Over the last few weeks, USNS Comfort has been part of the Haiti zeitgeist, both in America and overseas. The ship appears in hundreds of stories, articles, videos, and blog posts. Her white hull has become a symbol of United States humanitarianism in Haiti. However, the converted oil tanker’s original primary purpose was to support combat operations, not conduct the humanitarian assistance and disaster relief missions that gained her renown. So I ask the readers, if you were to design the next generation of hospital ship, the next USNS Comfort, what would the vessel look like? Here are some of my own thoughts.
Small, Fast, And Shallow
As previously mentioned on the USNI blog, USNS Comfort arrived off the coast of Haiti slightly over 88 hours after the earthquake. In that time, the converted oil tanker, manned by only a skeleton crew, was stocked with supplies, staffed with medical personnel from multiple services and NGOs, and sailed down the Atlantic coast. In getting the massive ship from a pier in New England to a disaster zone in the Caribbean, the crew proved themselves to be true professionals. Impressive is not strong enough a word to describe their accomplishment, it was Herculean. And, that is the problem.
To maximize effectiveness, rapid arrival on station after a disaster should occur because of the ship’s design, not in spite of it. Hospital ships must be small, fast, and shallow. They must operate in areas with small, damaged, or no ports. They must navigate waterways littered with debris without assistance and anchor in the shallow waters close to shore. Most importantly, hospital ships must be fast. Arriving in the first 24 hours is orders of magnitude more helpful than arriving in the first 48 hours, or 88.
Dedicated Medical Team
Instead of staffing hospital ships with an ad hoc complement of riders, hospital ships deserve dedicated medical contingents. Dedicated medical teams would reduce deployment time and improve mission effectiveness. I am not discounting the importance of NGOs such as Project Hope, but rather suggesting that NGO health professionals should supplement a core medical team that has trained and worked with each other and with the ship. Many will say the armed forces do not have enough medical personnel. They are right, but that does mean we should not do it. Rather, it only means we must train more personnel.
Christopher Albon is a Ph.D. candidate specializing in armed conflict, public health, human security, and health diplomacy.
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It should also have extended on-shore capabilities, being able to project medical capabilities on-shore. This would probably require that it is able to deploy an inflatable hospital and some on-land transport capacity, and has the ability to unship all this autonomously (without needing to use land-based cranes etcetera); probably this would imply some sort of amphibious transport, but there are other options.
Thanks for your thoughts on this. Agree on all of the above and would add, for those that have never been aboard, just how truly impressive a capability it is to ramp up from a skeleton crew, get underway in five days, and park a large floating hospital off the coast anywhere in the world. It is an increasingly important capability for our American security and humanitarian efforts, and certainly a capability that must be outfitted to better operate in the shallow, infrastructure lacking environments where it will be most often needed.
I directed folks from my blog to this post at http://www.andrewdwelch.com/2010/02/christopher-albon-on-designing-next.html — again, thanks for your thoughts!
Even a 30 knot ship would only have a 720 nautical mile range then. Also, the USNS Comfort is the largest hospital in Maryland. Not sure how much smaller one would want it to be. Would a 100-bed hospital ship be more efficient?
IMHO, the key here is to ramp up medical “throughput” as rapidly as possible. (where throughput is the number of people helped per day). Tactical platform speed may not be as useful here as delivering a much larger capability somewhat later. (i.e. given the grand scale of the relief effort, arriving in a few hours with a small medical facility and staff with limited capacity and capability may just not have much of an impact). Also, forward basing can reduce travel times significantly.
Certainly USNS Comfort and Mercy are too large. Perhaps we need a range of systems rather than one “hospital ship” type. Containerized hospitals can be carried and operated aboard ships (though performing surgical procedures on a high speed catamaran was found to be problematic due to ship motions in the seaway). Offloading them to shore can speed throughput, but only if you can maintain logistics flow to them and provide security.
Dedicated vessels could also be bought, but they should be sized to fit in a large percentage of potential ports. Numbers will have to make up for size of individual ships. Unfortunately the more ships you buy, the greater the overhead costs to crew each one (on top of medical staffing). Bigger is just more efficient when it comes to ships.
Ship-to-shore transfers are a huge problem in humanitarian disasters like these. It impacts every aspect of aid delivery. Early arrival of mobile pontoon causeways and elevated piers is critical, IMHO. Driving directly off of a ship onto a pier or causeway is a lot faster than offloading to a limited number of landing craft.
