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.
44th Surgical Hospital (Mobile Army) MASH operating room, Korea, January 1954.
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.
Helicopter Evacuation: Korea
A wounded American soldier is placed into the litter carrier of an evacuation helicopter at the 21st Infantry Regiment collecting station, Painmal, Korea (one mile south of the 38th Parallel),
3 April 1951.
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 Unit 8054th Evacuation Hospital
MASH Unit 8055th Staffed at onset of hostilities, June 1950.
Became the 43rd Surgical Hospital.
MASH Unit 8063rd Staffed at onset of hostilities, June 1950.
Became the 44th Surgical Hospital.
MASH Unit 8076th Staffed at onset of hostilities, June 1950.
First to use helicopters in Korea.
Became the 45th Surgical Hospital.
MASH Unit 8209th Originally 1st MASH, Arrived Korea September 1950.
Became the 46th Surgical Hospital.
MASH Unit 8225th Originally 2nd MASH. Deactivated end of May 1952.
Became the 47th Surgical Hospital.
MASH Unit 8228th Organized April 1952 to treat hemorrhagic fever patients.
Became the 48th Surgical Hospital.
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.
HISTORY OF THE 8076TH ARMY UNIT,
MOBILE ARMY SURGICAL HOSPITAL
(19 JULY 1950-31 JANUARY 1953)
45TH SURGICAL HOSPITAL, MOBILE ARMY
(1 FEBRUARY 1953-JULY 1953)
45TH M0BILE ARMY SURGICAL HOSPITAL
12 March 1953
Activated Yokohama, 19 July 1950
1. General Order No. 162, dtd 19 July 1950, Headquarters, Eighth United States Army activated the unit as a 60 bed MASH.
2. Personnel including twelve (12) Nurses and eighty-nine (89) Enlisted Men were drawn from hospitals all over Japan. One (1) MSC and one (1) Warrant Officer transferred out of hospitals in Japan. Ten (10) Medical Officers and other MSC Officers were flown from the states.
3. Organization was assisted in equipping itself at 155th Station Hospital in Yokohama. Personnel original were assigned to 155th and thus from there to 8076th MASH, APO 707 which was later changed to APO 301.
4. Personnel for Unit D, 8076th MASH, began arriving at 155th on 17th and were processed and equipment issued through period of 19 July. On 19th of July equipment was loaded on trucks and pulled over to Pier 2, Yokohama for combat loading on Sgt. USNS, George D. Keathley for shipment to Korea. Following key assignments wore made this date.
Major Kryder E. Van Buskirk -- Commanding Officer
Captain George O'Day -- Chief Surgery & Ex.
Captain Elizabeth Johnson -- Chief Nurse
Lt Richard E. Eddleman -- Supply Officer
Lt Octavian Buta -- Detachment Commander
Boarded the USNS George D. Keathley on the 20th of July. Personnel all in excellent physical condition. Trucks and equipment were loaded on board.
Sailed at 0800 on the morning of the 21st. During the following days of 21st, 22nd, 23rd, and 24th the personnel were briefed by the Commanding Officer on what to expect. Daily inspections of the ship were made, and a tentative plan on the job assignment was made. All personnel wore screened and interviewed. SOP's set up, and a general overall plan for operations and movement was established. During this time the overall administration operations of the hospital were taking place.
We arrived in Pusan on the 25th of July under the command of Major Kryder E. Van Buskirk. At midnight that night they departed by train for Kumchon and arrived there on the morning of the second day. They remained there only a few hours and departed for Taegu, only to stay there for only five days. At 0330 hours en the 1st of August they left Taegu for Miryang to the south. They began setting up at 1730 and worked all night getting tents etc. ready. Guerilla attacked the supply truck that night. The hospital had no operation tables and many ether essential items had to be improvised, however the hospital became first time operation that day with Sgt. Reed (Mess Sgt) as the first patient.
They remained in Miryang for two months until the 4th of October, during which time they were the main hospital of the MASH category which was supporting the Pusan Perimeter, furnishing forward hospital support of every division in Korea with the exception of the 25th division. During this period of time 5,674 patients were admitted to this hospital and in one instance 608 patients were admitted in one (24) hour period. Again at this time the supply truck was attacked by guerilla.
It was during this period that the amphibious landing was made at Inchon and accordingly the tide of battle was turned and the Eighth Army troops began to advance north and the MASH moved north to Taegu on 4 October, and remained there for one week before moving to Taejon on 11 October. It remained in Taejon only two days and moved north to Suwon on the 12th of October where it remained for only eight days, when it moved to Kumchon on the 21st October. It remained in Kumchon for only a week and moved on the 28th of October to Haeju and there again for only eight days until 5 November.
From the time after Hiryang when the landing was made at Inchon until Haeju things seemed to be going quite well for the U.N. troops and it was about this time that the famous statement that the boys would be home for Christmas was made. This was made without considering that the Chinese would enter which they did on 27 November (Major Van Buskirk was promoted to Lt Col 5 November 1950). About this time the hospital began to work in earnest again and the hospital moved again to Kumchon on 7 November staying two weeks until 22 November when it moved to Kunuri for perhaps what was the most tragic episode in its history.
It was then that the coldest weather ever encountered in Korea was met with temperatures as low as 23 and 30 degrees below zero with copious amount of snow. Because of the complete surprise of the Chinese intervention, and the unusually cold weather, there were men who were fighting in nothing more than fatigues and field jackets, so along with numerous battle casualties there were literally hundreds of men froze to death. During the six days they were in Kunuri there were 1,836 admissions to the hospital and on one day 661 admitted.
