Triage and Trauma Medicine in United States Military History

Amanda Snodgrass is an English Major at Grinnell College, in Iowa who has an interest in biological chemistry, genetics and the zombie apocalypse. She has a chocolate cocker spaniel named Buddy and a hedgehog named John. She is a Lord of the Rings, Harry Potter and BBC Sherlock buff. Live long and Prosper.

Military medicine has come a long way since the Civil War. Gone are the days of the willy-nilly amputations and a shot of whiskey as an anesthetic. Today, military surgeons have better training, more experience, and better tools to save the lives of the soldiers defending our country’s interests. The journey to today’s triage and traumatic surgery was dangerous and often uncoordinated. The United States’ wartime participation has produced a modern, flexible form of military medicine despite the nation’s originally messy forms of medicine.

During the Civil War, Jonathan Letterman, former head of the medical staff in the Army of the Potomac (1862) assembled a small group of medical doctors to work with specific regiments in the Union Army. He introduced the Ambulance Corps, a group specifically for medical purposes. Previous ambulance groups were disorganized, understaffed, and frequently commandeered by non-medical officers. Letterman assigned each regiment litter bearers and doctors, but, as Kyle Wichtendahl notes, because these regiments were so divided, doctors “worked for their unit only, were either swamped with casualties or idle”. One of the most memorable parts of Civil War medicine is the amount and type of amputations performed in the battle field hospitals; these were done to lessen the chances of infection by the bullets lodged in limbs. The development of amputation and the Ambulance Corps were developed to help civilians get to hospitals and survive.

World War I brought new types of weapons, which called for new types of medical practices. A Belgian doctor, Antoine De Page created a five-step evacuation system adapted by the US that allowed the injured to be removed from the trenches and taken to newly established field hospitals for care.

  1. Remove the injured under cover of darkness: This had to happen at night because the German lines were so close, sometimes only 500 yards away.
  2. Casualty Clearing Station (CCS): De Page found that clearing wounds of all debris and dead tissue aided in healing
  3. Ambulances: The American Red Cross and the YMCA taught drivers’ training in order to quickly navigate potholes and road bombs while evacuating the injured
  4. Postes Avances des Hospitaux du Front: These mobile hospitals were set up several miles behind the lines and cared for the intermediately injured, those who could not make it farther but could be saved.
  5. Pre-Established Hospitals: The injured were then evacuated to hospitals along the coasts of France and Belgium.

Machine gun, shrapnel-flinging shell, and poisonous gas injuries brought soldiers by the hundreds, even thousands to the CCS’s causing the doctors, surgeons, nurses, and anesthetists to form an assessment order, giving priority to the most injured who could be saved in order to conserve supplies and energy. This evacuation technique needed to be adapted for World War II, as the soldiers avoided being stuck in trenches like World War I.

World War II brought much of the same wounds, giving doctors the chance to create a better way of healing. Doctors began inspecting the open wounds they worked on, searching for debris, drainage or edema. If the wound was clean, it would be closed and allowed to heal, if not, the wound would be treated and observed before closing. The fighting in North Africa was so bloody that the US army called for the creation of a blood bank. The creation of surgical outfits in the military helped develop new forms of medical aid in the next wars in the East.

The Korean and Vietnam Wars adapted to their landscape by creating MASH units, or Mobile Army Surgical Hospitals. These units were deployed throughout Korea and Vietnam. Helicopters became a very important form of transportation for the critically wounded, making the MASH units the first and only requirement for the treatment of the general wounded population. According to Robert Love, Tom H Brooking, and Darryl Tong, specialty surgeries, like use of the newly developed artificial kidney, were performed in pre-established in hospitals in large cities. The MASH units began as quick-moving 60-bed mobile units but grew to 200-bed fixed hospitals throughout the war.

Between the Persian Gulf War and the current war in the middle east, the United States Army discovered that rapidly moving fronts did not allow for MASH units any longer and thus developed five levels of care: “Level I, front line first aid; Level II, FST [Forward Surgical Teams]; Level III, CSH [Combat Support Hospitals], which is similar to civilian trauma centers; Level IV, surgical hospitals outside the combat zone; and Level V, major US military hospitals.” The response time of evacuation personnel dropped with the development of this framework of care. Those injured in Iraq or Afghanistan could be evacuated to a Level II or Level III hospital within 30 to 90 minutes, depending on the situation.

From drastic amounts of amputations and unorganized doctors to detailed practices and definitive levels of care, US military medicine has changed greatly, each step aiding not only medical practices in the US, but also the world as well as the thousands of lives saved by doctors around the world.


References:

Robert Love, Tom H Brooking, and Darryl Tong. “The management of maxillofacial trauma during the Korean War – A coming of age of a specialty.” Journal of Military and     Veterans’ Health 19, no. 2 (2011): 10-14.

M.M. Manring, Alan Hawk, Jason H. Calhoun, and Romney C. Andersen. “Treatment Of War  Wounds: A Historical Review.” Clinical Orthopaedics and Related Research 467, no. 8 (2009): 2168-2191.

Kyle Wichtendahl, “Dr. Jonathan Letterman: Father of Modern Emergency Medicine.” Civil War Museum -Gettysburg & Antietam battlefield. http://www.civilwarmed.org/lettermmandinner/letterman-father-of-battlefield-medicine/ (accessed September 30, 2013).

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