Commentary

Finding Comfort Around the World

by Catherine Feinman

The Navy Hospital Ship USNS Comfort was pushed into the spotlight last year during its 60-day disaster-relief mission in Haiti following the massive 7.0 earthquake that struck that tortured island on 12 January 2010. Formerly the SS Rose City, an oil tanker, the Comfort has actually been carrying out a broad range of disaster-relief, humanitarian-assistance, and combat-casualty missions for more than two decades – ever since it was commissioned in 1987, in fact. For various political and chain-of-command missions, the 70,000-ton ship is “owned” and operated by the U.S. Military Sealift Command (MSC), but is primarily used for Navy missions.

In Haiti, the Comfort was categorized as a Level 1 trauma center and, according to HM1 Leslie Prasad, saw the “most neuro patients that Walter Reed [the Walter Reed Army Medical Center in Washington, D.C.] would rival, in six months, of the surgeries we saw in 45 days. … It [the mission] was a very intensive, very fast-paced environment.” The effectiveness of that type of mission in a foreign nation, complicated by so many unknown variables, is determined primarily by the cooperative efforts, exceptional professionalism, and preparedness practices of all of the hundreds of crew members and medical staff involved.

Cooperation on the High Seas

The crew of the Comfort sets a good example for multi-discipline, multi-jurisdictional collaboration. There are three senior officers in charge of the ship – the ship’s Commanding Officer (Captain David K. Weiss, USN), the MSC Commander (Civil Service Master Captain Randall Rockwood), and the Commodore (Captain Brian C. Nickerson, USN) for Continuing Promise 2011. The members of the ship’s crew, and the medical and political/diplomatic personnel also involved, include U.S. Coast Guard, Navy, Army, Air Force, and Marine Corps personnel as well as U.S. State Department representatives, various U.S. Non-Government Organization (NGO) groups (directed through the U.S. Southern Command), some Canadian NGOs, and even a number of foreign military personnel.

The professions represented by these same personnel are equally impressive: surgeons, nurses, veterinarians, dentists, optometrists, physical therapists, pathologists, histologists, and information technology (IT) specialists, as well as security personnel, mechanics, pilots, translators, cooks, marine engineers, and volunteers from other organizations such as the American Red Cross and Project Hope. When not deployed, many of the medical personnel continue to hone their special skills in various land-based hospitals.

In addition to the teamwork and medical acts of mercy provided by those aboard the Comfort, this floating hospital significantly improves U.S. international relations with host countries as well as numerous local communities. Setting up onshore clinics for chronic patients, participating in a broad spectrum of outreach programs, and establishing an educational exchange with local doctors are just a few ways in which the Comfort serves the United States as an ambassador to the world. The opportunity to work closely, for an extended period of time, with local government officials and medical professionals is a key to the ship’s hugely successful mission of “providing a full hospital service asset for use by other government agencies involved in the support of relief and humanitarian operations worldwide.”

Preparing for Rough Seas and Disaster-Stricken Shores

Valuable preparedness practices are routinely demonstrated aboard the Comfort. When not deployed on a mission, 55 to 60 crew members maintain the ship in a high state of readiness to ensure that it is able to get underway within three days of being assigned to yet another humanitarian mission – usually on short or no notice. Just before and during the deployment, the number of crew members grows exponentially, to a total of approximately 700 medical personnel and ship’s company, plus 150 or so NGO members.

To prepare for onboard hazards, the crew carries out realistic abandon-ship drills before each deployment. While at sea, additional weekly drills are scheduled for all-hazards situations such as the flooding of interior spaces and various hazmat and fire simulations. The ship’s incinerators are used to dispose of any bio-hazard trash. In addition, all of the ship’s equipment is carefully calibrated, and re-checked periodically, to ensure the continuity of operations – ship operations as well as medical operations.

Ensuring the availability of safe and clean water – tons of it every day, literally – is a major concern of any modern ship deploying to underdeveloped countries. To meet that requirement, the Comfort is equipped (as are other U.S. Navy ships) with its own self-contained water source – namely, a three-stage filtration system that separates salt from the water scooped up from the ocean and produces enough pure water (300,000 gallons per day) for drinking, showering, cooking, cleaning, and running the steam cycle that powers the ship safely and at high speed through heavy seas and frequently turbulent weather.

Three 2,000-kw diesel generators provide the power needed for all of the ship’s medical purposes. A separate 1,000-kw generator provides emergency back-up in case the main generators become inoperable. A battery back-up also is available if the emergency generators fail. The Comfort uses its self-sustaining abilities to prepare for uncertain environments.

Following the Patient Flow Route

A group of emergency preparedness professionals had the privilege of touring this 894-foot long, 135-foot wide floating hospital early last month in the port of Baltimore, Maryland, where the USNS Comfort is currently berthed. To provide a glimpse of the normal patient flow route during deployment, the civilian officer in charge of the ship (First Officer Chief Mate David Lieberman) began the tour on the flight deck. In Haiti, that deck received a helicopter every 6-8 minutes or so. According to Chief Hospital Corpsman (HMC) Amanda Doolittle, “It looked like a flock of helicopters.”