At this time there were only 12 Medical Officers and 120 Enlisted Men. There were no such things as blowers for heating, and the entire hospital was in tents. Routinely there were 13 and 14 persons in each squad tent.
The patients were arriving in such a large number that literally there was no place to put them inside the hospital tents, and when the ambulances would arrive they would just have to leave the patients lying in the snow, where unfortunately some froze to death before they could even be brought into the hospital tents. However being brought inside was no assurance against freezing because the temperature in the tents was so low that patients froze there, their resistance being lowered as a result of injuries.
It was at this time that one of the most difficult decisions any Medical Officer ever had to make was made. The influx of casualties was such that the unit was unable to care for all of them. Therefore some of the more seriously injured patients were given sufficient medication to prevent suffering and then they were put aside to die while the hospitals attention was focused on those casualties who could be saved.
After being in Kunuri for only six days, the order to "bug out" was given on the 28th of November, and accordingly the hospital loaded up and moved out at 1600 hours. Because of the pressing nature of the tactical situation then, not all of the patients were able to be evacuated simply because there were not enough ambulances to carry them out, and as a result about 40 of the patients, one of the doctors and several of the corpsmen were left behind to somewhat uncertain fate since the Chinese were advancing with such speed that all of the roads and highways were clogged with retreating U.N. personnel and equipment. Fortunately, help was gotten to rescue the stranded patients with the doctor and corpsmen, so none of the personnel were killed or taken prisoners.
It was on the "bug out" from Kunuri (four hours before CCF) that the MASH experienced its nearest disaster. Orders had been given Lt. Col. Van Buskirk to with draw to Pyong-yang, the north Korean Capitol by a certain route. However on reaching the forks in the road where the convoy was suppose to go left, Col. Van Buskirk decided that the route was unsafe and instead took the right fork, which is quite fortunate because all the troops and convoys which took the left fork were trapped in a road block with almost 100% of them either being killed or taken prisoners.
The unit arrived at Pyong-yang at 0200 and took over 1,000 patients from the l71 evacuation hospital which had been forced to retreat. It continued to treat casualties plus take care of the evacuation of all those casualties left by that unit. Most of those evacuations wore by air and the situation was so acute that planes that normally carried 35 or 40 patients were taking loads of 50 and 60.
The hospital remained at Pyong-yang for four days only before it was again forced to retreat southward to Kaesong, the old site of the truce talks. At Kaesong they stayed only a week leaving there at 1530 on the 10th December, again "bugging out", this time to Suwon for the second time.
At this time the retreat of the U.N. forces was so rushed that the roads were lined actually bumper to bumper with vehicles and the orders were that if any vehicle broke down, it was to be pulled to the side of the road, the motor destroyed, and the vehicle burned.
The tales of personal bravery, heroism, self preservation and sheer guts at that time, are a true credit to the Army. There was one soldier who was captured by the Chinese, who did nothing more than take his boots and later released him in his bare feet. The weather at that time was sub zero and the ground covered with snow. This soldier walked barefooted trying to reach our lines until his feet froze so that he was unable to walk further; he was forced to sit out in the open for three weeks with no food, no shelter except for his uniform and no water except for what he could obtain from eating snow. He was found at the end of this three week period weighing approximately 65 pounds and with both feet gangrenous and black, necessitating amputation of both logs. He was one of many who passed through this hospital.
The first Christmas and New Years Day were spent in Suwon while the front stabilized a bit, but again the U.N. forces were forced to retreat and this time the hospital with drew still further south to Taejon, setting up only to have to breakdown again after a few hours and go to Sanju on an over night move arriving 6 January.
At present most of you have no comprehension of what a move is like because we are so well established here that it seems inconceivable that the hospital could actually move, but at that time the hospital was set up to break down the tents, pack up the supplies, load them on trucks and be ready to pull out within 6 hours. There were no chances for each man to build up a little empire such as we have now, because there was no place to carry the excess gear. Between 4 October and 31 January the hospital moved on an average of once a week, and on one move the hospital was broken down and ready to pull out in one hour and fifteen minutes. The corpsmen and officers who were not driving vehicles, rode on top of the trucks after the gear had been packed.
The month of January was spent in Sangju as U.N. regrouped its forces and began the long slow drive back up the peninsula. At Sangju, the hospital was pitched in the river bed and guarded by heavy tanks.
On 1 February l95l the hospital moved north to Chungju where it stayed for a month before moving to Wonju on 4 March. It was at Wonju that U.N. troops took over a Chinese aid station when the Chinese retreated, and found approximately 79 of our own UN soldiers that had boon held as POWs. The unit moved to Hongchon 5 April.
At this time the MASH was functioning as a truly Mobile Hospital and as a truly Surgical Hospital and as a result it was nevermore than 10 miles and often as close as five miles behind the front, and as the fighting moved forward the MASH was right behind it.
At Hongsh'on in the latter part of April the Communists began their second counter offensive, and again the MASH had to "bug out", this time on 25 April which happened to be the 9th month anniversary of the MASH's arrival in Korea. At that time the hospital was only eight miles behind the MLR and knowing that the Communists were advancing we had been quite anxious about it and when we would have to move, however we were assured by Army we would hold fast our positions on the evening of the 25th, and about 0100 of 26 April, Corps advised unit would have to "bug out". All personnel were assembled, the hospital taken down and patients evacuated. By 0730 the hospital was enroute to Chungju for the second time.
This organization was placed in reserve at this time some 60 or 75 miles behind the front and sat up in a school building in Chungju which was later occupied by the 11th Evacuation Hospital.
