This html article is produced from an uncorrected text file through optical character recognition. Prior to 1940 articles all text has been corrected, but from 1940 to the present most still remain uncorrected. Artifacts of the scans are misspellings, out-of-context footnotes and sidebars, and other inconsistencies. Adjacent to each text file is a PDF of the article, which accurately and fully conveys the content as it appeared in the issue. The uncorrected text files have been included to enhance the searchability of our content, on our site and in search engines, for our membership, the research community and media organizations. We are working now to provide clean text files for the entire collection.
By Lieutenant Commander Dana C. Covey, Medical Corps, U.S. Naval Reserve
The fleet-hospital concept is well-founded, as demonstrated by the outstanding performance of those units deployed during the Gulf War. Nevertheless, this initial deployment revealed areas for improvement that should be addressed prior to the next contingency.
Operation Desert Storm saw the first-ever deployment of Navy fleet hospitals, including Fleet Hospital Fifteen in northeastern Saudi Arabia (right). They performed well—here, staff of Fleet Hospital Five discuss an upcoming procedure—but casualties were light and the hospitals were not severely tested. Still, lessons from this initial sea trial can improve the fleet hospital system and ensure maximum readiness for the next conflict.
The 1990 invasion of Kuwait by Iraq set in motion the largest deployment of U.S. forces since World War II. This conflict also prompted a massive mobilization of medical assets to the Persian Gulf to support these forces; it was estimated that 20,000-40,000 U.S. combat casualties could occur in a full-scale war
against Iraq.'
This medical mobilization included a number of firsts, including the first-ever deployment of fleet hospitals, the Navy components of the triservice Deployable Medical Systems—tent-based field hospitals designed for rapid deployment to an area of actual or threatened hostilities. The medical materiel is essentially the same for Army, Navy, and Air Force field facilities of similar scope and is subject to DoD standardization.
The Fleet Hospital Concept
Combat-zone fleet hospitals are third-echelon field medical treatment facilities designed for resuscitation, stabilization, and medical and surgical care of combat and noncombat casualties. They have a designated 250- or 500-bed capacity and operating rooms designed for basic operative treatment of a wide range of injuries. Fleet hospitals are prepositioned overseas and, for the most part, are self-sustaining for 60 days.
During Operations Desert Shield and Desert Storm, three 500-bed, Navy combat-zone fleet hospitals were deployed to the Persian Gulf. Fleet Hospital Five, comprised almost entirely of active-duty personnel, was deployed in August 1990 to A1 Jubayl, Saudi Arabia, where it located within the port facility. Fleet Hospitals Six and Fifteen, manned primarily by recalled Naval Reserve personnel, subsequently deployed to Bahrain and to the desert region northwest of A1 Jubayl, respectively.
Fleet hospitals are designed to provide a more advanced level of patient care than the first- and second-echelon medical units organic to the Marine Corps (i.e., battalion aid stations, collecting-and-clearing companies, and surgical support companies). The 500-bed combat-zone fleet hospitals deployed to the Persian Gulf, each with a complement of more than 900 personnel, technically are classified as mobile treatment facilities; but once set up, they are difficult to move.
A 500-bed combat-zone fleet hospital requires more than 400 International Standards Organization (ISO) containers for loadout, in addition to civil-engineering support equipment and rolling stock, which are not containerized.2 This requires significant sealift, offload and line-haul assets to get the nascent fleet hospital to its intended site. These responsibilities generally arg
under the auspices of the fleet commander-in-chief, who must provide for the hospital’s establishment among many competing priorities.
During the Persian Gulf War, the relative luxury of a prolonged logistical buildup prior to hostilities allowed all three deployed fleet hospitals to be fully operational before the start of the ground campaign on 24 February 1991. However, in an absolute sense, the time needed by the fleet hospitals to reach an initial operational capability (IOC) was too long. This could have resulted in increased Patient morbidity and mortality had combat casualties occurred sooner than Coalition forces expected.
