After watching the Navy struggle to employ their enormous 70,000 ton Mercy Class hospital ships in unimproved harbors (details here and here), I’m struck by a passage from a September 1937 Proceedings, in “The Fleet Hospital Ship” by Captain Lucius W. Johnson:

The size of the hospital ship must be based on a judicious compromise between the needs of war and those of peace, since during her expected life of 30 years or more she will be employed under both conditions. During the World War the Aquitania and the Mauretania (30,000 tons), the France IV (29,000 tons) and the Britannia (47,000 tons) were used as hospital transports but proved unsatisfactory for this purpose. They were too large to enter Alexandria, Malta, and other harbors, so patients had to be ferried out on smaller ships, requiring an extra handling and greatly delaying evacuation. A full load of patients was not always available, resulting in uneconomical employment. They required so much fuel and fresh water, it was difficult to supply their needs. Too great size would prevent the hospital ship from entering many harbors where an advanced base might be desirable.

In a service that values the newest things on the firing line, it’s awfully easy to dismiss old stuff as “irrelevant” and “dated.” But if you can, go visit a few dank sub-sub-sub basement journal store-rooms. there’s a heck of a lot of wisdom hidden in some of the old journals. You just gotta find it.

Springboard!




Posted by Defense Springboard in Uncategorized


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  • leesea

    which is why I proposed converting the T-LKAs El Paso and Mobile to T-MMS support ships with significant medical capability (about 18 months ago)

  • http://informationdissemination.blogspot.com/ Galrahn

    It is noteworthy nobody ever said the Hospital ships were too big until we began sending them on these medical diplomacy deployments.

  • http://www.jimdolbow.blogspot.com Jim Dolbow

    Perhaps we could learn from Brazil. hat tip to Christopher Albon over at War & Health who hat tipped Galrahn

    http://warandhealth.com/brazils-brown-water-hospital-ships/

  • http://springboarder.blogspot.com springbored

    Yeah, the Mercy and Comfort were done up with the “big trauma war” in mind, with little to no planning for diplomatic non-war missions. Of course, once they were built, they got sent out on a diplomatic/visibility mission–but–if I recall correctly–the destination harbors required a quick dredging before the hospital ships arrived. (Also think they traveled in conjunction with a fleet tug, too.)

  • Byron

    Makes me wonder why people would complain when these big white ships show up to help those that need it. It’s not like they’re paying for it. And yes, the first job of these vessels is to support OUR people in need. Personally, I think they’re just the right size.

  • http://springboarder.blogspot.com springbored

    Erm…who is complaining? It ain’t exactly the people using it who complain. It’s the folks who either do the planning or who operate/manage the plaftorm who complain. Hell, until a couple years ago, it couldn’t take infectious disease cases without endangering everybody aboard.

    Final line, it’s got design issues that make it a less-than-optimal platform–for either casualty care OR projecting medical power.

  • http://www.jimdolbow.blogspot.com Jim Dolbow

    does anybody know the projected service life of the Mercy and Comfort?

  • Byron

    Then scrap ‘em. Buy a cruise ship. Gut the staterooms. Should have plenty of hotel generation to handle all the services they need. But for sure, let them keep the names, and paint them white.

  • leesea

    well for once Springbored got it right (up to that BS about mariners complaining and infectious disease crap Comfort got a hazmat segration unit 7 yrs ago). I was involved in the T-AH 19 class ship introduction. They were specifically designed for “wartime use”. Hence the 400 patients a day throughput rqmt!

    MSC has been fixing the ships ever since introduction (updated helo deck, boats and systems) and MEDCOM has been updating the MTF spaces & equipment also.

    Based on prior discussions with the Comfort’s master, the ships size is too large but the medical capablities are awesome. Part of the problem is that naval staffs do no know intrinsically how to manage a medical diplomacy mission. I would assume the Navy is learning but then again there will be a different staff for the next mission.

    JimD the T-AH class plant is old and has taken a lot of TRANSALTs to keep running. The hull is getting old and there are major improvements which could be done to the ship itself. I believe the MTF is still state of the art?

  • sid

    If any mission called for a modular and joint CIV/MAR- approach, this one is it!

    Is there any reason such units…neo MASH’s… could not be configured for true sea/land use…with elements transportable by any means including air?

    Any hull capable of operating in the intended missions areas and capable of supporting the units would work.

  • Chap

    Sid,

    There are at least three ways I’ve read or heard about that do what you say; medical professionals volunteer to join USN, the hospital ship and dedicated State/DoD money provide logistics and support, and they do good work alongside the military folks.