When the ship is not actually tied up to a pier, but positioned just offshore, most patients are taken to the ship by helicopter or small boat. They are logged in twice: once on-shore and again as they debark from the helicopter after boarding the ship, where they are issued identification bracelets before being escorted (or sometimes carried) to the ship’s medical spaces. From the flight deck or gangway, patients are led to one of the 50 beds in “casualty receiving” – i.e., emergency room (ER). If the ship’s elevators are inoperable, medics are almost always able to transport patients by gurney to the triage area, within 2.5 minutes. New arrivals are assigned to one of the ship’s three ER bays: (a) “expectant,” for the unfortunate near-death cases; (b) “immediate,” for urgent-care cases; and (c) “isolation,” for those suffering from tuberculosis (TB) or other contagions.

“Pods” positioned just above the beds are fitted with vacuums, electrical outlets, oxygen, and PROPAC machines to make it easier to record electrocardiograms and measure the blood pressure and temperature of new arrivals. Sturdy straps and D-rings positioned on the bulkheads (walls), overhead (ceiling), and deck (floor) are used to secure the lights, tables, and other medical equipment – plus the beds themselves – when the ship is encountering rough seas.

During its stay in Haiti last year, roughly 1,000 patients passed through 10 of the ship’s medical operating spaces – the other two ORs were used for those infected with TB (two additional ORs, located on a lower deck, are reserved for dental surgery). The Comfort’s low infection rate is probably due in large part to the designation of some ORs as post-surgery “wash-out rooms,” where dead tissue can be safely removed, isolated, and disposed of until a patient’s healthy flesh has started to return.

Only a few yards down the passageway (hall) from the ORs, there is a CAT scan room, four X-ray rooms, an anesthesia space, a pre-op holding area with six bays, and an angio room fully equipped with the X-ray and diagnostic monitors needed for telemedicine. Portable X-ray units can be wheeled to various other spaces all over the ship and were, in fact, used in Haiti to screen all incoming patients, upon entry, for TB. When the results of any patient showed positive for TB, that patient was taken directly to an isolation space. With approximately 5,000 units of blood in stock, the Comfort’s blood bank has a sufficient supply to meet most of the disaster situations that it encounters.

Somewhat farther down the main passageway is the ship’s 20-bed Post-Anesthesia Care Unit (PACU). Under extreme circumstances, the PACU serves as backup for casualty receiving. Patients may expect to spend one to three hours in the PACU to ensure that the anesthesia wears off properly before they are taken to a lower space where most of the ship’s hospital “wards” are located. Central monitoring capability throughout the various units allows the monitoring of all patient beds from a single location.

Four Intensive Care Units (ICUs), with 20 beds each, can serve as isolation rooms, or as burn units, if and when needed. Physical therapy rooms in the same area of the ship are equipped with treadmills, stationary bikes, step machines, and exercise balls to assist the recovery process. Litters (stretchers) are stacked, within easy reach, in the passageway and kept always ready. With a full-functioning laboratory and microbiology equipment also installed, the ship has all of the basic testing equipment it needs to screen patients for infectious diseases without requiring them to leave the vessel.

Most patients are moved to the ship’s recovery wards, on a lower deck of the ship, after their condition is stabilized. Each of the wards has its own nursing station, pediatric racks for children, restrooms, showers, and kitchenette. Lower bunks are reserved for patient use, while upper bunks are often offered to family members of those patients. The eight recovery wards also can be partitioned to help respect the religious and/or gender concerns of the host country. Combining the PACU, ICUs, and recovery wards, there is a total inventory of about 1,000 patient beds aboard the ship.

Embarking on New Missions

The USNS Comfort is currently scheduled for yet another deployment, starting around the middle of March, on a humanitarian mission to nine countries in Central and South America. That mission will include a number of three- to four-day port stops to treat such conditions as cleft palates, hernias, and cataracts, as well as a large number of hysterectomies and numerous gynecological, orthopedic, laparoscopic, and endo-gastro procedures. The ship’s onboard optometry clinic and lens laboratory are capable of caring for up to 500 patients in a single day, and will provide reading and prescription glasses to many who do not have access to these services in their local communities.

In providing the same treatment and standard of care to these “foreign guests” as they would in U.S. hospitals, the dedicated men and women of the Comfort supply the highest-quality medical care possible to new friends of the United States in many countries throughout the world. The ship’s valuable disaster-relief and humanitarian, as well as wartime, missions will continue to help communities in need well into the future. Thousands of innocent “citizens of the world” facing sudden disaster in their own country, and/or who have been deprived of quality medical care in their home communities, may someday find Comfort close at hand.

Members of the DomPrep staff would like to extend their appreciation to the crew of the USNS Comfort and to the ship’s Public Affairs staff who graciously welcomed them aboard: HMC Amanda Doolittle, Chief Mate David Lieberman, HM1 Joseph Perron, ET1 Darell Larocque, HM1 Leslie Prasad, ABF1 David Simkins, and HM2 Andrew Johnson.

Catherine Feinman is Associate Editor for the DomPrep Journal. She joined the DomPrep team in January 2010. With over 20 years of experience in publishing, she previously served as Journal Production Manager and Subscription Manager for Bellwether Publishing, Ltd.. She received a bachelor’s degree from the University of Maryland, College Park, in International Business/French.