Sanitätssoldaten – The German Wehrmacht Medical Services

During World War II, amidst the chaos of conflict and the brutal realities of battle, German army medics emerged as crucial figures on the front lines. Tasked with the vital responsibility of providing medical care to wounded soldiers, these medics faced immense challenges as they navigated treacherous terrain during dire circumstances. Their training equipped them with the ability to perform lifesaving procedures, which saved the lives of countless fellow soldiers. The article is the first in a series of articles pertaining to the Sanitätssoldaten and covers the organisation of the German Army’s Health Service and the care pathways available for lightly and heavily wounded personnel. 

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The Organisation of the Health Service 

Throughout the second world war, the German Army’s health service was headed by the Chief Medical Officer (CMO) of the General Staff (Generaloberstabsarzt Prof. Waldmann als Heeressanit-tsinspekteur ((1932 – 1940), Generaloberstabsarzt Prof. Siegfried Handloser (1941 – 1944), Generaloberstabsarzt Prof. Walter (1944 – 1945)) and, as their immediate inferior hierarchically, the Chief Physician (CP) of the General Staff (Generalstabsarzt Dr. Ott als Heeresarzt) who was responsible for settling health affairs of the field army and to support Chief Health Officers. The CMO of the General Staff is the next step down and was responsible for the coordination of tasks for the health service, the Refuelling Centre for Sanitary Facilities and the Military Medical Academy as a training centre for health officers. The next rungs down the ladder would be the GeneralArtz, Stabsarzt(Senior Officer of the Medical Service), Sanitätsoffizier (Junior Officer of the Medical Service, Sanitätsunteroffizier (Medical NCO), Sanitätssoldat (Medical Orderly) and the Krankentrager (Stretcher Bearer).  

Auxiliary Stretcher Bearer – Hilfskrankenträger

The Hilfskrankenträger were fully combatant soldiers who were not strictly classified as part of the medical staff. Their main function was to provide assistance to the stretcher bearers (Krankenträger) in the stabilisation and transferring of the wounded. These troops were identifiable by their white arm band bearing the inscription “Hilfskrankenträger” which was worn on the right arm.  When not needed by the Krankenträger, these men would be fulfilling various other non-medical roles within the company. Around four to ten Hilfskrankenträger were present per company.
 

  

Two Hilfskrankenträger, identifiable by the white armband inscribed with the word “Hilfskrankenträger” on their right arm, are assisting a Krankenträger in the stabilisation of a wounded soldier. – Gettysburg Museum of History  

 

Stretcher Bearer – Krankenträger

The Krankenträger were the most inferior in rank of the medical personnel. They played a vital role in securing the wounded on the battlefield and in providing emergency first aid such as stopping bleeding or quick immobilisation of fractures. These men would have received basic medical training and were identifiable by the Red Cross armband constantly worn on their left arm, which brought them the protection of the Geneva Convention. Although the Geneva Convention designated these men as non-combatants, thus disallowing them from directly partaking in any offensive combat, the directive from the Army High Command (OKH) of May 23, 1939, stated that all members of the Wehrmacht were combatants, thus leading to the members of the medical corps being armed with pistols as well as K 98k rifles. These men still reserved the right, as allowed under the Geneva Convention, to defend themselves and any person under their care in the eventuality of any urgent danger. It is also worth noting that although they were disallowed from taking place in any offensive combat, the Geneva Convention offered no means of international control or official consequences related to the breaking of this rule.  

 

 

 

Two Krangenträger carrying a wounded soldier on a stretcher – Men of Wehrmacht

The Medical Soldier – Sanitäter 

The sanitäter played a crucial role in the location, stabilisation and evacuation of wounded from the location of injury to the Wundnest  “nest of the wounded” where they would triage, stabilise and prepare casualties for transport. Apart from the evacuation of casualties with the aid of the Krankenträger, they also managed minor injuries (blistered feet, abrasions, cuts and grazes), treated certain diseases (nausea, vomiting, diarrhoea, sunstroke, etc) and applied emergency first aid to critical cases. These men were identifiable via the Red Cross Armband worn on the left shoulder and the Medical Trade Badge, or the Aesculapian Staff, on their right forearm. They were equipped with two medical pouches (the contents of which shall be described in a later section) and would also have a larger-than-standard M31 Canteen. These men would work under the supervision and coordination of the Medical Non-Commissioned Officer.

The Medical NCO and Commissioned Officer – Unterazrt and Assistenzarzt, Oberarzt/Bataliionsarzt  

The Unterarzt was the rank given to the Medical NCO and was equivalent to the rank of Oberfeldwebel. These were men who had completed their medical training and were posted along with the Assistenzarzt and Oberarzt at the troop bandaging station, with their main function being the assistance of the latter two commissioned officers.  

Casualties receiving care at a Truppenverbandplatz

The Assistenzarzt was responsible for the provision of support to the Oberarzt in the treatment of patients at the company level. These men dealt with more minor injuries and common illnesses whilst also aiding the Oberarzt in their duties. 