  • http://usniblog D.P. Barrett

    MERCY and COMFORT weren’t built to do medical missions in the Third World. These tankers were modified to provide exemplary medical care to large numbers of American combat casualties. I served on MERCY in the Gulf War and it was clear from the comments of the medical staff that the ship was a trauma care center with no equal afloat or ashore. If we want to do kumbayah medical missions, why not get something smaller dedicated to winning hearts and minds in every port no matter how small?

  • http://fredfryinternational.blogspot.com/ Fred Fry

    I took a tour of the MERCY back in the ’90’s. It was very interesting, especially the operating rooms, which if I remember correctly was setup to be able to perform 2 operations on a patient at the same time multiplied times 12 operating rooms. I also remember the statement that they were the largest emergency room facilities afloat or ashore.

    Another issue was crewing the hospital as it placed demands on hospital staffs across the country when deployed. Sure they did the humanitarian thing recently, but how fully staffed was the medical team and where did they come from? That type of mission has different staffing requirements from those that the ship was original mission the ship was designed to operate under. (GPs and pediatricians, etc… instead of so many trauma surgeons)

  • leesea

    The staffing of the Medical Treatment Facility on both ships has pretty much been worked out now by BUMED. Active duty from specific Naval Hospitals and back filling by naval reserves. The ships’ crew of CIVMARs as well as the MTF staff is scable to the mission intended. Granted that medical diplomacy missions wereNEVRER thought off to begin with, but scaling the operation was. Now with the addition of medical staffs from other services and other countries and NGOs that impact is less on supporting hospitals.

    I believe the Comfort’s last mission was about 1/3 medical capacity? Go to the master’s blogsite for more details.
    http://mercycaptain.blogspot.com/

    Like I said the ships are old and their size and systems create problems. A smaller more flexible ship is probably desirable to more than me? BUT no one is going to insert new or converted ships into the already questionable SCN budget. The Navy will continue to show the flag using less than optimal ship platforms because that is what they have been told to make do with.

    PM me and I will send you the T-MMS concept.

  • http://springboarder.blogspot.com Defense Springboard

    They are–at least, as of a few years ago–tied for the the fifth largest medical facility in the USA, and when fully mobilized, they do have a substantial impact upon the established shore-based medical infrastructure. A full mobilization, obviously, has secondary impacts at home.

    But to prevent that, there’s a range of manning models for the diplomatic missions. In general, they’re not fully staffed and NGOs participate and so on…thus reducing the drag of full asset mobilization.

  • sid

    I misued CIVMAR to to describe what I meant civilian/military medical cooperation…I was talking about the merge of military medicine with entities such as <a href=”http://www.dmat.org/DMAT.

    Why must this mission be hard engineered into a ship? They are of little benefit for an earthquake in Armenia, or famine in Zimbabwe.

    A for instance…When Ike East Texas this past summer…instead of sending an LHA (which 99 percent of the population of SE Texas never even knew was there)… A perfectly good platform was moored to a pier in Galveston that could have accomodated such a modular facility.

    Unmarry the mission from a single platform.

  • galrahn

    “They are–at least, as of a few years ago–tied for the the fifth largest medical facility in the USA”

    I never realized they were that big. Very interesting, unique doesn’t do them justice when you consider where they have been sent.

  • leesea

    sid the “extra” help from civilians and other military is one thing that makes the hosptial ship deployments more affordable.

    G, When built the Mercy and Comfort were the 7th & 8th largest hospitals in the US. I do not know where they rank now?

    Springbored got it wrong again. The multiple manning levels of the MTF and crewing for the ship were written into medical “conops” for the T-AH class as soon as the Mercy came back from its first mission to WestPac in the ’90s! They are established at 250 beds. 500 beds and full MTF. Mission size determines crewing & staffing not the other way around! The “conops” document corrected the medical staffing problems initially encountered in the ’90s.

    There already exists the Expeditionary Medical Facility which is mostly containerized and could be put on any sealift ship. I built that into the T-MMS concept by adding container cells in a after hold. Also by keeping the fwd cargo holds for use by Seabees and to stow vehicles associated with EMF. The Seabess erect the EMF ashore. Those who can’t be treated ashore go the MTF on the T-MMS.

    EMFs are not expensive and managed/stored at Cheatham Annex VA

    G while amphibs offer some distinct scale advantages (personnel & assets) to medical diplomacy, smaller ships (auxiliary or sealift) afford the Navy less exppensive, less formidable platforms which do not detract from military missions. More support on ships fwd prepositioned could certainly enable faster response?

