How the Korean War’s MASH Units Changed Combat Medicine Forever

A soldier wounded in Korea in 1951 had better survival odds than soldiers wounded in World War II despite heavier casualties and harsher conditions. The difference was time. Mobile Army Surgical Hospitals brought surgeons closer to the front lines, and helicopters brought casualties to them faster.

That innovation evolved into today's Forward Surgical Teams, 20-person units that can set up a functioning operating room in an hour and perform life-saving surgery within kilometers of active combat.

MASH Units Transform Combat Care

Dr. Michael DeBakey and other surgical consultants conceived the Mobile Army Surgical Hospital at the end of World War II. The Army created the first unit in 1948 as a 60-bed facility that could move with combat units. When the Korean War broke out in June 1950, no MASH units existed in the Far East.

The Army deployed them quickly. Within six months, casualties overwhelmed the units, and the Army expanded them from 60 to 200 beds. MASH units operated four to five miles behind front lines, often close enough to hear artillery and occasionally within enemy small arms range. Setting up required 24 hours. Breaking down and moving took the same.

The results changed military medicine. Soldiers who reached a MASH alive had a 97 percent survival rate. World War II fatality rates for seriously wounded soldiers hit 4.5 percent. Korea dropped that to 2.5 percent.

MASH surgeons also pioneered techniques the Army officially prohibited. Arterial repair wasn't authorized based on World War II data showing poor outcomes. Surgeons at the 8055th and 8076th MASH units began experimenting anyway, using reversed saphenous veins to replace damaged arteries. They feared court martial, so they didn't document the procedures in patient charts. When transferring patients to Japan, they called accepting physicians to inform them about the vascular repairs performed.

One MASH surgeon enlisted a Japanese silversmith to make less traumatic vascular clamps. These forbidden experiments became standard practice and saved thousands of limbs.

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Vietnam and the MUST

The MASH proved too large for Vietnam. The conflict required different capabilities. In 1968, the Army replaced MASH units with Medical Unit, Self-contained, Transportable facilities. MUST units used trailers and inflatable sections with technology focused on a wider range of wounds. Only one MASH unit served in Vietnam, operating from October 1966 to July 1967.

The last MASH unit in South Korea deactivated in 1997. Members of the television series cast including Larry Linville and David Ogden Stiers attended the ceremony. Operation Iraqi Freedom became the final military campaign to utilize MASH units.

Forward Surgical Teams

Modern warfare demanded something smaller and faster. Operation Desert Storm demonstrated that MASH units and Combat Support Hospitals couldn't keep pace with rapidly moving front lines. The Army fielded the first Forward Surgical Team during Operation Just Cause in Panama in December 1989.

FSTs consist of four surgeons, three nurses, two nurse anesthetists, one administrative officer, one detachment sergeant, three licensed practical nurses, three surgical technicians and three medics. Equipment and supplies pack into six Humvees with trailers. The entire unit can be slingloaded onto cargo helicopters.

A functional operating room opens within 60 minutes of arrival. Full capability takes two hours. Breaking down to move requires two hours. The team can operate continuously for 72 hours before requiring resupply.

FSTs perform damage control surgery, not definitive care. Surgeons control hemorrhaging, stabilize patients and prepare patients for evacuation to Combat Support Hospitals. The focus is keeping casualties alive through the golden hour, the first 60 minutes after injury when immediate surgery offers the best survival odds.

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Combat Experience

The 274th FST deployed with initial entry forces to Afghanistan in October 2001 and Iraq in March 2003. During the Iraq invasion, the 555th FST evaluated 154 patients over 23 days while moving multiple times. It opened for business within 30 minutes at new locations.

The 250th FST achieved an average time to surgery of 1.5 hours after injury in Iraq. In Afghanistan, split operations became common, dividing the 20-person team into two 9- to 11-person teams to cover more area and reduce evacuation time.

FSTs operated within several kilometers of the front. The 555th FST came under fire on multiple occasions and took prisoners of war. Teams occasionally handled their own defense with light weapons.

Beyond combat, FSTs performed humanitarian missions. The 250th FST conducted 161 civil affairs medical operations in Iraq, more than their combat surgeries. They revamped local emergency medical systems, reestablished surgical grand rounds at Iraqi hospitals and formed the Iraqi-American Surgical Association.

Current Relevance

The Army continues refining FST doctrine for large-scale combat operations. Modern FSTs train at the Army Trauma Training Center at the University of Miami's Ryder Trauma Center. Each team completes a two-week rotation, including a 24-hour capstone exercise managing all trauma patients arriving at the facility.

From MASH tents in Korea to Forward Surgical Teams in Afghanistan, the principle remains constant. Bring surgeons to the wounded, not the wounded to surgeons. Speed saves lives.

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