BATTLEFIELD MEDICINE IN THE KOREAN WAR

By Dwight Jon Zimmerman

Though the Korean War came to be regarded as a failure by many because of its unsettled conclusion, in one area it was an unreserved success: the care and treatment of wounded soldiers. In World War II, the fatality rate for seriously wounded soldiers was 4.5 percent. In the Korean War, that number was cut almost in half, to 2.5 percent. That success is attributed to the combination of the Mobile Army Surgical Hospital, or MASH unit, and the aeromedical evacuation system – the casualty evacuation (casevac) and medical evacuation (medevac) helicopter. Both had been developed and used to a limited extent prior to 1950, but it was in the Korean War that both – particularly the helicopter – came into their own, and, as Army Maj. William G. Howard wrote, “fundamentally changed the Army’s medicalevacuation doctrine.” Helicopter medevacs transported more than 20,000 casualties during the war. One pilot, 1st Lt. Joseph L. Bowler, set a record of 824 medical evacuations over a 10-month period. Another example tellingly highlights the impact of the helicopter. The Eighth Army command surgeon estimated that of the 750 critically wounded soldiers evacuated on Feb. 20, 1951, half would have died if only ground transportation had been used.

An operation is performed on a wounded soldier at the 8209th Mobile Army Surgical Hospital, twenty miles from the front lines, on Aug. 4, 1952.

The Korean War also provided an opportunity to study and test new equipment and procedures, many of which would go on to become standards of care in both the military and civilian medical communities. These included vascular reconstruction, the use of artificial kidneys, development of lightweight body armor, and research on the effects of extreme cold on the body, which led to development of better cold-weather clothing and improved cold-weather medical advice and treatment. The newest antibiotics were used widely, and other drugs that advanced medical care included the anticoagulant heparin, the sedative Nembutal, and the use of serum albumin and whole blood to treat shock cases. In addition, computerized data collection (in the form of computer punch cards) of the type of battle and non-battle casualties was used for the first time. The extensive detail and accessibility of this data allowed for the most thorough and comprehensive analysis of military medical information yet.

Like the other organizations within the military, when the war started in June 1950, the medical departments were short of everything. The most acute shortage was with doctors, particularly specialists. A doctor draft was instituted in August 1950, and the first medical draftees arrived in Korea in January 1951. By the following year, 90 percent of the doctors stationed in Korea were draftees. Combat medical care doctrine in Korea consisted of a relay system. The first line of care was organized around two groups: a battalion aid station and a separate forward collecting station. The latter contained eight men composed of a doctor, medics, and litter-bearers. Wounded would be gathered at them and an initial diagnosis, triage, and tagging would be performed. Harold Selly was an Army medic, part of a forward collecting station team. “We were always in danger of being attacked by the enemy, overrun by the enemy, being shelled by artillery, shelled by mortar, and grenades thrown into the station,” he recalled.

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The wounded would then be transported to a larger collection station located behind the front line. Once the wounded had been stabilized, they would be transported to a MASH unit or a division clearing station, depending on the type of wounds. From there, the wounded would be transported to an evacuation hospital. If the wounds were serious enough, the wounded would then be airlifted to a hospital in Japan.

Prior to the war, leaders in all the branches believed that the best way to transport wounded was by ground-based vehicle or ship. Rotary-wing evacuation was considered a means of last resort. The primitive to nonexistent road network in Korea forced commanders on the peninsula to reassess that doctrine and seek a faster alternative solution.

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In July 1950, the Air Force deployed the 3rd Air Rescue Squadron (ARS) under Capt. Oscar N. Tibbetts. It was a unit trained to rescue downed aircrews behind enemy lines or in the sea. In August 1950, however, the 3rd ARS received an Army request that changed the role of the helicopter in Korea and marked the beginning of a doctrine change in casualty evacuation. A forward aid station located on the summit of a 3,000-foot mountain had a seriously wounded soldier, but couldn’t do a ground-based evacuation because the enemy had cut off its route to the rear. The request was to fly the wounded soldier out by helicopter. The mission was a success, and the soldier’s life was saved.