Being in reserve was short lived, though, and two weeks later the unit was moved forward to Suwon for the third time. During the history of the MASH all was not grim all the time but occasional humorous things happened which made life quite liveable and did much to blend the MASH into a well-functioning integrated unit with one of the highest esprit de corps of any outfit in Korea. One of those incidents happened in Suwon, and although it was anything but funny at the time it later served as a wonderful basis for reminiscing: This was the night of the big rain, (one night after several days of almost continuous rain when the mud was almost up to the top of your boots. In addition to the rain there was a terrific wind storm which effectively blow down almost every tent on the compound pulling out the tent stakes as if they were matches. Everyone was routed out by the tents falling down on top of them and in the middle of the night with the rain pouring down in sheets everyone was outside trying to drive in new tent stakes; there was so much mud this was impossible so in the end all the trucks from the motor pool were called out and the tents were held up by the trucks until the mud dried out sufficiently to permit tent stakes to be used again.)
It was at Suwon that the 8076th was awarded the Meritorious Unit Commendation which reads as follows:
The MOBILE ARMY SURGICAL HOSPITAL, 8076th ARMY UNIT is cited for exceptionally meritorious conduct in the performance of outstanding services in Korea in support of combat operations during the period from 25 July 1950 to 11 May 1951. During this period the MOBILE ARMY SURGICAL HOSPITAL, 8076th ARMY UNIT functioned in close support of front line units rendering outstanding medical services. Its primary mission was to perform as a sixty-bed surgical hospital, however, in many instances the unit assumed the additional responsibilities of an evacuation hospital without loss of operational efficiency. Between 2 August and 5 October [at] Miryang, the unit furnished forward hospital support for all front line troops except the 25th Infantry Division, admitting 5,674 patients and in one twenty-four hour period handled 244 surgical procedures. On another occasion this unit processed 608 patients in one day. A total of 15,000 patients were cared for during the nine months this unit has been in operation, and the medical service rendered to the United Nation Forces was of the highest caliber. Under all types of conditions, this hospital has displayed outstanding initiative and aggressive action in performing its many missions.
Although the hospital was required to operate in no less than thirteen different areas in close medical support of front line units, its effectiveness and efficiency has excelled the high standards set by the Army Medical Service. The MOBILE ARMY SURGICAL HOSPITAL, 8076th ARMY UNIT displayed such outstanding devotion and superior performance of exceptionally difficult tasks as to set it apart and above other units with similar missions. The efficiency effectiveness and versatility shown by the members of the unit in the performance of their assigned missions reflect great credit on themselves, the Army Medical Service, and the military service of the United States
BY COMMAND OF LIEUTENANT GENERAL VAN FLEET
The Unit moved from Suwon north to Chunchon on 29 May 1951 and shortly after arriving there, Lt. Col. Van Buskirk rotated to the States and the new commanding officer was Major John Mothershead, later Lt. Col. Mothershead. At the tine of arrival in Chunchon, there was only a small air strip. There was no rail transportation available, and no bridges on the road between Chunchon and Seoul so after a heavy rain, supply trucks were frequently held up for several days until the streams went down enough to permit the trucks to ford them.
While at Chunchon the peace talks were started and accordingly the tactical situation diminished sufficiently that the unit had very few patients with the exception of one night when approximately 200 Chinese patients were sent within the period of about an hour, UN forces having overrun a Chinese clearing station. Among them was a Chinese Nurse who remained with the unit for approximately a month taking care of the numerous prisoner patients during that time.
On 17 September 1951 the unit moved forward to Hwachon. The stay at Chunchon was the longest which had been accomplished in any one location, and by that time all of the original members of the outfit had rotated to the states, so this move was accomplished with less finesse and ease than the other moves, and in fact had to be made in a period of two days.
During the last quarter of 1951 the unit remained at Hwachon and as described above continued to function in a most efficient manner. From the period of 17 September 1951 to 31 December 1951 the unit took care of 3,986 patients, 98% of them being battle casualties. Rotation and transfers to other areas in the Far Fast Command made heavy indentations on the experienced personnel. Adequate replacements commenced to arrive during the latter part of November and December to the extent that the enlisted strength went from a figure of 196 in November to 223 by the end of December. During the last quarter of l95l the unit was in direct support of the 1st Cavalry Division and the 7th Infantry Division until mid-November, when the front lines were moved north approximately nine miles and extended to our left and right flanks for an average of twenty miles. ROKA Divisions commenced to replace American Divisions which reflected in the patient status to the extent that about one half were ROKA patients for the last half of December.
Due to the peace negotiations the entire front was comparatively quiet with the start of the New Year which created a situation that found the unit for the first time in its history doing work comparable to that of an evacuation hospital. Which including running a rather large out-patient service, giving consultations, performing laboratory work for nearby units and in general rendering a more diversified medical service. However the primary mission as always was to give surgical support to combat divisions. During the month of January through April the hospital supported the 7th Division, 2nd, 3rd, and 25th and some elements of the II ROKA Corps who commenced to move in the area to the north. The unit participated in one campaign during this period, the second Korean winter, 28 November 1951 to 30 April 52 inclusive. In January of 1952, 1,178 patients were processed with only 323 battle casualties. In February 1952, 1,132 patients were processed with 208 of them as battle casualties. In March, 986 patients were admitted and 239 of them were battle casualties. In April 963 patients were processed with 223 of those as battle casualties.
