AH Hospital Ships
Hospital ships are flexible, capable and unique Navy HSS [health service support] assets that can be used in joint operations or combined/coalition wartime operations and peacetime operations. They are well suited for joint operations with a naval component because of their self-sustainability. They can be employed in war operations and in certain military peacetime operations, such as humanitarian assistance and disaster relief. In peacetime operations, the hospital ship may operate independently or as part of a joint or coalition force. Hospital ships are designed for operations of a long-term nature (i.e., 60 days or longer, 30 days without major resupply).
The primary mission of a U.S. Navy hospital ship is to provide rapid, flexible, and mobile acute medical care to support a Marine air/ground task force (MAGTF) deployed ashore, Army and Air Force units deployed ashore, and naval amphibious task forces and battle forces afloat. Operations are governed by the principles of the Geneva Convention for the Amelioration of the Condition of Wounded, Sick, and Shipwrecked Members of the Armed Forces at Sea of 12 August 1949. As a secondary mission, the ships (with appropriate tailoring of manning, medical material/equipment, and provisions) are capable of providing mobile surgical hospital service for use by U.S. government agencies involved in disaster or humanitarian relief, or of limited humanitarian care incident to these missions or to peacetime military operations.
Those coming aboard a hospital ship might mistake it for a luxury cruise ship, but they shouldn’t get used to the life. The ship is designed only as an intermediate holding area that prepares the wounded for transition from the field back to larger hospitals, so patients are quickly relocated to land-based hospitals. When the wounded come aboard, they encounter a ship that is like no other Navy vessel, she said. The passageways are wide enough to accommodate two gurneys passing each other. Instead of hatches, which sailors must duck and high-step, the Mercy has doors that swing open. Wide stairwells with moderate slopes replace narrow single-person ladders that have nearly vertical drops from one deck to the next.
Aboard hospital ships, the suites are much larger than operating rooms in a land-based hospital because doctors often perform more than one specialty surgery at a time. The spacious rooms, equipped with state-of-the-art equipment, ensure wounded troops receive the best care. Besides surgery, the ship provides a wide range of medical services. Dental, optometry, psychiatric, physical therapy and burn care units are some examples.
Unlike other naval vessels, hospital ships do not have their own defensive systems. Large red crosses emblazon the white ships’ sides, front and top to distinguish them from gray warships. The white ship with red cross identifies the hospital ship. No other country has floating hospitals.
The use of ships for the care of sick and wounded naval personnel is not new or unique to our time. As early as 400 B.C. there is record of a trireme in the Athenian fleet, called Therapeia, that served as a floating hospital. Later, floating sanctuaries, called "immunes" accompanied the galleys that transported Caesar's legions to the "edge of the earth." These vessels were kept free from combat duty, and their special status, for the most part, was recognized and respected. It was there that the concept of the hospital ship as a protected place set apart from the travails of war and dedicated to the care of the sick and injured, came into being.
The US Navy's history with hospital ships can arguably be dated to years of the Tripolitan War. In June 1804 the armed 60 foot ketch Intrepid, fresh from a daring sortie into the fortified harbor of Tripoli, was fitted out as a hospital ship and received the sick from the USS Enterprise. Since then, at least 26 ships have been used by the U.S. Navy for the care of sick and wounded.
The US Navy's Bureau of Medicine and Surgery was created by Congress on 31 August 1842. The first hospital ship, a converted side-wheeler Red Rover, was commissioned on Dec. 26, l862. The medical complement included 30 surgeons and male nurses, as well as four nuns. Red Rover sailed the Mississippi River during the Civil War, treating 2,947 patients over a three-year period. She was sold at public auction in 1865.
The Additional Articles Relating to the Condition of the Wounded in War of 1868, which was never ratified, set forth basic precepts that continue to inform the law of armed conflict relative to hospital ships. Principal among them is that “vessels not equipped for fighting which, during peace the government shall have officially declared to be intended to serve as floating hospital ships, shall . . . enjoy during the war complete neutrality, both as regards stores, and also as regards their staff, provided that their equipment is exclusively appropriate to the special service on which they are employed.” Although it was not in legal force, belligerents in both the Franco-German War of 1870–71 and the Spanish-American War of 1898 agreed to accept and abide by the 1868 accord.
USS Relief, a converted passenger liner, was used by the US Army as a floating ambulance during the Spanish American War and later turned over to the US Navy. Since the refitting of the Relief, belatedly purchased in May 1898 for use as a hospital ship, had not been completed when men began to fall ill, the Olivette, which had been functioning as the fleet's water-carrier, had to serve in her place. The Navy converted the 377-foot steamer SS Creole into a 200-bed hospital ship, USS Solace, in only 16 days. This ship was on station near Cuba when the Marines landed at Guantanamo Bay and the two navies fought at Santiago. The ship collected wounded Marines, U.S. sailors, and Spanish sailors to treat and evacuate them. Finding that it still had some empty beds, the Solace then collected some US soldiers. For the remainder of the war, she shuttled sick and wounded servicemen from Cuba to New England until the war was over.
