121st Field Hospital Revives Korean War-Era Rail Evacuation With a Commercial Railcar

Soldiers from the 121st Field Hospital “Legends,” part of the 549th Hospital Center and the 65th Medical Brigade “Pacific Medics,” converted a commercial Korean passenger railcar into a casualty evacuation platform here during exercise Pacific Medic Forge 26-2 in August 2026.

At an installation railhead, the team moved 20 simulated patients, including eight live role players, onto the railcar to practice decompressing a full hospital and sending casualties onward through the theater.

Serving as the 121st Field Hospital’s external evaluation, the exercise’s railhead event brought together the hospital’s emergency treatment, intensive care and intermediate care sections.

Moving wounded Soldiers by rail is a practice with deep roots in military medicine. During World War I, the American Expeditionary Forces rented hospital trains from the French government. Early in World War II, the U.S. Army relied almost entirely on commercial Pullman sleeping cars, and loading them was so difficult that patients were sometimes brought in through the windows, according to Smithsonian Magazine.

South Korea has its own chapter in medical railroading. In July 1950, three Korean coaches were refitted with crudely built litter racks and coupled to freight trains to move patients to Pusan, according to a Korean War study published in Railroad History. The Army maintained hospital train units until the mid-1970s, when those units were inactivated and doctrinal reliance shifted toward host-nation rail support.

“In 1950, Soldiers turned Korean coaches into ambulances with whatever they had on hand,” said Lt. Col. A. Nicole Gonzalez, commander of the 121st Field Hospital. “Seventy-six years later, we are relearning that lesson on the same peninsula, and it reminds us that good ideas in combat medicine rarely go out of date.”

Planners noted that in large-scale combat operations, contested airspace may limit helicopter medevac, and ground ambulances alone cannot clear a theater’s volume of casualties. A train, however, can move dozens of patients at once. In Ukraine, Médecins Sans Frontières (Doctors Without Borders) moved 2,481 patients by medical train over eight months in 2022, according to a study published in JAMA Network Open.

Across the Army, medical units are testing similar capabilities. During exercise Immediate Response / Saber Strike (SWORD 26) in Poland in May 2026, the 30th Medical Brigade also evaluated rail as a casualty evacuation platform.

“Moving into large-scale combat operations, we need to use all forms of evacuation methods,” Col. Crystal L. Belew, commander of the 519th Hospital Center, 30th Medical Brigade, said during the May exercise in Poland.

For the 121st Field Hospital, the August after-action review showed that loading and unloading simulated patients on the converted railcar went smoothly, and patient administration Soldiers reported zero lost patient packets during peak transfer periods.

“Loading patients onto a railcar is a team effort,” said Master Sgt. Miriam L. Reyes, senior enlisted advisor for the 121st Field Hospital. “Every litter team had to communicate and move together, and our Soldiers took real pride in getting it right.”

Leaders emphasized that administrative preparation prior to arrival at the railhead is critical to success.

“The railcar was never the problem,” said Maj. Joshua Okoemu, executive officer of the 121st Field Hospital. “Our lesson is that patients and their records have to be ready before the vehicles roll, and the only way to get good at that is to train it again and again alongside our Korean partners.”

Seventy-six years after Korean coaches were refitted with litter racks to carry the wounded, the Soldiers of the 121st Field Hospital showed that the concept still works—and are training to make it routine.

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