T-AH 19 Mercy Class

Some have suggested that the hospital ships Comfort and Mercy soon will be retired. 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. The argument is that combat medicine is better done on the battlefield than on a ship at sea, and the trend toward smaller, more flexible and more mobile hospitals on land will continue.

Two hospital ships [HSS] operated by Military Sealift Command are designed to provide emergency, on-site care for US combatant forces deployed in war or other operations. Hospital ships have two missions. First, to provide a mobile, flexible, rapidly responsive afloat medical capability to provide acute medical and surgical care in support of amphibious task forces, Marine Corps, Army, and Air Force elements, forward deployed Navy elements of the fleet and fleet activities located in areas where hostilities may be imminent. Secondly, to provide a full-service hospital asset for use by other government agencies involved in the support of disaster relief and humanitarian operations worldwide.

The HSS mission in joint operations is to minimize the effects of wounds, injuries, and disease on unit effectiveness, readiness, and morale. This mission is accomplished by a proactive preventive medicine (PVNTMED) program and a phased health care system (echelons of care) that extends from actions taken at the point of wounding, injury, or illness to evacuation from a theater for treatment at a hospital in the continental United States (CONUS). One measure of this system's effectiveness is its ability to save life and limb, to reduce the disease and nonbattle injury (DNBI) rate, and to return patients to duty quickly and as far forward in the theater as possible. Another measure is the system's ability to stabilize patients for evacuation to the Communications Zone (COMMZ) or out of the theater as appropriate, within the operational evacuation policy guidelines, and with minimum delay.

Hospital ships have inpatient capabilities comparable to major medical facilities ashore. USNS Mercy (T-AH 19) and USNS Comfort (T-AH 20) each contain 12 fully-equipped operating rooms, a 1,000 bed hospital facility, radiological services, medical laboratory, a pharmacy, an optometry lab, a cat scan and two oxygen producing plants.

The primary mission of the T-AHs, as prescribed in the ROC and POE, is to provide mobile, flexible, rapidly responsive afloat medical capability, along with acute medical and surgical care in support of ATFs, Marine Corps, Army and Air Force elements, forward-deployed elements of the fleet, and fleet activities in areas where hostilities may be imminent.

In support of the primary mission, the T-AH will:

• Receive patients who are suffering from wounds and DNBI primarily by helicopter, but also by boat, while anchored or underway.
• Provide surgical and other HSS to patients until they can be returned to duty or evacuated to other acute care facilities or to CONUS for further treatment.
• Provide a safe, stable, mobile platform, out of imminent danger, for carrying out the assigned mission.
• Provide all the necessary personnel services and facilities required for support of the medical command.
• Operate the full medical facility while at sea.
• Provide 12 operating rooms, 1,000 beds, and associated medical support while in its highest readiness condition (Condition I: Battle Readiness). This includes 80 beds for intensive care, 20 beds for recovery, 400 beds for intermediate care, and 500 beds for minimal care.
• Carry out extended operations off a hostile beachhead and provide an aviation facility with minimal helicopter support capabilities, for both day and night operations. Helicopter operations will be conducted for both delivery and evacuation of patients to other facilities.
• Deploy within 5 days from receipt of mobilization orders.
• Refuel at sea from other ships.
• Receive and deliver dry cargo (supplies, provisions) by VERTREP, CONREP, or small boat.
• Remain in a continuous condition of Readiness III (Wartime and Deployed Cruising). Operational systems are manned and operating to conform with prescribed ROCs, while also accomplishing normal underway maintenance, support, and administrative functions.

There are five echelons of medical care. Echelon I will provide basic first aid (self or buddy). Echelon II provides initial resuscitative care in the form of surgical and medical resuscitation. Echelons I and II are provided by the operating forces as part of their table of organization and manning documents. Echelons III and IV are provided from service component resources in support of casualties generated by combat. Echelon V is CONUS. Wartime casualties are evacuated through the HSS system until arriving at a facility capable of decisive intervention and which has both the time to perform the necessary procedures and the bed capacity to retain the patient, which becomes the site of principal treatment.

Echelon III provides a higher level of surgical and medical resuscitative capability. In addition to general surgeons and orthopedists, other surgical specialists will be present. The HSS provided by these facilities - for example, the T-AH and CBTZ fleet hospital - will have greater capabilities, particularly in laboratory and radiology support. The scope of treatment requires clinical capabilities normally found only in a hospital properly staffed, equipped, and located in an environment with a low level of threat from enemy action. This level of care constitutes the definitive treatment that is needed to return many patients to full duty.

These ships are appropriately listed as a 1,000-bed hospital ship. However, those 1,000 beds are sub-categorized into 500 limited (self) care beds, 120 light care beds, 280 intermediate care beds, 80 intensive care unit beds, and 20 post-anesthesia care unit beds. It was discovered during Operation Iraqi Freedom in 2003 that each 20-bed intensive care unit could accommodate only 15 patients requiring mechanical ventilators, reducing the advertised intensive care unit capabilities. Iraqi EPWs and civilians were admitted to intensive care units separate from Coalition intensive care unit patients, and the number of intensive care unit beds available for Iraqi nationals was frequently the most limiting factor.

The Mercy-class hospital ship is quite large, which is both good and bad. The primary benefit of its size is that it can accommodate 1,000 beds and can receive up to 200 patients per day. Because of its size, round-shaped hullform, and high block-coefficient, it is a stable platform that is suitable for performing most surgical procedures in various sea conditions. these physical characteristics make it somewhat slow, with a maximum speed of just over 17 knots. Also, the large ship is not easily or quickly deployed or docked. Its size gives it a substantial radar signature that, combined with its lack of maneuverability, makes it vulnerable to attack. The Mercy class is much larger (in terms of medical capacity) than is needed for most military operations.

Both vessels have a helicopter deck capable of landing large military helicopters, as well as side ports to take on patients at sea. The Navy has placed CH-47 helicopters on its hospital ships which relieves the ground forces of the burden of having to transport the patients onto the deck of the ship, a task they do not train for regularly. This also frees up Army Air Ambulances to concentrate their efforts where they belong - with the ground effort.

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.

There has been much debate recently over the future of the MERCY Class hospital ships and potential replacement platforms. In the aftermath of the attacks of September 11, 2001, and with the current global war on terrorism, the MERCY Class hospital ships need to remain ready to answer the call for their next mission. Consideration should be given to expansion of the flight deck to accommodate the simultaneous operation of two helicopters. This would improve the delivery of casualties and avoid the possibility of one helicopter fouling the flight deck with a mechanical breakdown. A dedicated helicopter asset would also provide significantly increased flexibility in patient transfers to and from the ship. One of the ship's weakest features is its lack of flexibility in patient movement. It has one helicopter pad for receiving patients and no ability to receive patients from the sea. Patient movement within the ship is limited by the way the ship was converted. Its conversion from an oil tanker was accomplished by removing everything above the top deck, including the deck itself, and building a new top deck and superstructure. The lower bulkheads have no hatches because the lower portion of the oil tanker is used to carry oil. The bulkheads in the tanker prevent oil from sloshing from stem to stern. These interior bulkheads were kept; but, because the bulkheads in the lower decks have no hatches, patients must be brought to the top deck if they are to be moved from a lower compartment in one part of the ship to another. The replacement for this ship should more carefully consider patient movement (i.e., patient ingress, egress, and movement within the ship.)