Shortly after the Spanish-American War, the Russian and Japanese navies also employed hospital ships. Their successful use convinced the Navy's surgeon general of the value of maintaining a hospital ship during peacetime. After some discussion, the Navy Department acquired an old hospital ship, the Relief, from the War Department and renovated it. For years, however, the ship sat idle because the Bureau of Navigation did not furnish a line officer to command it. Finally, President Roosevelt personally authorized use of a medical officer to command a hospital ship with a merchant crew. The Relief joined the Great White Fleet and sailed with it as far as the Philippines, where the ship remained permanently.
By the advent of World War I, the role of the hospital ship had evolved significantly. No longer hovering at the fringe of battle to attend to stricken seamen after engagements, the hospital ships of that conflict were principally engaged in the transport of wounded and sick combatants from theaters of operations ashore to hospital facilities at home.
In 1909, the Solace was recommissioned, and in World War I, two passenger liners were converted into the Mercy and the Comfort. The first USS Comfort (AH-3) and the first USS Mercy (AH-4) joined USS Solace in the Atlantic Fleet. With a combined total of 700 beds, Comfort and Mercy brought back more than 3,000 casualties from Europe from November 1918 to March 1919. The second USS Relief was commissioned Dec. 28, 1920. She was the first U.S. Navy ship designed and built as a hospital ship.
At a very early stage of the war arose the problem of how to return the sick and wounded to America. The ideal solution would have been for the Army to return its casualties in ambulance ships owned, manned, and equipped by its Medical Department and convoyed by the Navy. This was impossible, and the next measure considered was the use of the Navy hospital ship Solace, with its capacity for returning 200 casualties a month, and the use later of two other hospital ships in process of equipment able to bring back 300 sick apiece per month. The Army's estimate of a minimum of 5,000 returnable casualties per month showed these resources to be utterly inadequate even had these three vessels not been required for their original and legitimate purpose of caring for the Navy sick. Out of this situation developed the arrangement by which all Navy transports would, on the westward passage, serve to the limit of capacity for the return of Army sick and wounded, and a schedule of each ship's carrying capacity was forthwith gotten up and generally promulgated for the guidance of all concerned.
Fifteen Navy hospital ships saw duty in World War II. All were converted liners, freighters and transports, except for USS Relief. The second USS Solace, a converted passenger liner added to the fleet just before World War II, was moored at Pearl Harbor on the morning of Dec. 7, l941. Within 30 minutes of the surprise attack by the Japanese, Solace was treating casualties. USS Solace and USS Relief cared for soldiers and Marines wounded in the island campaigns of the South Pacific. Later they were joined by the second USS Comfort and second USS Mercy. They took turns shuttling tens of thousands of wounded to a rear area and stateside hospitals. Hospital ships required the services of personnel in much the same way as shore-based hospitals, except that those on ship were afloat and subject to attack. Other classes of vessels, such as landing ships and patrol craft (LSTs and PCERs), became large floating clinics/ambulances which required additional Hospital Corps personnel.
In general, the plan for an amphibious assault was to have one or more LST's, especially equipped as hospital ships, support the landing until the beach was secure and the evacuation hospital was established. Each LST then acted as all evacuation hospital ship. These LST's received patients during daylight hours, pulled offshore at dusk, and remained at sea during the night. They had U.S. Navy surgical teams. These teams consisted rarely of well-trained surgeons. Colonel McGowan would advise augmenting the staffs of these LST hospitals with well-trained surgeons from the Army to do the surgery on these ships. An ophthalmologist and a neurosurgeon were required in the surgical team. On Luzon, in the XI Corps action (Zig Zag Pass, Bataan, Corregidor), there was no trained ophthalmic surgeon. Close cooperation between the Medical Corps of the Army and the Navy in amphibious warfare was vital. Only thoroughly trained personnel should be entrusted with the receiving and disposition of casualties. On many landings, the LST's were storage places for units of whole blood. The stored, refrigerated blood should have been packed by plan, with a medical officer responsible for its care, screening, and distribution. Too often, blood was distributed haphazardly throughout a convoy and was difficult to locate.
USS Comfort was struck by a Japanese Kamikaze plane off Okinawa on April 10, 1945. A total of 28 people were killed, including several of the ship's surgeons, along with six nurses and seven patients. Another 48 people were wounded, and there was extensive damage to the ship.