The Oberarzt held a dual role, which changed depending on whether the battalion was engaged in combat or not. During quiet periods, the Oberarzt would focus on the treatment of communicable diseases and epidemics whilst also working to prevent disease by performing duties such as checking hygiene at field kitchens, supervision of hygienic measures in barrack areas, latrines, garbage dumps and cadaver disposal facilities. Other duties included health announcements, training of medical service subject and the training of medical personnel.  

During combat, the main responsibility of the Oberarzt was to set up and manage the Truppenvarbandplatz, which was a station that received casualties from the Wundnest and stabilised them further.  

Senior Officer of the Medical Service – Stabsarzt, Oberstabsarzt, Oberfeldarzt and Oberstarzt   

As senior officers, these men would assume responsibilities at the divisional and army corps level. These officers were doctors which were heavily involved in the supervision of a large number of medical staff and in the decision-making process for the proper functioning of medical units in the field. These men were also highly qualified in the medical field, enabling them to participate actively in surgical care and in other important medical procedures reserved for the most grievously injured patients at the Feldlazarett (field hospital), Kreigslazarett (war hospital) and Wehrkreislazarett (district hospital).  

Generaloberstabsarzt Siegried Adolf Handloser – The first head of the Army Health Inspectorate.

The Chief Medical Officer of the General Staff – Generalarzt  

Within the medical service, three generals occupied positions of high responsibility. The first rank, Generalarzte, was responsible for the direction and management of important medical facilities such as hospitals. The second rank, Generalstabsarzt, was responsible for front-related medical issues. They maintained direct communication with the Generalobeststabarzt, who held the highest medical function within the Wehrmacht.  

Further Organization 

At the division level, the medical services were organized as follows: 

First Medical Company 

  • Horsedrawn 
  • 6 medical officers 
  • 2 officials 
  • 160 NCOs and men including 
  • Medical NCOs 
  • Stretcher Bearers 
  • Care personnel 
  • Drivers 
  • 17 horsedrawn vehicles  
  • 45 horses 
  • 1 car 
  • 1 truck 
  • 1 solo motorcycle 
  • 1 sidecar motorcycle  

Second Medical Company  

  • Motorized 
  • 6 medical officers 
  • 3 officials 
  • 157 medical NCOs and men  
  • 4 cars 
  • 21 trucks 
  • 2 solo motorcycles 
  • 4 sidecar motorcycles 

The duties of the 2 companies either relieved or overlapped each other, with the trailing company on the advance either taking over an already established Truppenverbandplatz or overlapping the existing one and setting up a new one further ahead.  

The first platoon of every medical company was the stretcher bearer platoon with its main function being the search and location of wounded on the battlefield. It would also set up vehicle stops (manned by one NCO) to take the sick and wounded from the bandaging stations to the main bandaging station via horsedrawn of motor vehicles.  

The second platoon’s main function was to set up and run the Hauptenverbandplatz which was a station which offered a level of intervention higher than that offered at the Truppenverbandplatz. Further details in a later section. 

The third platoon’s main functions were to provide replacements to the other 2 platoons, to carry spare medical equipment and to aid those affected by chemical warfare. 

Other services present within the medical company were a dental station manned by a dentist and dental assistant, a field pharmacy led by an army pharmacist and assistant whose function was to prepare and dispense medications, carry out foodstuffs and provision of medical equipment.  

Care Pathways 

The starting point of every medical evacuation is the point of injury. The first step in the process is simple visual inspection of the wounded by the Krankentrager, who had the task of offering basic point-of-care first aid (such as the application of a tourniquet to a bleeding limb) and determining the feasibility of moving the casualty away from the point of injury based on the extent of injuries and the combat situation. The Krangentrager would facilitate the evacuation of the wounded soldier from the point of injury to the Verwundetenest via the use of body carriers or improvised stretchers using re-tasked Zeltbahns or blankets.  

 
The Wundnest were casuality collection points set up a short, yet safe, distance away from the unit in contact (20-25m). At the Wundnest, casualties would be triaged and sorted in order of urgency and basic medical interventions in order to stabilize the casuality for transport to the Truppenverbandplatz would also be performed here. The Verwundetenest would be primarily manned by the Sanitater with the support of Krangenträger and Hilfskrangenträger.  
Graphical representation of the buttoning together of two triangular shelter quarters, followed by the folding along the central seams and the opposite side also being buttoned together to form an improvised stretcher.

