Navy Medicine in Araby (Episode 5)

This is instalment 5 of a series of 7, wherein I endeavor to contrast medical care of sailors of the 19th century with that of today.

Before I discuss our Navy’s medical assets, I must discuss the concept of Levels, Echelons or Roles of Care in today’s combat casualty care environment. Combat casualty care has evolved significantly since the Barbary Wars. The Napoleonic surgeon Larrey made a significant first step toward modernity when he established a system of horse-drawn “flying ambulances” to move casualties – who heretofore may have lain for days in the field without care, food or water – to facilities where prompt care of their wounds could be given. Modern combat casualty care started in the U.S. Army during the Civil War as a result of a series of reforms brought forth by the Lincoln-appointed Sanitary Commission led by Frederick Olmstead. Basing many of its recommendation on learnings from the Crimean War, the Commission and the Army built hospitals, established a system of evaluation of prospective Army doctors (the Navy already had such a system in place) and provided supplies and equipment. Under this system, Army Surgeon Jonathan Letterman established an ambulance corps to effect prompt evacuation of field casualties to facilities in the rear; he also established an early system of echelons of care with field dressing stations on the battlefield, field hospitals for definitive surgery located in nearby homes, churches or barns, and larger hospitals in the rear for longer term treatment. While more advanced surgical technique and evacuation by ambulance were utilized in World War I, it wasn’t until World War II that an appreciation of the need for rapid surgical intervention in injured soldiers was institutionalized with the development of mobile surgical teams attached to division level field hospitals. Shortly after our entry into the war, it became clear that transfusion of flood was an essential element in the resuscitation and ongoing management of men who suffered extensive wounding, and the robust system of blood collection that I described earlier was implemented. In the Korean War, an emphasis on the treatment of shock with IV fluids and transfusions saved many additional lives, and the forward care surgical facilities referred to as MASH units plus the use of helicopters for casualty movement further improved outcomes for injured warriors. During the Vietnam war, emphasis was put on shortening the time from injury to surgical care by keeping medical facilities close to the area of combat and by using helicopter transport.

©2016, 2017 Thomas L Snyder

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