Mobile army surgical hospital (United States)

U.S. Army soldiers and Dilmurod interpreters train local Uzbek anesthesia providers on the 885 Mobile Anesthesia Machine at the Fergana Emergency Center in support of Operation Provide Hope.

The Mobile Army Surgical Hospital (MASH) refers to a United States Army medical unit serving as a fully functional hospital in a combat area of operations. The units were first established in August 1945, and were deployed during the Korean War and later conflicts. The term was made famous in the television series M*A*S*H, which depicted a fictional MASH unit. The U.S. Army deactivated the last MASH unit on February 16, 2006. The successor to the Mobile Army Surgical Hospital is the Combat Support Hospital.

World War I

The American Expeditionary Force Mobile Hospital No.1 was established following the example of the French military automobile-chirurgical units shortly after the American entry to the war.^[1]

World War II and after

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, medic in Patton's Third Army.^[2] The effectiveness of his efforts were widely admired and supported by the command structure, but no formal designation was established. Formally the MASH unit was conceived by Michael E. DeBakey and other surgical consultants as the "mobile army surgical hospital." Col. Harry A. Ferguson, the executive officer of the Tokyo Army Hospital, also aided in the establishment of the MASH program. It was an alternative to the random individual systems of portable surgical hospitals, field hospitals, and general hospitals used during World War II. It was designed to get experienced personnel closer to the front, so that the wounded could be treated sooner and with greater success. Casualties were first treated at the point of injury through buddy aid, then routed through Battalion Aid Stations for emergency stabilizing surgery, and finally routed to the MASH for the most extensive treatment. This proved to be highly successful; during the Korean War, a seriously wounded soldier who made it to a MASH unit alive had a greater than 97% chance of survival once he received treatment.^[3]

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.

MASH units continued to serve in various conflicts, including the Vietnam War.

During the Gulf War, in October 1990, the 5th MASH, 44th Medical Brigade, XVIII Airborne Corps, Fort Bragg, North Carolina, deployed to Saudi Arabia and was the first fully functional Army hospital in the country. This unit moved forward six times, always as the first up hospital for the region. In March 1991, the 5th MASH was operationally attached to the 24th Infantry Division to provide forward surgical care (often right on the front battle lines) to the combat units that attacked the western flank of Iraqi army. In March 1991, the 159th MASH of the Louisiana Army National Guard operated in Iraq in support of the 3rd Armored Division during Operation Desert Storm.

Other MASHs that served in 1990–91 included the 2nd MASH, 1st Medical Group, Benning; the 10th MASH, 1st Medical Group, Carson; the 115th MASH (DCARNG); the 475th MASH (341st Med Group, KY USAR); the 807th MASH (341st Med Group, KY USAR); and the 912th MASH (TN USAR).^[4] 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). MASH units have since been replaced by the U.S. Army's Combat Support Hospitals.

Worldwide, the last MASH unit in the U. S. Army was converted to a Combat Support Hospital on October 16, 2006.^[5] 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.

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

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.^[6] 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.

Black	Deceased or so severely wounded that there is no hope for survival.
Red	Requires immediate treatment in order to survive.
Yellow	Not in immediate danger but requires medical care. Requires observation.
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 the MASH units during the war put it into real practice that the idea was fully developed. World War I and World War II saw the introduction of weapons, such as poison gas, that could wipe out everyone. The battles left many casualties, and therefore there were more patients arriving at the MASH hospitals. 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/treatment and which soldiers could go back onto the battlefield.^[7] The soldiers that needed further treatment were the transferred to the MASH units and underwent 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",^[8] 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.