One scenario-driven innovation of World War II included the utilization of three grey-hull medically modified personnel transport vessels (APH). The attack personnel transport (APA), although not designed or properly equipped for handling casualties, often bore the brunt of the initial load from beach assaults—for example, at Iwo Jima. The use of APHs was considered desirable in an amphibious attack, because this type of ship could carry assault forces inbound, had a complete staff of specialists, and had a large sick bay so that specialized treatment could be provided.
During World War II amphibious operations, and in subsequent landings at Inchon, Korea, “grey hull” tank landing ships (LST) were converted into an important component of the medical care system—the LST(H). Modified for surgical support of limited scope, these ships were primarily used by forward surgical teams to stabilize the wounded.
USS Repose (AH-16), the last of the World War II hospital ships on active duty, was decommissioned January, 1950. She was recommissioned six months later because of the Korean War. The three Haven-class ships saw almost 35 percent of battle casualties admitted through September 1952. These hospital ships were a new type of mobile hospital, moving from place to place, sometimes supporting the Inchon invasion or aiding the Hungnam evacuation, or simply shifting about the Korean coast as needed. Two senior Navy nurses, Commander Estelle Kalnoske Lange and Lieutenant Ruth Cohen, received the Bronze Star for their work on the Navy hospital ships. For the first time helicopters played a significant role in medical evacuations. USS Consolation, USS Repose and USS Haven all were modified with helicopter landing platforms.
The ships were air conditioned, and they carried “luxury” foods like milk and ice cream that were unavailable to servicemen and women in Korea. However, the medical personnel aboard the hospital ships were inundated with patients, and often worked 36 hours without rest. Hospital ships often took on many more patients than they had been designed to carry during emergencies on the battlefield. Often, patients lay stacked in triple bunks. Shipboard life was very crowded, with little room for privacy to reduce stress. Operating rooms were open around the clock.
The successful Inchon invasion by the 10th Corps coordinated with a break-through by the 8th Army perimeter defenders from the south destroyed, captured, and dispersed the bulk of the enemy forces. Psychiatric casualties were numerous during the initial severe fighting, but sharply declined with the collapse of enemy resistance. The 1st Marine Division, who bore the brunt of the fighting for Seoul, suffered heavy battle losses and consequently incurred a large number of psychiatric casualties. Marine psychiatric patients were first evacuated to a Navy hospital ship in Inchon Harbor, since intradivisional psychiatric treatment was not available. Despite the excellent psychiatric staff and facilities aboard the hospital ship few psychiatric patients were salvaged for combat duty. This was in sharp contrast to the results obtained somewhat later in the more primitive environment of a field hospital, where 50 percent of Marine psychiatric casualties were recovered for combat duty by a 1- to 3-day period of rest, sedation, and superficial psychotherapy. Obviously, the comfort and safety of a hospital ship militates against the motivation of psychiatric patients to face again the rigors of combat.
Except for such patients as were flown by helicopter direct to hospital ships in the harbor at Inchon, the 1st Marine Division was supported by rail, from Munsan, through Seoul to Inchon. With the extreme tides that occur at Inchon it was necessary to schedule the trains for the port siding at the time of a high or rising tide. Since hospital ship patients who were evacuated from the ship to Japan also came in by rail from Inchon to the airfield, this was an operation that epitomized tri-service cooperation. The function of the hospital ship in Korea is indicated by the fact that it retains that title yet, while the late "hospital" train is now more aptly called an "ambulance" train. The hospital ship was utilized as a floating hospital, primarily as an evacuation hospital for the 1st Marine Division. Its role in the transportation of patients was only incidental. As ships were replaced and moved back to their base in Japan they might carry along a few special patients; the bulk of their load was transferred to the new ship arriving on station.
During Vietnam, Hospital Corpsmen were assigned aboard ships of various kinds, providing offshore medical support to U.S. forces. The largest commitment here was on the hospital ships USS Repose and USS Sanctuary. Some 200 Hospital Corpsmen, representing the gamut of technical specialties, worked on each ship. USS Repose was commissioned for the third time in 1965 and outfitted with a 750-bed hospital. During four years in Southeast Asia, USS Repose treated more than 9,000 battle casualties and admitted a total of more than 24,000 patients. Repose was joined by USS Sanctuary in 1967. USS Sanctuary remained in Vietnam, once spending a record 121 days on the line. She left Da Nang Harbor for the last time in April 1971 and was decommissioned in 1974. She was the first U.S. Navy ship to house a mixed male-female crew and was the Navy's last hospital ship until the current USNS Mercy and USNS Comfort joined Military Sealift Command. The current hospital ships are USNS, rather than USS and are the third ships to carry the name Comfort and Mercy. After more than 20 years of commissioned service spanning three wars, USS Repose left Vietnam in March 1970 and was decommissioned two months later. She earned 28 battle stars for action in Korea and Vietnam.