Something along the lines of an LPD would be ideal. I would have small landing craft, or hovercraft, capable of crossing most beaches. This way, between the ship, boats and helicopters, it will be able to reach further than we currently can. In addition to the medical team, we need a team of engineers. This will allow the team to set up forward operations and increased operations within the disaster area. Also the engineering team would prove useful in basic foreign outreach.
It might be useful if this capability was also a partnership with the State Department.
US Merchant Marine Officer here, former engineering crew on COMFORT during humanitarians, and during Reduced Operating Status (”skeleton crew”). Have also done deployments on very small ships.
COMFORT only looks big when she’s doing nothing, in ROS. Once the fan hits the shizzola, it’s VERY crowded onboard; departments fight over who’s gonna get which tiny closet for storing essential items.
COMFORT always brings SeaBees during deployment. On humanitarians, they also carry the (incredibly proficient) Navy Show Band, which usually is just as beloved by the local yokels as the medical assist!
I don’t think you could have a serious hospital maintaining sustained operations, in anything smaller than a LHD.
Ever tried to install/use a serious crane on a small ship?
Ever tried to install a medical-grade waste incinerator (don’t forget the identical second, backup unit) on a small ship?
Ever sailed on a small ship that could even make truly enough water for its own CREW, much less an embarked hospital – much less SERIOUSLY injured patients?
I could go on, and on, and on with war stories. A small hospital ship, like the other countries have, is pure PR. I leave to those smarter than myself, to decide if the PR is actually more important than the do-gooding.
I would like to thank Alan for his insight into the operations of USNS Comfort. Based upon his comments, I checked on some of the data about her. Personally, I did not realize what her size was. I would not want to skimp on capabilities. So I would note, I was not actually suggesting a smaller ship . . . rather, additional capabilities.
I do believe the addition of a well deck for a few landing boats would be helpful. This could include dedicated ambulance boats. We should have a larger flight deck.General purpose helicopters could be augmented with dedicated ambulance versions . . . such as the army’s MEDEVAC variant of the UH-60.
I think our goal should, first, to find ways to enhance the next generation. Second, we should increase the number of vessels without charging the cost to the navy. Finally, try and use the PR of these ships to our national advantage. I mention this only because, unfortunately, there will always be PR concerns.
How about JHSV? Roomy and fast and especially geared for shallow water sailing.
PHS Environmental Health Officer aboard MERCY for Unified Assistance and Pacific Partnership 08. I’ll second everything Alan says. Vertical lift (including hangar space) and endurance are the limiting factors. Steaming at 25 knots vice 15 is irrelevant – she’s not an ambulance and will never arrive before the airplanes and grey hulls. Ability to operate with little footprint ashore is critical. I recommend Naval War College’s white paper “Waves of Hope” re: sea basing lessons learned from Unified Assistance.
Something more maneuverable than a single-screw single-rudder line hauler would be useful. Maybe a T-AKE conversion? Band-aid boats, particularly their launch and recovery, are another aspect which needs to be improved.
Dedicated medical crew would sit 350+ days a year. Why not have them train together aboard MERCY/COMFORT and work at Balboa/NNMC most of the time? That’s what is supposed to be happening now. An operational sea-based HA/DR asset? SIgn me up, but I’m afraid I’ll be retired by the time it happens. Maybe a more robust public health / prevmed contingent aboard Africa Partnerhip Station is a stepping stone . . . .
Great comments all.
TEJ: You make a good point about the speed.
About the medical crew, the ideal would be humanitarian assistance operations 350 days a year, and disaster relief 15 days a year.
Chris
I know sailors belong on ships and ships belong at sea, but nothing and nobody steams 365 days a year! Every 4 – 6 month deployment will be followed by, say, a 2 – 3 month dockside availablity. Boatswain’s mates will be scraping paint, what will the dental techs be doing? Just to make the point that there’s a lot of doctrine yet to be developed here, though the “If you could build your own . . .” mental exercise is fun.
Hm. The rare valid point from TEJ. :)
Ideas?
Cross posted from USNI Blog:
Speaking as someone involved in introducing the TAH19 class to the fleet back in the mid-’80s, I think this is not the right approach. As always one needs to define the actual ship rqmts. So I ask:
What it the world does high speed add to the medical capabilities? They still have to get the ship crewed, the MTF staff assembled, all perishables onboard and the ship fueled before it departs its homeport.
