Preface

Unfortunately for the earth’s fragile ecosystem, war remains the policy of choice among feuding nations and peoples, wreaking havoc not only on fellow human beings but on all living species. One of the few positive outcomes to emerge from this man-made trauma was the effort, begun by Dominique-Jean Larrey during the Napoleonic Wars, to bring organized medical support and transport to the soldier wounded on the field of battle. Elements of Larrey’s support system were later introduced into the Crimean War, the American Civil War, the Franco-Prussian War, various fin de siecle wars and hotspots, the Philippine Insurrection, and finally the trenches of World War I—all of which are traced in the pages of this book.

We know, of course, that the military ambulance continued to respond to innovations in military tactics and technology. Examples were apparent with the development of the Echelon II hospital units situated close to unit-level aid stations in World War II, and later, with the U. S. Mobile Army Surgical Hospital (MASH) units located minutes from the battlefield in Korea. The proximity of these mobile units to the battlefield continued into Vietnam and the first Gulf War, providing an exceptionally high survival rate for the seriously wounded soldier. The last of these units, the 212th MASH, was established in Iraq in 2003 before being transferred to Pakistan to serve earthquake victims. Along with these organizational changes came improved ground and air transportation. While the first medevac helicopter was employed in April 1944 in Burma, not until the Korean War did the Bell 47, with its external basket stretchers, become the mainstay of air medical evacuation. Following that were the Bell UH-1 (Huey) during the Vietnam War, which allowed for treatment during flight, and the UH-60 Blackhawk in Iraq and Afghanistan.

More recently, the emergence of asymmetrical threats and insurgencies, often by nonstate combatants, have forced paradigmatic changes to existing support systems. Today, due in no small measure to improvised explosive devices and other unconventional weaponry, the military has responded with mobile forward surgical teams to provide basic advanced-trauma life support to stabilize seriously wounded soldiers unable to survive medevac care. These units, organized around advanced-trauma life support, operating room, and recovery components, are intended to treat combat casualties within the “golden hour” following injury before transferring them to hospitals for further care.

This book is dedicated to the men and women of my father’s generation who fought in World War II and Korea, to those of my own generation who fought and died in Vietnam, and to those before and since who put their lives at risk in support of our nation’s values and purposes. To them I tender my profound respect and humble thanks.

February 2011 J. S. H.