The Mobile Army Surgical Hospital

INTRODUCTION

Mobile Army surgical hospitals (MASH) were designed to keep pace with combat units during time of war, providing immediate, lifesaving care to casualties. MASH units have been deployed in every major U.S. military conflict since World War II and are undoubtedly responsible for saving thousands of lives on the battlefield. Interwoven with this history of the MASH is the history of resuscitation and care of combat casualties. The authors of this article recently served with the 212th MASH during Operation Iraqi Freedom. The 212th entered Iraq on the first day of the war and cared for a large number of both military and civilian casualties during the initial weeks of this military campaign. In this article, we chronicle the history of the MASH and outline its many contributions to military and civilian trauma care.

World War II: Birth of a Concept

Many concepts implored in modern military surgery can be traced to the innovations of Baron Dom-inque Jean Larrey during the Napoleonic Wars. Lar-rey, hailed by many as the father of combat medicine, laid the foundation for medical evacuation as we know it today with his “ambulance volante.” He was also one of the first military physicians to conceptualize forward surgical hospitals by bringing medical support to the frontline. These concepts translated later to the mobile units of World War II and the Korean War. dutasteride hair loss

During the later part of World War II, it became apparent that the transport of patients to field hospitals and general hospitals in the rear was time-consuming and cost many lives. The notion of providing immediate lifesaving treatment to soldiers on the battlefield was therefore introduced. This meant that special surgical teams needed to be deployed closer to the front-lines. The field hospital was the Army’s most mobile medical unit at the beginning of World War II. These hospitals were comprised of three or four smaller units, with a combined 400-bed capacity. These medical units were generally situated near airfields, to facilitate transport of injured patients out of the combat zone. Field hospitals were large, fixed facilities, unable to advance with rapidly moving combat troops, and evacuation to these hospitals required the use of ground ambulance. The time required for evacuation was often lengthy, and many of the most severely injured patients did not survive transport.

In the early 1940s, Colonel Michael DeBakey (one of the founders of modern cardiac surgery) and other members of the surgical consultants division were given the task of providing the surgeon general with recommendations on the optimal delivery of surgical care to soldiers on the battlefield (Figure l). The surgical consultants division recommended the creation of “auxiliary surgery groups” (ASGs). These were to be small, mobile units attached to larger field and evacuation hospitals. Brigadier General Fred W. Rankin (head of the surgical consultants division) and General Norman T. Kirk (surgeon general of the Army) immediately endorsed these recommendations. Initially, there was difficulty in convincing some members of the Army staff to adopt this concept. However, the eventual effectiveness of these mobile units in combat soon alleviated any skepticism. revatio online

Figure 1. Colonel (Dr.) Michael DeBakey receiving the Legion of Merit Award from General Rankin for his contributions to the development of the MASH (photograph courtesy Dr. Michael DeBakey).

ASGs were effective despite the relative inexperience of their surgeons. Many of these surgeons had less than three years of surgical training. However, these groups were successful in providing resuscitation, surgical management and postoperative care in the battle zone. Each ASG consisted of a chief surgeon, an assistant surgeon, an anesthesiologist, a surgical nurse and two enlisted technicians. Specialized teams were also formed, with surgeons selected from various disciplines, including thoracic surgery, neurosurgery, plastic surgery, maxillofacial surgery and orthopedics. Four such ASGs were initially organized during World War II, and a fifth group was added later. buy bupropion online

The Second Auxiliary Surgical Group, under the command of Colonel James C. Forsee, was the first mobile surgical hospital activated during World War II. This unit supported the Fifth Army (160,000 troops) in North Africa, Sicily and Italy in 1943. The ASGs were able to maneuver with combat units and sustained operations within a few miles of the front-lines. This led to shorter evacuation times, earlier resuscitation of the wounded and reduction in casualty deaths. At the time of the Allied invasion of Normandy, ASGs were called to support the First, Third, Seventh and Ninth Armies. Shortly before the beginning of the Korean War, the ASGs were renamed “Mobile Auxiliary Surgical Hospitals” and later “Mobile Army Surgical Hospitals.”

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Tags: combat support hospitals, forward surgical teams, MASH, military medicine, mobile hospitals