Since when is small a good feature? Go ask the medicos in the Comfort’s MTF if they want a smaller hospital?
How do you justify having 250 to 1000 medical personnel assigned to a hospital in resevre status?
Or maybe you think the small shallow draft hospital ship should sail up the Potomac River?
that was sort of a rant my next post is a more serious proposal
Multi-Mission Support Ship Concept:
There is an apparent need for ships to support several missions falling in between the sealift transport and fleet auxiliary ship types. The missions that such ships could perform include: humanitarian assistance, disaster relief, Station Ship, or forward afloat logistics support (to include LCS support). These ships can supplant or augment the large wet well amphibious assault ships or big hospital ships which are often used for such missions currently. They should be called “handy size” multi-mission support ships. I believe that civilian mariners can quite adequately crew them.
Proposal: The US Navy can acquire this type of ship economically by converting existing ships. There are two partially converted T-LKAs, the ex-USNS El Paso and ex-USNS Mobile in NISMF at Philadelphia which are possible platforms for the T-MSS concept. Estimated cost to finish the El Paso is $35 million while the Mobile may cost as much as $50 million.
Ship requirements: Based on current mission descriptions and prior knowledge of prepositioning ships, the following functions appear needed necessary across several support missions:
- A large superstructure to provide messing and berthing spaces not only for the ships’ crew, but also for embarked military teams and NGOs.
- A significant organic medical treatment facility (MTF) with employment ashore by carrying additional emergency modular facilities (EMF).
- A large helo facility including hanger space for operation and maintenance of at least two H-60 type helicopter with adequate fuel tankage. Flight deck large enough to land up to CH-53/CH-47 helos
- Organic lighterage of at least two LCM-8 type landing craft as well as at least two utility boats for personnel transfer (MPF lighter preferred).
- Organic cargo gear to discharge any cargo and lighters in a seaway.
- Multiple accessible cargo holds to stow reconstruction and relief materials to include SeaBee equipment.
- Convertible cargo spaces suitable for stowing, supporting and accessing Modular Facilities for a medical treatment facility i.e. container cells.
- Additional large capacity water making systems with some equipment to pump ashore.
- Increased auxiliary generator capacity for internal and external power distribution (inport).
there is absolutely NO reason to base a hosptial ship replacement on ANY warship design and certainly not the ridiculously expensive LPD17 class. Hospital ships are naval auxilaries not warshhips. Go read the Geneva convention on hospital ships.
Hi Lee,
I have seen nothing in the Geneva convention regarding hospital ships as to ban basing a hospital ship on a warship design (there are other good reasons, like cost, but that is a different point). I’d love to hear where you think the convention bans such practice.
Cheers
Chris
I know this may sound like overkill, but would it make sense to convert one of the old fossil-fueled carriers into a hospital ship? I think the Kitty hawk is still in pretty good shape, you could put a lot of hospital beds on that hangar deck… Just an idea.
Is this the high water mark for War & Health / Conflict Health comments? Reminds me of Information Dissemination’s ‘Design your own fleet’ thread. Lotsa fun, let’s do another soon!
Buy up one or more old cruise ships, convert them into hospital ships.
A) They are often designed to stop at undeveloped areas; last I heard, in fact, they were still stopping by in Haiti.
B) They are designed, by definition, with human habitation in mind. Passenger rooms can be converted to hospital rooms. Storerooms for luxury items can be used to store medical supplies. Amenities that aren’t convertible to use healing people can be converted into ORs and other specialized rooms–on top of the medical facilities that are already available for passenger and crew care.
C) Between construction of new ships and a slowdown of the cruise industry, you can probably pick up some sweet deals.
leesea has given a very good description of what I would expect for the next gen capabilities for a hospital ship. Also, correct, on not using LPD 17 as a basis. LPD 17 has a number of undesirable features. For one, it’s armed — that is why it fails convention requirements. It was also designed to have a low radar cross section — not a feature that is needed in a hospital ship. It is important to remember that when we speak of LPD type capabilities we are not referring to a particular class of ships (San Antonio).
One other fact about hospital ships that should be emphasized — they can not be dependent upon local infrastructure. This factor is invaluable in their operations. In fact, the more dependent they are the less capable of making a difference.
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