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It's hard to find someone whose life hasn't been touched in some way by our fighting men
and women. We hope and pray that those overseas will be taken care of well if injured.
So it has been in every war, including the Korean War, the first to utilize the M*A*S*H,
or Mobile Army Surgical Hospital. To truly understand the importance of this innovation,
one must first recognize the background of military medicine and the challenges faced
by the doctors and nurses. As early as the Napoleonic Wars in France
from 1799 to 1815, Baron Dominique Jean Larrey recognized the problem of quickly giving surgical
aid to those wounded at the front. He was one of the first physicians to bring medical
support to the very front, and laid the foundation for M*A*S*Hs with his concept of "ambulance
volante", or "flying ambulance".
In WWII, this concept translated to medical units following combat divisions as they advanced
or retreated from the front. However, at the beginning of WWII in 1939, the most mobile
Army medical unit wasn't mobile at all. Large, fixed field hospitals comprised the
medical facilities, necessitating ground evacuation from the combat zone. Many critical patients
died en route in long ambulance transports. The newly formed Surgical Consultants Division,
established to advise on matters of combat surgery, realized that this method was costing
many lives. The Chief Consultant in Surgery to the Chief Surgeon of the European Theater
of Operations was Colonel Elliott Cutler. His previous experience, which included working
as Professor of Surgery at Harvard University Medical School, convinced him of the benefit
of forward surgery through a completely mobile surgical team that could function independently.
With the rest of the Surgical Consultants Division, he recommended these, called auxiliary
surgical groups, to Brigadier General Paul R. Hawley, the Chief Surgeon of the European
Theater of Operations, every chance he got. Early in 1943, the Surgeon General requested
the formation of 4 (eventually 5) auxiliary surgical groups, or ASGs, in the European
Theater of Operations. On paper, one of these groups was made up of teams of
24 of the approximately 35 teams making up the group were for general surgery, and the
rest were specialty teams -- neurologic, maxillofacial (concerned with the face around
the upper jaw), thoracic (chest), plastic, and orthopedists. Teams supported division
clearing stations, evacuation hospitals, or, most importantly, field hospitals. Field hospital
platoons supported at least one division (15,000 to 20,000 soldiers), if not more, and could
require up to six teams each, which they relied upon for their entire surgical service.
As the new groups tried their legs, some things were found to be lacking. Good documentation
of the groups' operations helped to improve these.
Despite these improvements, many took a lot of convincing as to the benefits of the ASGs.
Platoon commanders disliked that the teams didn't come under their administrative control
and that their awkward position caused problems of transport and supply;
After months of drilling and training, the ultimate test of the teams' worth came on
June 6, 1944: D-day.
The relatively inexperienced teams were attached to seaborne and glider-borne echelons and
thrown into a tumult of frantic activity, some setting up surgeries in German garrisons
by flashlights so as to not give away their position, some performing surgery under falling
shells, and all having to improvise with few supplies and personnel either at or only a
mile or two from the front. As the dust settled, the benefits were clear
-- in one week following D-day, the teams of one ASG treated over 900 patients alone,
and they helped evacuate over 8,000. The influence of the teams was steadying and heartening
to the men unused to such brutal combat. 22 days after D-day, as an experiment, five mobile
surgical units and three mobile X-ray units came to Normandy and were attached to the
Third ASG. These units moved in trucks and carried all of their own supplies. The 1944
Annual Report to the Surgeon General from the Third Auxiliary Surgical Group writes
ASGs had reduced
morbidity and mortality significantly.
After the fascist powers were defeated and most troops returned home, the United States
Army Medical Department took stock of the auxiliary surgical groups' well-documented
work, ultimately deciding to combine the ASGs and mobile surgical units. Five of these Mobile
Army Surgical Hospitals were staffed in America between 1948 and 1950.