With the passing of winter and a comparative quiet front. A general improvement program was ordered by Lt. Col. Maurice R. Connolly that actually started in July 1952. For the first sustained period in the history of the unit personal conveniences and material comforts become of paramount importance. Prior to this everyone was too occupied in work, keeping warm and moving to be very concerned about the adequacy of latrines and quarters, the suitability of the EM and Officers clubs etc. In conjunction with the improvement program a training program was also put into effect for the first time in the history of the unit. Even paper work, reports and red tape in general commenced to increase to an extent that at times even the expression "police action" seemed like a vague term as applied to the general situation where the 8076th was concerned. Rotation continued to have its effect as reflected in the decrease of EM strength of 223 in December to 194 in Apri1. The Officers and Nurse strength remained constant the majority of the time.
During May and June American Divisions to the north were shifted ta other sections of the front and replaced entire with divisions of the II ROKA Corps which included the 2nd, 3rd, 6th, 8th, 9th and Capital ROKA divisions. Other than receiving patients from American divisions in reserve and as a result of vehicle accidents most admissions were ROKA soldiers. In May 762 patients were admitted with 246 of them battle casualties. In June there were 846 with 229 as battle casualties. In July there were 642 patients with 149 battle casualties.
The summer was highlighted by a formal presentation, complete with band and formation on the 30 July 1952, from General Paik Nam Kwon Commanding General of the II ROKA Corps commending the organization for its support of ROKA divisions.
August l952 was an uneventful month with a total admission of only 432 of which 214 were battle casualties. Such factors as R & R quotas, trips to Seoul, picnics and social activities gradually became of more importance, although dirt and generally undesirable living conditions were a constant problem.
Improvements of the area were expedited with the advent of winter which included new tentage and floors for the hospital proper and pre--fab wall lining. The EM mess tent was replaced, a complete new holding ward was framed and setup, the Officers and Nurses quarters were completely replaced, and EM quarters were replaced as required. Pre--fab structures replaced supply housing, Officers and EM club, theater and chapel, shower unit and motor pool. The PX, barber shop and post office were put into one tent with new floor, counters and shelves.
August and September found many older personnel leaving. By 15 September the enlisted strength had decreased to 129 and new personnel were commencing to arrive weekly. The training program was stepped to counteract this in the form of on the job training, classroom instruction and field training.
September found admissions only 362 with 221 of these battle casualties. October admissions went to 486 with 284 battle casualties. In November only 322 patients were admitted of which 189 were battle casualties. December ended 1952 with 278 admissions of which 108 wore battle casualties.
On the 4th of November Lt. Col. Maurice R. Connolly was evacuated with hemorrhagic fever to the ZI and Captain Charles E. Hannan assumed Command. Major Irvine O. Jordan was transferred from the 121st Evacuation Hospital on the 9th of November and assumed command on that date. Major Harry Grossman was transferred from the 8063rd MASH on the 2nd December and relieved Major Jordon of command on that date.
On the 2nd of December the 8193rd AU, Helicopter Detachment was reorganized as the 50th Medical Detachment, Helicopter Ambulance with an authorized strength of 7 Officers and 21 EM. This change attached them to the hospital for administration and logistical support. Their strength to date was only 4 Officers and 4 EM.
The year 1953 commenced in an uneventful manner. For the month of January, 155 patients were admitted to the hospital, 42 of them battle casualties. Rotation continued to make constant changes in personnel. The enlisted strength continued to drop to the extent that for the first two months of the year it averaged 115 men. Major Harry Grossman was evacuated medically on the 29th of January and Captain Charles Hannan assumed Command on that date.
On 7 February 1953 Lt. Col. Charles F. Hollingsworth was assigned and assumed command. On 1 February the 8076th MASH AU was redesignated to the 45th MASHosp per General Order No. 69 Hdq. (EUSAK) dtd 10 Jan 1953 to operate under TO&E 8-571, which authorizes 16 male officers including 3 administrative officers, 12 female officers and 93 enlisted men. The redesignation entailed a considerable amount of administrative work which was effected completely by 20 February. On 24 February practice moves by all hospital sections were made a part of the regular training program. The results were most gratifying in that during the week ending 28 February the hospital proper had moves by sections and the longest time taken by any one department was an hour and fifteen minutes to completely load, unload and set up to receive patients. As a result of this it was estimated that in spite of the long stagnant period experienced, the hospital proper could set up and receive patients in five hours.
The 45th Surgical Hospital was operational for the entire month of March. Our mission was to provide medical support for the divisions of the II ROK Corps. In addition, hospitalization and out-patient treatment was given to American divisions in reserve.
Evacuation of patients and casualties was effected by units of the 584th Medical Ambulance Company and the 50th Medical Detachment, Helicopter Group.
On April 3, 1953 the hospital made its first move in several months from Hwachon to Munsan-Ni for the purpose of participating in Operation Little Switch, the first prisoner exchange. The function of the hospital was to receive and give first medical attention to the returned sick and wounded United Nations prisoners of war. By afternoon of April 4, 1953 the hospital was set up and ready to receive patients.
In an effort to provide a maximum of comfort for the patients, metal folding type beds with mattresses were used and were made up with new linen and two new blankets. On each bedside stand were a set of new pajamas, a bathrobe, towel, and slippers. The patients were able to get a meal, a coke, coffee, malted milks, frappes, and cigarettes.
Since there were no cases requiring surgery among the 213 returned prisoners, the average time spent in the hospital was relatively short. . . . . only forty minutes.
The medical operations for the rest of the month consisted of sick call for our own and adjacent units.
After Operation Little Switch was carried out, the physical plan of the hospital had to be altered in order to carry out the needs of and efficient Surgical Hospital. The case with which the succeeding great number of casualties was handled proved the change to be adequate and practical. Many of the casualties were Turkish Armed Forces Personnel and there was some difficulty overcoming the language barrier.
