Did MASH Get Chest Compressions Wrong?

A chief medical criticism of MASH is either a lack of chest compression during patient recussitation or the use of improper chest compression techniques. Chest compressions are certainly portrayed on MASH at least twice, but is the general lack of external compressions during CPR incorrect? Did MASH get it wrong?

External chest compressions used on MASH - Season 4, Episode 11, Dear Peggy: B.J. performs chest compressions on a patient and Season 7, Episode 23: Preventive Medicine: Hawkeye performs chest compressions.

The answer is no. When viewed threw a historical lens, MASH did not get chest compressions wrong. If anything, the use of external cardiac massage techniques on the show at all was historically incorrect, or at least unlikely. Hawkeye, on several occasions, uses open-heart massage to get a patient’s heart beating again, which is portrayed as unusual and heroic. But first, let’s talk about three times that chest compressions were used in the show.

First MASH Chest Compressions – Season 4, Episode 11: Dear Peggy

In Season 4, Episode 11, titled Dear Peggy, Frank is having trouble with a complex operation while B.J. is serving as his anesthetist. B.J. announces that the patient has no pulse, and Frank immediately begins removing his gloves, saying, “Well, that’s that.” What do you mean, that’s that? Do something!” yells Hunnicutt, alarmed. Frank replies that the patient didn’t have a chance, anyway.

Hunnicutt jumps up, thumps the patient on the chest, and begins performing chest compression, telling Kelly to bag the patient (use a bag to ventilate his lungs), while Frank complains. B.J.’s technique is more modern and “correct” than Hawkeye’s previous technique in the earlier episode.

Hawkeye suggests trying open heart massage, but B.J. insists, “We can do it closed. I saw it back in the States!” Hawkeye replies, “Good, I’d rather not open his chest.” B.J. was successful, and the patient’s heart began beating again.

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First MASH Chest Compressions – Season 5, Episode 21: The General’s Practitioner

During an OR session, a Colonel named Bidwell arrives to see Potter, who is scrubbing for surgery. Bidwell tells Potter that he is looking for a private doctor for his commander, Lt. General Theodore A. Korshak, and wants to know who Potter’s best man is. Potter reluctantly admits that Captain Pierce is the best, but tries to convince Bidwell that Hawkeye is not the doctor he wants, as he’s too unmilitary and unpredictable. Bidwell disregards this and demands to see the doctor in action.

With Colonel Bidwell looking on, Hawkeye’s surgery patient suddenly loses his pulse. Hawkey performs a precordial thump and then begins vigorous chest compressions. The quite quick and slightly upwards (toward the head) technique he uses has been criticized as being incorrect. By modern standards, the correct technique involves pushing straight down in a steady and slower rhythm. The use of a thump technique has also been criticized. This technique is historically accurate, but it is no longer used very often today.

When chest compressions are unsuccessful, Pierce decides to “go inside” to perform open-heart massage. While doing so, he says, “Live, dammit, live. Don’t let the bastard win!” He successfully revives his patient, helping to cement Colonel Bidwell’s interest in having Pierce be the General’s personal physician.

Since B.J. had performed closed-chest compressions successfully in a previous episode, Hawkeye’s use of the technique makes more sense. It also makes sense that he might not be aware of and standard or correct procedure for the technique.

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Season 7, Episode 23: Preventive Medicine

Although chest compressions may have been shown at other times on the show, this is the third and final time I will discuss them for the purposes of this article. In Season 7, Episode 23, titled Preventive Medicine, a problematic Battalion Commander, Colonel Lacey is visiting his wounded troops, of which there are many, as he has the highest casualty rate in Korea.

When Colonel Lacey is trying to present a Purple Heart to one of his men in post-op, the man suddenly has a medical crisis. Hawkeye and B.J. rush over, shooing the colonel out of the way, and find that the patient has a faint and very irregular pulse. B.J. picks him up into a sitting position while Hawkeye orders bicarb solution. They place a board behind the man’s back and lay him back down. Pierce administers the bicarb, but there is still no pulse. He straddles the man, saying, “I’m going to beat the daylights into him.”

Captain Pierce delivers a hard precordial thump and then begins chest compressions much like the ones he performed before. His technique here is, again, incorrect by modern standards. Not only is he straddling the patient, causing the compressions to be delivered at an angle, but his elbows are bent, and he thrusts with his lower arms, instead of using a straight-arm technique that relies on one’s own body weight to help deliver the force necessary. Not only would Hawkeye’s technique be less effective, but much more fatiguing.

B.J. bags the patient while Hawkeye continues delivering chest compressions. After the Colonel is called away by a phone call, B.J. tells Radar to “keep him out of here!”