According to fleet-hospital doctrine, a limited operational capability should be established ten days after the initial group of hospital personnel, known as the air detachment, arrives on site.3 After the arrival of its air detachment, Fleet Hospital Fifteen required 15 days to roach a limited IOC of 200 beds and an additional three days to reach its full, 500-bed capacity.4 Similarly, Fleet Hospital Five required 16 days to set up.5
Set-up Time Is Critical. The time required to bring the ^'eet Hospitals on-line during Operation Desert Storm was a rosult of several factors, not the least of which was competition for scarce transportation and construction resources Wlthin the theater of operations.
Prior to the arrival of fleet-hospital personnel, site section and preparation should be complete and ready for container staging, so hospital construction can proved on schedule. To reduce the time needed to achieve an initial casualty-treatment capability, the fleet hospital I °uld be modularized, so priority components are pal- eflzed and shipped by C-141 or other transport aircraft to a staging area near the hospital site. This priority module ^°uld include a limited casualty-receiving area; surgical, Moratory, and X-ray ISOs; and 10 recovery-room or in- nsive-care-unit beds and 40 acute care beds, to provide an initial fly-away surgical capability.
Given the speed with which international tensions can escalate, it is not unreasonable to expect that a third-echelon medical treatment facility should be able to establish an initial surgical capability 3-5 days after the arrival of the initial hospital contingent. Modularization would greatly increase the flexibility of the combat-zone fleet hospital, allowing it to adapt to contingencies ranging from natural disasters to full-scale armed conflicts.
Mobility Is Important. With the current focus on maneuver warfare and Marine Corps tactical doctrine emphasizing mobility, the fleet hospital must be able to relocate to keep abreast of the tactical situation. This is important because the MedEvac time from the forward edge of the battle area (FEBA) is directly related to patient morbidity and mortality.
During Operation Desert Storm, Fleet Hospital Fifteen, the northern-most deployed hospital, was 118 miles south of the Kuwaiti border. Once the ground campaign began, however, the FEBA rapidly moved north, realistically precluding helicopter transport of acute battle injuries to a fleet hospital. C-130 transport aircraft became the primary mode of patient evacuation from the forward areas to the airhead at the A1 Jubayl naval air station.
Patient transport via these fixed- wing aircraft was fraught with delays that degraded the fleet hospitals’ ability to provide timely medical care. Frequently, injured patients would be evacuated from the front by helicopter to a forward fixed-wing staging area, travel south via C-130, and transfer again to a helicopter or ambulance for the final ride to the fleet hospital. This typically took many hours, which could mean the difference between life and death.
Current fleet-hospital doctrine, drafted before the Persian Gulf War, says the facility should be “close to” (within 75 miles) the FEBA, to shorten the evacuation chain, but should also be “out of harm’s way.”6 These two tenets are no longer compatible, as demonstrated during Operation Desert Storm. Fleet Hospitals Five and Fifteen both were located in an area known as Scud Alley, and Iraqi Scud missiles either passed overhead or landed nearby during efforts to hit the large allied air base farther south at Dhahran. Thus, the location of the fleet hospitals created a long MedEvac chain, but still did not keep them out of harm’s way.
The advent of missile warfare precludes a safe rear area, in the traditional sense of the term. A compromise must be struck between hospital safety and proximity to the wounded. Reasonably, this location would be beyond the reach of long-range artillery and short-range rockets, 40 miles or so behind the FEBA.
To ensure fleet hospital mobility, we must consider downsizing, modularity, and compatibility with varied transportation. Downsizing today’s 500-bed fleet hospital, while retaining its present operating-room capability, would increase its flexibility. Since only three operating- room ISO containers (each with two operating tables) are included in a designated 500-bed combat-zone fleet hospital, a 200-250-bed capacity would be more appropriate. This lower number of beds would more closely match the actual operating room capability. Thus, a modularized, transport-friendly, 200-bed combat-zone fleet hospital could be moved and assembled more rapidly and would require fewer personnel.
Fleet Hospital Operations
The strength of any military unit can be traced directly to the leadership abilities of its command staff. The commanding officer’s ability to lead the fleet hospital
under austere conditions and to remain focused on his primary objective—providing the highest possible quality patient care—is essential.
