Advancements in Trauma Patient Care made in the Korean WarBy Temma Perry October 19, 2020
Considering the scope and scale of the Australian Defence Force (ADF) Health capabilities under review at the moment; between the Employment Category Review L2061, the various phases of JP2060, and the Army Health Capability Establishment Review, the appetite for change and to be Future Ready is clear. Using these future-focussed changes as a backdrop, it is an opportune time to take a look at our current practices through the lens of the Korean War, and how it has evolved over time to meet the changing needs of Army.
Medical treatment employed presently by the ADF has been influenced by the USA due to our alliance throughout many major conflicts, and Australia has since learnt and adapted our methods, priorities and capabilities to ensure greater interoperability with US capabilities. The Korean War marked an era of significant technological advances and innovation that impacted both civilian and military treatment and evacuation of trauma patients. Practices implemented within the conflict are still present in multiple facets of the both the Australian Army Medical Corps and ADF Joint Operations procedures today.
The rudimentary framework of the system known today as the Land Based Trauma System (LBTS) was established at the culmination of WWII (The Korean War, 2020). Improved medical assets in the Korean War made significant developments to the LBTS and allowed us to see firsthand the effectiveness of the system as used by the US. Compared to WWII where casualty movement was slow and did not always result in a casualty arriving at the level of medical care required, this newly implemented system led to fewer fatalities by almost half (Zimmerman, 2014) from 4.5% to 2.5% during the conflict and set the stage for how medical professionals treat trauma patients today.
The greatest development in casualty care during the Korean War was the consolidation of medical assets known as the Mobile Army Surgical Hospitals (MASH) units. Having been conceived during WWII, they were tested and developed during the Korean War. MASH units were; for their time, able to rapidly deploy and quickly adapted to the rugged Korean terrain with the hospital being moved roughly once a month. The successes of the MASH units and aeromedical evacuation system in Korea were a defining moment for military medical care, and the lessons learnt, later applied and refined during the Vietnam War, have proven just as applicable today as they were in the 1950s.
Used to great effect in conjunction with the MASH Units was the development of aeromedical evacuation platforms. Prior to the war, leaders in all the branches believed that the best way to transport the wounded was by ground-based vehicle or ship. Rotary-wing evacuation was considered a means of last resort. The primitive to non-existent road network in Korea forced commanders on the peninsula to reassess that doctrine and seek a faster alternative solution. Helicopters had been used for medical transportation before 1950, but it was during The Korean War that it became routine, partially out of necessity. The success of medical helicopters during the Korean War led to their continued use by the military as well as civilian hospitals around the world. In 1951, it was agreed within the US joint operations model that Army helicopters would be responsible for frontline rotary-wing aeromedical evacuation (AME), and the Air Force would provide fixed-wing aeromedical evacuation outside the combat zone. This model was later adopted by the ADF following the demonstrable success, yet due to capability constraints the ADF do not currently have any dedicated AME platforms and rely on the shared assets of our coalition partners in current conflict zones. This presents a significant risk for planners and commanders to consider were Australia to lead operations in our region.
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 (Innovation and Dedication, 2017). Previously moved in glass containers, the normalisation of plastic bags for storing, shipping and administering bloods is a military innovation that rapidly became common practice in civilian medicine. Vascular reconstruction and the use of artificial kidneys were trialled in a combat setting during this conflict, and research was conducted 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. Computer punch cards were, for the first time, implemented as an early edition of computerised data collection used to document the type of battle and non-battle casualties. The ability to document and analyse this data provided real time ability to track casualties and assess casualty rates and trends. This technology has subsequently facilitated the creation of casualty calculators which enhance planning and prevention capabilities.
The Korean War provided an opportunity for those involved to implement and test & adjust the battlefield casualty care from WWII. The developments and opportunities were so intrinsic in reducing fatality rates and ensuring capability preparedness that the lessons learned in the early 1950’s remain the pillars of health care for defence forces around the world today.