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Mobile Army Surgical Hospitals, or MASH units, were units of the US Army used from World War II up through the Gulf War to provide quick and essential surgeries to wounded soldiers coming from the front.
MASH units became fully utilized at the outbreak of the Korean War in 1950. At the height of the war, there were a total of nine MASH hospitals in use, with each serving Army groups as large as 20,000-strong.
The Auxiliary Surgical Groups of World War II were far poorer equipped than the later MASH units. Surgeons, doctors, and nurses would travel just behind the front lines, exposing themselves to nearly as much danger as the soldiers they were trying to save.
Dr. Michael DeBakey, a surgeon who served in World War II as head of the Surgical Consultant's division, is widely cited as the man who conceived of the Auxiliary Surgical Groups and later, in preparation for the Korean War, helped refine and further develop the new mobile surgical hospitals known as MASH units.
Unofficial units of surgeons traveled the long, winding supply lines of WWII-era Europe, providing support much closer to the front and greatly decreasing the distance soldiers in need of surgery had to travel. They were known as Auxiliary Surgical Groups, and served as the direct precursors to MASH units.
MASH units were nothing more than a simple collection of tents, located as close as was safely possible to the front lines, that acted as a halfway stop between the violence and the full hospitals of the cities.
The Korean War was a notoriously bloody conflict, with a mortality rate higher than that of Word War II or the Vietnam War. An estimated five million people, including more than 2.5 million Korean civilians, were killed in the war. Without the help of the MASH units, the number would be even higher: the brave and tireless teams working in MASH units brought the wartime post-evacuation mortality rate from 4%, in WWII, to 2.5% during the Korean War.
The rough, mountainous terrain in Korea made it dangerous, inefficient, and time consuming to transport patients to the larger, metropolitan hospitals far from the front lines. MASH hospitals provided quick and necessary care to soldiers from the front lines in mere minutes.
The Korean War made intense use of the new MASH units. With most MASH units sitting less than 20 miles (32 km) from the front lines, these primitive, mobile hospitals were the first stop for nearly all of the war's American and South Korean casualties.
Despite the horrific conditions of working right on the outskirts of the war, MASH units proved to be incredibly effective in keeping soldiers and civilians alive. Seriously wounded individuals who successfully made it to a MASH unit had an incredible 97% chance of survival.
The close proximities of MASH units to the front line was instrumental in their excellent performance. Being so close to the action allowed surgeons to treat patients before the "golden hour," the immensely important first stage of trauma during which the chances of a successful surgery are best.
At the start of the war, MASH units were equipped with 60 beds each, but as the true human cost of the war quickly made itself apparent, that number went up to 120. Each unit was staffed by around 10 surgeons and medical officers, a dozen nurses, and around 80 other enlisted officers including anesthesiologists, clerks, cooks, and bedside caretakers.
Despite being so close, there was still an abundance of hurdles to cross before the wounded found themselves on a MASH operating table.
The first treatment was given by front line medics, and through "buddy aid," which refers to the basic first-aid skills learned and administered by fellow soldiers. Once it was deemed possible and/or necessary to move the wounded, those involved in field care would rush their comrade away from the front.
With far less surgeons or operating tables than patients, it was of the utmost importance to find out quickly which patients needed immediate attention and which ones could wait. MASH personnel revolutionized the practice of triage, ascribing colors to different severities of conditions, and tagging the wounded as they came in so that they could be quickly organized and save as many people as possible.
The vast majority of surgeons and nurses in MASH units were drafted civilian doctors, used to certain conditions and being able to take their time. These were luxuries none could afford in a wartime tent hospital, and these highly skilled professionals were forced to simply work as quickly as possible in order to save the life that was on the table, no matter how messy it made the job. This came to be known as "meatball surgery," a term popularized by US Army surgeon Richard Hooker in his 1968 novel 'MASH.'
Air lifts, or "aerodynamical evacuation," was an integral part of the speedy process bringing casualties from the front lines to the MASH units. Primitive helicopters, known as "airmobiles," could carry patients in a much quicker, and smoother, manner than jeeps and trucks could.
MASH units may have been far enough away to stay in relative safety, but that by no means meant they were sheltered from the horrors of the brutal conflict. Drafted soldiers as young as 17 years old came through the operating room in a constant stream with limbs blown off, eyes shot out, and all of the other horrendous scars war can put on a body.
Of course, as a mobile army surgical hospital, MASH units were always prepared to completely pack up shop with as little as six hours' notice. Wherever the war moved, MASH units moved with it, with most hospitals being relocated around once a month.
Despite the war, the work, and the homesickness, MASH personnel made the most of a bad situation. They would allow themselves to enjoy the warm Korean summers whenever possible, and try to relax with the people they were working with, being closer than any civilian hospital staff.
The protagonist of the immensely popular 'M*A*S*H' television show, Hawkeye Pierce, played by Alan Alda (pictured right), was based on one Dr. Richard Hornberger (pictured left), a doctor who served in the 8055th MASH unit during the Korean War. He would come to fame under his pen name: he was the aforementioned Richard Hooker who wrote the novel 'MASH,' which became the source material for both the subsequent film and television series.
Doctors, nurses, and the enlisted would gather for football games, swimming, singing, and dancing whenever the war allowed them the time to do so in a safe manner.
During the war, it was against Army regulations for surgeons to repair burst arteries: they were only meant to block them, which almost always leads to amputation. Hornberger, along with some other surgeons at the 8055th, decided that this went against their Hippocratic oath to "do no harm," and started defiantly repairing arteries and saving limbs. This dissenting practice spread to all other MASH units in Korea.
The final MASH unit in existence, the 212th, was last deployed to Pakistan to aid in relief operations after the devastating 2005 Kashmir earthquake. Before finally being disbanded and permanently retired from service, the 212th treated over 30,000 civilians, with a 97% survival rate.
Sources: (PBS) (History) (Encyclopedia.com)
See also: The bone-chilling stories behind this abandoned German hospital
The new modes of warfare that came into use in the Vietnam War, along with the new landscapes, quickly made MASH units obsolete. A huge number of soldiers in Vietnam needed treatment for burns caused by the widespread use of chemical weapons like Agent Orange, and thus required more burn specialists than surgeons. Most remaining MASH units were converted into "Medical Unit Self-Contained Transportable," or "MUST," units.
Despite the changing battleground proving MASH units unnecessary and inefficient, they still held on for a long time after the Korean and Vietnam wars. Seven MASH units were deployed during the Gulf War of 1990-91.
But Hornberger wasn't a fan of the show, and disliked the anti-war sentiment so central to the character of Hawkeye. Originally a reflection of Hornberger himself, who was decidedly pro-war and a staunch conservative, the beliefs of the real and the fictional didn't add up. However, there was one thing about the character that stayed true to its inspiration: Hawkeye's noble rebelliousness.
Only one MASH unit was deployed during the Vietnam War, known as the 2nd MASH Unit. This unit only served from October 1966 to July 1967, and saw very little action.
Stories of war are almost always centered around the soldiers, the commanders, and the pilots who face active battle in the skies, seas, and on the front lines. Those who keep these fighters alive, on the other hand, are rarely mentioned or given the praise they deserve. As we all now know thanks to the classic television show 'M*A*S*H,' those heroes in the Korean War were the drafted surgeons, nurses, anesthesiologists, and other medical professionals who worked tirelessly in the Mobile Army Surgical Hospital units just behind the front lines. Working tirelessly around the clock, these small teams could treat over 600 wounded soldiers and/or civilians in just 24 hours.
Intrigued? Read on to learn more about the brave and valiant professionals who worked in the MASH units of the 1950s.