A fleet hospital’s commanding officer should be a clinically oriented Medical Corps officer, with broad experience in trauma or surgery, as well as operational medicine. This is important because the perceived expertise of the commanding officer is crucial to eliciting the highest level of performance from his medical staff.7
The executive officer should have a broad-based understanding of acute patient care in an operational setting, together with the administrative skills needed to manage the day-to-day logistical and personnel issues. These are minimum requirements.
The fleet hospitals also must have an adequate initial stock of equipment and supplies to treat those injuries most likely to be seen on today’s battlefield. During Operation Desert Storm, many of the containerized perishable supplies, as well as dated medications and solu
tions, had expired, because appropriate restocking did not occur during the years the hospital remained containerized at its prepositioned overseas site.
Additionally, a significant number of basic medical supplies and surgical instruments listed on the initial-outfitting lists, in fact, were not present in the hospital loadout. Typical examples include missing craniotomy instruments, needed by neurosurgeons to treat severe head trauma; absent bone plates, screws, external fixators, and associated instruments needed for basic operative treatment of broken bones; and plaster of paris needed to apply casts.
The experience of the British during the Falkland Conflict, and our own experience during Operation Just Cause in Panama and the Persian Gulf War, tell us that orthopaedic trauma is the most common type of battlefield injury.8 Nevertheless, it was in this area that supplies were most notably deficient or absent.9
It is imperative that the basic instruments, medications, and supplies needed to treat the most likely injuries be present from the outset. The packing of these critical items has been delegated to a private contractor, who also assumes responsibility for ensuring that perishable and dated materials periodically are replaced. In this regard, the contractor’s performance fell far short of the mark. Nevertheless, the Navy ultimately is accountable for the readiness of fleet hospitals.
A mechanism for periodic, rigorous inspection must be established, to ensure that a prepositioned fleet hospital is 100% ready for deployment at all times. An inspection team analogous to the Navy’s Board of Inspection and Survey may be appropriate to ensure compliance with the established standards.
Additionally, a board of practicing Navy physicians, representing those disciplines incorporated in a fleet hospital, should meet once a year to review and update the container loads related to their specialty. Once the shooting starts, and the theater commander is besieged with multiple taskings for his limited resources, there may not be time to obtain missing critical medications and equipment before the casualties begin arriving.
The strength of the fleet hospitals during Operation Desert Storm was the uniformly high-quality medical personnel, who provided expeditious and compassionate medical and surgical care. Operating under harsh environmental conditions, frequent missile attacks, and a paucity or absence of many basic medical supplies, the fleet hospital staff members improvised, horse-traded, or otherwise obtained many basic necessities, to treat sick and injured U.S. and Coalition forces personnel.
To put the number of patients treated by one fleet hospital in perspective, during a two-and-one-half month period, Fleet Hospital Fifteen provided care to more than 8,000 outpatients, performed 193 major surgical procedures (42% of which were combat casualties), 181 minof surgical procedures, and admitted 697 inpatients.10
Conclusion
The first major Navy treatment facility to reach the Pet' ^ sian Gulf during Operation Desert Shield was a fleet hoS'
bil
fut
pital, which was on line before the arrival of either the hospital ship Comfort (T-AH-20) or Mercy (T-AH-19). These deployable medical systems demonstrated the importance of having land-based, relocatable hospitals, to provide care beyond that available within the Marine Corps medical organization or on board most ships.
Although much press coverage was given the Comfort and Mercy, neither ship treated casualties from the ground campaign." This responsibility fell to the Marine Corps medical units and to the fleet hospitals. Although the Comfort and Mercy, as fourth-echelon treatment facilities, are better equipped to handle complex injuries, their location away from the Primary MedEvac chain and vulnerability to hostile ac- tton precluded their direct support in the management °f combat casualties.12
The value of deployable medical systems, as manifested by the fleet hospital, was validated during Operation Desert Storm. Nevertheless, much work lies ahead.
