The History of First Aid in the Army

U.S. Army soldiers in California, rifles in hand, wear gas masks during a 1943 training exercise related to chemical attacks. As warfare has become more complex, so have the injuries medics must treat on the battlefield.
U.S. Army soldiers in California, rifles in hand, wear gas masks during a 1943 training exercise related to chemical attacks. As warfare has become more complex, so have the injuries medics must treat on the battlefield.
The Frank S. Errigo Archive/Hulton Archive/Getty Images

Ever since humankind has learned to batter the body through warfare, we've striven to mend it with medical care. In fact, the battlefield has served as a laboratory in which new medical techniques and advances have been formed throughout the ages. Chief among these is the concept of first aid -- medical assistance rendered to a wounded person as close to the time of damage as possible.

The history of first aid in the United States Army begins with the conflict that formed our country: the Revolutionary War.

When the battle for American independence began in 1775, the level of health care in the New World was generally poor. Although there were approximately 3,500 people who called themselves physicians in the colonies, only about 200 of them actually held medical licenses [source: McCallum]. This isn't surprising considering that the first medical college at the University of Pennsylvania had opened just 10 years earlier.

If caring for the public wasn't a priority, caring for the soldiers fighting for a new homeland was even less so. This was perhaps most clearly shown by the actions of General Horatio Gates who, after the Battle of Bunker Hill, left his wounded men on the field for up to three days, causing many of them to die. Of the men who were saved, many were forced to pay outrageously high fees to stay at convalescing quarters.

These conditions led the Massachusetts Provincial Congress to mandate the establishment of military hospitals and require that one surgeon and two surgeon's mates would serve with the colonel of each regiment in the field.

Yet in the winter of 1776, men were still dying in droves -- and not necessarily from bayonet strikes. They were falling prey to diseases like pneumonia, dysentery and smallpox. Therefore, General George Washington petitioned the Continental Congress to establish what he called "the Hospital": a general medical corps for soldiers. Begun on July 27, 1775, it was set up to serve an Army of 20,000 with four surgeons, an apothecary, 20 surgeon's mates, one clerk, a storekeeper and one nurse for every 10 patients [source: McCallum]. It was the first national medical military organization ever established in the newly forming country.

Despite this, care remained poor. A full 10 percent of all soldiers who fought on the American side of the war died -- 6,500 of them on the battlefield, 10,000 in the hospital [source: McCallum].

So how did Army first aid improve over the years? Keep reading to find out.

Civil War: Civil Treatment on the Battlefield

In 1864, battlefield first aid was performed in triage stations, like this one in the camp of the chief ambulance officer of the 9th Army Corps near Petersburg, Va.
In 1864, battlefield first aid was performed in triage stations, like this one in the camp of the chief ambulance officer of the 9th Army Corps near Petersburg, Va.

While the Revolutionary War established the precedent for the proper treatment of soldiers, the Civil War truly advanced first aid on the battlefield. This is due in large part to a man named Jonathan Letterman, who became known as the Father of Modern Battlefield Medicine.

After it took one week to remove wounded soldiers from the battlefield at the second Battle of Bull Run in the summer of 1862, General George McClellan gave Letterman, who was the assistant surgeon of the Army medical department, the freedom to do whatever it took to provide the men the care they deserved.

Letterman didn't waste any time. He created the country's first ambulance corps that consisted of a multi-stage process in which men would run onto the field during battle, retrieve the wounded and get them to a field-dressing station where his new system of triage -- in which men were tended to based on their likelihood to live or die -- was used. From there, men were moved to a field hospital -- usually a nearby home or barn -- if necessary and eventually to a large offsite hospital where they could receive long-term treatment without the chaos of battle raging around them.

The new, multi-step process where soldiers were given first aid directly on the battlefield was tested at the Battle of Antietam in September 1862. It was a resounding success as medical personnel were able to remove all of the wounded from the field within 24 hours. Letterman's system was successful at both the Battle of Fredericksburg and the Battle of Gettysburg, where thousands of wounded soldiers' lives were saved. His system was subsequently adopted for the U.S. Army by an Act of Congress in March of 1864.

Post Civil War Era

From 1865 to 1898, America was at peace, which kept advances in battlefield medicine relatively minor. There were, however, several significant events during this time that helped contribute to the Army's first aid system:

  • The American Red Cross was founded in Washington, D.C. by Clara Barton on May 21, 1881. It was an organization that would greatly help America's troops starting with the Spanish American war in 1898.
  • In 1882, the United States ratified the first Geneva Convention, which mandated the obligation to extend care without discrimination to wounded and sick military personnel. It also established that there should be respect for medical personnel transports and equipment marked with the sign of the red cross on a white background.
  • On Nov. 20, 1886, General Order No. 86 was issued from the War Department that introduced first aid to all Army soldiers through a series of lectures and pamphlets.
  • Congress passed the law that officially formed the Hospital Corps on March 1, 1887, which stated that the medical personnel in the Army "shall be regularly enlisted in the military service" and that "said Corps shall be permanently attached to the Medical Department, and shall not be included in the effective strength of the Army nor counted as a part of the enlisted force provided by law." The law also established new chevrons (insignia) combined with red crosses to designate members of the Corps.

While these were certainly positive advancements, when war with Spain broke out in 1898, many of Letterman's Civil War reforms were forgotten, and the result was that the military was again unprepared to care for its wounded.