The hospital continued operations at Munsan-Ni until June 21, 1953 when it moved to a new area at P'Aiu-Ri, Korea. At no time during the move was the hospital non-operational. Casualties for the period from American Divisions, the Turkish Army Brigade, and other United Nations troops.
During the initial days of the month much time was spent in adding conveniences and luxuries to the area. A shower unit and laundry were set up. The EM club and Red Cross tent provided recreational facilities during off-duty hours.
On July 9, 1953 we were alerted to move and on July 10 the move was effected. The hospital was operational near Toknon-Ni, North Korea from July 10, 1953 thru July 27 supporting 7th Infantry Division troops during the pushes against Pork Chop Hill. On July 24 this unit received a letter of commendation (dated 18 July 1953) from Major General Arthur G. Trudeau, Commanding general of the 7th Infantry Division, for its outstanding medical support.
At Toknon-Ni we were rather cramped for space, therefore few conveniences or recreational facilities were available. Morale remained high, however, due primarily to the excellent food prepared by our new mess sergeant, Sergeant Loving.
With the signing of the truce on July 27, 1953, we were ordered to move back to our former location at P'Aiu-Ri to ready ourselves for our part in the long awaited Operation Big Switch.
MOBILE ARMY SURGICAL HOSPITAL
8076TH ARMY UNIT
14 January l95l
SUBJECT: Annual Report of Medical Department Activities, Mobile
Army Surgical Hospital, 8076th Army Unit.
THRU: The Surgeon
8th US Army Korea (EUSAK)
TO: The Surgeon General
Department of the Army
Washington 25, D. C.
1. PRINCIPAL MEDICAL ACTIVITIES OF THE COMMAND
The principal medical activities of this command have been; to furnish surgical and medical support to the combat division, principally in the care of non--transportable casualties so seriously wounded that further evacuation to the rear would jeopardize their recovery; to co-ordinate evacuation of all casualties, from division areas to installations in the rear, and treat slightly wounded cases who can be returned to duty within ten days, tactical situation permitting. Casualties here receive emergency as well as highly specialized treatment. They are given skilled pre-operative, operative and post-operative care. When transportable these are evacuated to rear installations.
2. ORGANIZATION AND EQUIPMENT
A. This hospital was activated per General Orders No. 161, Hq 8th US Army, APO 343, dated 19 July 1950, under T/O&E 8-571, dated 28 October 1948, and expanded per General Orders No. 180, Hq 8th US Army Korea, APO 301, dated 24 November 1950. Due to the wide variation in the tactical situation encountered in this theatre, the missions of this unit have varied widely. This unit has been operational 152 days and had 9,008 admissions. It was first operational at Miryang, Korea, from 2 August 1950 to 5 October 1950. During this 65 day period, 5,674 patients passed through the hospital. 244 surgical patients on one occasion and 192 on another were admitted during a 24 hour period. The greatest number of dispositions in one 24 hour period was 608. It was fortunate that the unit during its busiest time at Miryang had selected a woolen mill to set up in, for its expansion was unlimited. Storage warehouses were used as wards and as the patient load increased, new wards were opened up in vacant warehouses. At one time this unit had a census of 427 patients. At the beginning of operations, the unit was organized into a Headquarters Section, a Professional Service and Administrative Service. The Professional Service consisted of operating, Ward, Pharmacy, Laboratory and X-ray Sections. The Administrative Services consisted of Detachment Headquarters, Supply, Mess, Registrar and Motor Sections. On 15 October 1950, per paragraph 211, Hq 2nd Infantry Division, one lieutenant, Dental Corps, and one dental technician, enlisted man, was attached to the command.
On this date a Dental Section was added to Professional Service.
This arrangement while caring for but surgical cases worked well; but as the situation changed and the mission of the hospital, in addition to being primarily surgical, become one of an evacuation hospital, minor changes were made which it is believed helped the unit to function more smoothly. The Headquarters Section and the Detachment Headquarters were consolidated thereby pooling the resources of three clerks. Four Enlisted Men were originally in the Registrar Section; two more were assigned because of the heavy patient load. An Evacuation Section consisting of one Medical Corps officer, one Medical Service Corps officer and one NCO was established as a subdivision of the Registrar Section. This provided for a smooth co-ordination of patients designated for evacuation from the Holding wards to the evacuating medium (i.e. ambulance, train and/or air).
The need for local security, which because of the tactical situation and locations in some areas rendered it impossible for other units nearby to supply local security made it necessary to add a Guard Section consisting of ten Enlisted Men. By making this a permanent section disruption of night and day personnel shifts was avoided making for a smoother functioning unit.
From 28 October 1950 through 3l December 1950, the unit moved six times. Local buildings were utilized in all instances and supplemented with tents as necessary. Because of the problem of weatherproofing, heating, and lighting these buildings, a separate Utilities Section of seven Enlisted Men was set up, which greatly facilitated housekeeping. It is believed a trained electrician and carpenter would be a definite addition and facilitate greatly the lighting and housekeeping problem encountered.
B. Equipment -- Equipment as basically supplied this unit was entirely adequate for function of the operating section and ward sections, however, when casualties were exceptionally heavy there was a shortage of oxygen flow meters, suction apparati and anesthesia machines, but as the need for this additional equipment arose it was promptly supplied through 8th Army Medical Supply channels.
