Hektoen International

A Journal of Medical Humanities

Leaving nothing to the imagination: Casualties Union and post-war first aid training

Jessica Douthwaite
London, UK


Air raid precaution. Practice, first aid party at work. Credit: Wellcome Collection. CC BY

In 1940, a new method for training the emergency services in casualty rescue emerged from the demands of the Second World War.1 Until then, rescue training was perfunctory —neither concerned with recreating representative conditions for trainees, nor taking account of the quality of victims’ experiences. Due to the exigencies of the war, however, a group of medical and civil defense experts began to test the notion that realistic and varied training simulations would better equip rescue teams to sensitively identify and respond to urgent first aid needs. Civilian volunteers, specialized in make-up and acting techniques, became irreplaceable protagonists in simulated training. This quasi-theatrical group was established by 120 members at the first official meeting of Casualties Union in November 1942.2

The aims of Casualties Union were twofold:

1. To use make-up and staged sets to portray medically-sound physical injury and environmental damage in war.
2. To use acting techniques and narrative plots to improvise the behavior and psychology of a representative cross-section of society during emergencies.

Casualties Union stood for inclusion. It ensured that diverse reflections of ordinary British citizens’ bombing experiences were brought to life. The organization mirrored the leveling-out of society that occurred in wartime Britain: everybody was an equal subject to air raids. As Eric Claxton wrote in his official history of the Casualties Union:

“Here was a person with problems as well as injuries, and there was a need to care for the person as well as the broken leg. This person was part of a community of responsibilities – not just another statistic.”3

At the close of the Second World War, Casualties Union reorganized as a voluntary body that trained to replicate peacetime emergencies, from domestic accidents and car crashes to train wrecks. Many sources from this post-war era emphasize the dedication demonstrated by its volunteers, who suffered hardships themselves in order to portray disaster scenes. “Members of Casualties Union never receive a fee,” wrote one commentator:

“[T]hey spend a lot of time training, even going to hospitals to observe cases. They sometimes have to lie out in the open in the rain, or in glaring sun; their dentures may be taken from them and lost; they may be offered drinks from empty cups or be made to drink five glasses of orange squash in quick succession . . . But their enthusiasm grows. They know they are doing valuable work.”4

The highly specialized and intense experience of volunteering for Casualties Union created a strong bond between, and lasting memories amongst its members. In 2015, I interviewed Dr. Esmond Colin Dawson, who had been a GP, St. John’s Ambulance volunteer, and a member of Casualties Union since 1952. Despite his age of eighty-nine at the time of the interview, his enthusiasm for first aid training on real life casualties was undimmed.5 In his archive—papers amassed across his career—I found what can only be described as his Casualties Union manifesto, dated 1963.6 In it, he reflected on the role of a casualty in training for first aid, rescue, and nursing. A “skilled casualty” he wrote, was “a person, who has studied the behaviour of sick and injured people and, who is able, after being briefed and rehearsed, to portray a particular condition, to simulate the changing conduct of a person with that condition.” “Supported by make-up to simulate deformity and also discoloured and damaged tissues,” he continued, “the casualty would be ‘placed in appropriate physical environment to create the specific situation in which the accident or illness could have occurred’ and those situations would affect and obstruct the ‘conduct of those sent to examine and to take care of him.’”7 There is no doubt that Dr. Dawson believed in the integrity and expertise of his volunteers’ performances.

Casualties Union’s fictional, gory, dramatized depictions of first aid crises were not without critics in the 1950s. Winston Churchill, for example, was horrified at shocking depictions of atom bomb casualties in a Coventry civil defense exercise in 1954, declaiming the media hype whipped-up by public scenes: “[W]ho thought of the bloodstained woman with the birdcage? […] The newspapers made an absurd fuss.”8 Yet the efficacy of Casualties Union techniques was appreciated enough for many to rebuff such criticism, as Home Secretary Maxwell Fyfe emphasized in response to Churchill:

“. . . since at least the beginning of the war it has been the practice in almost all civil defense exercises […] to include faked casualties; much ingenuity is exercised in these imaginary situations, and they have been found by experience to add to the interest and value of exercises.” 9

Another doctor bitterly criticized the poor medical knowledge of many casualty actors, writing to the Casualties Union that:

“The make-up ‘artists’ soon become the slaves of an imagination wholly divorced from reality. One such, an employee at I.C.I. was asked by me to make up a casualty for shock, and proudly presented to me a man with a greasy white face, red ears, glycerine coursing down his face, more reminiscent of Niobe’s tears than beads of perspiration . . .”10

Yet it was the Casualties Union’s professionalism and attention to detail that led him to be so scathing about amateur actors, for he was “profoundly interested . . . in the urgent necessity” for a creditable organization like Casualties Union to diminish the “mushrooming into existence the ignoramuses who manage somewhere and somehow to get make-up material together and pose as experts.”11 There is a wealth of evidence to suggest that Casualties Union’s mission and innovative technique became highly respected across the groups that it came in contact with; including the BBC, which valued the realistic effects that Casualties Union brought to television broadcasts.12

