Portal de Periódicos da CAPES

Perspectives from MTF USNS Mercy

2006; Oxford University Press; Volume: 171; Issue: 1S Linguagem: Inglês

10.7205/milmed.171.1s.30

1930-613X

Mark Llewellyn,

Disaster Response and Management

T massive underwater earthquake off the coast of Northern Sumatra Indonesia and subsequent tsunami of December 26, 2004 (Fig. 1), not only changed the physical landscape but also changed the way we look at our response to natural disasters and, specifically, how we use the hospital ships. The primary mission of the hospital ships USNS Mercy (T-AH 19) and USNS Comfort (T-AH 20) is to provide rapid, flexible, mobile medical care as a trauma hospital to support combat forces. The secondary mission is to provide a mobile surgical hospital for use by U.S. government agencies involved in disaster or humanitarian relief. The ships remain in a state ready for being sea and mission capable within 5 days for the primary mission. Because of the complexities envisioned for response to a humanitarian assistance (HA)/disaster relief (DR) scenario, the mission-capable requirement had been 30 days. The USNS Mercy was activated to provide tsunami relief at 10:45 p.m. on December 31, 2004. She left the homeport of Naval Station San Diego at 12:30 p.m. on January 5, 2005. The ships are national assets, requiring presidential or Secretary of Defense authority for activation. They are not only national assets; they are true national treasures. As such, they should be treated the same as other capital Navy assets, such as aircraft carriers and strategic submarines. Owned and operated for the U.S. Navy by the Military Sealift Command, the hospital ships are equipped with 1,000 hospital beds, of which 20 are postanesthesia care beds and 80 are fully equipped intensive care unit (ICU) beds. There is an 11-bed respiratory-isolation area in the ICU. There are 12 operating rooms, one of which has been converted into a state-of-the-art angiography suite. Each ship has a new, rapid, computed tomographic scanner. There is a 50-bed casualty receiving area; extensive laboratory, blood bank, and radiological capabilities; a large pharmacy; an extensive medical repair capability; a large dental capability, including a dental laboratory; and an optical fabrication laboratory. In short, the ships physically are among the largest trauma hospitals in the world. For the tsunami relief efforts (Operation Unified Assistance), we were staffed to operate 50 inpatient beds and 10 ICU beds. We were staffed for four operating rooms. We filled our ward beds. In addition, we had at least one family member accompanying each patient, and often the “escort” became a patient. The two wards that we opened became alive with activity, like villages within the ship, with patients ranging from 2 days to 80 years of age. Not only are the direct medical capabilities significant, but also the ship has other, equally significant capabilities. She can produce ice and 300,000 gallons of potable water per day. She has a large laundry capability. She has an oxygen-generating capability that can make and store large amounts of medicalgrade oxygen. And very importantly, inherent in the skills of the civilian mariners are engineering and repair capabilities. Before the tsunami relief mission in 2005, the USNS Mercy last deployed operationally in 1990/1991 for Operation Desert Shield/Operation Desert Storm. The USNS Comfort, homeported in Baltimore, deployed to Iraq in 1990/1991, to the Baltic Sea in 1998, to New York City after September 11, 2001, and to the Middle East again in 2003 for Operation Iraqi Freedom. (As I make the final revisions to this article, the Comfort is preparing to respond to disaster left in the wake of Hurricane Katrina.) The ship is maintained in a ready-for-sea state by the reduced operating staff (58 Navy personnel and 12 civilian mariners). The majority of the full operating staff for the medical treatment facility (MTF), including the commanding officer, comes from Naval Medical Center San Diego. However, at one point of the Indonesia deployment, MTF Mercy had 40 different Navy commands represented. Working closely with the reduced operating staff crew, pierside training exercises are conducted quarterly, to maintain readiness. At-sea training evolutions are scheduled every 6 to 12 months. Along with the reduced operating staff, a “critical core” group from Naval Medical Center San Diego is available at all times to prepare and to man the MTF. Activating the ship within 5 days and ordering and loading large amounts of supplies and consumables are daunting tasks. The authorized medical allowance list for the primary combat trauma mission is relatively well established but requires constant attention, revision, and upgrading. The authorized medical allowance list for a HA/DR mission had in the past been much less well defined. Similarly, the staffing for the primary mission is codified but the manning for the secondary mission is not. In this particular disaster, soon after the tsunami occurred it became more and more apparent that the magnitude of destruction and devastation was massive. There is no clear threshold for the activation of the hospital ships, but it has always been high. If any natural disaster reached that threshold, then this one surely approached it. Consequently, as 2004 ended and 2005 dawned, the Mercy was activated. Because time was critical, the 250-bed logistical package was requisitioned. It is important to reiterate that this was a combat trauma package that would need significant supplementation to cover pediatric, obstetrics/gynecology, medical, preventive medicine, and outpatient supplies for the HA/DR scenario. And it should be made clear that, just because a 250-bed logistic package was activated, a 250-bed personnel package was not. Defining exactly what the personnel package would be evolved over time. Because direct information about the medical situation was initially limited, planning required major assumptions. Nevertheless, getting the ship moving westward with a minimal capability was the first step. Most of the “critical core” was immediately recalled over the holiday weekend and ordered to report to the ship in 24 hours. An essential core immediately USNS Mercy. Reprint & Copyright © by Association of Military Surgeons of U.S., 2006.