The Organization of Hospital Services for Casualties Due to the Bombing of Cities, Based on Experience Gained in Barcelona—with Special Reference to the Classification of Casualties

Abstract

(1) Difference between modern “total population” war and old-fashioned war. Difference between bombing of (a) military objectives and (b) civilian population. (a) The heavy bomb, e.g. 750 lb., with large fragments, upward throw, great destruction of buildings. (b) The light bomb with finger nail fragments, horizontal throw, great velocity. There is in addition the incendiary bomb, little used in Barcelona because the buildings are built of stone and concrete. (2) Aerial bombing of a town produces injuries needing more immediate hospitalization than most front-line wounds. At the same time it is possible in a town to organize rapid collection of patients and their immediate transfer to hospital. (3) Experience shows that it is most desirable to make this transfer of patients to hospital a primary consideration. On arrival they are “sorted” and minor injuries are given First Aid treatment and sent home, others are fully examined, classified, and dispatched to the theatres on a priority list, to nearby wards for resuscitation, to wards for rest, or sent on to plaster rooms for splintage, or to a neurosurgical centre. (4) First-aid posts in a town should be in hospitals and treat superficial injuries, &c., after primary sorting in the hospital reception room. (5) First-aid posts in outlying areas should carry out the same function for the same type of cases; all the more seriously wounded, including those with tiny penetrating wounds, should be dispatched without first aid treatment direct to hospital. (6) Hospital arrangements, for circulation of ambulances, for sorting, undressing of patients, docketing of valuables, &c. (7) Classification must be carried out by surgeons of experience and judgment. They must regard not only a standard priority list but the particular clinical picture and prognosis in each case. (8) The surgeon will furthermore draft the cases with regard to the special abilities of the surgical units available, e.g. chest, abdomen, or limbs. (9) Review of wounds in limbs, chest, abdomen, and head, caused by fragments from heavy bombs or by splinters from small light bombs. (10) Injuries from falling masonry. (11) Standard classification by urgency of operation. (12) Classification re possible early evacuation. © 1939, The Royal Society of Medicine. All rights reserved.