During the 1950s, as tensions with the Soviet Union hardened and the suggestion of atomic war increased, the Home Office rolled out civil defense plans that required the emergency services to train for unimaginable and unpredictable wartime situations. Maintaining the wartime spirit that fostered its creation, Casualties Union members naturally began practicing the simulation of atomic war scenarios for which the emergency services were required to train. One such large-scale training exercise was staged jointly across the Oxford and Reading regions by the Hospital Board, Civil Defence Corps, and local military units in April, 1963. A recruitment letter sent to CU members acknowledged that the exercise asked “a very great deal of the ‘casualties’” and would “not be a very easy day!”13

This exercise intended to “keep the Forward Medical Aid Unit fed with casualties for long enough to find out what the problems of nursing large numbers of moribund would mean.” It investigated “the problems of actually feeding casualties” and moving “casualties over something like realistic distances” in order to “examine the problems of an ambulance column, and rate of admission to hospital wards.”14 Indeed, in attempting to recruit as many as 1,000 civilian volunteers to play parts in this training scenario, the exercise relied on the make-up and acting technique of its most committed members to operate effectively—their help was sought therefore “in achieving the impossible!”15 This impossibility lay at the heart of training for nuclear attack. The estimated size of such a nuclear attack and its unique consequences meant that the emergency services rarely had a chance to practice to scale. Thus in the UK, US, and Canada the Casualties Union concept “became the standard technique internationally for rehearsing rescue and medical scenarios” in the nuclear era.16

In the post-war period, Casualties Union volunteers could be found on television, at public showcases, on military drills, in a regional hospital practice, or at their local training center rehearsing on each other. The level of enthusiasm for their work—from both volunteers and recipients of their skills—is testament to more than a love of make-up and improvisation. The organization symbolized democracy in rescue. Its attempt to replicate, honestly and truthfully, ordinary injuries in training practices, and the sacrifices performed by its volunteers, recalled an era of war with which its audiences empathized. Its scripts and characters mirrored the wide variety of local concerns that constituted the community. Casualties Union left nothing to the imagination; its training events were far more than mere first aid practices.



  1. Eric Charles Claxton, The Struggle for Peace: The Story of Casualties Union in the Years Following the Second World War, (Lewes: Book Guild, 1992); Eric Charles Claxton, More Ways than One of Fighting a War: The Story of a Battle School for Civil Defence and the Creation of Casualties Union, (Sussex, England: Book Guild, 1990).
  2. The organisation still operates today: http://www.casualtiesunion.org.uk/
  3. Claxton, More Ways than One, 38.
  4. Joan Llewlyn Owens, ‘Spare-Time Casualty’ in The Lady, (2 February, 1961). Wellcome Library, London, (hereafter WL) ref. SA-CAS Acc 1185, uncatalogued papers.
  5. Interview (January, 2015), Jessica Douthwaite with Esmond Colin Dawson (born July, 1925).
  6. [WL] Correspondence 1963-1965, Dr EC Dawson, The Role of Casualty in Routine Training For First Aid, Rescue & Nursing, (1963) 1-6, SA-CAS Acc 1185.
  7. Dawson, The Role of Casualty, (1963), 1.
  8. Tracey C. CDavis, ‘Between History and Event: Rehearsing Nuclear War Survival’, TDR/The Drama Review, 46, no. 4 (December 2002): 11–45, quote 30-31.
  9. Davis, ‘Between History and Event’, 31.
  10. [WL] Letter from Helen Nicholson to Colin Dawson, quoting Dr. V. St. C. Lucas, (28 November 1962)
  11. [WL] Letter, Nicholson to Dawson.
  12. BBC Written Archives Centre, ‘Bermondsey, Civil Defence: Sunderland Wharf'(Television Outside Broadcast), T14/266, 1953-1955; ‘Saturday Night Out’, T14/1094/10, 1955 – 1957.
  13. [WL] Confidential memo, ‘Re. Casualty Evacuation Exercise Oxford Regional Hospital Board, Sunday 28th April, 1963’, (London, 30 January, 1963).
  14. [WL] Confidential memo, ‘Re. Casualty Evacuation Exercise Oxford’.
  15. [WL] Confidential memo, ‘Re. Casualty Evacuation Exercise Oxford’.
  16. Tracey C. Davis, Stages of Emergency: Cold War Nuclear Civil Defense, (Durham, N.C: Duke University Press, 2007), 204.



JESSICA DOUTHWAITE, PhD, completed an AHRC-funded Collaborative Doctoral Partnership PhD with the University of Strathclyde and Imperial War Museum in April 2018. Her thesis is the first oral history of everyday life in Cold War Britain; it combines cultural, emotions, and interview methodologies to investigate the civilian experience of the Cold War and nuclear weapons development in Britain between 1945 and 1968. Jessica focuses on using inter-disciplinary methods to investigate the relationship between citizenship, emotions, and subjectivity in twentieth century Cold War Britain.


Spring 2019  |  Sections  |  History Essays

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