Onboard the USNS Comfort

MMT 2008 Volume: 12 Issue: 8 (November/December)

A Floating, Full-Service Hospital
 

A HISTORY OF COMFORT

In 1986, the Navy decided to convert a supertanker into a hospital ship. Two sister ships, the Comfort and the Mercy, were christened in 1987. The Comfort is maintained in reduced operational status (ROS-5) at a lay berth in the Port of Baltimore, while the Mercy makes its home port on the West Coast, in San Diego, Calif. The ship is crewed by civilian mariners, and the hospital, the medical treatment facility (MTF), is staffed by Navy personnel. While in reduced operational status, the Comfort has a crew of about 18 civilian Military Sealift Command (civilian mariners), and the MTF is maintained by a staff of approximately 58 active duty Navy military personnel and two civilian contractors, who also deploy when the ship is activated.

Stand on the dock next to the Comfort, and you will be amazed at her size. The ship is as tall as a 10-story building, and about as long as three football fields. Of course, that size is necessary when you consider the ship’s ability to expand to full operational status and house up to 1,000 patient beds, approximately 1,000 naval hospital staff, more than 250 naval support staff, and about 60 civilian mariners. The Comfort houses 12 operating rooms, and as Captain James Ware pointed out, “The only things we really can’t do are transplants or joint replacements.”

The USNS Comfort can fulfill three types of missions. They include combat casualty care, humanitarian assistance/disaster relief, and humanitarian civil assistance (planned medical missions). Comfort’s first combat casualty care mission was an eight-month deployment during Desert Shield in 1990. Comfort operated in the Arabian Gulf and Gulf of Oman, treating 8,700 patients and performing 337 surgeries during the mission. Comfort also served as an afloat trauma center in support of Operation Iraqi Freedom in 2003. For 56 days, military personnel, injured Iraqi civilians and enemy prisoners of war were treated on board.

The Comfort has performed a number of humanitarian/ disaster relief missions, most notably after 9/11 and Hurricane Katrina. The ship and crew were activated on the afternoon of September 11, 2001, to head to New York City to serve as a 250-bed hospital facility. Upon arriving at the pier in Manhattan, the mission was changed, and the Comfort was charged with providing services to the relief workers. The medical staff treated workers for injuries sustained at Ground Zero, as well as provided mental health consultations. The ship also served 17,000 meals to police, firefighters and volunteers, while providing beds for more than 2,000 people. Comfort also was deployed to Mississippi and Louisiana following Hurricane Katrina in 2005. During the month-long period the ship spent in the Gulf of Mexico, the MTF provided medical care to thousands of residents and relief workers in need. “The ship itself can be activated quickly. We have a five-day activation period. Within a 96-hour period we can get everything going and be able to leave the pier,” said Ware.

The third mission, humanitarian civil assistance, has been the Comfort’s most recent venture. “This is a planned medical mission, where we go out for months or a year, and go somewhere where we can help people,” Ware said. Funding for these missions is entirely different from other missions. As Ware puts it, the money is funded by Congress from an “entirely different pot of money.”

In the spring of 2007, the ship departed from Baltimore for a 120-day goodwill mission called Partnership for the Americas tour, with working ports in Belize, Guatemala, Panama, Nicaragua, El Salvador, Peru, Ecuador, Columbia, Haiti, Trinidad, Guyana and Suriname. Nearly 100,000 patients were treated during this time, and up to 1,500 surgeries were performed, including cataract removal, cleft lip repair and burn treatments. Medical care, including dental care, vaccinations and optometry are much-needed services in these countries. Civilians from nongovernmental organizations, such as Project Hope and Operation Smile, come aboard and travel with the naval staff for the duration of the mission. The staff goes beyond the Navy to include Army and Air Force active duty and reserve personnel, as well as the U.S. Public Health Service.

Captain Ware said the main purpose of these missions is to not only provide humanitarian relief and build goodwill, but to provide training opportunities for military personnel. “To go out and interact in these countries is very good training. It helps us partner with these countries, so if we need to provide services [such as after a tidal wave or a hurricane], we have already established connections with their medical systems,” he said. “They can teach us things about their medical culture that we are not aware of. We might have never seen medical conditions that are prevalent there.” In return, Ware said “these countries gain a new appreciation of America.”