On June 25, 1950, North Korean forces invaded South Korea. The US immediately sent troops
from Japan to block the Communist invasion, involving 21 UN countries in an international
conflict. 3 M*A*S*Hs, supporting 4 U.S. infantry divisions (15,000 to 20,000 soldiers) were
deployed as well. These M*A*S*Hs followed the front no less than twenty miles and often
as close as three or four miles behind. When the time came to "bug out," the unit was
packed and ready within six hours. It moved in two phases, sending half the tentage and
personnel ahead of the rest, and so for a short time, two completely functional hospitals
existed. The front half was operational within four hours once it had arrived at the new
Road conditions, along with a violent fighting situation, made the original design of the
evacuation hospitals impossible to carry out, so the M*A*S*H was modified from its 60-bed
"nontransportables" capacity to a 200-bed capacity. However, this was not matched by
an increase in personnel; the only way to keep up was rapid evacuation. One M*A*S*H
could handle over 400 patients a day. An ambulance platoon was attached to each unit to facilitate
swift patient conveyance to and from the unit. For the first time in combat, helicopters
were used for evacuation -- a product of WWII's aeromedical evacuations by plane.
The hospital itself consisted of a "basic U" of tents, comprised of a Receiving section,
preoperative ward, laboratory and X-ray area, surgery area, postoperative ward, evacuation
section, and an administrative section. Fields and rocky roads provided an area for ambulances
and helicopters to bring patients. The hospital staff was comprised of about
four general surgeons, including the chief surgeon, an orthopedic surgeon, a maxillofacial
surgeon, one or two anesthesiologists, about three nurse anesthetists, five nurses, and
about ten technicians. Half of the unit's staff rotated on 12-hour
shifts, on occasion working all together, should the patient load necessitate it.
Once a patient was received from the offloading ambulance or helicopter, he was brought into
the Receiving tent and examined by the triage officer. X-rays, labs, and IVs were ordered,
if needed, and staff would attempt to stabilize his condition. After moving to the pre-operative
ward, personnel removed his clothing and put him in a gown. The operating room was prepared
and the patient brought to the pole frame that together with the litter made an operating
table. The nurse anesthetist put the patient to sleep and worked with one or two surgeons,
two technicians, and the O.R. nurse to heal the patient. After the surgery was completed,
the patient was moved to the post-operative ward and, as soon as possible, to a rear evacuation
hospital or back to the front.
While still very similar to previous methods, this treatment of patients was clearly superior.
Though the end of the Korean War in 1953 was only eight years after the end of WWII, little
time for medical advancement, the casualty statistics told the story:
"There were 565,861 men wounded in WWII. Of those, 20,810 died. Part to whole, that's
3.7% of men dying after being wounded. In the Korean War, 77,596 were wounded and 1,887
died. Part to whole, that's 2.4%, more than a one percent decrease. If the mortality rate
had stayed the same in the Korean War, we'd be looking at 2,871 men dead. Do the math
-- that's another almost 1,000 men who get to live another day and go home to their
families. How's that for impact?"
M*A*S*Hs continued to serve the Army in Vietnam, the 1991 Gulf War, and the conflicts in Iraq
and Afghanistan. The innovations of the MASH during the Korean War were not effectively
matched in the civilian world for another 15 to 20 years. The combined effort in trauma
management through helicopter evacuation and paramedics formed the model for metropolitan
trauma centers today.
In November 1995, Colonel Michael E. Debakey, who had received the Legion of Merit for his
help in developing the M*A*S*H, gave a speech entitled
In it, he quoted the Chief Consultant to the Chief
Surgeon of the Mediterranean Theater of Operations, Colonel Edward D. Churchill, from a speech
In this case, learning from history means
a bit more than a history teacher telling you that it's important. Learning from history
can mean the difference between lives lost and lives saved.
The last M*A*S*H in South Korea was deactivated in 1997, and the last in the world, the 212th
M*A*S*H, was converted to a combat support hospital, or CSH, a smaller casualty surgical
hospital intended to be deployed even closer to the front lines than the MASH, in October
2006. Though the M*A*S*H is gone, its effects will never be forgotten. The MASH-developed
doctrine revolutionized and defined the standard of practice in the U.S. and the rest of the