Journal of the Royal Society of Medicine Volume 82 November 1989
679
The Zed Expedition: the world's first air ambulance?
M D Scholi MD Department of Family Practice, Enloe Hogpital, Chico, California 95926, USA rnia Ate University, Chico, California 95929, USA C L Geshekter PhD Departmient H ry Keywords: aviation medicine; history; aeromedical transport
There has been a rapid growth in aeromedical transportation in the past two decades. The history of aviation medicine includes reports of wounded soldiers being evacuated from the besieged city of Paris by hot air balloon, although these accounts may be apocryphal. Use of aircraft to transport the warwounded was first suggested in 1910. The first actual use of an air ambulance may have occurred during the Somaliland Campaign of 1920 (the Zed Expedition).
Introduction Many US hospitals today depend on aeroplanes or helicopters to transport critically ill or injured patients. There has been a steady growth of hospitalsponsored helicopter programmes in both urban and rural areas since August 1972, when the nation's first hospital-based aeromedical helicopter service was established at St Anthony's Hospital in Denver, Colorado. At this time, more than 300 helicopters are dedicated to air medical transport throughout the world. Annually, an estimated 150 000 patients are transported in helicopters in more than 24 countries'. Prior to the development of hospital-based air ambulance services, most aeromedical transportation was limited to wartime situations. The first air transport of the wounded may have occurred during the siege of Paris in the Franco-Prussian War of 1870/71. However, it remains unverified that wounded soldiers were ever transported from Paris by hot air balloon and with the hospitals of the city available, even though the city was cut off from the rest of France, it seems unlikely that anyone would have been evacuated by 'air transport' to the surrounding countryside. Louis Bleriot's crossing of the English Channel by air in July 1910 not only astounded political and military strategists by its implications, but excited medical visionaries who anticipated the evacuation of the wounded by air. French physician and aviator, Reymond, predicted that 'in the future it will be possible to construct aeroplanes for the tansportation of wounded men'2. During World War I aircraft were used ordinarily as weapons of war. Although incidents of wounded men being transported in the fuselage of military aircraft have been described, it is doubtful if the actual use of an organized aeromedical transport ever occurred. In 1920, General Toubert, Director of Medical Services for the French War Department, arranged for the construction of 80 air ambulances whose cabins contained two stretchers, space for a surgeon, 'coverlets, electric boilers, an oxygen tank, thermos bottles, a medicine chest, instruments, and dressing material'3. In the early 1920s, these aircraft were deployed extensively for aeromedical evacuation during French campaigns in Morocco. In 1923, after
one fierce battle in the central Atlas Mountains, nearly 1000 wounded were transported across desert regions in a few hours instead of several days2. In the 1930s, German involvement in the Spanish Civil War saw the evacuation by air of wounded and sick in 10 hour flights from Spain to Germany3. Widespread use of air evacuation came during World War II when the US Forces moved almost one million patients by air4. With wars in Korea and Vietnam came the first extensive use of rotary-wing aircraft for aeromedical evacuation from the actual battlefields.
The Zed Expedition Aside from these examples of the use of aeroplanes and helicopters in various theatres of war, it appears that the first organized aeromedical operation in history took place inearly 1920 during a frontier war in the northeast African country of Somalia. In January 1919, following the end of World War I, Winston Churchill reluctantly accepted Prime Minister Lloyd George's appointment as Secretary of State for War (and Air). When Churchill complained, 'What's the use in being War Secretary if there's no war', a political opponent retorted, 'If we thought there was going to be a war, we wouldn't appoint you War Secretary'5. There was, however, an unresolved little war or revolt in British Somaliland that had been ongoing since 1899. For 20 years, an African leader, Sayyid Muhammed Abdille Hasan, nicknamed the 'Mad Mullah of Somaliland' by the press of England, had fought to expel Christian colonizers from the Muslim land of Somalia. In 1903, the nomad leader expressed his sentiments in an 'open letter' to the English people: 'I wish to rule my own country, and proectt my own religion ... We have both suffered considerably in battle with one another ... I have with me plenty of came!i and goats and sheep ... I will not take your country. r.haveno forts, no houses, no cultivated fields, no silver or gol fobr you to take. If the country was cultivated or cod houses or property, it would be worth your while to fight. There qe many -ant heaps. The sun is very hot. If you wish peace, I am content. But if you want peace, you must go away from my country to your own.'6
The Dervishes inflicted numerous defeats on British forces between 1900 and 1919. During World War I, Sayyid's warriors actually controlled half of the colony. Eventually, the Dervishes began to fight among themselves and by 1919, his movement had nearly spent itself but was still smouldering enough to warrant conclusive military action. Churchill chose to authorize the formation of a special RAF unit (code-named 'Z' or Zed Expedition) for deployment in what became the final campaign against the Somali rebels, the 'Somaliland Campaign of 1920'7.