A wounded American is lifted onto a helicopter at the 21st Infantry Regiment collecting station at Painmal, Korea, one mile south of the 38th Parallel, for evacuation to a base hospital on April 3, 1951.

Capt. Leonard A. Crosby of the Army Medical Service Corps immediately recognized the helicopter’s potential impact. In order to expedite its implementation as an aerial ambulance, on Aug. 3, 1950, he arranged for a demonstration in the courtyard of Taegu Teacher’s College. The demonstration was so successful that one week later the commander of the Fifth Air Force authorized the use of its helicopters in frontline evacuation of Army wounded. U.S. Army Surgeon General Maj. Gen. Raymond W. Bliss heard of Crosby’s demonstration and, after a fact-finding tour of Korea and a meeting with theater commander Gen. Douglas MacArthur, returned to the Pentagon with MacArthur’s recommendation “that helicopters should be in the Tables of Organization and Equipment and should be part of medical equipment – just as an ambulance is.” By the end of October 1950, eight helicopters assigned to frontline evacuation of wounded were on their way to MacArthur’s Far East Command. In 1951, the Army and the Air Force agreed that Army helicopters would be responsible for frontline rotarywing aeromedical evacuation, and the Air Force would provide fixed-wing aeromedical evacuation outside the combat zone.

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In January 1951, four aeromedical evacuation helicopter detachments arrived in Korea. One unit, the 1st Helicopter Detachment, never became operational because its helicopters were all reassigned to other units. As none of the units had organic administrative and support units, the remaining three detachments were attached to MASH units that had all the necessary support elements.

The Mobile Army Surgical Hospital evolved out of the Portable Army Surgical Hospital and the forward surgical teams of World War II. As its name suggests, it was a small, fully equipped and staffed hospital capable of following an army in its campaign. Originally conceived as 60-bed hospitals, they soon expanded to 200 beds as a result of the large numbers of wounded they received. As the war went on, orthopedic surgeons, surgical technicians, and other enlisted, as well as more nurses, were added to the personnel originally planned for the MASH. More vehicles and trailers were also added, as the fluid nature of the Korean conflict had meant the “mobile” in the MASH acronym was employed time and time again. As a result of the draft that alleviated the doctor shortage in the military, almost all the staff doctors in the MASH units were civilian draftees, and though they took their work seriously, they displayed a more relaxed attitude about Army rules, regulations, and discipline. Dr. H. Richard Hornberger was one such medical draftee, assigned to the 8055th MASH. His experience with the unit served as the basis for his 1968 bestselling book M*A*S*H, which later became an Academy Award-winning movie and a successful, long-running television series.

A wounded U.S. Marine awaiting transportation back to a field hospital after receiving first aid in the battle zone.

MEDEVAC

The medevac helicopters used in the Korean War were the Sikorsky H-5, the Bell H-13, and the Hiller H-23. They were fragile, high-maintenance aircraft with limited range. The early models had no radio or instrument lights in their cockpits. They couldn’t operate in bad weather, were limited on where they could land, and were fatally vulnerable to enemy ground fire. Even though they were not supposed to fly medevac missions at night, in emergencies many pilots did, holding a flashlight between their knees in order to see their instruments.

A helicopter of the 3rd Air Rescue Squadron settles gently to Korean soil to evacuate an injured soldier being carried in a stretcher by medics. In a matter of minutes, the soldier would be under the professional care of a medical officer at one of the Mobile Army Surgical Hospitals (MASH) at the rear.

Ironically, the lack of a radio in some of the helicopters proved a boon. This forced the implementation of a doctrine using colored smoke grenades, marker panels, and hand signals to identify locations and landing sites.

In addition to the direct lifesaving benefit of swift transport from the battlefield to the MASH unit, the use of helicopters had an ancillary benefit: It boosted morale. Troops on the front knew that should they get seriously wounded, even if their unit was cut off, they could still be evacuated. Also, once casualties were strapped into a litter pod, they tended to develop a “the worst is over” feeling, which contributed to their recovery.