The following recommendations are submitted for the Orthopedic Set as it is supplied. The table portable, field orthopedic, has been satisfactory with the exception of one factor. It is impossible to apply a body jacket or a Minerva jacket to spinal injuries in hyperextension while the patient is under general anesthesia. Two modifications of the table could be made very easily - one the addition of the Goldthwaite irons and their end pieces to the present table for the application of jackets in the hyperextended supine position and the use of a canvas strap with fixation at the chest symphisis to apply jackets in the prone position. Minerva jackets can be applied with the same apparatus by the use of the Goldthwaite irons. There is too much equipment available in the orthopedic line of some types and too little of other types in the field. The use of plates, screws, Lohman clamps, twist drills, etc. is of questionable value at the field levels and under field conditions but these and others are included in the field fracture and amputation sets. Coversely [sic] there is very little Kirschner wire and Steinman equipment available and in the Korean Theater up to this time there has been almost none of this available. It is felt that these should be heavily stocked in the Mobile Army Surgical Hospitals. These are unquestionably emergency treatment items and are of more value than equipment provided for definitive surgical procedures. The stock of wire suture material is largely confined to heavier gauges. This should be available down to the level of No. 36 wire. It is well known that wire suture material is inert in the presence of sepsis and the use of it in closing the lateral borders of wounds to decrease their size, when it is known that sepsis will follow, would be of value. Then too, the use of finer gauges of wire in the Bonnel technique of tendon repair presents itself in cases incurred under clean circumstances and recently enough to be repaired, such as one finds in mess and utility personnel of nearby units.
The 250,000 BTU gasoline space heaters as supplied to this organization have been invaluable, however much difficulty has been experienced in keeping them operational. The chief difficulty with the blower type unit heater being the frailness and lack of stability of the gasoline engines which require almost constant maintenance to keep them in adjustment and in functioning condition. These blower motors can be only regarded as gadgets rather than as functional pieces of equipment. At present this organization has converted one of these units which became so unserviceable that it is powered by an electric motor. This modification has proved much more dependable and satisfactory than the units supplied.
C. Attached Units -- This unit has always been supplied with at least one ambulance platoon and sometimes with two depending on the tactical situation.
Too much cannot be said in praise of the helicopters stationed at the hospital who brought seriously wounded patients from inaccessible areas and evacuated seriously wounded casualties from forward medical installations, thereby providing a quick, smooth comfortable evacuation from forward areas to the hospital with a minimum of shock and delay.
3. PHYSICAL AND MENTAL HEALTH OF THE COMMAND
In general, the physical and mental health of this command has been excellent, of all disease encountered in the past six months, those of infectious origin have predominated. Included below are diseases and incidence of such in this command during the past six months.
Poliomyelitis -- a rapidly fatal case of bulbar polio was observed. That patient was evacuated to a hospital ship where, despite treatment in a respirator, he died six hours later.
Hepatitis -- There have been five cases at sporadic intervals. All were evacuated to Japan. Two have returned to duty.
Dysentery - Dysentery, presumably bacterial, was of moderate incidence during the summer months. All cases responded quickly to the newer antibiotic agents (aureomycin and chloramphenicol). The source of infection could not be localized, but mess, water and latrine sanitation in hospital area were definitely excluded.
Upper Respiratory Infections -- There have been two mild outbreaks of nasal pharyngitis, acute catarrahal, in this command. There has been no pneumonia, either viral or bacterial.
Tuberculosis -- One case of suspected TB of kidney, manifested by persistent hematuria, dysuria, and irregularity of one calyx on retrograde urography was studied and evacuated. No instance of pulmonary TB has been seen.
Venereal Disease - Gonorrhea five cases and chancroid two cases have been noted. No suspected luetic lesions have been observed.
Malaria -- There has been no malaria observed in this command. All have received by roster weekly prophylactic doses of chloroquin during the malaria season.
No Cholorea, Tetanus, protozoan, or metazoan diseases have been observed.
b. Organic Disease
One case of hypertensive cardio--vascular disease in a forty-five year old Enlisted member of the command was observed and evacuated.
c. Accidents and Injuries
Burns -- There have been three cases of burns, all due to gasoline explosions. One case of 1st and 2nd degree burns involving 10% of body surface required evacuation, others were treated on duty status.
Injuries -- Four fractures due to injuries have occurred, two of sufficient severity to require evacuation. Others were treated on duty status. There was one case of severance of radial artery with concurrent dislocation of radio-carpal joint, treated here and evacuated for physio-therapy. He has subsequently returned to duty. One nurse developed torticollis and was evacuated.
There has been no heat exhaustion or frost--bite. There have been no casualties as a result of enemy action.
d. Psychiatric Disease
Two psychiatric casualties have been evacuated from the theater with diagnoses of paranoid schizo--phrenia, and severe anxiety state, in general the mental health of this command has been excellent, and morale has remained high.
The officers, nurses and enlisted personnel have been housed in local buildings within the hospital compound when these were available. Sectional and squad tents have been used at other times. Ventilation and heating have always been good to excellent. General cleanliness of the quarters has been well maintained. During the summer months mosquito and fly control was good. DDT spraying was carried out effectively throughout the hospital area with the occasional assistance of a sanitation team from a nearby unit. The usual "fly attractive" areas such as the mess, the latrines, and garbage disposal pits, were kept fly free by the usual general measures: frequent changes of pits and latrines, scrubbing of latrine boxes with disinfectant solutions, and mess cleanliness. Rodents presented no problem. Frequent aerosol bomb spraying of the operating room was carried out during the summer months, and mosquito netting was placed so as to cover the entrance to the operating room, as well as to the patients wards. Insect repellent as well as DDT powder was available to all patients. Tissues removed at surgery, as well as old dressings were burned and buried. Water supply has at all times been within easy reach of the hospitals water truck. The hospital utilities section has made shower baths available to the unit whenever possible. Occasionally the shower points of nearby larger unite have been available. Hospital laundry has been handled very efficiently by the Quartermaster laundries of nearby divisional units. While at Miryang, their facilities were not available and local labor was hired to do the hospital laundry. The hospital supplies and equipment for necessary sanitary measures have been quite adequate.
