A Combat Support Hospital (CSH, pronounced "cash") is a type of modern United States military field hospital. The CSH is transportable by aircraft and trucks and is normally delivered to the Corps Support Area in standard military-owned Demountable Containers (MILVAN) cargo containers. Once transported, it is assembled by the staff into a tent hospital to treat patients. Depending upon the operational environment (e.g., battlefield), a CSH might also treat civilians and wounded enemy soldiers. The CSH is the successor to the Mobile Army Surgical Hospital.
The size of a Combat Support Hospital is not limited, since tents can be chained together; it will typically deploy with between 16 and 256 hospital beds, with 54 beds being most common. For patient care the CSH is climate-controlled, and has pharmacy, laboratory, X-Ray (often including a CT Scanner) and dental capabilities. It provides its own power from generators.
The great operational advantage of the DEPloyable MEDical Systems (DEPMEDS) facility is the use of single or double expanding ISO containers/units to create hard sided, air conditioned, sterile operating rooms and intensive care facilities, which can produce surgical outcomes similar to that seen in fixed facility hospitals, and do so in an austere environment.
A CSH has two separate components, the HUB (Hospital Unit Base) and the HUS (Hospital Unit Surgical). HUS personnel consist of surgeons, surgical nurses, surgical technicians, nurse anesthetists and anesthesiologists. The HUB consists of all other hospital and support personnel including food service, motor pool, hospital admissions (PAD), nurses, biomedical engineers, laundry & bath, etc. In concept, a HUS could be activated separately and interoperate with an existing fielded HUB. HUS surgeons, surgical nurses, nurse anesthetists and anesthesiologists are usually back-filled with IMA (individual mobilization augmentees).
Because they are large and relatively difficult to move, Combat Support Hospitals are not the front line of battlefield medicine. Battalion Aid Stations, Forward Support Medical Battalions and Forward Surgical Teams are usually the first point of contact medical care for wounded soldiers. The CSH receives most patients via helicopter Air Ambulance, and stabilizes these patients for further treatment at fixed facility hospitals. Ideally, the CSH is located as the bridge between incoming helicopter ambulances and outgoing Air Force aircraft.
The CSH is capable of providing definitive care for many cases. Current medical doctrine does not encourage wounded soldiers, if they are not expected to quickly return to operational status, to stay in the combat zone. This is a pragmatic decision as the resources are usually available to bring them home quickly. Military aircraft constantly fly into a theater of operations loaded with equipment and supplies, but often lack a back cargo. Given that adequate "airlift" is usually present, it is easy to evacuate wounded promptly. For this reason the CSH bed capacity is not as heavily used as in past conflicts.
The CSH will generally have a Medical Evacuation Company attached. This company consists of approximately 4 platoons of ground ambulances commanded by a Medical Service Corps officer. The Ambulance Company in cooperation with available air ambulances (MEDEVAC) is responsible for the movement of sick and wounded from the Battalion Aid Station and other forward-deployed locations to the CSH, as well as evacuation through an established medical treatment chain leading ultimately, for those seriously sick or wounded, to hospitals in the Continental United States in cooperation with resources in the U.S. Air Force.
The CSH is larger than its predecessor, the Mobile Army Surgical Hospital. It is commanded by a Colonel, rather than a Lieutenant Colonel.
A fully manned CSH has 624 people to staff 256 beds. The modular nature of the organization allows for partial deployments, and the full unit is not often deployed.
History and past configurations
In 1973 and 1974, the 28th Surgical Hospital MASH helped phase-in new designs for operating rooms and patient facilities from the previous canvas tents. Since then all MASHs and Field Hospitals have been inactivated or reconfigured to the CSH configuration. The last to convert was the 212th Field Hospital.
In 1978 the 28th Combat Support Hospital (28th CSH) was established at Fort Bragg, North Carolina, as part of the 44th Medical BDE as a MUST (Medical Unit Self Contained Transportable) Hospital. MUST was the ancestor of the current DEPMEDS design. It contained all necessary functions to provide care for 250 beds, including 2 intensive care units, 8 medical wards, emergency room, 4 operating rooms, orthopedic room, laboratory, X-ray and pharmacy. It consisted of hard containers which housed the operating rooms, laboratory, X-ray, and pharmacy. Inflatable shelters were used to provide double wall insulated areas for the patient care areas of the hospital. These "inflatables" required a power system called a Utility Pack (also known as a U-Pack or power station) to provide utility services. The Utility Pack (Power Plant, Utility, Gas Turbine Engine Driven - Libby Welding Co. Model LPU-71, Airesearch Model PPU85-5, AmerTech Co. Model APP-1, or Hollingsworth Model JHTWX10/96), powered by a centrifugal flow gas turbine engine, provided electricity (60 Hz AC, 400 Hz AC, and 24vdc), heating, air conditioning, compressed air, vacuum, and hot/cold water. At 250 beds the hospital required 8 U-Packs. Each consumed 30 gallons of jet fuel per hour. After several years of using inflatables they were abandoned in the mid 1980s, largely due to the weight of the inflatables, and the amount of fuel required just to keep the tents from collapsing.
List of active CSHs
- 10th Combat Support Hospital (Fort Carson, Colorado)
- 14th Combat Support Hospital (Fort Benning, Georgia)
- 21st Combat Support Hospital (Fort Hood, Texas)
- 28th Combat Support Hospital (Fort Bragg, North Carolina)
- 31st Combat Support Hospital (Fort Bliss)
- 47th Combat Support Hospital (Fort Lewis, Washington)
- 86th Combat Support Hospital (Fort Campbell, Kentucky)
- 115th Combat Support Hospital (Fort Polk, Louisiana)
- 801st Combat Support Hospital (Fort Sheridan, Illinois)
- 399th Combat Support Hospital (Fort Devens, Massachusetts)
- 865th Combat Support Hospital (Utica, New York)
- 121st Combat Support Hospital (Yongsan Garrison, Seoul, South Korea)
- 212th Combat Support Hospital (Germany)
List of former CSHs
- 67th Combat Support Hospital (Germany)
- Support 377th Combat Hospital (United States, Tennessee, Chattanooga)
- 46th Combat Support Hospital (Fort Devens, MA) Unit disbanded 1994
- Military medicine
- 45th Portable Surgical Hospital
- Ibn Sina Hospital, Baghdad, Iraq
- Casualty Clearing Station
- List of former United States Army medical units
- Mraz, Steve (17 October 2006). "Last MASH unit becomes Combat Support Hospital, improves capabilities". Stars and Stripes. http://www.stripes.com/news/last-mash-unit-becomes-combat-support-hospital-improves-capabilities-1.55542. Retrieved 8 January 2012.
- Donohue, Hugh. "A Combat Support Hospital in the Gulf War". American College of Physician Executives. http://www.thefreelibrary.com/A+combat+support+hospital+in+the+Gulf+War-a011902721. Retrieved 7 August 2010.
- PBS NOVA: Life and Death in the War Zone
- The Journey, by surgeon E. T. Rulison, Jr., M.D., F.A.C.S., firsthand account and photographs of the 51st Evacuation Hospital during World War II
- The Nurses of the 51st Evac Hospital In WWII, by nurse First Lieutenant Tillie (Horath) Kehrer, firsthand account and photographs of the 51st Evacuation Hospital during World War II
- Author Webcast Interview and Firsthand Account of Rule Number Two: Lessons I Learned in a Combat Hospital based on Dr. Heidi Squier Kraft seven months with a Marine Corps surgical company in Iraq, ISBN 9780316067904
- Lineage and Honors - Hospitals at the United States Army Center of Military History archives
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