    I would consider converting older LHA/LHDs to other missions but that cost would have to be compared to using/converting existing ships. My OOM estimate for converting T-LKA ElPaso to T-MMS is $50mil and two years. Seems like a small amount but like I said in today’s SCN reality? IMHO Navy would rather spend on “high price fancy” ships.

  • sid

    Also by keeping the fwd cargo holds for use by Seabees and to stow vehicles associated with EMF. The Seabees erect the EMF ashore. Those who can’t be treated ashore go the MTF on the T-MMS.

    Leesa, I think an issue is the word “extra”. It should be “integral”. Make the complexion of the mission less USN ship centric; less military centric.

    And divorce the mission from a single ship’s hull.

  • leesea

    sid – well the personnel and materials have to get there somehow? I doubt that airstrips will be usuable for fixed wing a/c? The cargo is too large for most helos. One has to have a plarform to draw the mission support from.

    One of the issues with T-AH is they have NO cargo capacity and limited gear & boats. I would use three holds for materials and vehicles and keep 2 LCM-8s and add two RHIBs (utility & security).

    I used the hulls I know and that means more than two. They are now auxiliary in nature not warships.

  • sid

    sid – well the personnel and materials have to get there somehow? I doubt that airstrips will be usuable for fixed wing a/c? The cargo is too large for most helos. One has to have a plarform to draw the mission support from.

    Make the medical elements not only modular but scalable. A cholera outbreak needs different elements from an earthtquake…

    Indeed, the USAF routinely air deploys elements in such cases. But theen there are times where a full up mission package may need to be to be deployed for longer periods. Then a response may be to deploy aboard a ship.

    Take the capability out of being hard engineered into just two hulls, and you have a more flexible capability, that would be more effective across a broader range of scenarios.

  • sid

    sid – well the personnel and materials have to get there somehow? I doubt that airstrips will be usuable for fixed wing a/c?

    I have actually worked charter lift supporting a DMAT after hurricane in Saint Thomas.

  • pk

    guys the medical profession has a dirty little secret. first they have houmoungas scandalous costs. second is that they have these costs even with a very large percentage of their effort and capital investment DONATED.

    next time you go to a hospital (non military) look at the donated wings, count the volunteers…..

    it gives you a different view of the thing.

    C

  • leesea

    sid go tell your idea to the MEDCOM folks. They think the EMF is a scaled down Fleet Hospital and there are some other variations on the FH mission. But the Hospital ships are managed by a different part of the folks from Foggy Bottom.

    Airlift been there done that too, can’t substitute for sealift and can’t be preopositioned. Not enough US airbases around the world with big damn warehouses.

    Goto USNS Comfort Master’s website and ask yourself how the USAF could have ever done the same mission? nada! If you can’t get there in an aircraft and land flyboys are SOL.

  • sid

    If you can’t get there in an aircraft and land flyboys are SOL.

    In most “sysadmin” applications they will.

    Again, taking the capability out of a single ship’s hull allows for a scalable response that would be more effective in a broader range of scenarios.

  • sid

    The Baltimore Sun article Springbored provides in his post above illustrates what I mean:

    Despite the tremendous surgical capability the ship brought to the region, many patients were turned away because local health systems weren’t equipped for follow-up care and the ship’s schedule didn’t allow for enough recovery time onboard.

    When the ship leaves, so does all the capability. A more modular setup could redeploy the more in demand surgical assets, while leaving behind more rudimentary follow-on care.

  • leesea

    sid the advantage to having smaller medical support ships prepositioned (and not otherwise tasked) is that they could remain on-station as opposed to how the navy plans the T-AH missions. Remaining on-station and being resupplied is a very important function. But so long as the Navy sees medical diplomacy in terms of short duration missions, the problem the SUN cites will continue.

  • PK

    guys:
    it is a fact of life with hospitals that they are in a continuous cycle of construction and modification to bring themselves into line with various requirements and regulations in the medical world.

    imagine a situation where some pencilnecked inspector padlocks the vls launchers on the ticonderogas because the exhaust gasses from the missiles is hazardous. that particular situation happened a few years ago to the hospital types and they in acutality have not over come it yet.

    C

  • sid

    it is a fact of life with hospitals that they are in a continuous cycle of construction and modification to bring themselves into line with various requirements and regulations

    After spending all my adult life going to sea prior to working at one, the most notable thing I found is that a hospital is first and foremost a building slam full of women… ;-)

    But back to the topic…such an issue suggests a modular approach not wedded to a single ship’s hull may well be the best approach.

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