CHAPTER XXI
THE AIRPLANE AMBULANCE
The first known report of any plans to transport patients by airplane was made by Capt. George H. R. Gosman, Medical Corps, United States Army, and Lieut. A. L. Rhoades, Coast Artillery Corps, to the Surgeon General of the Army early in 1910. These officers had constructed a plane at Fort Barrancas, Fla., the first flight of which was made in January, 1910. Shortly thereafter Captain Gosman brought his report to Washington and endeavored to obtain funds from the War Department for the work of improving upon this plane and using it for carrying surgical dressings and transporting patients. His
FIG. 140.-Trial flight of the Rhoades-Gosman airplane, January 26, 1910
mission failed, but he was undoubtedly the first to point out the great possibilities of the airplane for this purpose.1
In February, 1912, in France , Doctor Duchassoy suggested the use of the airplane ambulance.2 In April of that year a proposal that our Army use the airplane ambulance was made to the representatives of military aviation, who reported to the Secretary of War on May 23, 1912 . So far as known, nothing came of this recommendation. However, during the retreat of the Serbian Army in November and December, 1915, 13 wounded or sick were transported 80 to 200 kilometers. This was an emergency measure, and no special provision was made by the modification of the plane. The maneuver was successful, and not only were the patients safely transported, but they escaped otherwise inevitable capture.
In France , during the World War, Doctor Chassaing, a member of the Chamber of Deputies, succeeded in inducing the aviation department to construct an airplane ambulance designed for patients in a recumbent position.
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The airplane was first tried out at Villa coublay in September, 1917, and later on the Aisne front.3
In the United States Army the necessity for this mode of transportation for flyers injured in crashes became prominent soon after flying fields were established. It was evident that an airplane ambulance would not involve the delay and discomfort of the ordinary ambulance at many of our stations where the roads were poor and the distance great. This was especially true of victims of airplane crashes, who, while in a critical condition, frequently had to be carried long distances and by roundabout roads to reach a hospital. In addition, it was seen that a flying ambulance would offer the means of getting a medical officer to the patient quickly and in some instances would mean the saving of life. So far as records show, the first flying field to use the airplane in transporting medical officers to the site of crashes, and also for trans
FIG. 141.-Airplane ambulance, first used at Gerstner Field, La., January 28, 1918
porting patients, was Gerstner Field, Lake Charles, La. This station was located in low swampy country surrounded by many bayous. Crashes occurred at places which could be reached by no transportation except the airplane, consequently, in February, 1918, the commanding officer at that field authorized the conversion of a JN-4 airplane into an ambulance, and it was completed and placed in commission during that month.4 Two officers on duty at the station made the plans and supervised the construction of this ambulance at Gerstner Field. They are entitled to the credit for first transporting patients in an airplane ambulance in this country. One of them in his report states:
Up to this time, while we were constructing the airplane ambulance, we used ordinary flying machines to carry doctors to the scene of accidents, and in this way Major Driver was able to save the life of two cadets. In one case a rib punctured the lung, and in one case he arrived in time to stop what would have been a fatal hemorrhage. The surgeon had an emergency kit in the hospital ready to go in the airplane at all times, and the medical officers were ready to fly with any flyers in any machine at any time to the scene of the accidents. They received no flying pay, and their only object was to save life and improve the service by rendering such help as possible to pilots.4
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The practical utility of the airplane ambulance was at once established; and, based on the reports of actual results at Gerstner Field, the Director of the Air Service, on July 23, 1918 , directed the construction of airplane ambulances at all flying fields.5
The necessity for providing prompt medical aid at the site of crashes was also recognized at a very early date at Rockwell Field, San Diego, Calif., as is shown by the following communication from the surgeon at that station on February 12, 1918:6
Owing to the size of the flying field at this post, sometimes there is considerable delay before the arrival of the ambulance; also, because accidents occur at distant landing fields which may be remote from medical aid, I have this day improvised a first-aid pouch that can be put in an airplane.
2. When an accident occurs, I take the Hospital Corps pouch, enter an airplane that is always standing, ready, and, piloted by the chief of the training department, reach the scene of the accident in a few minutes, render such aid necessary until the arrival of the ambulance and assistant surgeon.
3. First Lieutenants Pope, Kramer, and Brooks, M. R. C., have volunteered to answer these calls in my absence and are being trained in such duties.
4. This, I think, will often be the means of saving lives.
5. Owing to the urgency of the situation, I have taken this liberty without first consulting the chief surgeon and am writing to ascertain if this meets your approbation.