Clinically active Navy physicians and surgeons must be the ones to determine the medical allowance for a fleet hospital, given the constraints of a deployable system. Administrators and physicians not actively practicing their sPecialty should not be making potentially life-or-death decisions that they are not qualified to make.
. Fleet-hospital training must be real. This means tak- 'ng care of patients in a fleet-hospital setting. At no time does the training curriculum at the Fleet Hospital Operations and Training Center at Camp Pendleton include Seating patients within a fleet-hospital-like tent and jbO facility. This does not mean moulage, but actual clin- |cal and operative patient care within a field facility. Only ,n [his way can the shortcomings of this system be iden- hfied and corrected by those knowledgeable about treat- lng patients.
, Professional line officers would never consider accept- lng a ship or an aircraft into the fleet without rigorous trials. Nevertheless, three Navy fleet hospitals were deployed Without ever being tested for their ability to provide real Operative and nonoperative patient care—the sole reason 0r their existence.
, Fleet hospitals must be able to adapt to the ever-changing scenario of modern warfare. This mandates flexibil- dy> mobility, and the ability to quickly establish a third- echelon surgical facility wherever conflict or disaster Incurs. As our armed forces become smaller, more mo- e> and more versatile, so must our fleet hospitals. This Ure role should not be built solely on the lessons learned 'n the Persian Gulf War, for errors will result if planning future conflicts is based primarily on the last war. nether the next military contingency is unconventional,
low intensity, or large-scale, the fleet hospital must be properly outfitted and ready for immediate deployment. Our warriors deserve nothing less.
'Maj. Gregory B. Knudson, MS, USA, “Operation Desert Shield: Medical Aspects of Weapons of Mass Destruction,” Military Medicine, June 1991, pp. 267-271. S. Nelson. “Desert Storm Exposed Some Problems for Wartime Medicine,” Navy Times, 1 July 1991, p. 10.
2ISO containers are 8 feet wide, 20 feet long, and 8 1/2 feet high. Their specific design allows the use of standardized materiel-handling equipment for moving, offload and onload.
’Fleet Hospital Support Office, “Field Assembly Plan for Fleet Hospitals,” (Alameda, Calif.), January 1989, pp. 4, 33.
4Capt. L.R. Leslie, MC, USNR, “Fleet Hospital Fifteen, Operation Desert Shield, After Action Report,” 26 April 1991, p. 11.
5J02 Michael Dean, “The Shining Star,” Navy Medicine, January/February 1991,
p. 2.
‘•“Field Assembly Plan for Fleet Hospitals,” p. 36.
7Col. Edward K. Jeffer, MC, USA, “Medical Units: Who Should Command?,” Military Medicine, September 1990. p. 415.
Tessa Richards, “Medical Lessons from the Falklands,” British Medical Journal, 5 March 1983, pp. 790-792. P.S. London. “Medical Lessons from the Falkland Islands Campaign,” The Journal of Bone and Joint Surgery (British), August 1983, pp. 507-510. Alvin Nagelberg, “A Call in the Night Puts Military Surgeons Back in Action,” The AAOS Bulletin (Chicago. III.), April 1990, p. 24. Fleet Hospital Fifteen. "Patient Statistics,” 1991. p. 2. yLeslie, p. 10.
,0“Patient Statistics,” pp. 1-3.
"Marc Zolton, “Military Fears Post-War Exodus of Medical Reservists,” Navy Times, 18 March 1991, p. 6.
LCdr Steven L. Oreck, MC, USNR, “Hospital Ships: The Right of Limited Self Defense.” Proceedings, November 1988, p. 65.
A graduate of the U.S. Naval Academy, Commander Covey served seven years as a surface warfare officer prior to medical school and subsequent orthopaedic surgery residency and fellowship training. During Operation Desert Storm, he was a staff orthopaedic surgeon assigned to Fleet Hospital Fifteen and Explosive Ordnance Disposal Group One Detachment Alpha, in Saudi Arabia and Kuwait, respectively. A previous Proceedings contributor, he currently is chief of orthopaedic surgery at Naval Hospital, Bremerton, Washington.
