Mash Units

A Mobile Army Surgical Hospital (MASH) is a self-support-ing, tented, portable medical unit designed to provide front-line combat care. The U.S. Army Medical Department developed the idea for a highly flexible, self-contained surgi-cal hospital based on its experience in World War II. By 1948, five of these hospitals had been authorized by the surgeon general of the Army, and they were the first medical units deployed in Korean War. MASHs were used extensively in the Vietnam War, and in all subsequent major conflicts including the Gulf War and the Iraq War. MASHs helped develop and refine the principles and techniques of coordi-nated trauma care that serve as the foundation of the modern civilian trauma management system in the United States.

Military medical planners have always struggled to find optimal methods for providing combat casualty care, continu-ally trying to establish the right balance among mobility, prox-imity to the combat zone, and safety of medical personnel. The first important innovation in modern warfare was the introduc-tion of motorized vehicles in World War I to transport surgical teams and their equipment to the front. In World War II, [Page 460]mechanized field hospital platoons and forward surgical teams were created to provide close medical support to troops in Europe. The jungles and mountainous terrain of Asia necessi-tated an even more mobile medical unit, the portable surgical hospital capable of being moved on the backs of porters.

Shortly after World War II, the surgeon general of the Army established the Surgical Consultants' Division to evalu-ate the performance of the Army Medical Department in com-bat casualty care. The research team, led by Michael E. DeBakey, was charged with making recommendations for improvements in surgical techniques and facilities. One of the proposals of DeBakey's team was the creation of a more mobile and surgically capable frontline surgical hospital. By 1948, the Army had developed the MASH, commissioning them as reg-ular and permanent units of the Army Medical Department. When the Korean War broke out on June 25, 1950, three of the five active MASH units (the 8055th, 8063rd, and 8076th) were hastily outfitted in Japan and sent to Korea in July 1950.

The prototype MASH was a 60-bed hospital intended to support an infantry division. It had five surgical tables, preop-erative and postoperative areas, and full ancillary support including a laboratory, X-ray suite, and blood banking. An experienced team could erect and dismantle a MASH in 10 hours. The contingencies of Korea, however, radically changed the methods and capabilities of these units. Because of the inadequate road and rail system and the fluid nature of combat in the early part of the war, the helicopter became the predominant means of accessing the MASH. In addition, these units were forced to act not only as limited-service for-ward hospitals but also as full-service evacuation hospitals, serving multiple infantry divisions. By the end of 1950, the MASH bed capacity had grown to 200 and the units were routinely providing sophisticated definitive surgery, including frontline neurosurgery and vascular surgery. The introduc-tion of the MASH units and these new surgical procedures helped reduce the mortality rate of wounded men in Korea.

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