Personnel and equipment needed to save lives are assembled at the headquarters of the 8225th Mobile Army Surgical Hospital, Korea, on Oct. 14, 1951.

Though the primary focus by the military medical staffs was on the care of the uniformed personnel that composed the United Nations Command (UNC), they became involved in additional missions during the war. As a result of the 50-year Japanese occupation of the country that had killed, imprisoned, or exiled almost all the educated classes, there were almost no Korean doctors for the civilian population. UNC medical staff at all levels assisted in giving care to civilians throughout the war whenever duties permitted.

One of the most unusual, and certainly the most dangerous event involving military medical personnel, was a deep-penetration special operations mission into North Korea involving the theater’s top military medical officer, Chief of the Public Health and Welfare Section of the Supreme Commander of Allied Powers in East Asia Brig. Gen. Crawford F. Sams.

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As United Nations (U.N.) troops crossed the 38th parallel and advanced north in the fall of 1950, they encountered a civilian population decimated by epidemics of typhus, smallpox, and typhoid. In addition, captured North Korean, and later Chinese, troops were ill with these and other contagious diseases. All the U.N. personnel had been vaccinated for the variety of diseases they were expected to encounter. But what troubled Sams, who received POW debriefing transcripts, were mentions of men turning black as they died. This suggested to him that bubonic plague – the Black Death – was in Korea. Unlike other vaccines, the one for bubonic plague renders only a short-term immunity. Because the plague threatened both the U.N. troops and approximately 23 million civilians in South Korea and it would take time to produce sufficient vaccine to inoculate everyone, confirming the presence of bubonic plague became a top priority.

One of the first shipments of whole blood from A.R.C. blood centers in the United States for shipment to Korea.

By February 1951, word of disease epidemics in the Communist armies and civilian population were becoming generally known. The North Koreans and Chinese Communists launched a propaganda campaign accusing Eighth Army Commander Gen. Matthew B. Ridgway and MacArthur of conducting biological warfare, and demanding they be tried for crimes against humanity. The charges were false. The truth was that North Korea’s rudimentary health care system had collapsed under the combined weight of tens of thousands of infected troops, a large displaced population, bad hygiene, and other problems. But to conclusively refute the accusation, MacArthur needed proof delivered by an authority on the disease. Since the Communists refused to allow the independent International Red Cross access to the infected areas, MacArthur had to take matters into his own hands. That meant a special operations mission into one of the infected regions with an expert on the disease who would examine victims, take samples, and if possible, capture someone with the disease and return to Japan with him. The problem was, there was only one man in the theater who had hands-on experience dealing with the disease: Sams. If the theater’s top medical officer, and a general, were killed or captured during the mission, the Communists would achieve an immense propaganda coup. Nonetheless, MacArthur agreed. “Operation Sams,” as the mission came to be known, was on.

A seriously wounded soldier of the 116th Engineers is prepared for his operation at the 121st Evacuation Hospital, Aug. 17, 1951.

Operation Sams was led by Navy Lt. Eugene F. Clark, who earlier had conducted a harrowing reconnaissance mission of Inchon for the amphibious assault of the harbor. Despite the mission being compromised, in the middle of March 1951 Clark’s team, including Sams, was able to covertly land near the North Korean port of Wonsan, an area where bubonic plague had been reported. They found a makeshift hospital. Though he confirmed other diseases, Sams determined there was no evidence of bubonic plague. As it turned out, the “Black Death” plague was actually a virulent form of smallpox known as hemorrhagic smallpox, which also causes the body to turn black as the victim nears death. The team was able to safely return to Japan, where Sams made his findings public, effectively destroying the credibility of the accusations.

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The successes of the MASH and aeromedical evacuation system in Korea were a watershed for military medical care, and the lessons learned, later applied and refined during the Vietnam War, have proved just as applicable today as they were in the 1950s.

This article was first published in The Forgotten War: 60th Anniversary of the Korean War.