This html article is produced from an uncorrected text file through optical character recognition. Prior to 1940 articles all text has been corrected, but from 1940 to the present most still remain uncorrected. Artifacts of the scans are misspellings, out-of-context footnotes and sidebars, and other inconsistencies. Adjacent to each text file is a PDF of the article, which accurately and fully conveys the content as it appeared in the issue. The uncorrected text files have been included to enhance the searchability of our content, on our site and in search engines, for our membership, the research community and media organizations. We are working now to provide clean text files for the entire collection.
By Lieutenant Commander Dana C. Covey, Medical Corps, U.S. Naval Reserve
The fleet-hospital concept is well-founded, as demonstrated by the outstanding performance of those units deployed during the Gulf War. Nevertheless, this initial deployment revealed areas for improvement that should be addressed prior to the next contingency.
Operation Desert Storm saw the first-ever deployment of Navy fleet hospitals, including Fleet Hospital Fifteen in northeastern Saudi Arabia (right). They performed well—here, staff of Fleet Hospital Five discuss an upcoming procedure—but casualties were light and the hospitals were not severely tested. Still, lessons from this initial sea trial can improve the fleet hospital system and ensure maximum readiness for the next conflict.
The 1990 invasion of Kuwait by Iraq set in motion the largest deployment of U.S. forces since World War II. This conflict also prompted a massive mobilization of medical assets to the Persian Gulf to support these forces; it was estimated that 20,000-40,000 U.S. combat casualties could occur in a full-scale war
against Iraq.'
This medical mobilization included a number of firsts, including the first-ever deployment of fleet hospitals, the Navy components of the triservice Deployable Medical Systems—tent-based field hospitals designed for rapid deployment to an area of actual or threatened hostilities. The medical materiel is essentially the same for Army, Navy, and Air Force field facilities of similar scope and is subject to DoD standardization.
The Fleet Hospital Concept
Combat-zone fleet hospitals are third-echelon field medical treatment facilities designed for resuscitation, stabilization, and medical and surgical care of combat and noncombat casualties. They have a designated 250- or 500-bed capacity and operating rooms designed for basic operative treatment of a wide range of injuries. Fleet hospitals are prepositioned overseas and, for the most part, are self-sustaining for 60 days.
During Operations Desert Shield and Desert Storm, three 500-bed, Navy combat-zone fleet hospitals were deployed to the Persian Gulf. Fleet Hospital Five, comprised almost entirely of active-duty personnel, was deployed in August 1990 to A1 Jubayl, Saudi Arabia, where it located within the port facility. Fleet Hospitals Six and Fifteen, manned primarily by recalled Naval Reserve personnel, subsequently deployed to Bahrain and to the desert region northwest of A1 Jubayl, respectively.
Fleet hospitals are designed to provide a more advanced level of patient care than the first- and second-echelon medical units organic to the Marine Corps (i.e., battalion aid stations, collecting-and-clearing companies, and surgical support companies). The 500-bed combat-zone fleet hospitals deployed to the Persian Gulf, each with a complement of more than 900 personnel, technically are classified as mobile treatment facilities; but once set up, they are difficult to move.
A 500-bed combat-zone fleet hospital requires more than 400 International Standards Organization (ISO) containers for loadout, in addition to civil-engineering support equipment and rolling stock, which are not containerized.2 This requires significant sealift, offload and line-haul assets to get the nascent fleet hospital to its intended site. These responsibilities generally arg
under the auspices of the fleet commander-in-chief, who must provide for the hospital’s establishment among many competing priorities.
During the Persian Gulf War, the relative luxury of a prolonged logistical buildup prior to hostilities allowed all three deployed fleet hospitals to be fully operational before the start of the ground campaign on 24 February 1991. However, in an absolute sense, the time needed by the fleet hospitals to reach an initial operational capability (IOC) was too long. This could have resulted in increased Patient morbidity and mortality had combat casualties occurred sooner than Coalition forces expected.