To help supplement medical personnel, George M. Sternberg, the Army's surgeon general at the time, contracted trained nurses from the Daughters of the American Revolution. As a result, more than 1,500 female nurses served in the field in the U.S., Cuba and the Philippines, as well as on the Army hospital ship Relief [source: Greenwood]. These were supplemented by approximately 700 additional nurses from the Red Cross, marking the organization's first war-related mission [source: American Red Cross].

Sternberg additionally ordered the distribution of first aid packets to the troops that contained gauze for controlling bleeding in the field. They proved fairly successful, especially since the size of bullets were now smaller than in previous wars, and the puncture wounds they caused could be stopped up with gauze.

World Wars I and II

World War I marks the first time in American history that Army medical personnel were assigned to work directly in the field, alongside combat soldiers. In addition to administering first aid to wounded troops, these field medics also evacuated soldiers from the field. Sometimes this was accomplished with a pulley system in the trenches, but more often than not, it meant dragging their countrymen through acres of difficult terrain.

Once cleared from the field, the medics were greeted by any of up to 83 different kinds of ambulances -- from horse-drawn wagons to more modern jeep-like vehicles [source: History Channel]. Because World War I marked the first time gas had ever been used in combat (it was first employed by the Germans on April 22, 1915), special ambulances were devised that provided showers for soldiers to wash off contaminants and gas masks were distributed.

Although the work was bloody, muddy and backbreaking, medics did get some assistance in their fight to keep America's fighting forces alive. The Red Cross grew exponentially during the war, with membership numbers and local chapters skyrocketing. As a result, the organization recruited 20,000 registered nurses to work in military hospitals and ambulance companies [source: American Red Cross].

Military medical personnel also got a helping hand from science. Thanks to new technologies such as portable X-rays and the antiseptics and inoculations that grew out of modern germ theory, World War I was the first war in which disease didn't kill more men than battle injuries.

The body of medical knowledge had grown even more by World War II, and the widespread use of penicillin and antimalarials helped keep soldiers healthier than ever -- if not exactly out of harm's way. When soldiers were wounded, the first use of morphine in the field -- through self-contained needle delivery systems known as syrettes -- helped to ease their pain. All soldiers were also equipped with Carlisle Model enhanced first aid kits that contained, among other helpful gear, a bandage with long tails that could be quickly and easily tied around a wound.

Thanks to advancements like these, by the end of World War II, the odds of dying from combat-related injuries had dropped significantly to 30 percent.

Wars in Korea and Vietnam

While medical advances continued throughout the years, it was a transportation advance that helped reduce the number of wounded soldiers who died in the Korean War by 48 percent: the helicopter. For the first time, men could be whisked off the field -- two at a time -- and transported by air to a hospital at a safe location.

The Korean War also gave birth to another major advancement in care on the battlefield: the MASH unit, which stands "mobile Army surgical hospital." These portable medical centers were able to travel with the fight, ensuring that frontline soldiers were never far from care -- whether they need life-saving surgery or the simple setting of a broken bone.

However, approximately a decade after the end of the conflict in Korea, the United States would join another war -- one without a front line. Because so much of the Vietnam War was fought in jungles without any real front line, MASH units were not as practical as they had been in Korea. Instead, the Army relied more heavily than ever on air transport, employing a fleet of UH-1 "Huey" helicopters that could each transport up to nine men at a time to any of the 28 hospitals the Army had set up throughout the country. A medial crew could load a Huey and get the wounded passengers to safety in an average of 35 minutes -- with care beginning in flight. The system resulted in an impressive 98 percent survival rate of airlifted men [source: History Channel].

Modern Wars

In Vietnam, the problem facing soldiers and medical personnel was an undefined front. In Operation Desert Storm, the issue was the fastest moving front in history. In fact, the war raced through the desert at such a pace that medical teams couldn't keep up with it. Had there been more casualties of that conflict, it could have posed serious issues regarding medical care. Fortunately, that wasn't the case. But to prevent such a thing from happening again, the Army is researching portable hospitals that can be dropped out of a helicopter and quickly assembled to provide on-the-spot care to battle-wounded soldiers [source: History Channel].

Another way in which the immediate care given to wounded soldiers is improving is through the use of the Life Support for Trauma and Transport (LSTAT) stretcher. This high-tech gurney is like an emergency room on wheels, and when medics place a wounded soldier upon it, they can take advantage of its built-in oxygen generator, defibrillator, ventilator and critical life signs monitoring equipment. Research is also being conducted on something known as a Trauma Pod whereby a wounded soldier would be retrieved by an automated vehicle and transported to an unmanned pod where doctors working remotely could stabilize the patient and even perform robotic surgeries to save lives.

Until these pods are available, the Army has taken other types of computers into the field -- especially those that allow medics to begin creating a digital patient record in the field. Having such statistics travel with the wounded can save valuable minutes when they arrive at treatment facilities. The thinking in rendering first aid care has now switched from a focus on what used to be known as the "golden hour" to the "platinum 10 minutes," meaning that the faster medical care can be rendered to a wounded solider, the higher his or her likelihood for survival. That's a long way from the thinking that once left wounded soldiers untended on America's battlefields for days at a time.

To learn more about Army first aid, check out the next page.

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