5. INCIDENCE OF INFECTIOUS DISEASES OBSERVED IN HOSPITALIZED CASES
a. Venereal Diseases -- chancroid, gonorrhea, luetic chancre, and lympho-granuloma venereum were the most frequently observed infectious illnesses. All diagnoses were clinical, save for smears in suspected gonorrhea and chancroid, as this installation has no facilities for serological diagnosis. Whenever possible, persons with venereal disease were returned to duty, but often they had to be evacuated because their unit had left the area. Gonorrhea was treated with either 300,000 or 600,000 units of procaine penicillin with good effect. Patients with suspected primary syphillis were started on a course of procaine penicillin, 600,000 units daily x 10, and then returned to duty with instruction to report to their unit dispensary to complete the treatment. Chancroid was treated with streptomycin 0.7 gms twice a day for five days, initially, but later in the year, good results were obtained with aureomycin 2 to 4 gms daily for five to ten days. The same treatment was used in lymphogranuloma venereum.
b. Dysentery - dysentery was the next most frequent type of infectious disease. No laboratory confirmation as to type was obtained. The majority were presumed to be bacillary, and most of these responded to aureomycin or chloroimycetin therapy, usually being ready for duty in two to five days.
c. Malaria -- malaria was observed frequently in August and September. A few cases were found in December, but these occurred among members of the Philippine 10th BCT, and were thought to be acute recurrense of chronic malaria acquired before arrival in Korea. All cases beceme clinically well with chloroquin, the most frequent dosage schedule used being 1.0 gm stat, with 0.5 gms three times daily for three days thereafter.
d. Encephalitis -- Encephalitis of unknown type, but thought to be Japanese B was seen often in August and September. All had positive spinal fluid findings, usually showing 100 to 1200 cells per cu. mm., with lymphocytes and neutrophils varying in predominance from case to case. All cases were acutely and severely ill at the time of evacuation, but no patients died before leaving the unit. Only three eases of poliomyslitis were observed, two of whom expired because of respiratory failure.
e. Hepatitis - hepatitis as evidenced by icterus was seen infrequently, and all such cases were quickly evacuated for definitive therapy.
f. Respiratory Infections of various types were seen with increasing frequency during late November and December. The most serious of these were pnuemonitis, of unknown type, seen most commonly among Philippine troops and Thailanders. These patients were evacuated due to the tactical situation before the results of aureomycin therapy could be evaluated. For incidence and control of infectious diseases in the command, see paragraphs three and tour.
6. OUTSTANDING CLINICAL EXPERIENCES, IMPROVEMENTS IN MEDICAL PRACTICE
This unit was located in an area where casualties were extremely heavy, and for a time we received all surgical casualties from the 2nd Infantry Division, 24th Infantry Division, 1st Cavalry Division, 5th Regiment--1st Marine Brigade, and ROK forces. In less than a two months period, three hundred (300) laporatomies were performed in this institution. About fifteen (15) ruptured uretheras, numerous injuries to extremities, chest and head were encountered. TBM [Technical Bulletin Medical, TB MED] 147, and its forerunner, the "ETO Manual of Therapy", was familiar to all surgeons, and was used as a basis for all treatments, however, from experiences during this period, it is believed some points can be emphasized which can be of future help to the trained surgeon uninitiated in war surgery. For all wounds or injury other than enumerated below TBM 147 very adequately covers the basic procedures.
A bold, ample para median incision provides better exposure and is much less time consuming than a transverse incision and is in nearly all cases the incision of choice. The surgeon then quickly assays the amount of work to be performed. The first step should be gentle but rapid exploration of the small bowel from Treitz to cecum, with complete evisceration of the small bowel. This maneuver affords thorough inspection of the small bowel for perforations; inspection of the mesentery for bleeders, which if present are promptly secured; direct vision of all colic gutters, and easy and thorough inspection of the posterior abdomen. Intestinal perforations are marked and clamped to prevent further contamination of the abdomen, and the remainder of the abdomen surveyed. The viscera are now replaced and the survey completed and the necessary operative procedures are now performed. While it is realized that evisceration is a shocking procedure the operating time and the more thorough exploration afforded, well overweighs the disadvantages.
Severely lacerated livers were encountered accompanied in several cases by marked hemorrhage. Fibrinfoam has been the only one of the foams available at this installation. Its use in these cases has in general been disappointing. Best results have been obtained using deep mattress sutures with generous fat grafts beneath the loops to prevent the sutures from lacerating the liver substance. In several cases rather large hepatic ducts were torn by the missiles, and rather than trust entirely a Penrose drain, a latex tube of 26 F with side perforations was placed along the damaged area or actually incorporated into the bed of the furrow before securing the mattress sutures. The tube, along with the Penrose drain, was then delivered to the outside through a stab wound in the right flank. Over 350 cc of bile drainage has been obtained from these tubes in a 24 hour period.
Combined thoraco-abdominal wounds were handled in the main by aspirating the blood from the cheat by catheter and suction prior to closure of the defect in the diaphragm. The case was then handled primarily as a chest case. We were very much impressed by the very small number of wounds of the chest which required open thoracotomy. The majority responded well to repeated aspirations of blood, maintenance of normal chest physiology in so far as possible, blood transfusions, oxygen and general supportive measures. When catheter drainage of the thorax with underwater seal was indicated, the use of large catheters cannot be stressed too strongly, as smaller ones tend to become blocked and require too much attention to keep them functioning properly.
