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. The Medical Treatment Facility provides a mobile, flexible and rapidly responsive afloat medical capability for acute medical and surgical care in support of amphibious task forces, Marine Corps, Army and Air Force elements, and forward deployed Navy elements of the fleet and fleet activities located in areas where hostilities may be imminent. As a secondary mission, they are capable of providing full hospital services for use of other government agencies involved in the support of relief and humanitarian operations worldwide.
The first-line Navy vessels equipped for casualty reception are designated “primary casualty receiving and treatment ships.” They are the large-deck, multipurpose amphibious vessels of the LHA (Tarawa) and LHD (Wasp) types. Most of the beds aboard these platforms are suited to light to moderate casualties, not requiring intensive nursing care. Significantly fewer beds are available for severely traumatized patients. The LHD has six operating rooms, seventeen intensive-care beds, forty-seven ward beds, and a 536-bed overflow capacity, but it is not equivalent to a civilian trauma-care facility with the same number of patient care units.
The military aim of health care facilities is to act as a force multiplier, returning the injured to service as quickly as possible. The principles of trauma care still apply at sea. Time elapsed between wounding and the delivery of medical treatment is vital. First aid should be followed by stabilising surgery, organised evacuation and definitive management. Speed is crucial: the wounded should be treated if possible within six hours of injury (the golden period). Receiving effective care during the first “golden” hour is vital in achieving maximum patient salvage.
The environment at sea is unpredictable and sometimes hostile. Humidity, extremes of temperature, vibration, dust, salt water and the effects of battle plus the lack of highly skilled regular maintenance of specialised equipment can also limit health service activities. When a ship is pitching and tossing or rolling from side to side during bad weather, any type of surgery may be prohibited and even the simplest health care can be difficult. The larger the ship on which one is working, the greater the stability, although size is not the only factor. Flat-bottomed ships and ships with a high freeboard tend to roll more than most other ships. Fitting stabilisers to ships may reduce roll, but it will not eliminate this problem altogether. Moving ships into harbors may exchange one hazard for navigational or military ones.
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. The First Hague Peace Conference, drafted and adopted, among other instruments, the 1899 Hague (III) Convention for the Adaptation to Maritime Warfare of the Principles of the Geneva Convention of 22 August 1864. Article 5 stated that military hospital ships are to be painted white (with a horizontal green stripe) and fly "the white flag with a red cross" to identify them as protected vessels. The 1907 Hague (X) Convention continues the 1899 Hague (III) Convention regime with respect to mandatory steps to enhance the identification of hospital ships -- for example, external surfaces painted white with a green stripe, and a white flag with a red cross. Subsequently, hospital ship markings consisted of a single red cross on the hull and one on the funnel[s] and a horizontal green bar the length of the ship.
Government hospital ships were required to be painted white with a broad longitudinal green stripe on each side extending from bow to stern; hospital ships belonging to aid societies to be similarly painted, but the stripe is to be red. Both varieties of ships must fly the Red Cross flag as well as their national ensign. Between the Wars some American hospital ships were painted white, without hospital ship markings. The post-World War II hospital ship markings consisted of three large red crosses on the hull connected by a green stripe and one on the funnel[s]. By 1953 new hospital ship markings deleted the horizontal green bars between the three red crosses.
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. The commanding officer of a hospital ship or the commander of a medical aircraft shall be responsible for complying with the appropriate provisions 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. Where necessary to the fulfillment of this responsibility, a departure from other provisions of Navy Regulations is authorized. One of the central requirements under the 1949 Geneva Convention is that the ship or aircraft maintain a non-combatant status. Under this Convention, the following conditions do not deprive hospital ships or medical aircraft of their non-combatant status:
- a. The fact that the crews are armed for the maintenance of order, for their own defense or that of the sick and wounded.
b. The presence on board of apparatus exclusively intended to facilitate navigation or unclassified communications.
c. The discovery on board hospital ships or in sick bays of portable arms and ammunition taken from the wounded, sick and shipwrecked and not yet handed to proper authorities.
d. The fact that humanitarian activities of hospital ships or of the crews extend to the care of the wounded, sick or shipwrecked persons.
e. The transport of equipment and of personnel intended exclusively for medical duties, over and above normal requirements of the hospital ship.