MIESAU ARMY DEPOT, Germany — When Lt. Col. Ken Canestrini took command of the 212th MASH in August 2001, not one of the unit’s 37 vehicles was operable.

It wasn’t neglect, necessarily.

It was the Army’s transformation of medical units. The 212th had just returned from peacekeeping in Bosnia and Herzegovina, and the thinking was the unit wouldn’t need the vehicles. In the future, even though MASH stands for Mobile Army Surgical Hospital, medical units would just be dropped into pre-positioned facilities instead of hauling tents and hospital equipment MASH-style in 20-foot-long trailers hauled by 32, 5-ton trucks.

Instead of MASHs, there would be FSTs, 30-person forward surgical teams of doctors, nurses and medical technicians who would treat soldiers in the first critical hour, then evacuate the wounded within 72 hours to higher levels of care at large combat support hospitals, or CASHs.

That’s not the way it turned out.

Six CASHs and the 212th were supposed to set up in Iraq near the front during Operation Iraqi Freedom. Only the 212th MASH made it, the sole Army hospital operating in Iraq during the first 19 days of the war.

“The CASHs were always coming, but they never made it,” said Staff Sgt. Charlton Chase. “It was just us. There was no hospital down the street. It was just the MASH there for two divisions” and elements of V Corps inside Iraq.

In October 2004, the Army’s last Mobile Army Surgical Unit is scheduled to stand down. Iraq may have been the last war for the 86-year tradition of putting Army hospitals and medical personnel at the front. That concerns a lot of people in that last MASH.

Canestrini hopes Army officials will retain two MASH units, one on the West Coast, another perhaps in Germany. Those units could support troops as rapid deployment teams, with the CASHs coming behind, Canestrini said.

His officers and noncommissioned officers agree.

“I’m 100 percent certain they should take a relook” at scrapping the MASH concept, said Sgt. 1st Class Zimberlist Hester, chief ward master.

For a racing wildfire of a war such as Iraq, the MASH was the perfect fit, unit members said. A slice of the CASH, called a hospital unit surgical forward, is mobile, just not as mobile as a MASH unit. Though a CASH has a larger number of people, it has fewer trucks than a MASH, said Maj. Suzanne Richardson, 212th’s chief of nurses. Not only is the 212th more mobile, it’s also more self-contained, she said. With the ability to perform 100 procedures in 15 days without external support, “no one had to push us anything logistically. I think the strategy we had was the perfect fit for the battle.”

Another reason the MASH performed so well is that its people train together, while CASHs are equipment modules and personnel, mostly reservist, assembled for war from the four corners of the globe, said 212th personnel.

For example, the 212th’s 78-hour convoy to Baghdad was harrowing, but the unit had already had a taste last year of how demanding war can be during eight days of exercises before a 265-mile convoy across Germany to Hohenfelds Training Area.

“That was the real gut check,” Canestrini said. At the time, his people thought that was “the convoy from hell. We didn’t realize what was coming.”

CASHs “are great,” but Army officials “should make sure that [personnel] get to spend some time together before going to war, said Capt. Art Finch, the 212th’s clinical psychologist. “That’s one of the lessons we learned.”

Soldiers and officers say once Canestrini took command, he imbued the 212th with a Special Forces-like sense of being in a unit capable of doing anything. Wearing a close-cropped haircut that flirts with being a high-and-tight, Canestrini is as far as you can get from a zany character in the “M*A*S*H” TV show.

He began his 212th stint by re-emphasizing training, equipment maintenance and rapid-deployment skills.

“If you can’t do that, you don’t belong in the Army,” Canestrini said.

He added vehicle maintenance days to the Army’s regular equipment maintenance schedule. He added more training that simulated battlefield conditions. It all paid off when the 212th made it to the Iraqi front first.

Because the war was run by U.S. Central Command, “we did not have that good a view of what was going on there,” said Jaime Cavazos, media relations officer at U.S. Army Medical Command public affairs, at Fort Sam Houston in San Antonio, in a phone interview.

But Cavazos confirmed that the 212th was the only Army hospital operating in Iraq “for some time.”

Keeping the MASH would be a decision “made in the stratosphere,” the stratosphere being Army Medical Command and the Department of Defense, he said.

The CASH-vs.-MASH debate somewhat echoes the debates about fast-wheeled combat vehicles vs. tanks, and lighter faster forces vs. armor’s superior power during the 30 years he was active duty, said Cavazos, a retired staff sergeant major.

But the Army is moving toward faster, lighter forces, “and you need for medical assets to be light as well,” he said. Right now, the forward surgical teams at the front sending soldiers to hospitals at the rear is the Army’s future, he said.

Soldiers and medical personnel in the 212th couldn’t help but compare themselves to other medical units and not draw one conclusion, Finch said: “They couldn’t, and we did. And there is something special about that.”

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