Wounds of the G U Tract
Perforated urinary bladders and vesico--rectal fistulas were treated in accordance with TBM 147. There is nothing outlined in this bulletin as to the care of uretheral wounds. Approximately 15 completely ruptured urethras were observed. These were almost always associated with perineal and pelvic injuries. While it is realized that the procedure as suggested here cannot be properly evaluated until the final end results are appraised, it is believed. that difficult secondary reconstructive surgery has been minimized, in that a patent splinted channel has been maintained from the bladder through the urethral meatus in all cases. If a catheter could be passed to the bladder and a free flew of urine obtained, the catheter, usually a 20 F or 22 F 5cc Foley, was left indwelling and no further treatment was believed indicated. If, however, a catheter could not be passed the defect was explored, and a primary reconstruction was accomplished over a splinting catheter. Urinary flow was diverted from the anastomosed area by one of two methods, depending on the location of the detect. If the rupture was in the bulb or anterior, an external perineal urethrostomy was done with bladder drainage accomplished by a 26 F 5cc Foley catheter, and a No. 20 F or 22 F splint extending through the urethrostomy and out through the urethral meatus. If the lesion was proximal to the bulb, a splinting catheter was passed to the bladder, a suprapubic cystostomy accomplished, the defect repaired, and the pelvic diaphragm and perineal muscles repaired as well as possible.
Traumatic lesions of the upper G U tract included many contused kidneys lacerated kidneys, and one case in which the ureter was severed in the upper third. As with lesions of the lower tract, there was almost always coexistent pathology. In general, where possible, operative procedure was delayed and serial urinalyses were done to determine the progression or regression of the hematuria. If the hematuria decreased, and the patient was adequately supported, as one could be certain the kidney was the only organ involved, no operative intervention was attempted. Cases not responding to the treatment as outlined above, were explored, usually transperitoneally, as there was usually associated abdominal pathology. Resection of a badly shattered lower pole of one kidney was carried out in one case. Two lacerated parenchymal lesions of renal tissue extending into the pelvis were repaired and nephrostomy tube inserted. The severed ureter was treated by insertion of a splint tube down the ureter, and a nephrostomy on the same side. A pyelostomy probably would have been preferable, but the procedure was further complicated because the subject had an intrarenal pelvis. At the same procedure three perforations of the small intestine were also repaired. Only three nephrectomies were performed during the entire period of this report.
It is regrettable that due to the rush and pressure upon this unit more detailed studies could not be carried out on these casualties. It is also unfortunate that the results of the work done here cannot be further observed. The salient points learned from this experience can only restate that which has so often been stated. Before any operative procedure is attempted, the patient must be adequately treated for shock, only those measures essentially necessary be done, speed and gentleness throughout all procedures must be strictly observed.
This organization as any other has encountered personnel problems. The personnel strength has been increased by General Orders 180, HQ EUSAK, and it is felt that the proper number of personnel, including medical officers, nurses and enlisted men, is now sufficient to carry out the assigned tasks of this hospital. Under T/O&E 8--571, the following breakdown of personnel is supplied: 14 Medical Corps Officers, 2 Medical Service Corps Officers, 1 Warrant Officer, l2 Army Nurse Corps Officers and 97 Enlisted Men. By issuance of General Orders 180, Hq EUSAK, the following revision was made: 15 Medical Corps Officers, 5 Medical Service Corps Officers, 17 Army Nurse Corps Officers and 121 Enlisted Men. Attached for administration, duty, rations and quarters was always an ambulance platoon from either the 567th Medical Ambulance Company (Sep) or 584th Medical Ambulance Company (Sep). This was always provided by Medical Section, EUSAK, in order that proper evacuation be accomplished.
With the constant moving up and down the peninsula, administration at times has been hindered, but on the whole, taking into consideration the difficulties of distribution and mail, breakage and occasional loss of equipment, and the shortage of AR's, SR's and other governing materials, the organization has been able to keep up its administration in a very satisfactory manner.
During the majority of the time, the personnel of the hospital have been working. Because of the steady influx of work, "on the job training" has been the source of knowledge acquired by personnel. It is believed that "doing" plus an occasional helping suggestion is the best way of learning under field conditions.
During the periods of time when the hospital was not abnormally busy, inventories, policing and improvements of all kinds were and still are generally in order.
Supply problems experienced during the period of this report have been relatively small. During the period of time this unit was located at Miryang, Korea, all medical supplies were procured from the 6th Medical Depot in Pusan. Usually a representative of the supply section was dispatched to Pusan with a requisition to be filled and returned either by hospital or by vehicle, however, from time to time when emergencies occurred medical items were flown in by liaison plane and helicopter.
On moving North a constant flew of supplies was provided by the advance platoons of the 6th Medical Depot. The use of helicopter transport proved invaluable during periods of action resulting in large numbers of seriously wounded casualties, when as many as 100 units of whole blood were used in an 8 hour period and reserve blood supplies were depleted.
Blanket and litter exchange proved to be somewhat of a problem at various times due to shortages in the theatre, however, the hospital trains at present are furnishing an adequate exchange. Exchange of blankets and litters on patients evacuated by air has caused some concern, since no exchange has been provided. The exchange of blankets at Kunu-ri during the latter part of November proved quite a problem due to the extreme cold weather requiring up to six blankets per patient, the exceptionally high census, and fact that all patients were evacuated by air. Since the supply run to Pyongyang required at least a full day, the shortage was alleviated by airlifts arranged through the 8th Army Surgeon's office.
Quartermaster, Signal, Ordnance, Engineer logistical support has been adequately provided by the 2nd Infantry Division and 24th Infantry Division, as well as the various Army technical supply units.
K. E. VAN BUSKIRK
Lt Colonel, MC