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175
/
l\iULE TRANSPORT BY FORWARD SURGICAL UNITS.
i
By Major T .. LEVITT,
Royal Army Medical Corps,
Of a Mobile Surgical Unit.
[Received May 22, 1945]
-
THE transport of medical supplies and material b;}' mules at night along intricate tracks
through fonyard mined· areas has recently demonstrated difficulties which have to be overcome by the responsible medical personnel.
There is the ever-present possibility of loss of valuable instruments by mules straying
in the dark, or packs being thrown oil to the adjoining mine-fleld& by distraught mules.
The following recommendations are made, with all due humility, to assist forward medical
units in training their transport personnel.'
As the call for Il'lule transport is ?ften unexpected, the procedure .is perforce an improvisation b~~d on materials actually carried by thlul}it or available locally. ,
.
METHOD OF PACKING.
If Indian Yak Dans are not obtainable, 4·5 ammunition boxes or P.I.A:T. mortar boxes
are eminently suitable. Each ammunition box with contents weighs 40 lb. TWQ boxes on
each side of the mule provide the required weight of 80 lb. for the side-load.
Care in packing is esseritial so as to prevent undue movement and bn;akage of important
apparatus. Each box is so packed as. to hold suffi,cient material for at least twenty opera. tions. Lists of contents are.rriade in triplicate, one copy being attached to the inside of each
box. This prevents any undue difficulty in initiating a surgical operation under adverse
circumstances. / Each box is marked plainly with its number and weight to facilitate loading
and repacking (see Appenj,ix). Phosphorescent paint, if available, is invaluable for marking
boxes used during night ~perations.
.
.
The Standard C.C.S. Operating Table, without its steel box, weighs approximately.72 lb.
and can be carried either as a top-load or part of a side-load. As a: top-load it has been
found necessary to take great precautions to secure it absolutely firmly to the pack saddle
by ensuring that the two pack saddle-straps and surcingle are applied tightly. It is at the
best 6f times an unwieldy apparatus to transport and one can usually dispense with it. A
stretcher supported by ammunition boxes often suffices. Four paratroop stretchers, folded,
make a comfortable 76. lb. load.
Blankets are carried, 16 each, as a side-load, We have found the large sail~doth kitbags
(Navy type) suitable as containers for blankets.
.
The Sterilizing S-et, packed in a larger box, is best carried ~s a top-load ~f 120 lb. 'It
consists of a fish kettle sterilizer, bpwl sterilizer, copper boiler with stand and an instrument
/
.
table. Two prim:us stoves. can easily be added tothe load.
Plasma in a box containing 14 bottles with 7 giving-sets weighs 78'lb. and can be carried
as a side"load.
.
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Mttle Transport by Forward Surg ical Units
176
Tentage .for the operating theatre, required when no hou~e is available, is transported in
the usual fashion.
ApPARATUS CARRIED BY THE THEATRE STAFF.
I
1
.
'
, Each oflhe theatre staff carries hold-alls containing instruments,
rubber tubing and suri
gical needles, so divided that an operation can be performed with the instruments carried
by one person.
'
The ancesthetist has charge of the mask,stethoscope; airways, tourniquet and E.yle's tube.
A Higginson's syringe" in addition to its usual functions, takes the place, when used in a
reverse direction, of la suction apparatus. Intestinal and chest suction measures, need not
be specially carried ~s they are best adapted from used plasma bottles arid tubing.
In addition each person has 5Q grammes of sterile sulphanila~ide in 5-gramme packets.
Loads must be Balanced.-Tb.is is a most important factor. Correct previous weight
measurements, duly tabulated, are essential.
Ropes Must be Well and Truly Tied.-Tying of ropes and loadIng has, perforce, to be done
, by the relatively untrained medical team and not by the muleteers. It is best' accomplished
by using two men on each side of the mule..' Loads must be placed, on to all 'four hpoks
simultaneously. If three men only are available, the odd one takes the weight of the opposite
loaded side, whilst the new weight is being added. While tying the surcingle, it is essential
to depress the load opposite the sjde of the buckle in order to maintain the balance.
Night Transport.-Sadexperience h~staught that, for traversing min~d fields in the dark
along taped paths, the most effective metl;lOd for medical personnel, is to grasp the tail of
the p,recedin,g mule. A comfortably loaded mule kicks but seldom and then only sideways.
