircraft were available. The holding capacity of these units was not large enough to deal with the numbers to be evacuated and on several occasions a FDS or CCS was sited to help out in this task. The number evacuated by air up to 26 July was 7,719.
There was no shortage of medical stores in the assault period and only minor losses of equipment occurred.
The system of supply over the beaches depended on the daily delivery of Medical Beach Maintenance Blocks, each composed of two half blocks weighing 25 cwts. and containing items of medical equipment designed to meet all reasonable demands until Advance Depots Medical Stores were established.
Two of these were sent over in split loads of five and ten tons between D+3 and D+10. This was considered necessary in view of possible sinkings. In addition six tons of medical equipment were preloaded on RASC transport to augment the medical maintenance blocks.
To meet the expected demands for transfusion fluids in the early days of the operation, the following arrangements were made :—
• Special issues of blood were made to the assault forces.
• Transfusion fluids were included in the maintenance blocks.
• FTUs landed with an estimated supply to last two days.
• Two Advance Blood Banks were landed on D+3 and allocated to each of the corps fronts.
• Supplies of whole blood were sent initially from UK by naval despatch launch and later from D+16 by air.
In a later stage of the campaign the two blood banks which had been allocated to the assault corps were put at the disposal of First Canadian and Second British Armies. These were supplied with blood from No. 1 Blood Transfusion Unit which landed on D+16 and set up at BAYEUX.
The supply to corps and divisional medical units was maintained by a daily service of trucks carrying blood from the army advanced blood bank. Penicillin was also distributed through the agency of the Blood Transfusion Service.
During this phase the following quantities of blood, plasma and penicillin were used : -
Blood . . . 18,000 pints
Plasma . . . 15,000 pints
Penicillin . . 2,400 mega units
The incidence of cases of exhaustion rose steeply from the beginning of July (2.5 per 1000 per week) to the week ending 22 July (5.63 per 1000).
Enemy mortar fire was stated to be the main cause of the collapse of these psychiatric cases.
To deal with them Divisional Exhaustion Centres were opened, where casualties who could be quickly cured were admitted for four or five days. Corps Exhaustion Centres admitted casualties evacuated from divisional level for seven days’ treatment.
Beyond these at the Army Centres and at the Second Army Rest Camp men were treated and then given a period of convalescence.
Over 65 per cent of exhaustion casualties were returned to duty in the theatre. Of these 50 per cent returned to full duty, and the other 15 per cent to duty in a reduced medical category.
The employment of Mobile Dental Units at a distance of two or three miles in the rear of troops engaged in battle was fully justified, for the dentists were able to give treatment in the battle zone and retain the services of men of operational units, who would otherwise have been evacuated to the rear areas.
The solution of hygiene questions did not present any serious difficulties. The water supply was not tampered with by the enemy, but required strict supervision. flies began to appear in large numbers and anti—fly precautions were improvised until fly-proofing materials arrived.
Nursing sisters began to arrive in the theatre from D+10 onwards. Their arrival was much appreciated because they improved the standard of post-operation treatment tremendously.