Present U.S. Navy hospital ships—the Mercy (T-AH-19) and Comfort (T-AH-20)—have several significant limitations, which could be remedied by reconfiguring existing amphibious assault ships (LHAs) as their replacements. The LHA offers a quantum leap in capability and flexibility over the two ships by providing for rapid, large-scale embarkation and debarkation of patients by air and sea and substantially improved over-the-horizon capabilities through embarked helicopters, air cushion landing craft (LCACs), and/or utility landing craft (LCUs). Additionally, state-of-the-art command, control, and communications capabilities would allow commanders to direct and coordinate the full range of medical and humanitarian operations.
The primary mission of the hospital ship is to provide rapid, flexible, and mobile acute medical and surgical services to support military forces ashore and afloat. Their secondary mission is to provide mobile medical and surgical hospital services for use by U.S. government agencies in disaster or humanitarian relief or for limited humanitarian care incident to peacetime military operations. In fact, it is the secondary mission that has been the primary assignment for the hospital ships since first providing tsunami relief in Indonesia in 2005. Additionally, the LHA-similar general-purpose LHD amphibious assault ships have been used in such roles over the past two years, recognizing the superior capabilities of the large amphibious carrier in these challenging missions.
Compare and Contrast
The LHA affords a number of advantages as a hospital ship when compared to the Mercy or Comfort. Most notably, the ability to quickly and simultaneously embark casualties at ten helicopter landing areas and a floodable well deck during coordinated air and boat operations. The T-AH is limited to one helicopter landing area, has no floodable well deck, and no significant hangar capability. A foul deck during a multiple-patient casualty scenario on a hospital ship forces jettisoning the helicopter over the side. A single foul deck landing area on the LHA leaves nine other landing positions. The well deck permits embarkation of casualties by the large landing craft.
While underway, the primary means for patient embarkation on a T-AH is by helicopter with secondary means by small boat operations using a boat derrick or brow entry. These boat operations are slow, potentially dangerous, and may be untenable in even a moderate sea state. An LHA underway can safely conduct small boat embarkation and debarkation through the well deck while simultaneously launching and recovering multiple helicopters.
Clearly, a critical capability for any hospital/disaster relief ship is the ability to gain access to those in need of medical attention and assistance. Reconfigured LHAs with embarked helicopters, LCACs, and/or LCUs provide a far greater ability to deliver medical personnel, humanitarian assistance, or to conduct evacuation operations over the horizon than do T-AHs. They also have greater speed for quicker response, less draft for improved access in shallow harbors, a hangar deck for large-scale triage operations, and twin screws for improved reliability and maneuverability in tight areas.
LHAs can produce approximately 150,000 gallons of potable water per day from the desalinization of seawater. Without embarked Marine units, this capability can meet the needs of all embarked medical assets, hospital operating requirements, and provide safe drinking water in emergency disaster response missions. Additionally, they have the ability to pump potable water and fuel ashore to support operations where these critical resources may not be available.
What It Will Take
The Mercy and Comfort began their lives as commercial tankers in 1976 and transformed from ships with no medical capability into afloat tertiary-care medical centers through "keel-up" conversions in 1984 and 1985. The modifications required to convert LHAs for this role would be modest by comparison. LHAs already have a fully operational medical department complete with three operating rooms (ORs), 14 intensive-care unit (ICU) beds with monitoring and ventilator capability, and 48 ward-level beds. Additionally, a digital x-ray suite with telemedicine capability, lab facility, and blood bank are present. Removal of troop berthing on the LHA (which can accommodate up to 1,700 combat-loaded Marines) makes room for an additional and substantial complement of intensive-care and hospital-ward beds, nine or more additional ORs, two CT scanners, full radiology lab, and blood bank capabilities which can exceed the present T-AH medical abilities. Additionally, conversion for operation by the Military Sealift Command (MSC) would provide more space than that proposed in the table as MSC manning is significantly less than that for regular Navy ships.
The LHA is a flag-configured platform outfitted with the Navy's latest and most sophisticated communications equipment. This enhances the ship's ability to support on-scene commander duties and includes the capability to perform air-traffic control functions associated with large-scale medical, humanitarian, or evacuation operations ashore or over the horizon. The flag berthing, dining, and communications equipment already present enables additional medical personnel, non-governmental organizations, flag officers, VIPs, and leaders of host-nations to live on board and communicate worldwide on a real-time basis, including encrypted messaging.
