Mobile Army Surgical Hospital

thumb|American personnel and equipment needed to save a life are assembled at HQs of the 8225th Mobile Army Surgical Hospital, Korea, in 1951.

Mobile Army Surgical Hospitals (MASH) were U.S. Army field hospital units conceptualized in 1946 as replacements for the obsolete World War II-era Auxiliary Surgical Group hospital units. MASH units were in operation from the Korean War to the Gulf War before being phased out in the early 2000s, in favor of combat support hospitals.

Each MASH unit had 60 beds, as well as surgical, nursing, and other enlisted and officer staff available at all times. These units had a low mortality rate compared to others, as the transportation time to hospitals was shorter, resulting in fewer patients dying within the "Golden Hour", the first hour after an injury is first sustained, which is referred to in trauma as the "most important hour".

World War II

thumb|upright=1.2|3rd Republic of Korea Mobile Army Surgical Hospital, Wonju, Korea, 1951

Principles for a mobile medical unit and their implementation were established through trial and error in the dental field during World War II by Major Vincent P. Marran, a medic in the United States Third Army. The effectiveness of his efforts were widely admired and supported by the command structure, but no formal designation was established. The first trials for what would become MASH units were established by the U.S. Army during World War II. MASH units often took 24 hours to set up at new locations once moved with armored units, trucks and airmobile. With mountainous terrain in Korea, this was crucial as ground transport could compromise the patients lives and would take longer to arrive to MASH units.

In 1997, the last MASH unit in South Korea was deactivated. A deactivating ceremony was held in South Korea, which was attended by several members of the cast of the M*A*S*H television series, including Larry Linville (who played Frank Burns) and David Ogden Stiers (who played Charles Winchester).

Vietnam War

The Vietnam War had little action for the MASH units within the U.S. Army. The Vietnam War marked the demise of the MASH units as only one unit, known as the "2nd MASH Unit", served actively, and only from October 1966 to July 1967. The Vietnam War was a very different environment from the Korean War which MASH units were created in.

Operation Iraqi Freedom

The 212th MASH – based in Miesau Ammo Depot, Germany – was deployed to Iraq in 2003, supporting coalition forces during Operation Iraqi Freedom. It was the most decorated combat hospital in the U.S. Army, with 28 campaign streamers on the organizational colors. The 212th MASH's last deployment was to Pakistan to support the 2005 Kashmir earthquake relief operations. The U.S. State Department bought the MASH's tents and medical equipment, owned by the DoD, and donated the entire hospital to the Pakistani military, a donation worth $4.5 million.

Conversion to Combat Support Hospital

Internationally, the 212th MASH was converted to a Combat Support Hospital on October 16, 2006, as the last MASH unit.

The 212th MASH's unit sign now resides at the Army Medical Department's Museum in San Antonio, Texas.

In addition, one of the last MASH units worldwide was located in Pakistan serving as a civilian hospital to aid in recovery efforts following an earthquake in 2006. The aeromedical evacuation system was developed to transport soldiers by aircraft at a quicker pace. Helicopters were frequently used as "air ambulances" during the Korean War, with the Bell H-13 serving as a predominant medical evacuation aircraft during the war. Military doctors stabilized wounded soldiers midair before getting them to a field hospital. MASH onsite paramedic care and air ambulance system decreased post evacuation mortality from 4% in World War II to 2.5% in the Korean War.

Triage

MASH units played an important role in the development of the triage system, a technique that underscores emergency room (ER) medicine in hospitals today.

The system allows for caregivers to prioritize patient's wounds and injuries in order to get those who are severely injured treated as soon as possible. The patient's status is determined an overview of their respiratory, perfusion, and mental status. The current triage system consists of color-coding; each patient (and at times their different wounds) are tagged with either a black, red, yellow, or green tag.

:{| cellpadding="4" cellspacing="0"

| style="background:black; color:white;" |Black

|Deceased or so severely wounded that there is no hope for survival.

| style="background:red; color:white;" |Red

|Requires immediate treatment in order to survive.

| style="background:yellow; color:black;" |Yellow

|Not in immediate danger but requires medical care. Requires observation.

| style="background:green; color:white;" |Green

|Wounds or injuries that aren't completely disabling. Referred to as "walking wounded".

While the concept of triage had been used years before the Korean War, it wasn't until MASH units put it into real practice that the idea was fully developed. World War I and World War II saw the introduction of chemical weapons, such as mustard gas, which created a large influx of casualties and the need for more organization. Triage was first performed on the soldiers at battalion aid stations. Those who worked in the stations, be they nurses or medical officers, used the system to determine which soldiers needed further care or treatment and which soldiers could go back onto the battlefield. The soldiers that needed further treatment were then transferred to the MASH units to undergo triage once more. This time, nurses and doctors would work to prioritize who needed to be taken into surgery first; if it appeared that the soldier wouldn't survive much longer without surgery they were prioritized. MASH units typically followed the saying, "life takes precedence over limb, function over anatomical defects", a phrase which essentially means that they had to repair the most serious defect first. This thought process has since rolled over to the modern technique of triage in ERs nationwide.

In popular culture

The MASH unit made its way into popular culture through the 1968 novel MASH: A Novel About Three Army Doctors by Richard Hooker, the 1970 feature film based on the novel, and the long-running television sitcom (1972–1983) also based on the novel. A 1953 film, Battle Circus, also took place at a MASH.

thumb|US Army medics move a wounded soldier on a stretcher from a 568th Medical Ambulance Company ambulance into a tent for treatment at the 8225th Mobile Army Surgical Hospital (MASH), Korea, September 1, 1951.

For narrative simplicity, the "4077th MASH" unit depicted in the novel, movie, and television series was smaller than real MASH units. The fictional 4077th consisted of four general surgeons and one neurosurgeon, around 10 nurses, and 50–70 enlisted men. In an average 24-hour period, they could go through 300 wounded soldiers. By comparison, the 8076th Mobile Army Surgical Hospital had personnel including 10 medical officers, 12 nursing officers, and 89 enlisted soldiers of assorted medical and non-medical specialties. On one occasion, the unit handled over 600 casualties in a 24-hour period.

References

External links

Office of Medical History for the U.S. Army Surgeon General

NPR Audio: Last U.S. MASH Unit Handed Over to Pakistan
MASH Units