In the late 19th century, combat doctors often didn't have more than a tent as a makeshift hospital, with few lifesaving instruments or medicines available to them. The rescued wounded would be brought in by stretcher or horse-drawn wagon, where doctors would treat them with what they might have available, such as the following:
- Morphine or other opiates
- Purgatives (laxatives)
- Depressants and stimulants
- Diaphoretics (fever aids)
- Antiperiodics, such as quinine as an antimalarial medicine
- Caustics to help slough off skin
- Astringents to constrict tissue
The manual of military surgery from 1861 recommends keeping just the essentials on hand:
Combat casualty care has come a long way since then. In the 21st century, military medicine has expanded beyond treating injured soldiers with morphine and watchful waiting. Today's Army has an estimated 120 active duty general surgeons (and about the same number of reservist general surgeons) [source: Gawande]. General surgeons are trained to operate on the gastrointestinal tract, the abdomen, breasts, the vascular system and the endocrine system. They perform organ transplants, manage surgical critical care and oncology treatment, and treat trauma and burn patients. And many have additional skills, training and experience in specialized areas. A combat-experienced trauma surgeon may be, for example, a vascular surgeon in the civilian world. General surgeons and orthopedic surgeons often work together as combat-surgery teams.
Whether combat-experienced surgeons find themselves in a combat zone or practicing in a military hospital, these surgeons must adjust for risk as well as for the environment. Let's take a look at the places you'll find combat surgeons and the types of technology available to them today.
Mobile Military Medicine
First responders to combat casualties are typically other soldiers trained as medics (or sometimes other soldiers in a unit, with EMT training or not). Surgical teams are equipped with both general surgery and anesthesia packs, and in situations that require a quick medical response, some types of these packs also include rapid-response surgical kits with essential first aid items plus basic surgical tools.
The next level of care, known as level II care, was once a MASH unit, the Army's now outdated mobile surgical hospital. But since Operation Iraqi Freedom, the Army's forward surgical teams (FST) and forward resuscitative surgical system (FRSS) care for injured soldiers. Forward surgical teams treat patients in the critical moments before they're transported to a hospital. The FRSS is a lightweight mobile operating room. These mobile units are designed to be easy to move and easy to deploy. The surgical teams consist of a staff of 20, usually broken into four specialties: triage and trauma management, surgery, post-op recovery and administration and operations.
The units are equipped with portable oxygen-generating systems and within, surgical teams are equipped to administer general anesthesia, perform surgery (each FRSS is equipped with two operating tables), treat major injuries, including the following:
- Chest and abdominal trauma
- Respiratory distress
- Crush injuries
- Closed head wounds
These surgical teams are also able to provide postoperative care for up to eight patients for a maximum of six hours. Overall, the mobile operating room is self-sustaining for 72 hours or 30 patients.
Wounded soldiers may then be transported by helicopter, such as a CH47 with a critical care team (known as a critical care air transport or CCAT) on board, to a combat support hospital (CSH).
A combat support hospital is an expandable mobile military hospital, with care and equipment that rivals a fixed-location hospital. The 10th Combat Support Hospital, for example, houses the following:
- 84 beds (with another 164 available)
- A fully equipped operating room
- Intensive and intermediate care units
- A lab
- A blood bank
- A radiology section (complete with portable, digital x-ray equipment)
- A pharmacy
To learn more about Army surgeons' equipment, check out the links on the next page.
- The American Board of Surgery. "Specialty of General Surgery Defined." February 2010. (April 1, 2011)http://home.absurgery.org/default.jsp?aboutsurgerydefined
- Defense Industry Daily. "IT Enables Army Doctors to Retrieve Vital Records, Perform Surgery." Feb. 17, 2010. (April 1, 2011)http://www.defenseindustrydaily.com/IT-Enables-US-Army-Medics-to-Store-Retrieve-Vital-Records-06184/
- Department of Defense, 10th Combat Support Hospital. "About Us." (April 1, 2011)http://www.carson.army.mil/10cshweb/about.html
- Fincham, Christopher. "Forward Surgical Team demonstrates calm, swift precision." U.S. Army. Nov. 2, 2009. (April 1, 2011)http://www.army.mil/-news/2009/11/02/29657-forward-surgical-team-demonstrates-calm-swift-precision/
- Gawande, Atul. "Causalities of War -- Military Care for the Wounded from Iraq and Afghanistan." The New England Journal of Medicine. Dec. 9, 2004. (April 1, 2011)http://www.nejm.org/doi/full/10.1056/NEJMp048317
- Gross, S.D. "A manual of military surgery." Thomas Jefferson University. 1861. (April 1, 2011)http://jdc.jefferson.edu/milsurgusa/6/
- King, Booker and Ismalil Jatoi. "The mobile Army surgical hospital (MASH): a military and surgical legacy." Journal of the National Medical Association. May 2005. (April 1, 1011)http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2569328/
- Lewis, Nicole. "Doctors Increase EMR Use." Information Week. July 13, 2010. (April 1, 2011)http://www.informationweek.com/news/healthcare/EMR/showArticle.jhtml?articleID=225800003
- Medical Communications for Combat Casualty Care (MC4). (April 1, 2011)http://www.mc4.army.mil/
- Moran, Michael. "Doctors with orders -- for Iraq." MSNBC. July 25, 2005. (April 1, 2011) http://www.msnbc.msn.com/id/8703241/ns/world_news-mideast/n_africa/
- Smith, Michael W. "Medical Operations Handbook." U.S. Army Medical Service Corps. May 12, 2005. (April 1, 2011) http://www.cs.amedd.army.mil/simcenter/Library/Medical Operations Book/medopsbk.pps
- Stevens, Rom. "Health Affairs: The Forward Resuscitative Surgical System." Naval Reserve Association News. August 2004. (April 1, 2011)http://ausn.org/LinkClick.aspx?fileticket=9ybWBTxei38%3D&tabid=944
- U.S. Army. "Employment of Forward Surgical Teams, Tactics, Techniques, and Procedures." 1997. (April 1, 2011)http://www.brooksidepress.org/Products/OperationalMedicine/DATA/operationalmed/Manuals/FM81025/1025ch2.pdf
- U.S. Army Medical Department. "Forward Surgical Teams (1995)." June 25, 2008. (April 1, 2011)http://www.armymedicine.army.mil/about/tl/95-factsfst.html
- Wilson, William C et al, Editors. "Trauma: Emergency Resuscitation, Perioperative Anesthesia, Surgical Management" Information Healthcare USA, Inc. 2007.