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During World War II, the Echelon III hospital units of the field hospital were often employed in close proximity to a division clearing station, where they could provide more definitive care than that available in the division -- the predecessor of the Mobile Army Surgical Hospitals (MASH) that would be employed in Korea a few years later. The lack of sufficient surgeons and nurses in the hospital units of the field hospital was, in fact, one of several factors leading to the development of the Mobile Army Surgical Hospital. Experiments with Portable Surgical Hospitals during WW II showed the concept had promise.
Origin of the Mobile Army Surgical Hospital (MASH)
The Mobile Army Surgical Hospital, or MASH as it quickly became known, was a new kind of organization, announced on 23 August 1945, at the very end of World War II. The MASH was intended to bring emergency lifesaving surgery closer to critically wounded casualties. The concept called for placing a sixty-bed, truck-borne MASH in a forward location just out of enemy artillery range, in support of each division. The MASH was to be truly mobile, fully staffed with surgical and medical personnel, and equipped to provide definitive, life-saving surgery, to make the patient transportable to rear medical facilities, and to provide post-operative care for non-transportable patients. Five MASH units were created on paper between 1948 and early 1950, but were not staffed or ready for combat when North Korea invaded South Korea on 25 June 1950.
MASH Units in Korea
Three MASH units were established in Korea after hostilities began, staffed by personnel stripped from other Medical Department units, but not enough were in place to have one in support of each division as planned. Because of the lack of transportation, an inadequate road and rail network, and the volatile tactical situation, the 400-bed Army evacuation hospital could not properly function in Korea. In response, each MASH was enlarged to 150 beds (November 1950) and then to 200 beds (May 1951). The MASH concept of "surgery only" was abandoned under wartime pressure. With this expansion in workload (medical cases in addition to surgery) and with no increase in personnel, rapid evacuation of patients to higher echelons was essential. In effect, the MASH became a small 200-bed capacity evacuation hospital providing care to the division. In some instances, a MASH exceeded 400 patients a day. Up through 26 December 1950, three MASH units supported four U.S. infantry divisions (and other U.N. forces). By the end of 1950, there were four MASH units in support of seven divisions and attached U.N. troops.
The United Nations forces went on the offensive in 1951 and MASH units remained mobile, moving typically once per month. Through the latter part of 1951, a concerted effort was made to move the MASHs closer to the battles, usually about 20 miles from the front lines. This proved to be efficient for easy access for the wounded while still operating safely. Relatively inactive hospital staffs were moved to augment the heavily burdened MASH since it received the greatest casualty load. During 1951, there were five U.S. MASHs and a Norwegian Mobile Surgical Hospital (60-bed capacity) in support of U.S. and U.N. troops. An unstaffed MASH was held in reserve.
Standards for a MASH required that it was disassembled, loaded onto vehicles, and ready to depart on six hours notice. After arrival at its new destination, it was operational within four hours. Each MASH operated five surgical tables in a shift with a highly organized system of managing shock patients. An ambulance platoon was attached to each MASH to facilitate the rapid evacuation when post-operative recovery was complete. Additionally, four helicopters were attached to each MASH. They, in turn, were utilized for resupply, rapid patient delivery to the MASH, and comfortable evacuation from the MASH.
By 1952 the fighting had stagnated and MASH units functioned primarily as static hospitals through 27 July 1953 when a cease fire agreement ended the fighting..
The results were outstanding. The early treatment of wounded at a MASH located only minutes from the battlefield, combined with the swift, comfortable delivery and evacuation of the seriously wounded by helicopter, helped to lower the fatality rate for the Army's wounded. That rate had been 4.5 percent during World War II. In Korea, it would eventually reach a new low of 2.5 percent.
MASH Unit Names and Numbers
A total of seven MASH units were operational in Korea, not all active for the entire period. By 1953, unit designations changed from the post-WW II and early Korean War designation Mobile Army Surgical Hospital to Surgical Hospital (Mobile Army) using the two digit designation in the table (New #). For example, the 8055th MASH became the 43d Surgical Hospital (Mobile Army). However, in general use the units were still called MASH.
MASH Enters the American Popular Culture
The mix of near-death casualties, leading edge emergency surgery, and life in a front line Army unit has a lot of dramatic potential. In 1953 Humphrey Bogart starred as a MASH surgeon, along with June Allison as an Army nurse, in the film Battle Circus set in a Korean War MASH. In 1968 the novel Mash: A Novel About Three Army Doctors by Richard Hooker brought the drama of the MASH units fully into public view, and became the basis of Robert Altman's 1970 film , followed by the 1972-1983 smash hit TV series . MASH became a permanent fixture of American culture. Dr. Otto Apel's relatively unknown book Mash: An Army Surgeon in Korea is the historically accurate account.
MASH Units After Korea
The Mobile Army Surgical Hospital (MASH) concept was firmly established by its success in Korea and MASH units continued to serve, deployed to Vietnam, the 1991 Gulf War, and the conflicts in Iraq and Afghanistan in the 2000s. At the same time, after a lag of 15-20 years, the Korean War MASH success in trauma management through helicopter evacuation, enlisted medics (para-medics), and advanced methods in the treatment of shock became the model for civilian urban trauma centers. The MASH-developed doctrine became the standard of practice in the U.S. and the rest of the developed world.
The Last MASH
Since the mid-1990s MASH units have been decommissioned one by one, converted into facilities that better meet the changing demands of combat. In 1997, the last MASH unit in South Korea was decommissioned. In October 2006, the 212th Mobile Army Surgical Hospital (the most decorated Army tactical hospital) became the 212th Combat Support Hospital, part of the Department of Defense’s transformation to brigade combat teams. The 212th MASH's last deployment was to Pakistan to support the 2005 Kashmir earthquake relief operations. Its equipment was left there, donated to Pakistan.
With the last MASH gone, its role has been superseded by the Combat Support Hospital (CSH), smaller casualty surgical hospitals intended to be deployed even closer to the front lines than the MASH.
Recommended Books about the Mobile Army Surgical Hospital (MASH)
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