Mercy and Comfort were San Clemente-class supertanker before the Navy converted them into hospital ships in the mid-1980s. When not activated, they are in a “reduced operating status.” The two hospital ships fall under the Military Sealift Command and are part of the naval fleet auxiliary force. While they are on reduced operating status, a limited crew of civilian mariners and military personnel stay aboard each ship on a daily basis to ensure they’re ready to deploy in five days. Both Comfort and her sister ship, USNS Mercy, layberthed in San Diego were activated for the Persian Gulf war in August 1990. While in the Persian Gulf, Comfort treated more than 8,000 outpatients and admitted 716 patients.
Patients brought to underway hospital ships must be transported by helicopter. Due to ship design, access by sea is not considered reliable. In rough seas, ship-to-ship patient transfers can be unsafe. Helicopter transport to hospital ships was problematic in the Persian Gulf because each ship had only one landing pad, helicopter capacities were limited, and the ships had to stay out of harm’s way. As a result the distance and travel time would have increased. Hospital ships might not have been fully used to treat mass casualties, therefore, even if combat had continued.
USNS Comfort had two back-to-back deployments to the Caribbean in 1994. During her first Caribbean deployment, Comfort provided medical support for the processing effort and hotel services for U.S. government personnel conducting the processing operations. In addition, the ship served as the platform for hundreds of embarked Haitian migrants each day. By mission's end, Comfort provided safe haven for more than 2,300 Haitian migrants. The ship's second deployment was as a combat support medical asset in support of Haitian contingency operations.
In 1998, USNS Comfort participated in Exercise Baltic Challenge, a Partnership for Peace exercise in the Baltic Sea near Lithuania. Ten European nations participated with the United States in the exercise, which included 4,600 military personnel, 17 ships and assorted aircraft. Exercise activities included a 230-person casualty drill and training for more than 100 Baltic nation medical personnel in casualty care. This is believed to be the first time a US ship of this size (894 feet long) had entered the Baltic Sea since World War II. It also was Comfort's first mission to Europe for a multinational exercise.
USNS Comfort was activated Sept. 11, 2001, in response to the terrorist attack on the World Trade Center and sailed the next afternoon to serve as a 250-bed hospital facility at Pier 92 in midtown Manhattan. Comfort arrived in New York City Sept. 14, but her mission had evolved in transit from serving as a hospital to providing logistics support to disaster relief workers, some of whom had been napping briefly on the street and then returning to the smoking rubble of Ground Zero to search for survivors. During the next two-and-a-half weeks, the ship served 17,000 meals to New York City police and firefighters, National Guardsmen, New York State Militia and volunteer relief workers from around the country and the world, provided berthing for 2,300 guests and cleaned 4,400 pounds of laundry. The ship's clinic saw 561 guests for cuts, respiratory ailments, fractures and other minor injuries, and Comfort's team of Navy psychology personnel provided 500 mental health consultations to relief workers. Comfort also hosted a group of volunteer massage therapists who gave 1,359 medical massages to ship guests.
USNS Comfort was ordered to activate on Dec. 26, 2002, and set sail for the U.S. Central Command area of operations on Jan. 6, 2003. After stopping in Diego Garcia, the ship proceeded to the Persian Gulf to serve as an afloat trauma center in support of Operation Iraqi Freedom. Comfort remained in the Persian Gulf for 56 days providing expert medical care to wounded U.S. military personnel as well as injured Iraqi civilians and enemy prisoners of war. When Comfort returned to Baltimore in June 2003, it marked the completion of a nearly six-month deployment. During Comfort's OIF mission, the ship conducted more than 800 helicopter deck landings to bring aboard personnel, patients and cargo. Comfort's Medical Treatment Facility also performed 590 surgical procedures, transfused more than 600 units of blood, developed more than 8,000 radiographic images and treated nearly 700 patients, including almost 200 Iraqi civilians and enemy prisoners of war.
Combat medicine is better done on the battlefield than on a ship at sea. As a result, hospital ships like Comfort and Mercy soon will be retired. And the trend toward smaller, more flexible and more mobile hospitals on land will continue. In mid-2004 Vice Adm. Michael L. Cowan, the Navy surgeon general and chief of the Bureau of Medicine and Surgery, said the most visible symbols of Navy medicine, the hospital ships Comfort and Mercy, likely will be retired in the coming years. “They’re wonderful ships, but they’re dinosaurs,” he said. “They were designed in the ’70s, built in the ’80s, and frankly, they’re obsolete,” Cowan said. As an alternative to Comfort and Mercy, options are still being studied to include trauma treatment spaces aboard the Navy’s next generation of amphibious ships, he said.
But in 2006 work was focused on the TAH Future, the next generation of hospital ships.
