USNS Comfort: Caring for the Sick at Sea

To the Editor: In addition to military task, US Naval forces frequently conduct non-combat related missions, including emergency medical response and humanitarian assistance operations. Non-combat-related medical missions have involved the hospital ship USNS Mercy (T-AH 19) during tsunami relief efforts in Southeast Asia in 2004 and a follow-on 2006 humanitarian mission to the same tsunami ravaged region of Southeast Asia. The hospital ship USNS Comfort (T-AH 20) (Fig. 1) responded to the Hurricane Katrina disaster in 2005.Fig 1.: USNS Comfort (T-AH 20).Recently, the USNS Comfort (T-AH 20) embarked on a 4-month humanitarian mission to 12 Central and South American countries from June through October 2007. The USNS Comfort (T-AH 20) is the second ship of the Mercy Class. These ships were former San Clemente Class supertankers that were extensively modified to their present configuration. The Comfort has the capability to provide care for patients of all ages, with a total patient capacity of 1000 beds, 12 operating rooms, and all the ancillary services found in shore-based facilities. Additionally, there is a flight deck that supports helicopter operations and patient transports. The goal of the 2007 mission, appropriately named “Partnership for the Americas,” was to coordinate with host nations and nongovernmental relief organizations (Project Hope and Operation Smile) to provide humanitarian assistance during mission sites in Belize, Guatemala, Panama, Nicaragua, El Salvador, Peru, Ecuador, Colombia, Haiti, Trinidad, Guyana, and Suriname. The main focus of the mission was on preventive and primary care; surgical services were aboard to support this focus. Surgical services offered during the mission were general, general pediatric, gynecology, oral/ maxillofacial, orthopedic, otolaryngology, plastic, and urology surgery. The anesthesiology department consisted of two anesthesiologists and four certified registered nurse anesthetists. At each mission site, advance teams consisting of surgeons and anesthesia providers screened patients ashore before their transport by either boat or helicopter to the ship for surgery. Although the time spent operating in each country varied from 3 to 6 days, the surgical services offered were unchanged. The ship’s operating rooms contained the same contemporary equipment used in shore-based hospitals, which allowed personnel to integrate seamlessly into the surgical theater while underway. The available staffing model gave surgical services the ability to run three operating rooms 12 hours a day while at each mission site. More than 1000 surgical procedures were performed aboard the Comfort during the 4-mo period. This mission exemplified cooperation and teamwork, joining uniformed services medical assets from the US Navy, Army, Air Force, and Public Health Service with those of military health care professionals from Canada and other host nations as well as nongovernmental relief organizations. Indeed, the key to the success of the surgical mission was the interoperability among personnel, regardless of uniform, specialty or nationality. Flexibility, communication, and central focus on the mission led to team-building that facilitated a high-volume case load in an environment of patient safety, setting a standard for which future humanitarian missions should be compared. Philip D. Bailey, Jr., DO Department of Anesthesiology and Pain Management Naval Medical Center Portsmouth Portsmouth, VA [email protected]

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