Major Ream was one of the first medical officers of the United States Army to be designated as a flight surgeon. He was the first flight surgeon to be placed on a flying status. He was killed in an airplane crash at Eppingham, Ill., on August 24, 1918, while on duty with the Middle West flying tour. Ream Field, Houston, Tex., was named in his honor by the Director of Military Aeronautics in September, 1918.7
At Ellington Field, Houston, Tex., the first airplane ambulance was commissioned about April 1, 1918, having been constructed on the plans of the first airplane ambulance at Gerstner Field.8 An improved type was soon designed and was commissioned on July 6, 1918. This was the first plane to use the standard United States Army litter. The commanding officer of the field at that time made the following report upon the work of the airplane ambulance at that station:8
The first airplane ambulance was put into commission at Ellington Field about April 1, 1918 . This ambulance was made out of a JN-4D with a Curtis OX-5 engine. Later, when the Signal Corps at San Leon started operation, this airplane ambulance was sent to San Leon and a new airplane ambulance was made out of a JN-4H. The new one was completed and put into commission about July 6, 1918. This ambulance was used a great deal at Ellington Field. San Leon, the gunners` school, was about 17 miles from the main field, and all instruction in aerial gunnery was carried on at San Leon. A great number of crashes occurred at San Leon, and in each instance the injured flyers were transported to the hospital at the main field by means of the airplane ambulance. By bringing the men up in an airplane ambulance the actual time consumed in transportation was about 15 minutes. Had it been necessary to transport these men in a motor ambulance, it would have taken an hour and one-half. Thus it was plain that a great deal of time and possibly lives were saved by using the airplane ambulance.
Several instances occurred where men crashed when out on a cross-country trip at distances varying from 50 to 150 miles from the field. Upon telephonic notification the airplane ambulance was sent to the scene of the crash and the injured flyers were brought in with ease and comfort; whereas, to have brought some of these injured men in by motor ambulance would have meant their death from shock and discomfort because of the seriousness of their injuries. One particular instance is recalled where five planes crashed in a hurricane at Brenham , Tex. In this case it would have taken a motor ambulance at least a day to make the return trip over very bad country roads; whereas the two injured flyers were safely in bed in the Ellington Field Hospital two hours
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after the crash, by use of the airplane ambulance. So much use was made of the airplane ambulance at Ellington Field that we considered it as necessary to have the airplane ambulance in condition as we did to have the motor ambulance in condition.
The surgeon of Ellington Field submitted the following report on September 30, 1918:9
Lieut. C. E. _______ suffered a fracture of the left leg, tibia and fibula, and contusion of the face and head, following an airplane crash at Brenham , Tex. , September 27, 1918. He was immediately taken to the local hospital, where splints were applied to the leg and the contusions dressed.
On the following day, ambulance ship, Curtis H, left Ellington Field at 1.30 p. m., with pilot and medical officer, and arrived at Brenham at 3.15 p. m., making the 90 miles in 1 hour 45 minutes, due to adverse winds. On the return trip, left Brenham at 5.50 p. m., and arrived at Ellington Field at 6.45 p. m., making the trip in 55 minutes, with a favoring wind.
The patient stated that he felt the take off and landing very slightly. The trip across was very smooth, so much so that he almost went to sleep. The loading and unloading did not bother him at all. The difference between the ease and lack of jarring in the ship and ambulance carrying him to the ship was very marked.
In April, 1918, the surgeon at Gerstner Field became interested in transporting patients by airplane ambulance, and substituted an adjustable reclining
FIG. 142.-JN-4H airplane ambulance approaching scene of accident, Ellington Field
chair for the litter, in order that the patient might be placed either in a sitting or reclining position.4 This device, however, did not prove to be satisfactory.