Fallen Mules, injured or not, must always be unloaded. If the mule is injured the load
is best dispersed among two other mules as top-loads, if no spare mule is available. The
moral is obvious-retain a spare mule if possible. Medical orderlies have been injured by
trying to unbuckle straps between the legs of fallen mules. To readjust straps, fallen mules
must always be appro~ched from over the flank.
A 'Yeti,able guide is essential. An extra guide, left at a cross-road in the dark, has more than
once prevented the second half,of the train ending in a .rnine-field;.
'\
Steep declines tax medical orderlies most as personnel' are expected. by the muleteers to
assist in settling the loads by holding' on to the pack straps or ropes. It is common practice;
for members of the team to crowd up into a clump, espe~ially when halted. This tendency
must be prevented at 'all costs.
.
,
A 'load check must be carried out ten to fiftee~ minutes after d~parture and ,at every halt
under cover.
,
.
Beginners fail to appreciate the necessity of laden mules having to swing out well beyond
,
stationary objects or vehicles.
'
Complete and willing co~operation between medical orderlies and muleteers is essential
and will be facilitated by the medical orderlies' development of a "mule consciousness."
This is best obtained by previous practice in packing and tying up boxes, and by loading and
unloading mules,under both day and night conditions.
I
f
CONCLUSION ..
By packing the boxes in.the manner outlined in the Appendix, the fact emerges that if
only one mule of the whole train were to survive, provided he'were not 'carrying boxes of
plasma, steri~izing apparatus or the blankets, the operating team can still have the means
of operating on at least 40 battle casualties.
'
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T. Levitt
177
ApPENDIX.
f
The ammunition box measures
(i) unpacked weighs 22 lb ..
24 in. by 14 in .. by 10 in. and when l (ii) packed weighs 40 lb.
(1) Constant contents
(A)
It contains ~.
f(l) Additional material
(B)
L(2) Variable contents ./. or
(2) " 2 drums" .
(C)
(B) Flnd (C) are interchangeable, being equal in ,both weight . and volume.
The box therr;;foreholds either (A) + (E) or (A) + (C).
.
r
,
I
•
•
l
"
+ (B) I
1-'----.-I
(A) + (d .
fl(A)
Operating Unit
~
L
I(A)
I
I(A)
+
+
(B)/ 401]).
i
(C)l 40 lb.
The" side-load of two boxes, weighing a total of 80 lb~, form~ one completeoperatirig
unit. Each operating unit is capable of dealing with 20 battle casualties. A mule therefore
carries the means for dealing with 40 such' cases.
.
Constant Contents.
(A)
Chloroform
Ether
Ethyl chloride
'Pentothal ..
• Morphine" hyd."
Adrenaline
Coramine ..
Nikethamide
Gauze
Gauze type" B·"
. Vaseline gauze
Cotton-wool
W.O.W. bandages
"
"
Triangular bandages
Flannel bandages '
Elastoplast
.
Elastoplast ext.
Rubber sheet
1 lb.
I lb.
spray.
grammes
amps:
bot.
amps.
amps.
rolls
tin
tin
Ibs ..
6 in.
4 in.
1
.1
1
20
6
1
6 .
6
12
1
1
12
12
12
4
4 in.
3 in.
3 in.
yd .
6
1
1
1
Gloves, size 6;);, 7, 71;F of each p:;tirs
2
Sodii chIor.
..
. '. \ tabs.
30
:;;ulphanilami~e ..
tabs.
50
Penicillin.powder
grammes 25
"
solution \
amps,
2
Biniodide . .
tabs.,
30
Acrifiavine
tabs.
30 t
A.G.G:S. ..
bot.
1
T.A.B.
bot.
1
T.A.T.
. bot.
1
catgut Nos. 3, 1, 0 of e,\cll
tubes
12
. Silkworm gut
strands
12
Towels unsterile
3 .
Gowns .unsterile
:~
Cap~ and masks
3
KidneY dish
1
S o a p . . . ..
..
tab.'
,1
Cellona plaster, rolls 6 in. and 4 in., of each 6
. Variable 'Contents: Additional Material.
<B) Cellona plaster, 6 in and 4' in., of each
. SyringeS C.C.· or 10 c.c ....
.Many-tail qandages
Adhesive pIaster . .
3 in.
Nail brush
15
6
1
4
1
1
bot.
Iodine
, or,
2'Drums(C). Two packed drums 12 in. by 10 in. and Sin. by
lOin.
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Mule Transport by Forward
Surgical Units
T. Levitt
J R Army Med Corps 1945 85: 175-177
doi: 10.1136/jramc-85-04-05
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