0141.07768/89/ 110679
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Journal of the Royal Society of Medicine Volume 82 November 1989
The RAF medical unit that supported the Zed Expedition was commanded by the army medical officer William Tyrrell. Born 20 November 1885, Tyrrell graduated from Queen's University in Belfast, and had served with the Royal Army Medical Corps in France and Belgium where he won the Distinguished Service Order, the Military Cross, and the Croix de Guerre (Belgium). In November 1919, Tyrrell and an RAF officer had visited British Somaliland surreptitiously, in the guise of petroleum engineers, to evaluate the medical logistical needs of the forthcoming campaign. In early January 1920, Tyrrell returned to Somaliland as Medical Officer ofthe RAF medical detachment for the Z Unit8. Twelve DH-9 DeHaviland biplanes had been provided for the expedition and sent disassembled by ship from Britain to Egypt. One aeroplane was outfitted as an air ambulance to enable evacuations of the sick or injured from the remote desert areas, otherwise only accessible by camel. A coffin-like structure was constructed within the rear fuselage, enclosing the stretcher (Figures 1 and 2). The aeroplanes were reassembled at the northern Somalia port of Berbera in January 1920, and the RAF used them to pursue the Mullah and his followers during a three week campaign. With bombing and machine gun strafing, the Dervishes were driven from one desert fort to another. In early February, during a battle at Taleh in remote northern Somalia, only the Mullah and a handful of his supporters managed to elude capture and escape across the Somalia border into the Ethiopian desert. Tyrrell's medical unit was busy during and after the air attacks. From his notes: 'Three cases evacuated by aerial ambulance from Eil Dur Elan to Berbera: (1) Captain James Godman, aged 45, w/necrosis of phalanges, middle toe left foot. (2) Cpl. Edward Linnington, age 28, w/inguinal lymphadenitis secondary to Ulcus Molle. (3) AC/2W Sleath, age 19, petrol burns hand/arm.
Figure 1. Transfer of patient to stretcher from DH-9 air ambulance
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Figure 2. DH-9 aeroplane - dual purpose; note machine gun mounted forward Five others were evacuated by aerial ambulance b/t 15-24 February 1920, but not admitted to the hospital. A total of 13 officers and one hundred others were admitted to the hospital and all but 11 ... returned to duty.'9
Following the success of the Zed Expedition, Tyrrell served several tours of duty in Palestine and the Middle East and later served as Medical Oficer of the Royal, Air Force College at Cranwell, England. He reached the rank of Air Vice-Marshal in the Royal Air Force and upon retirement in 1944 received the order of Knight of the British Empire from King George VI. After World War II, he served for a time as Director of Medical Services for British Overseas Airways (BOAC). Air Vice-Marshal, Sir William Tyrrell, KBE, DSO, MC, died 18 August. 1961 at the age of 7610. Sayyid Muhammed Abdille Hasan died sometime in December 1920, at Imi, Ethiopia of epidemic influenza6. References 1 Rees CF. Editorial comment. Hosp Aviation 1989; No 8:3 2 Picque R. The present state of medical military aviation in France. Milit Surg 1924;54:561-70 3 -Hippke E. Transport by air of the sick and wounded. Milit Surg 1940;86:439 (Translated from Der Deutsch Miltarzt 1940;86.14) 4 Grant DNW. Air evacuation of one million patients. US Surg Bull 1945;2:334-6 5 Brendon P. Winston Churchill. New York: Harper & Row, 1984:91 6 Jardine DJ. The Mad Mullah of Somaliland. London: 'Herbert Jenkins, 1923:122 7 Archives. Public Records Office. (AIR 1/23). (Kew) London 1920. 8 Killingray D. Air power in British Colonial Africa: 1916-1934. J Afr Hist 1984;25:4 9 Papers of William Tyrrell. Archives: Imperial War Museum, London. 10 Who Was Who, London, 1971
(Accepted 10 February 1989)