In August, 1918, the surgeon at Eberts Field, Ark., devised a very useful form of litter to be used in the airplane ambulance at his station. This litter consisted of a frame, made of iron pipe, about 6 feet in length, constructed in such a way that each leg of the patient had a separate frame for splinting purposes. Canvas was laced to this frame, and broad canvas straps were provided to firmly fix all parts of the patient`s body to the litter.1
An article on the "Ambulance Airship" was published in the Annals of Surgery for November, 1918.10 The drawings and plans for the ambulance plane described bear the date of August 8, 1918. These plans of the Mather Field ambulance are practically identical with those for a plane constructed at Eberts Field and commissioned July 6, 1918. The Ellington Field ambulance was an improvement over the one made at Gerstner Field, and the plans for the Ellington Field ambulance were sent to practically all air service stations. Ambulances built after these plans were constructed in the summer and fall of 1918 at Taylor, Post, Mather, Rich, and Carruther Fields,1
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FIG. 143.-JN-4H airplane ambulance. Top removed from fuselage; litter being removed
FIG. 144.-JN-4H airplane ambulance. Rendering first aid to patient, Ellington Field
FIG. 145.-JN-4H airplane ambulance. Preparing to "load patient," Ellington Field
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After receiving the instructions noted above from the Director of Air Service, most fields rapidly provided airplanes for transporting sick and wounded. Many of them attempted to improve upon the Gerstner Field and Ellington Field types, developing models of their own, until all flying fields with two or three exceptions were equipped. Ingenious ideas were brought out in the matter of modifying planes and adapting litters. In some a modified Army stretcher was used; in others a Stokes litter in various modifications was used. In most cases the turtle back of the plane was removable, permitting placing the patient inside, or on the fuselage from above; in others from below; while in one model the patient was placed on a coffin-shaped litter and slid into the side of the airplane ambulance similar in manner to sliding the door of a chest. An interesting type was one which used the Stokes Navy litter. The advantages of this form of litter were recognized and emphasized by the flight surgeon at Rockwell Field, in the summer of 1918. In the airplane ambulance
FIG. 146.-JN-4H airplane ambulance. Placing patient in fuselage, Ellington Field
which he devised, the bottom of the fuselage was lowered at one end, making an inclined plane along which the Stokes litter slid, manipulated by cables and a small windlass. After the litter was lowered and winched up the incline into place, it was raised by another winch to its final position, flush with the bottom of the fuselage, and locked into place. By using this form of litter the patient could be so securely fastened as to permit handling both patient and litter as one object. The Stokes Navy litter appeared to be the best type devised for the handling of a wounded man, particularly the grave cases usually resulting from an airplane crash. The patient once securely fastened in a Stokes litter did not have to suffer disturbance until placed on the operating table or in his hospital bed. This litter therefore was adopted as the standard type at all flying fields for the use of airplane ambulances. The method, however, of drawing this litter up an inclined plane into the fuselage of the airplane was too complicated for practical use and was abandoned.1
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FIG. 147-JN-5H airplane ambulance, Ellington Field, showing empty and loaded litter
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FIG. 148.-Winching Stokes litter into place in the Rockwell Field airplane ambulance
FIG. 149.-Final position of litter, Rockwell Field airplane ambulance
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FIG. 150.-Stokes litter for DH-4 airplane ambulance
FIG. 151.-Stokes litter in place in a DH-4 airplane ambulance
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From what has been stated above it can readily be seen that the airplane ambulance was extensively used at flying fields in the United States during the World War. It is believed that no other country used it to any extent during the war, since there is little record in the literature outside of what has been mentioned herein.
REFERENCES
(1) Report on airplane ambulance, by Col. A. E. Truby, M. C. On file, chief surgeon`s office, Air Service, 20 (Truby, A. E.).
(2) Duchassoy, Blanchard, R.: Le Transport des bless en Aroplane. Medicine, 1916-1917, Paris, xxi, 53-55.
(3) Letter from Chief, Military Intelligence Branch, Chief of Staff, to Col. L. P. Williamson, M. C., War College , May l, 1918. Subject: Ambulance airplane. On file, chief surgeon`s office, Air Service, 451.8 (general).
(4) Letter from Capt. Wm. C. Ocker, Air Service, to the chief surgeon, Air Service, March 21, 1921 . Subject: First airplane ambulance in the United States . On file, chief surgeon`s office, Air Service, 451.8.
(5) Letter from the Director of Military Aeronautics to commanding officers of flying fields, July 23, 1918 . Subject: Ambulance plane. On file, chief surgeon`s office, Air Service, 452.1 (ambulance planes).
(6) Letter from the surgeon, Rockwell Field, San Diego , Calif. , to the chief surgeon, Aviation Section, Signal Corps, February 12, 1918 . Subject: Attending accidents by airplane. On file, chief surgeon`s office, Air Service, 201 (Ream, W. R.).
(7) Office memorandum No. 113, Office of the Director of Military Aeronautics: September 23, 1918 . Subject: Names of flying fields. On file, record room, office of Chief of Air Service, 201 (Ream, W. R.).
(8) Memorandum from Maj. W. H. Frank, Air Service, to chief surgeon, Air Service, March 16, 1921 . Subject: First airplane ambulance at Ellington Field. On file, chief surgeon`s office, Air Service, 451.8.
(9) Letter from post surgeon, Ellington Field, Houston , Tex. , to Air Service Division, S. G. O., September 30, 1918 . Subject: Report on ambulance ship. On file, chief surgeon`s offices Air Service, 451.8 ( Houston , Tex. ).
(10) Sharpe, N. W.: The Ambulance Airship, Annals of Surgery, lxviii, No. 5. November, 1918.