According to fleet-hospital doctrine, a limited operational capability should be established ten days after the initial group of hospital personnel, known as the air detachment, arrives on site.3 After the arrival of its air detachment, Fleet Hospital Fifteen required 15 days to roach a limited IOC of 200 beds and an additional three days to reach its full, 500-bed capacity.4 Similarly, Fleet Hospital Five required 16 days to set up.5
Set-up Time Is Critical. The time required to bring the ^'eet Hospitals on-line during Operation Desert Storm was a rosult of several factors, not the least of which was competition for scarce transportation and construction resources Wlthin the theater of operations.
Prior to the arrival of fleet-hospital personnel, site section and preparation should be complete and ready for container staging, so hospital construction can proved on schedule. To reduce the time needed to achieve an initial casualty-treatment capability, the fleet hospital I °uld be modularized, so priority components are pal- eflzed and shipped by C-141 or other transport aircraft to a staging area near the hospital site. This priority module ^°uld include a limited casualty-receiving area; surgical, Moratory, and X-ray ISOs; and 10 recovery-room or in- nsive-care-unit beds and 40 acute care beds, to provide an initial fly-away surgical capability.
Given the speed with which international tensions can escalate, it is not unreasonable to expect that a third-echelon medical treatment facility should be able to establish an initial surgical capability 3-5 days after the arrival of the initial hospital contingent. Modularization would greatly increase the flexibility of the combat-zone fleet hospital, allowing it to adapt to contingencies ranging from natural disasters to full-scale armed conflicts.
Mobility Is Important. With the current focus on maneuver warfare and Marine Corps tactical doctrine emphasizing mobility, the fleet hospital must be able to relocate to keep abreast of the tactical situation. This is important because the MedEvac time from the forward edge of the battle area (FEBA) is directly related to patient morbidity and mortality.
During Operation Desert Storm, Fleet Hospital Fifteen, the northern-most deployed hospital, was 118 miles south of the Kuwaiti border. Once the ground campaign began, however, the FEBA rapidly moved north, realistically precluding helicopter transport of acute battle injuries to a fleet hospital. C-130 transport aircraft became the primary mode of patient evacuation from the forward areas to the airhead at the A1 Jubayl naval air station.
Patient transport via these fixed- wing aircraft was fraught with delays that degraded the fleet hospitals’ ability to provide timely medical care. Frequently, injured patients would be evacuated from the front by helicopter to a forward fixed-wing staging area, travel south via C-130, and transfer again to a helicopter or ambulance for the final ride to the fleet hospital. This typically took many hours, which could mean the difference between life and death.
Current fleet-hospital doctrine, drafted before the Persian Gulf War, says the facility should be “close to” (within 75 miles) the FEBA, to shorten the evacuation chain, but should also be “out of harm’s way.”6 These two tenets are no longer compatible, as demonstrated during Operation Desert Storm. Fleet Hospitals Five and Fifteen both were located in an area known as Scud Alley, and Iraqi Scud missiles either passed overhead or landed nearby during efforts to hit the large allied air base farther south at Dhahran. Thus, the location of the fleet hospitals created a long MedEvac chain, but still did not keep them out of harm’s way.
The advent of missile warfare precludes a safe rear area, in the traditional sense of the term. A compromise must be struck between hospital safety and proximity to the wounded. Reasonably, this location would be beyond the reach of long-range artillery and short-range rockets, 40 miles or so behind the FEBA.
To ensure fleet hospital mobility, we must consider downsizing, modularity, and compatibility with varied transportation. Downsizing today’s 500-bed fleet hospital, while retaining its present operating-room capability, would increase its flexibility. Since only three operating- room ISO containers (each with two operating tables) are included in a designated 500-bed combat-zone fleet hospital, a 200-250-bed capacity would be more appropriate. This lower number of beds would more closely match the actual operating room capability. Thus, a modularized, transport-friendly, 200-bed combat-zone fleet hospital could be moved and assembled more rapidly and would require fewer personnel.
Fleet Hospital Operations
The strength of any military unit can be traced directly to the leadership abilities of its command staff. The commanding officer’s ability to lead the fleet hospital
under austere conditions and to remain focused on his primary objective—providing the highest possible quality patient care—is essential.