Margaret gets adrenaline ready, and Hawkeye stops compression long enough to deliver it. After several more compressions, the patient regains his pulse.

By this time in the series, the use of external chest compressions seems to have become standard practice. The doctors even have a board handy to place behind the patient’s back. Having a hard flat surface underneath the patient, instead of a soft bed, will help make the compressions more effective. While it is plausible, in the universe of the show, that the 4077 would have started using chest compressions regularly after B.J. demonstrates them, it is not likely for several reasons that I will discuss below. It is certainly hard to fathom why a MASH unit would have a board handy that seems to have been made especially for this purpose.

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First Open-Heart Massage – Season 3, Episode 5: O.R.

The first time we see the open-heart massage technique is in Season 3, Episode 5, titled O.R., Hawkeye’s surgery patient loses his pulse, and Hawkeye uses open-heart massage and adrenaline to get the heart going again. Both Henry and Frank react as if it is something they’ve never seen. Frank comments, “We’ve never done that!”

Curiously, before Hawkeye asks for a scalpel and opens the patient’s chest, he seems to be using some kind of “massage” technique with one hand, but it is completely unclear what is supposed to be portrayed here, and nothing he is doing with one hand could have had any effect on the patient’s heart. He is successful in reviving the soldier with the open heart technique, but the patient later dies.

Why is This Historically Incorrect?

As I said before, it is not the specific technique used on the show that is incorrect, it is the fact that it was used at all. Closed chest massage was not a widely recognized practice during the time of the Korean War.

Closed-chest cardiac massage has been referenced, studied, and used since the latter part of the 1800s. However, it never became a widespread and standard technique until after 1960, well after the Korean War had ended. In the 195Os, a team at Johns Hopkins was working on closed-chest defibrillation, and in a happy accident, found that manual chest compression restarted the femoral pulse in a dog. The team, Kouwenhoven, Jude, and Knickerbocker, published their findings in 1960. This led to closed-chest massage, used along with pulmonary resuscitation, becoming the standard of care. ¹

The other method shown on MASH, the precordial thump, has also been around for at least 100 years, but it is unclear whether this method would have been in widespread use by doctors in the Korean War. However, this dramatic and showy procedure was a favorite on medical TV shows of the 1970s, and is often still shown today since it looks dramatic and heroic. At the time the show was made, a thump for ventricular tachycardia was something that would have been known about. It’s accurate for the 1970s, when the show was made, but perhaps not for the 1950s, when the show was set. Today, outside of fiction, its use is limited. ²

As far as the technique for chest compressions, it wasn’t codified, let alone widely practiced, in the early 1950s. B.J.’s first use of external cardiac compressions is unlikely, as it would have been a quite foreign and unusual procedure. It is at least plausible, though, since B.J. says he “saw it done in the States.” The second incident, in which Hawkeye uses it, can now be seen as more realistic, as everyone would know of B.J.’s prior use, and there certainly would have been discussions and likely meetings about the incident.

As stated, while we can accept this as part of the universe of the show, it is not at all likely to have occurred in the way the show portrays it, as it seems to have become much too standard and familiar to the doctors of the 4077. Such new techniques would not have been used without reaction. Colonel Potter, as a real MASH commander, would have certainly questioned and discussed the procedure to decide if it were permissible. The Army Medical Command, in fact, may well have forbidden the practice had they become aware of it.

Regardless of its historical accuracy, the show fit what a 1970s audience expected to see, and this is often reflected in the medical scenes. If you watch older 1970s medical shows, you’ll probably find that the technique is depicted more like Hawkeye does in the show. I’ve even seen doctors straddle patients in more modern shows. It looks more intense and “heroic” but is a completely incorrect way to do chest compressions, as it eliminates the proper leverage and makes it difficult to use the proper depth and force.

Open Heart Massage On MASH Is More Historically Accurate

On the other hand, Hawkeye has a few scenes where he uses open heart massage, and everyone acts like it’s a brand new thing they’ve never heard of. This technique, however, was more well-known than external chest compressions, having been recognized since the late 1800s, at least. It was actually the standard until the late 1950s. ³ It’s likely that a group of doctors and residents who found themselves drafted into the war may have never used such an invasive and dramatic technique, or seen it used, though.

So, in summary, the use of open heart massage and the thump technique were historically correct, and both these techniques could have plausibly been used at a MASH unit in Korea. The use of closed-chest heart compressions is historically incorrect. It was likely not used by doctors during the Korean War, and if it was, this would have been a new and quite unusual technique to most medical personnel present.