Field hospital

A field hospital is a temporary hospital or mobile medical unit that takes care of casualties on-site before they can be safely transported to more permanent facilities.[1] This term was initially used in military medicine (such as the Mobile Army Surgical Hospital or MASH), but it is inherited to be used in civil situations such as disasters and major incidents.[2]

A U.S. Army Combat Support Hospital, a type of field hospital, in 2000

A field hospital is a medical staff with a mobile medical kit and, often, a wide tent-like shelter (at times an inflatable structure in modern usage) so that it can be readily set up near the source of casualties. In an urban environment, the field hospital is often established in an easily accessible and highly visible building (such as a manor house, restaurant, school, and so on). In the case of an airborne structure, the mobile medical kit is often placed in a normalized container; the container itself is then used as shelter. A field hospital is generally larger than a temporary aid station but smaller than a permanent military hospital.

International humanitarian law, such as the Geneva Conventions, include prohibitions on attacking doctors, ambulances, hospital ships, or field hospitals buildings displaying a Red Cross, a Red Crescent or other emblem related to the International Red Cross and Red Crescent Movement.

By country

France

Field hospitals in France are managed by the SAMU (French emergency medical service). Two types of mobile medical kits (poste sanitaire mobile or PSM) are used:

  • The level one mobile medical kit (PSM1): it can handle 25 heavy casualties on any type of ground; it is made of about 400 kg of equipment and drugs placed in 10 tanks, with also logistic equipment (trailer, inflatable tent, lighting, generating unit) ; there are 42 PSM1 in France;
  • The level two mobile medical kit (PSM2): it can handle resuscitation care for 500 patients; it is made of 8 tons of equipment and drugs (200 references) in 150 tanks, it can be divided ( is possible to set up several sub-fracedPSM2); in addition to the usual logistic equipment of the PSM1, the PSM2 has a tactical radio network and a management computer system. There are 21 PSM2 in France.

The PSM are stored in the hospitals where there are samus and smurs.

The PMA is organized in four zones:

  • a reception and triage zone, under the responsibility of a sort physician; the casualties are sorted and dispatched according to the seriousness of their state;
  • two zones for medical care:
    • Absolute emergencies zone (UA: urgences absolues): prehospital resuscitation unit for very serious cases: extreme emergencies (EU: extrème urgence) and grave injuries (U1);
    • Relative emergencies zone (UR: urgences relatives): for the serious (U2) and light injured (U3)
  • Mortuary zone (dépot mortuaire) for the deceased casualties. This zone is under the responsibility of the judicial police.

In case of really massive disaster, it is possible to have several PMA; the evacuation goes then not directly to a hospital, but to another big field hospital called "medical evacuation centre" (centre médical d'évacuation, CME), to avoid the saturation of the hospitals.

In case of a red plan, the PMA is under the responsibility of a physician chosen by the director of medical rescue (DSM), and he is assisted by a firefighter officer chosen by the commander of rescue operation (COS). The firefighter officer has in charge the identification of the living casualties and of the secretaryship. The aim of the PMA is to sort and stabilize the casualties before their evacuation to a hospital.

A similar system can be set up as a preventive measure for some very big events (sport championship, cultural events, concert...), but managed by first aid associations. It is then called an "associative medical post" (poste associatif médicalisé, PAM). (For smaller events, is simple first aid post, with only volunteer certified first responders and no medical staff, is set up.)

The civil defence military units (Unité d'instruction et d'intervention de la sécurité civile, UIISC) have airborne field hospitals. The general system is called DICA (détachement d'intervention de catastrophe aéroporté, i.e. airborne disaster unit), and is specialized in search-and-rescue and in emergency medicine; it can be enhanced by the Fast civil defence medical unit, called ESCRIM (élément de sécurité civile rapide d'intervention médicale). The ESCRIM is a surgical unit (detachement d'appui chirurgical) assisted by a medical assistance unit (DAMHo, détachement d'appui médical et d'hospitalisation); the later is specialized in pre- and post-operation care, and allows 48h of hospitalization. The UIISC also has a PMA (i.e. sort, stabilization and evacuation structure) when the hospital infrastructure of the country is sufficient.

Namibia

The Namibian Defence Force operates a mobile field hospital through its Defence Health Services Directorate. It was donated by the German government to Namibia in March 2013. Initially it was a UN level two hospital but has now been upgraded to level one. The field hospital is containerized in tents, it has capacity to treat forty outpatients per day and can admission capacity of twenty patients. It has two intensive care units, laboratories, an X-ray unit and a mobile oxygen concentrator.[3] The dental department can treat 20 and four operations can be carried out daily. It has its own mobile logistics support wing consisting of kitchens, water purifiers, water tanks, toilet and shower containers, generators and sewage and refuse disposal facilities.

During the COVID-19 pandemic the hospital was deployed to Hosea Kutako International Airport to aid the country's response.[4]

United States

Field hospitals were originally called ambulances.

