The Mobile Army Surgical Hospital: The Gulf War

The Gulf War

Operation Desert Storm was the first major conflict involving U.S. forces since Vietnam. Over 500,000 U.S. troops were deployed, with thousands of additional coalition forces. It was clear from the onset that this war would be fought with a radically different strategy. The exceedingly rapid mobilization of troops and equipment ushered in a new era of military medical care. Medical units had to become smaller, more flexible and more mobile.

Operation Desert Storm was initiated with a prolonged air campaign that lasted 38 days (January 17 to February 24, 1991). However, the ground war that fol lowed lasted only 100 hours, with 148 U.S. troops killed and 458 injured. Medical assets were mobilized to support a rapidly advancing army. The larger, less mobile, combat support hospitals (CSHs) were deployed along with the highly mobile MASH. The CSH units contained 3-4 operating tables and up to 200 intensive care and ward beds. These units utilized deployable medical systems (DEPMEDS) or tent expandable modular personnel (TEMPER), which were durable and easily erected in any environment. The CSH units were large and relatively nonmobile, and only portions of these units deployed to forward areas of the battlefield. The smaller elements of the CSH were known as forward surgical elements (FSE) or forward surgical teams (FST) and consisted of a triage/patient receiving area, 1-2 operating tables and 6-8 postoperative and intensive care beds. order cialis super active

Similarly, the 5th MASH was broken up into smaller units to improve flexibility and mobility. Four surgical units were created from this break-up: the FST, FSE, MASH (-) and the main body of the MASH. The FST was designed to advance ahead of the main MASH unit and capable to receive patients within two hours of arriving at its destination. The FST had limited supplies and could function independently only for 24—36 hours. The FSE, like the FST, could be assembled in two hours. It consisted of 110 personnel and four operating tables. FSEs were intended to sustain operation for much longer than the FST. The MASH (-) was a 36-bed hospital with 3-4 operating room tables, intended as a more rapidly deployable version of the MASH. The main body of the MASH had six operating room tables and 60 ward and intensive-care beds with separate sections for radiology, pharmacy, laboratory, central material supply and patient administration. It should be noted that the various smaller units of the MASH treated a large number of both military and civilian casualties throughout the war with considerable success.

The 5th MASH FSE was the first portion of the MASH to deploy into Iraq, and sustained operations for 48 hours. The FSE then joined the MASH (-) and advanced even further. Of note, the MASH (-) cared for the injured for seven days inside enemy territory. The FST was the final element to deploy and move deeper into Iraq and remained operational for one week, supported by surrounding medical units. cheap levitra professional

A large controversy arose in the Army medical department after the Gulf War. Many questioned the ability for MASH units to rapidly deploy and keep pace with highly mobile light infantry divisions. Many MASH units were decommissioned to allow the development of more mobile FSTs, which would go on to play an integral role in the war against terrorism in Afghanistan and have a prominent role in this recent conflict in Iraq.

The Balkans: Peacekeeping Missions

The signing of the Dayton Peace Accord ended years of ethnic strife in the former Yugoslavia. The North Atlantic Treaty Organization (NATO) dispatched troops for a peacekeeping mission in December 1995. Approximately 30,000 U.S. soldiers were deployed. Units from several nations provided medical support. In this conflict, there were very few U.S. military casualties, and the deployed medical units primarily treated injured civilians.

The 212th MASH (now the last MASH in the Army) was deployed to provide medical support as part of the “initial stabilization force” (IFOR). The 212th MASH operated a 30-bed facility that provided lifesav-ing care to soldiers injured in combat. However, much of the efforts of the MASH were directed towards providing humanitarian assistance to the local civilian population. In recent years, the 212th MASH has provided humanitarian assistance in Bosnia-Herzegovina, Croatia, Kosovo and Macedonia. actos 15 mg

Operation Iraqi Freedom

The 212th MASH played a prominent role in the recent conflict in Iraq. The 212th is a 36-bed hospital with six emergency room beds and two operating room tables. The personnel assigned to the MASH were trained to set up the entire hospital in 12 hours (Figures 5-7). However, this proved to be a laborious undertaking, requiring considerable manpower.

Figure 5. Aerial view

Figure 5. Aerial view of the 212th MASH in Iraq (80 miles south of Baghdad).

During Operation Iraqi Freedom, the clinical staff of the 212th MASH consisted of two general surgeons, a thoracic surgeon, plastic surgeon, orthopedic surgeon, gynecologist, anesthesiologist, emergency medicine physician, internist, family practitioner and nursing staff from various disciplines. The 212th MASH was the first U.S. military hospital to enter Iraq during the war (on March 21, 2003) and provided medical care to the advancing 3rd Infantry Division. Not since the Korean War was a MASH unit able to demonstrate this sort of mobility. There were 100 operations performed during 19 days of active combat (March 27 to April 14, 2003). A high proportion of injuries treated at the MASH involved the extremities. Wounds were generally debrided and kept open, and eventually closed at hospitals in the rear. There were few head and torso injuries among U.S. troops, attributable to the body armor worn in combat. Save on your pharmacy bills. Buy viagra professional online

Figure 6. 212th MASH personnel

Figure 6. 212th MASH personnel resuscitating a casualty in the triage area.

Battle casualties were evaluated, and initial resuscitation was performed in the triage area in front of the MASH. The triage area was located in close proximity to the helicopter-landing zone to facilitate patient transport into the MASH. Patients with minor injuries were treated and returned to duty. Those patients requiring surgery were admitted for preoperative preparation or taken directly to the operating room if emergency surgical intervention was required. Both operating tables could be utilized simultaneously with full anesthesia support. Postoperative patients were taken to the intensive care unit for further care and preparation for evacuation. Many soldiers sustained injury that precluded their return to duty. These patients were evacuated by helicopter or aircraft to higher echelons of care. cheap cialis professional

Figure 7. Surgeons operating

Figure 7. Surgeons operating in the portable operating container of the 212th MASH in Iraq.

Shortly after the fall of Baghdad, it became apparent that the needs of the Iraqi medical community needed to be addressed urgently. Several members of the 212th MASH, in conjunction with the 30th Medical Brigade, were tasked to evaluate hospitals in Baghdad and assist in the delivery of donated medical supplies. These hospital assessments revealed basic infrastructural deficiencies and requirements for potable water, fuel for hospital generators and security to prevent looting. Hospitals in the Baghdad area adapted quickly to the crisis and were functional within days after the fall of the city.