Critical Care
On the Battlefield and Around the World

The History of the Canadian Forces Health Services

By Dr. Cameron Pulsifer

Medical services first became an official part of the country's military organization as the Canadian Army Medical Corps in July 1904. They became the Royal Canadian Army Medical Corps in 1919. The medical services' greatest challenges were the three great conflicts of the twentieth century - the First World War (1914-18); the Second World War (1939-45); and the Korean War (1950-53). Never before or since has Canada sent greater numbers of men and women into battle for such consistently intense and prolonged periods. Disease was no longer the major killer it had been in previous conflicts, owing to advances in medical science. In these three twentieth century wars the major problem facing Canadian Army medical personnel was saving lives against the destructive power of modern weapons. Employing the latest scientific, medical, and technological advances to heal the wounded, they administered critical care on the battlefield itself and also set in place a system to evacuate the wounded as early as possible to safer, better-equipped hospitals farther from the fighting.

Of the 424,589 who served overseas in Canadian Expeditionary Force in the First World War, some 51,748 were killed and 138,166 wounded (44 per cent); of the 380,000 who served overseas in the Canadian Army in the Second World War, 41,940 were killed and 75,775 wounded (31 per cent). In Korea 309 were killed and 1202 wounded out of 21,940 who served (7 per cent). The chief problem for medical personnel in Korea was getting the wounded to proper care amidst the tortuous hills and ravines of the difficult topography.

The process of evacuation remained basically similar in all three wars, although the names of some facilities changed and some new ones were added in the two later wars. First, stretcher-bearers carried the wounded to their own unit's Regimental Aid Post. Here, they became the responsibility of a Field Ambulance run by the medical services, which was responsible for transporting them to various stages of care farther back. First to be encountered were Advanced and Main Dressing Stations close behind the lines, where proper dressings were applied. The next stop in the process was the Casualty Clearing Station, which was the first facility where surgery could be undertaken. In the First World War, this was also the earliest stage where nursing sisters were present. From there, after initial recovery, patients could be shipped further back to Stationary and General Hospitals for more serious attention and longer-term convalescence.

A number of advances helped improve patient survival rates between the First and Second World Wars. Speedier evacuation from the front lines by means of jeep ambulances was one important evolution. Another was the greater availability of anti-bacterial drugs. Also, although the procedure had been tried towards the end of the First World War, the Second World War saw the much more frequent undertaking of surgery and blood transfusions near the front lines by special Field Surgical and Field Transmission Units, often including nursing sisters, which significantly improved survival rates. Although not as common as depicted in the popular American television show M.A.S.H the use of helicopters for evacuation in Korea also helped survival rates.

The Canadian Army medical services rose to the challenges confronting them in all three wars. Even in the First World War, the survival rate of those who actually came under their care was 89 per cent, and the succeeding two conflicts saw steady improvements to 93 and 96 per cent respectively. The Canadian War Museum's Critical Care exhibition shows the intense and stressful conditions under which the medical personnel accomplished their task of caring for Canadian wounded in each of the three conflicts. Traditions established in these 'trials by fire' continue today at hotspots around the world wherever Canadian military medical personnel are stationed, from Haiti to the Balkans.