Field care

The Korean War played a great role in defining MASH units. High casualties in the front line called for onsite paramedic care, such as ambulances and medical tents. Having learned from World War II that transporting wounded soldiers to rear hospitals was highly inefficient in reducing mortality rate, MASH units were established near front lines to supply mobile and flexible military medical care. They contributed to making improvements in resuscitation and trauma care, patient transport, blood storage and distribution, patient triage, and evacuation.^[9] Aeromedical evacuation system was developed to transport soldiers by unnoisy air crafts at a quicker pace. Helicopters were frequently used as "air ambulances" during the Korean War. The Bell H-13 was a dominant medical evacuation aircraft during the war. Military doctors stabilized wounded soldiers midair, before getting them to field hospital. MASH onsite paramedic care and air ambulance system decreased post evacuation mortality from 40% in World War II to 2.5% in the Korean War.^[10][11]

MASH in M*A*S*H

Out of necessity, 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 can 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 nonmedical specialties. On one occasion, the unit handled over 600 casualties in a 24-hour period.^[12]

See also

• List of former United States Army medical units
• NORMASH, a Norwegian MASH unit during the Korean War.
• 45th Portable Surgical Hospital
• Battle Circus (1953 movie)
• Combat Support Hospital
• Field hospital
• M*A*S*H (1970 movie)
• M*A*S*H (1972–1983 TV series)

References

Further reading

• 300th Mash: Desert Shield/Storm, Germany, 1991. S.l: s.n, 1991. OCLC 26838805
• Apel, Otto F.; Apel, Pat. MASH: an army surgeon in Korea. Lexington : University Press of Kentucky, 1998. ISBN 0-8131-2070-5. OCLC 38738909.
• Churchill, Edward D. Surgeon to soldiers; diary and records of the Surgical Consultant, Allied Force Headquarters, World War II. Philadelphia, Lippincott [1972]. ISBN 0-397-59053-9. OCLC 267039.
• Cowdrey, Albert E. The medics' war. Washington, D.C. : Center of Military History, U.S. Army, 1987. OCLC 14378361.
• Garrett Corporation. 45th MASH, Tay Ninh, Republic of Vietnam. Phoenix, Ariz: AiResearch Manufacturing Division, 1967. OCLC 701255387
• Gouge, Steven F. Commanding the 212th MASH in Bosnia. Carlisle Barracks, Pa. : U.S. Army War College, 2001. OCLC 49979530.
• King, Booker, and Ismalil Jatoi. "The mobile Army surgical hospital (MASH): a military and surgical legacy." Journal of the national medical association 97.5 (2005): 648.
• Kirkland, Richard C. MASH angels : tales of an air-evac helicopter pilot in the Korean War. Short Hills, NJ : Burford Books, 2009. ISBN 1-58080-158-7. OCLC 318421406.
• Marble, Sanders. "The Evolution and Demise of the MASH, 1946–2006: Organizing to Perform Forward Surgery as Medicine and the Military Change," Army History (Summer 2014) #92 online
• Marble, Sanders. Skilled and resolute : a history of the 12th Evacuation Hospital and the 212th MASH, 1917–2006. Office of the Surgeon General, United States Army, Washington, DC, 2013. ISBN 0-16-092253-4. OCLC 861789107.
• Porr, Darrel R. To be there, to be ready, and to save lives : far-forward medical care in combat. Carlisle Barracks, PA : U.S. Army War College, 1993. OCLC 28208258
• United States. Army. Office. Chief of Army Field Forces. Airborne mobile army surgical hospital. Office, Chief of Army Field Forces, Army Airborne Center, 1951. OCLC 32681031.
• United States. Department of the Army. Mission training plan for the Mobile Army Surgical Hospital (MASH). Washington, D.C.: Headquarters, Dept. of the Army, [1993]. OCLC 39193710.
• United States. Mobile Army Surgical Hospital, 45th. Unit history of the 45th Surgical Hospital (8076th AU) : unit activation to 10 Aug 53. 1953. OCLC 14145260.
• Watts, David M. The creation of the portable surgical hospital. [1982?]. OCLC 45409004.

External links

Wikimedia Commons has media related to Mobile Army Surgical Hospital.

• Office of Medical History for the U.S. Army Surgeon General
• NPR Audio: Last U.S. MASH Unit Handed Over to Pakistan
• MASH Units
• The short film Big Picture: Pictorial Report is available for free download at the Internet Archive