The Truppenverbandplatz was the next port of call for a patient departing from the Wundnest. This was usually placed just outside of enemy infantry fire yet still within the reach of enemy artillery. Suitable locations needed to be adequately sheltered and usually included farmyards with barns or dugout bunkers. The troop bandaging station was primarily headed by the Oberarzt, whose task here was to perform the first definitive medical treatment, renew and improve bandaging of wounds and to provide general life support to critically wounded men. Another vital duty of his was to prioritise the transfer of wounded individuals to more advanced medical facilities based on the extent of their injuries. In order to triage patients for transfer, a medical tag was issued to each wounded individual. The tag included information such as personal data, extent of injuries and treatment/medicines received. The tag was made of stiff paper and included a red stripe which could be torn off on each side. A tag with two stripes intact denoted that the patient only had minor injuries and was fit to be transported seated, a tag with one stripe removed denoted a badly wounded man who could only be transferred lying down. A tag with two stripes removed denoted a grievously wounded individual which was not fit for transport by conventional means and could only be air lifted via Fieseler Storch airplane. 

Surgeons operating on a wounded man within a Feldlazarett

From the Truppenverbandplatz, the casualties would be once more transported to the better-equipped Hauptverbandplatz (Casualty Clearing Station), which was led by a surgeon and had a strength of around 45 men. As previously stated, this was manned by the second platoon of the medical company, which was further subdivided into 2 operation groups, with each group being made up of 1 surgeon, 1 or 2 physician/s, one instrument assistant, one anaesthetist, 1 sterilizer as an operation assistant and one post-operative care group. This Hauptenverbandplatz was usually located 6-10 kilometres behind the front in order to put it out of range of most types of artillery and was highly equipped with surgical equipment, a lighting system and a field X-ray unit. Suitable locations were hard buildings or the medical company’s tents set up outdoors. Here was the first location at which definitive medical assistance was available, and its main function was to perform life-saving interventions in order to prepare patients for further transport. Upon the arrival of a wounded man at the Hauptenverbandplatz, a medical NCO would examine the casualty and triage him according to his need. The injured could either, have been sent to the bandaging room for checking and replacing of bandages or for other minor checks, such as eye or ear examinations, or be prepared for urgent surgical intervention in order to stabilise the patient for transfer to more definitive care. Average operation time for the seriously wounded lasted between 30 minutes to 1 hour, and the facility also had the means for the carrying out of more intricate operations, such as those for abdominal, head or visceral trauma. As was the case with the Truppenverbandplatz, this station did not have the facilities to accommodate patients for an extended period of time and therefore the patient would either be returned to their unit (if fit to do so) or evacuated to more long-term medical facilities.  

A medical tent at a casualty collection point in Tunisia (Bundesarchiv 101I-421-2057-09A)

If the casualty required treatment at a higher medical centre, they would be evacuated to a Feldlazarett. The Feldlazarett was headed by the Oberstabsarzt, who was aided by 5 medical officers, four officials (including a dentist and pharmacist) and 66 medical personnel, including, on occasion, Red Cross nurses. It was also motorised with 6 cars, 12 trucks and 2 sidecar motorcycles at its disposal. Field hospitals were usually located some 20-25 kilometres away from the frontline in existing hospitals, schools or suitable large buildings. They were composed of a reception area, bandaging rooms, large operating rooms, X-ray facilities, a pharmacy, treatment and care rooms and a dental station. These hospitals were set up to house 200 sick and wounded, yet could accommodate more patients if the situation called for it. If patients required further treatment or rehabilitation, they were transported to a Kriegslazarett well away from the frontline or to a Wehrkreislazarett via train back in Germany.  

The previous section covered treatment pathways for moderate to critical casualties; the following will offer an overview of the care pathways for the lightly wounded.  

The lightly wounded or sick patients would follow a similar care pathway, yet, in theory, a somewhat separate one from the previously described. The reason for this was to free up resources for more critically injured patients. Although this provision was in place, due to the sheer number of lightly wounded/sick patients, this system would often overflow into the ‘moderate to critically wounded’ care pathway.  

The lightly wounded or sick would once again be initially assessed and stabilised by the Krankentrager at the point of injury (or illness) and would be evacuated to the Verwundetenest. From here, the lightly wounded/sick would be evacuated to the Truppenverbandplatz as needed. In an ideal situation, the lightly wounded/sick would march from the Truppenverbandplatz to the Leichtverwundetensammelplatz (Lightly Wounded Collection Point). Depending on the situation, the lightly wounded/sick could also be transported to the Hauptverbandplatz and then be sent to the Leichtverwundetensammelplatz from there. At the Leichtverwundetensammelplatz, the lightly wounded/sick would be triaged, and a decision would be taken on a case-to-case basis to either refer to further care or to send the casualty back to the front. Those requiring further treatment would be evacuated at the convenience of their parent unit via non-medical transport to the Krankensammelstelle einer Krankentransportabteilung (Collecting Point for an Ambulance Battalion) to be prepared for transport. Here the casualties would be triaged yet again and prepared for transport to either a Kriegslazarett or to a Leichtkrankerkriegslazarett, depending on their medical needs.  

 
Summary of the care pathways described above. – Sanitatssoldaten
 
by Matthew James Sacco

Bibliography