Medical Evacuation Evolution In the US

How Medical Evacuation Evolved from Post Civil War to Present
1st Historical Interest Timeline: 1877 to 1910
Medical advances during this period were more in organization and technique and not in medical breakthroughs. Jonathan Letterman is credited with creating a highly organized system of ambulances and trained stretcher bearers that were designed to evacuate the wounded quickly. This was a great improvement from the previous methods. It was also during this period that sanitary conditions for medical care were improved upon. Previously surgeons did not wash their hand before attending to a patient and their equipment was not sanitized. This resulted in the number of deaths occurring from medical care increasing and the mortality rate was two soldiers died out of disease and infections as compared to one who died from injury or gunshot wound in the battlefield. Organized trauma care was also suggested and practiced in the late 19th century. In the past priority of care for a patient depended on their rank, the surgeon\\\\'s best guess, or the order of arrival (Hawk, Calhoun, & Andersen, 2009). However, with the use a triage system, patients were evaluated on their needs and the seriously wounded would receive first attention regardless of their rank. This would be followed by those with less serious injuries.
2nd Historical Interest Timeline: 1911 to 1940
The unprecedented mass casualties of World War 1, there were terrific strains created on the medical units. With the advent of motorized transport, it was possible to have medical units following the soldiers 6 to 9 miles behind the front lines. The motorized units comprised of surgeons, nurses, and anesthetics. There was a complete turnaround from the handling of casualties with the emphasis now being given to helping more people in the shortest time. This meant that cases that required a great deal of time were less prioritized and cases that take less time given first priority. This was aimed at ensuring that the greatest number of soldiers were able to return to the battlefield. Air ambulances were developed and operated during this period. This resulted in the air evacuation of injured soldiers to medical facilities. However, the patient was enclosed in the fuselage without anyone attending to them during flight (Hawk et al., 2009).
3rd Historical Interest Timeline: 1941 to 1970
There were considerable improvements in medical evacuation technology and organization especially the use of helicopters. This played a significant role for the US forces in Vietnam. The medics would bandage and attend to the wounded patient, they would then radio the hospital to inform them of the incoming patient and their diagnosis. Using helicopter evacuation minimized the use of morphine and eliminated additional complications. Patients no longer underwent multiple transfers and levels of care. Mobile medical units were developed and they were stationed within 10 miles of the front liners. These units were referred to as MASH (Mobile Army Surgical Hospital) (Katoch & Rajagopalan, 2010). The units offered initial care to the wounded soldiers and only the critically injured would be transferred to physical hospitals.
4th Historical Interest Timeline: 1971 to Present
The MASH units were too heavy and they were unable to keep up with the rapidly advancing front lines. This resulted in a 20 person Forward Surgical Team (FST) being created in order to provide resuscitative surgery close to the front lines. Five levels of care have been developed for providing care to the US soldiers (Mabry et al., 2012). The military has developed highly capable medical units for transporting and evacuating injured soldiers. These air ambulances have been nicknamed flying ICUs because they have advanced medical equipment and they can transport the wounded to the US in less than three days of them being wounded (Gawande, 2004). However, the actual number of days will vary based on the individual requirements of the patient.


References
Gawande, A. (2004). Casualties of war—military care for the wounded from Iraq and Afghanistan. New England Journal of Medicine, 351(24), 2471-2475.
Hawk, A., Calhoun, J. H., & Andersen, R. C. (2009). Treatment of War Wounds: A Historical Review. Clinical Orthopaedics and Related Research, 467(8), 2168.
Katoch, R., & Rajagopalan, S. (2010). Warfare injuries: History, triage, transport and field hospital setup in the armed forces. Medical Journal Armed Forces India, 66(4), 304-308.
Mabry, R. L., Apodaca, A., Penrod, J., Orman, J. A., Gerhardt, R. T., & Dorlac, W. C. (2012). Impact of critical care–trained flight paramedics on casualty survival during helicopter evacuation in the current war in Afghanistan. Journal of Trauma and Acute Care Surgery, 73(2), S32-S37.