Field hospital after the Battle of Savage's Station (1862)
Italian Army field hospital on the Italian Front during World War I

The surgical, evacuation, or field hospitals would remain many miles in the rear, and the divisional clearing stations were never intended to provide emergency life-saving surgery. With the Army's larger mobile hospitals unable to assume their traditional role in support of the front line combat units, the chain of evacuation was interrupted at a critical point. Some sort of interim solution had to be found quickly to provide the necessary surgical services and care to the severely wounded directly behind the front lines. Otherwise, many wounded soldiers would die from either the lack of life-saving surgery at the front or from the long and arduous evacuation trek along jungle trails from the frontal clearing stations to the nearest surgical unit. Manned with skilled surgeons and located close to the fighting to render quick, life-saving surgical intervention, the portable hospital could be moved by its own personnel to remain with the infantrymen during fluid operations.

20th century

A team of Medical Corps officers modified the basic War Department for a standard 25-bed station hospital into a new theater and table of basic for a portable hospital of 25-beds. The new unit was capable of supporting small units in its camp-type version (with 4 female Army nurses and organic vehicles) or battalion and regimental combat teams in its task force version (without the 4 nurses and organic vehicles). Commanded by a Medical Corps captain or major, the new 29-man portable hospital had 4 medical officers, 3 general surgeons, and 25 enlisted men, including 2 surgical and 11 medical technicians. What really marked a radical departure was that all of the unit's equipment, medical and surgical supplies, and rations could weigh no more than the 29 men could personally transport. Because the surgical demands on the theater's hospitals were then only minimal, a large number of trained surgeons were available in Australia to man the new units.

The surgeons in many of the initial portable hospitals would set standards of excellence in surgery and care that firmly established the reputation of the portable hospitals throughout the theater. However, this was not true of all of the units, and in some instances hospital commanders took advantage of this opportunity to unburden themselves of their unproductive and less well qualified surgeons. Hastily assembled and trained, the portable hospitals suffered from many shortcomings in personnel and equipment, which would soon become obvious in the jungle fighting around Buna. Probably the single most critical problem was the severe limitation placed on the total weight to assure the unit's portability. From the start, this meant that to be portable the unit had to give up medical and surgical equipment and supplies that would have been most useful in the field. Another handicap was the lack of a coherent doctrine for the tactical employment of the portable hospitals, along with an explanation of their exact role in the chain of treatment and evacuation within the combat zone.

The Chief Surgeon's Office promulgated a basic doctrine in September 1942 when the portable hospitals were established, but that doctrine went to the base sections in Australia and the portable hospitals and not to the medical units or surgeons in the Advanced Base in Papua and combat units. With no actual operational experience as a basis, that doctrine was much more conjectural than concrete. The Surgeon General's Office and the War Department enthusiastically adopted SWPA's new hospital as a regular unit before the first portable hospitals proved their value in the Buna campaign. The Surgeon General sought and received approval to add 48 of the new portable hospitals to the War Department's troop basis for 1943. Based on what was learned at Buna. By the end of 1943, the 48 new units were activated, two of which were assigned to SWPA. Another 15 new units would arrive in the theater during 1944 to support the increasing pace of MacArthur's offensive operations along the northern coast of New Guinea and into the Philippines. One portable surgical hospital was now allocated per infantry regiment, 3 per division, although additional hospitals were often authorized in larger operations.

During the war, a total of 103 portable surgical hospitals were activated and 78 would serve in various theaters around the world through end of the war—19 in the China-Burma-India, China, or India-Burma theaters; 12 in the Pacific Ocean Area's South and Central Pacific theaters; and 51 in SWPA (4 moved to SWPA from the South Pacific during 1944). Six PSHs were assigned to the European Theater of Operations, but they arrived only after the end of hostilities. Thus, Carroll's temporary innovation gained significance far beyond SWPA, and the life-saving surgical work performed in all of these hospitals during the war saved the lives of many thousands of critically wounded soldiers and airmen. While equipment was always a critical concern, it was the skill level of the surgeons that most concerned the surgical consultants of the Sixth and Eighth U.S. Armies in SWPA. They saw as one of their primary functions the selection of the surgeons for the portable surgical hospitals. As the war dragged on into 1944, the pool of skilled and experienced surgeons that they could draw on in SWPA shrank as demands rapidly increased for such personnel. Increasingly, the portable surgical hospitals were manned with younger and less skilled surgeons.

Switzerland
Transport truck of the Swiss Army with field hospital in cargo module.

During the COVID-19 pandemic, the Swiss Armed Forces were mobilised to support civil hospitals in Switzerland. Similar measures were taken in other countries.

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See also

References
  1. Joy, Robert J. T. (4 December 2003). "A Grateful Heart: The History of a World War I Field Hospital (review)". Bulletin of the History of Medicine. 77 (4): 961–962. doi:10.1353/bhm.2003.0176. ISSN 1086-3176. Retrieved 19 April 2020. Field hospitals were mobile, were sent to support the battle line—as was the 103d—and served in every capacity, from disease hospital to resuscitation center to acute care (with surgical reinforcement) to reserve and rest status. Their job was triage, stabilization, and evacuation to the base hospitals.
  2. "In pictures: Field hospitals set up around world". BBC News. 30 March 2020.
  3. "Namibia Defence Force gets German-made mobile field hospital". Mar 7, 2013. Retrieved Jun 7, 2020.
  4. Namibian, The. "Mobile field hospital set up at airport". The Namibian. Retrieved Jun 7, 2020.

Further reading

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