The value of the LHA's large and capable floodable well deck cannot be overestimated. The LCACs, which can work from it are able to ferry large numbers of patients and equipment—up to 70 tons—from sea to shore, through the surf zone, and onshore beyond the high-water mark. As seen most recently in Indonesia, this asset proved invaluable in transferring equipment, personnel, and supplies from the USS Bonhomme Richard (LHD-6) to the beach. The LCAC has long-range and high speed—up to 50 knots over water and 25 knots over land. This significant capability greatly increases security of the parent hospital ship by allowing it to stand off over the horizon if necessary. The Mercy and Comfort have no LCAC capability.
The larger LCUs—which also cannot operate from the current hospital ships—can ferry more patients and equipment (up to 125 tons) than the LCACs. While slower at 11 knots maximum than the air-cushion craft, they have exceptional range with the ability to travel up to 1,200 miles at 8 knots. The LCU can deliver cargo either pier side or through the surf zone to the beach.
Multiple LCUs and at least one LCAC can be embarked on board an LHA during disaster relief/hospital ship operations. Simultaneous wet well and flight deck operations allow the rapid embarkation of large numbers of patients, personnel, and equipment in virtually any environment—a capability that does not exist with the two hospital ships.
Additionally, LHAs can operate the new Improved Navy Lighterage System. This consists of powered and nonpowered floating docks that enable movement of equipment from ship to shore in places where traditional port facilities may be damaged, insufficient, or absent.
Into the Future
Coupling the LHA's extensive over-the-horizon air and sea capabilities with medical personnel and specialized equipment will dramatically improve the ability of the United States to provide medical care in distant areas and ease human suffering in times of crisis and need. In so doing, converted LHAs will support the new maritime strategy's commitment to humanitarian and disaster relief.
As seen in the similarly capable platform to the LHA, the Bonhomme Richard, having an extensive airlift and sealift capability for replenishment both at sea and ashore provided life-saving relief to tsunami victims. The LHD was the first ship deployed to Indonesia, preceding the USNS Mercy. The ship's capabilities, especially for vertical air operations, rendered her exceptionally effective in the disaster relief role.
The LHA, with virtually the same capability for airlift/sealift as the Bonhomme Richard, can maintain a prolonged presence with copious fuel storage and enormous fresh water production. The USS Peleliu (LHA-5) deployed on a four-month mission—Pacific Partnership—in May 2007 with visits to the Philippines; Da Nang, Vietnam; Singapore; Madang, Papua New Guinea; and the Solomon and Marshall Islands before returning to her homeport in San Diego. Her performance during this mission—without modification—validates the LHA/LHD hospital ship conversion concept in disaster relief missions.
In mid-November 2007, the Kearsarge (LHD-3) was sent to Bangladesh to provide disaster relief and humanitarian aid following the devastation in the wake of Tropical Cyclone Sidr. The Kearsarge and the 22nd Marine Expeditionary Unit used the ship's extensive helicopter and LCAC capabilities to provide rapid and effective delivery of life-saving supplies. Additionally, the ship's flag configuration housed Bangladesh military and government officials, members of the United States Agency for International Development, and the U.S. Embassy.
Here at home, after Hurricane Katrina in 2005, the USS Iwo Jima (LHD-7) deployed to New Orleans where she safely conducted nearly 2,000 flight operations with helicopters from all branches of the armed forces and multiple federal agencies. The Iwo Jima also provided emergency medical, surgical, and dental care as the only tertiary-level medical facility in the city and served as President George W. Bush's flagship, with the Commander in Chief embarking on several occasions. During the Katrina response, the USS Bataan (LHD-5) sailed to Biloxi, Mississippi, with medical personnel to provide emergency care to that area.
She's a Solution
Although the Mercy and Comfort are highly sophisticated medical assets, significant limitations stymie their flexibility and effectiveness in today's environment. Reconfiguring LHAs from amphibious platforms for Marine Battalion Landing Team forces into hospital/disaster relief ships offers considerable advantages. During a Service Life Extension Program, selected ships could be reconfigured as hospital ships to be owned and operated by the Military Sealift Command. The result would be a far improved capability for the United States to rapidly deliver tertiary-level medical care and disaster relief at home and abroad.