A fleet hospital’s commanding officer should be a clinically oriented Medical Corps officer, with broad experience in trauma or surgery, as well as operational medicine. This is important because the perceived expertise of the commanding officer is crucial to eliciting the highest level of performance from his medical staff.7
The executive officer should have a broad-based understanding of acute patient care in an operational setting, together with the administrative skills needed to manage the day-to-day logistical and personnel issues. These are minimum requirements.
The fleet hospitals also must have an adequate initial stock of equipment and supplies to treat those injuries most likely to be seen on today’s battlefield. During Operation Desert Storm, many of the containerized perishable supplies, as well as dated medications and solu
tions, had expired, because appropriate restocking did not occur during the years the hospital remained containerized at its prepositioned overseas site.
Additionally, a significant number of basic medical supplies and surgical instruments listed on the initial-outfitting lists, in fact, were not present in the hospital loadout. Typical examples include missing craniotomy instruments, needed by neurosurgeons to treat severe head trauma; absent bone plates, screws, external fixators, and associated instruments needed for basic operative treatment of broken bones; and plaster of paris needed to apply casts.
The experience of the British during the Falkland Conflict, and our own experience during Operation Just Cause in Panama and the Persian Gulf War, tell us that orthopaedic trauma is the most common type of battlefield injury.8 Nevertheless, it was in this area that supplies were most notably deficient or absent.9
It is imperative that the basic instruments, medications, and supplies needed to treat the most likely injuries be present from the outset. The packing of these critical items has been delegated to a private contractor, who also assumes responsibility for ensuring that perishable and dated materials periodically are replaced. In this regard, the contractor’s performance fell far short of the mark. Nevertheless, the Navy ultimately is accountable for the readiness of fleet hospitals.
A mechanism for periodic, rigorous inspection must be established, to ensure that a prepositioned fleet hospital is 100% ready for deployment at all times. An inspection team analogous to the Navy’s Board of Inspection and Survey may be appropriate to ensure compliance with the established standards.
Additionally, a board of practicing Navy physicians, representing those disciplines incorporated in a fleet hospital, should meet once a year to review and update the container loads related to their specialty. Once the shooting starts, and the theater commander is besieged with multiple taskings for his limited resources, there may not be time to obtain missing critical medications and equipment before the casualties begin arriving.
The strength of the fleet hospitals during Operation Desert Storm was the uniformly high-quality medical personnel, who provided expeditious and compassionate medical and surgical care. Operating under harsh environmental conditions, frequent missile attacks, and a paucity or absence of many basic medical supplies, the fleet hospital staff members improvised, horse-traded, or otherwise obtained many basic necessities, to treat sick and injured U.S. and Coalition forces personnel.
To put the number of patients treated by one fleet hospital in perspective, during a two-and-one-half month period, Fleet Hospital Fifteen provided care to more than 8,000 outpatients, performed 193 major surgical procedures (42% of which were combat casualties), 181 minof surgical procedures, and admitted 697 inpatients.10
Conclusion
The first major Navy treatment facility to reach the Pet' ^ sian Gulf during Operation Desert Shield was a fleet hoS'
bil
fut
pital, which was on line before the arrival of either the hospital ship Comfort (T-AH-20) or Mercy (T-AH-19). These deployable medical systems demonstrated the importance of having land-based, relocatable hospitals, to provide care beyond that available within the Marine Corps medical organization or on board most ships.
Although much press coverage was given the Comfort and Mercy, neither ship treated casualties from the ground campaign." This responsibility fell to the Marine Corps medical units and to the fleet hospitals. Although the Comfort and Mercy, as fourth-echelon treatment facilities, are better equipped to handle complex injuries, their location away from the Primary MedEvac chain and vulnerability to hostile ac- tton precluded their direct support in the management °f combat casualties.12
The value of deployable medical systems, as manifested by the fleet hospital, was validated during Operation Desert Storm. Nevertheless, much work lies ahead.
