The battlefields of World War I laid the foundations for the medical advances that were to follow in World War II, Korea and Vietnam. War has always served as a proving ground for medical techniques that were later adapted to future military and civilian use.

Among the most important developments during World War I were improvements in blood transfusions and the diagnostic use of X-rays. For the first time, the military addressed the psychological effects of war, as’shell shock’ accounted for a considerable number of casualties. The widespread use of reconstructive surgery, orthopedic surgery and physical rehabilitation marked a turning point in preparing the veteran for postwar life.

By the end of the war, it was well understood that the sooner a wounded soldier received treatment, the better his chances of survival. Aid posts in the trenches and motorized ambulances were a boon, but as the pace of life in general accelerated in the run-up to World War II, so did the means by which the military dealt with its wounded. Combat medics were incorporated into fighting units and went into battle to administer immediate care in the field under fire. Like the stretcher-bearers in World War I, combat medics suffered high casualty rates.

World War II also ushered in the era of sulfa drugs and penicillin to treat infections. The synthetic antimalarial drug Atabrine was used extensively in the Pacific after the Japanese occupation of the Dutch East Indies effectively cut off the quinine supply. A method to separate plasma from whole blood was perfected in the 1930s, giving field medics a viable option for stabilizing the wounded when whole blood was unavailable. Morphine, which had been used in field hospitals for decades, was now available in individual doses that could be injected immediately, bringing a measure of comfort until the wounded could be evacuated from the field. Thanks to this progress, in World War II only 4.4 percent of those wounded died, compared to 8.1 percent in World War I.

Mobility was the watchword of the post-World War II era. The U.S. Army experimented with various mobile medical facilities before adopting the mobile army surgical hospital (MASH) late in 1945. Used extensively for the first time in Korea, MASH units were designed to move in response to the fighting. The first three MASH units — 8055th, 8063rd and 8076th — moved 50 times between July and December 1950; the 8076th alone admitted more than 5,000 patients as the battle for the Pusan perimeter raged from July to September.

What made this all possible was aeromedical evacuation, perhaps the most significant technological development in 20th-century military medicine. World War I saw the limited use of airplanes to move the wounded, but the field progressed rapidly. In World War II, the U.S. Army Air Forces modified a Douglas C-47 to carry 18 patients on stretchers in addition to medical technicians and nurses.

Arguably the most revolutionary development was the medical evacuation, or medevac, helicopter, which became symbolic of the Korean and Vietnam wars. In terrain that was often inaccessible to ground transport, the medevac could carry surgeons into the field if necessary, as well as carry wounded out. By 1951, 60 to 80 percent of battle casualties were taken to field hospitals or other treatment facilities the same day they were wounded. In Vietnam it was possible for a wounded soldier to reach a hospital within two hours. It was a far cry from World War I, the first industrialized war, when the journey from the trenches to the field hospital could take between 12 and 48 hours.

More than 50 years after Private Willcox stumbled into a dressing station in Ypres, Sergeant Fred Castleberry lay on a battlefield halfway around the world near Trang Bang, Vietnam. It was April 14, 1968 — Castleberry’s 21st birthday — and a rocket-propelled grenade had just severed his right arm below the elbow and his left leg above the knee.

Castleberry was doubting that he’d ever make 22 when he saw a ‘big green angel,’ a Bell UH-1 ‘Huey’ helicopter bearing a red cross — the officially recognized symbol of the medical corps since the 1864 Geneva Convention — coming for him:

For the rest of my life, I will never forget the whopping sound of the Huey’s blades and the sight of the spotlight clearing the tree line. As the Huey got closer, I could see sparks flying everywhere, as countless small-arms rounds hit the helicopter….I honestly thought the helicopter would be shot down, and we would all die.

But somehow, through all of the gunfire, they got in. I remember seeing these beautiful angels pick me up and take me aboard. I remember the pinging of the bullets ripping through the skin of the Huey and hearing the crew excitedly, yet calmly, talking to one another. Then I saw this face above me saying, ‘Buddy, stay with me. Hey, Buddy, you are going to be all right.’ Over and over again I would drift in and out of consciousness, and all I can recall is this bloody face telling me I was going to make it.

When I came to, this nurse asked me if I would like company….The entire dustoff crew was in the hospital with me. The guys that saved my life, the young boys that rescued me themselves had been wounded. The blood on the air medic’s face was not mine; it was his. A bullet had gone through his cheek, and rather than tend to his own wounds, he kept me alive.

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Castleberry testified before the U.S. Senate Committee on Veterans’ Affairs in July 2003 during a hearing to determine whether the criteria for awarding a Combat Medical Badge should be changed. Established in 1945, before the age of helicopters, the CMB has been given to ground personnel who provided medical aid in combat.

A bill to create a Combat Medevac Badge to recognize helicopter pilots and crews passed the U.S. House of Representatives in May 2005. As of June 6, it had been referred to the Senate Armed Services Committee.

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This article was written by Christine M. Kreiserand originally published in the November 2005 issue of Military History magazine.

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