Several medical advances, including the development of vaccines, better sanitation standards, and aseptic surgical techniques made World War I the first major American war in which deaths from battle injuries outnumbered deaths from disease. Shell fragments caused 75 percent of the World War I wounds, and the unprecedented mass casualties often swamped the system. CCSs, designed to receive between 150 and 400 wounded at a time, often received 1,000 or more patients. Their work was given a considerable boost by the work of Dr. Oswald Hope Robertson, a U.S. Army medical officer who established the world’s first blood banks, using sodium citrate as an anticoagulant and storing donated blood in chilled bottles at CCSs along the front. Robinson’s work was recognized as among the most significant medical contributions of the war, and the British government awarded him the Distinguished Service Order.

 

World War II, the Cold War, and Vietnam: From MASH to MUST

One of the most important periods in the history of military medicine – and in the influence of AMSUS as a clearinghouse for military medical information and research – was World War II. Because the war was fought on a global scale, the medical and logistical issues varied as widely as the theaters of operation. By this time, the Army and Navy medical establishments had matured considerably, but they were still working in parallel, with branch-specific missions and varying engagement with their reserve components or federal medical professionals.

In Europe, medical evacuation was performed through an echelon system, with the wounded evacuated to battalion aid stations, then mobile field or evacuation hospitals, and then to fixed general hospitals. The Army also introduced air transport of the injured. In the Pacific, this echelon system was, of necessity, altered somewhat. Navy hospital ships were active and busy throughout the war, and in 1943, amphibious landing ship tanks (LSTs) were modified to evacuate and treat wounded personnel. In both the Army and Navy, forward-stationed first-aid personnel were trained and performed as combatants, becoming the combat medics and corpsmen that remain in service today.

Breakthroughs in both preventive medicine and combat casualty care helped to save thousands of lives during World War II, and AMSUS played a significant role in facilitating intellectual exchanges. “AMSUS came to the colors in World War II,” said Smith. “The ’43 and ’44 meetings were full of stuff you needed to know as a doctor going to war. And those meeting publications were published separately from the journal, separate volumes of war medicine.” Both the Army and Navy medical departments administered their own continuing education and medical indoctrination courses, both stateside and overseas, to keep personnel knowledgeable and trained in the latest advances.

Before World War II had ended, it was clear that the echelon system of evacuation to field and general hospitals was too time-consuming and was costing the Army lives. The idea of providing immediate lifesaving treatments closer to the battlefield was introduced, and Col. Michael DeBakey – now more widely known as one of the founders of modern cardiac surgery – helped to pioneer the use of auxiliary surgery groups (ASGs): small, mobile units attached to field and evacuation hospitals. The ASGs greatly improved the survival rate of wounded soldiers and directly resulted in the development of Mobile Army Surgical Hospital (MASH) units during the Korean War.

The U.S. military underwent a massive reorganization after World War II, with each of the three service branches of the new Department of Defense (DOD) – the Army, Navy, and Air Force – administering its own streamlined and consolidated Medical Service Corps. The idea, supported by Gen. Dwight Eisenhower, to unite all the military medical services into one large medical service ultimately failed, even as the planning, doctrine, and operations of the branches became more “tri-service” or “purple.”

As the military began to build itself back up during the administration of President Ronald Reagan, AMSUS played a role, both in Military Medicine and its annual meetings, in addressing the growing reserve presence in the military medical establishment – and how these National Guard and Reserve professionals would interact and function within the medical departments, which were beginning to experiment with joint operations at stateside military treatment facilities.

There was little time for the medical services to absorb the lessons of the war before the Korean conflict began in the summer of 1950. The new MASH units, along with the first helicopter ambulance units, enabled wounded service members to reach fully equipped hospitals in minutes. More than 17,000 casualties were evacuated by helicopter in Korea, and the mortality rate from all wounds decreased to a historic low.

The success of these helicopters inspired further developments in aeromedical evacuation in Vietnam, where, during 1969, the peak year for air evacuation, 200,000 casualties were transported by helicopter. Corpsmen, medics, and surgeons performed valiantly in what was essentially a frontless conflict that featured a multitude of weapons – high-velocity small arms, grenades, rockets, mortars, mines, and booby traps – and a hot, muddy jungle environment that introduced new hazards and diseases.

One of the challenges of the tent-sheltered MASH units was that they were difficult to scale along with fluctuating casualty numbers. In Vietnam, the Army developed the Medical Unit, Self-Contained, Transportable (MUST), a modular installation that combined rigid-panel surgical shelters, inflatable ward sections, and utility packages. MUST and MASH units served together throughout the latter years of the war, but difficulties with the MUST soon emerged: It consumed a lot of fuel, wasn’t as agile as advertised, and the inflatable sections often suffered punctures.

Medical service in Vietnam wasn’t without its shortcomings. Even as military operations were becoming more integrated among the branches, the military medical departments remained distinct entities that continued to operate in parallel, without much interaction. Leaders at USUHS designed a curriculum that stressed joint thinking in military medicine, and Congress directed the Pentagon to create a standardized portable medical unit that could be used by all four branches of the armed forces. AMSUS had always had a strong relationship with VA (Veterans Administration, now Department of Veterans Affairs) physicians and nurses, because many of them were former military themselves, but the 1970s saw a greater effort to reach out to non-military physicians and researchers in the VA, many of them attached to academic and civilian hospitals. To emphasize its commitment to the spirit of collegiality and inclusiveness, the organization later changed its name to AMSUS: The Society of Federal Health Professionals, and redoubled its efforts to reach out to others involved in the continuum of military medical care.

As the military began to build itself back up during the administration of President Ronald Reagan, AMSUS played a role, both in Military Medicine and its annual meetings, in addressing the growing reserve presence in the military medical establishment – and how these National Guard and Reserve professionals would interact and function within the medical departments, which were beginning to experiment with joint operations at stateside military treatment facilities.

 

The Gulf War and Force Health Protection

When the United States and coalition forces launched Operations Desert Shield and Desert Storm in the Gulf War of 1990-1991, the military departments soon realized the MASH unit was too cumbersome to keep up with the pace of ground forces’ advance through Iraq. A new organizational structure was needed, and the 20-member Forward Surgical Team (FST) was devised to provide resuscitative surgery. The role of fixed hospitals was assumed by Combat Support Hospitals (CSHs): mobile and modular units capable of supporting between 44 and 248 beds.

Logistically, medical personnel from all branches performed well – and more jointly – in the Gulf War, both in theater and in European hospitals where some wounded were evacuated. Fortunately, the coalition’s rapid victory over Saddam Hussein’s forces resulted in very few American casualties.