Clinically active Navy physicians and surgeons must be the ones to determine the medical allowance for a fleet hospital, given the constraints of a deployable system. Administrators and physicians not actively practicing their sPecialty should not be making potentially life-or-death decisions that they are not qualified to make.
. Fleet-hospital training must be real. This means tak- 'ng care of patients in a fleet-hospital setting. At no time does the training curriculum at the Fleet Hospital Operations and Training Center at Camp Pendleton include Seating patients within a fleet-hospital-like tent and jbO facility. This does not mean moulage, but actual clin- |cal and operative patient care within a field facility. Only ,n [his way can the shortcomings of this system be iden- hfied and corrected by those knowledgeable about treat- lng patients.
, Professional line officers would never consider accept- lng a ship or an aircraft into the fleet without rigorous trials. Nevertheless, three Navy fleet hospitals were deployed Without ever being tested for their ability to provide real Operative and nonoperative patient care—the sole reason 0r their existence.
, Fleet hospitals must be able to adapt to the ever-changing scenario of modern warfare. This mandates flexibil- dy> mobility, and the ability to quickly establish a third- echelon surgical facility wherever conflict or disaster Incurs. As our armed forces become smaller, more mo- e> and more versatile, so must our fleet hospitals. This Ure role should not be built solely on the lessons learned 'n the Persian Gulf War, for errors will result if planning future conflicts is based primarily on the last war. nether the next military contingency is unconventional,
low intensity, or large-scale, the fleet hospital must be properly outfitted and ready for immediate deployment. Our warriors deserve nothing less.
'Maj. Gregory B. Knudson, MS, USA, “Operation Desert Shield: Medical Aspects of Weapons of Mass Destruction,” Military Medicine, June 1991, pp. 267-271. S. Nelson. “Desert Storm Exposed Some Problems for Wartime Medicine,” Navy Times, 1 July 1991, p. 10.
2ISO containers are 8 feet wide, 20 feet long, and 8 1/2 feet high. Their specific design allows the use of standardized materiel-handling equipment for moving, offload and onload.
’Fleet Hospital Support Office, “Field Assembly Plan for Fleet Hospitals,” (Alameda, Calif.), January 1989, pp. 4, 33.
4Capt. L.R. Leslie, MC, USNR, “Fleet Hospital Fifteen, Operation Desert Shield, After Action Report,” 26 April 1991, p. 11.
5J02 Michael Dean, “The Shining Star,” Navy Medicine, January/February 1991,
p. 2.
‘•“Field Assembly Plan for Fleet Hospitals,” p. 36.
7Col. Edward K. Jeffer, MC, USA, “Medical Units: Who Should Command?,” Military Medicine, September 1990. p. 415.
Tessa Richards, “Medical Lessons from the Falklands,” British Medical Journal, 5 March 1983, pp. 790-792. P.S. London. “Medical Lessons from the Falkland Islands Campaign,” The Journal of Bone and Joint Surgery (British), August 1983, pp. 507-510. Alvin Nagelberg, “A Call in the Night Puts Military Surgeons Back in Action,” The AAOS Bulletin (Chicago. III.), April 1990, p. 24. Fleet Hospital Fifteen. "Patient Statistics,” 1991. p. 2. yLeslie, p. 10.
,0“Patient Statistics,” pp. 1-3.
"Marc Zolton, “Military Fears Post-War Exodus of Medical Reservists,” Navy Times, 18 March 1991, p. 6.
LCdr Steven L. Oreck, MC, USNR, “Hospital Ships: The Right of Limited Self Defense.” Proceedings, November 1988, p. 65.
A graduate of the U.S. Naval Academy, Commander Covey served seven years as a surface warfare officer prior to medical school and subsequent orthopaedic surgery residency and fellowship training. During Operation Desert Storm, he was a staff orthopaedic surgeon assigned to Fleet Hospital Fifteen and Explosive Ordnance Disposal Group One Detachment Alpha, in Saudi Arabia and Kuwait, respectively. A previous Proceedings contributor, he currently is chief of orthopaedic surgery at Naval Hospital, Bremerton, Washington.