THE INNER WORKINGS OF THE COMFORT

Just as any hospital houses a variety of departments, one will find a full range of services and specialties aboard the Comfort, including radiology, laboratory, medical supply, pharmacy, physical therapy, burn care, dental and optometry.

MMT’s tour began at the “intake” area of the ship, a huge emergency room that houses 50 beds. The beds are grouped into different triage categories, with those needing urgent care located toward the front. During humanitarian missions, such as its most recent Partnership for the Americas tour, the ER also serves as a sort of waiting room for patients. Those patients are screened for communicable diseases and then most are transferred to one of the eight limited care wards on ship, where they sleep in bunkbed style hospital beds for the duration of their treatment.

How does one make his way onboard to the Comfort’s emergency room? There are three options: the gangway, a water-level entry and the flight deck. The flight deck is the main entry point to the ship and the ER. The Comfort carries two Seahawk helicopters on its missions, which are responsible for bringing patients on board and taking staff to shore. Many times, due to the size of the ship, it cannot dock at ports and must drop anchor farther out to sea. This makes the helicopters a vital part of transporting people and supplies.

On the flight deck, the Comfort has three decontamination stations. On one side, the “dirty” patient can go in and scrub down, and exit through a clean side to enter the ship and head to the point of care. The decon stations are more likely to be used in the event of combat or in a disaster relief setting that involves biological hazards. The ship has elevators located throughout, but it also features a top to bottom ramp system that runs from the water level entry up to the flight deck. In the event that the elevators would ever lose power, the staff would be able to move patients and their beds or wheelchairs throughout the ship as needed.

The Comfort features four standard X-ray rooms, as well as six portable X-ray units. It even has a single room with CAT scan equipment as well.

The ship has a blood bank located just outside the operating rooms. The bank can hold 3,000 frozen and 2,000 fresh units of blood. In the OR area, there are 10 main operating suites. Each room has the capability of doing one minor and one major operation at a time, for a potential of 10 total surgeries happening simultaneously. These operating suites look like any other OR you might have seen, with one exception. Take a look at the floor, and you will notice a variety of D-ring anchors. Those anchors are used to hold down operating tables and equipment, because, after all, this is an operating room on a moving ship! Fortunately, the anchors are usually just a precaution, thanks to the smart engineering of the Comfort. The OR is located center of the ship, which means it is not subject to the same rocking and rolling that one might feel in other locations onboard.

Following surgery, all patients move to the post-op area of the ship. This is also where staff can perform vaginal births if necessary. To that end, a row of baby warmers are lined up along the wall. Shrink wrapped in each warmer are all the necessary medical supplies, and even a few extras: a stuffed toy, soft baby blanket, and of course, a fresh package of diapers.

The intensive care unit is of substantial size. There are four ICU units, each of which can hold about 20 beds. The ICU is an open floor plan, with beds located throughout the large room. At each bedside, there is oxygen, suction and monitoring that is linked to the central monitoring system. Since this ICU also serves as the ship’s burn care unit, specialized beds from Hill-Rom can be found here. They are capable of relieving pressure points, assisting with turning the patients, and even massaging a patient correctly.

The Comfort also has a fully functional laboratory, which can do everything up to and including DNA analysis. The pharmacy is fully stocked with all medications you would expect to find in any major hospital.

One thing that makes the Comfort different than your typical hospital is that it also houses and feeds its entire staff. On the 2007 humanitarian mission, there were about 900 staff on board, including corpsmen, doctors, nurses, machinists and support staff.

Any sailors who are class E-6 or lower stay in the standard berthing area. Each berthing features 60 bunks stacked three high, and each crew member gets one large locker and one small locker to store any personal items. Though it is a tight space, the staff says it is actually quite comfortable compared to the living quarters in some other vessels.

Commissioned officers share a living space that is considerably larger. These rooms house four to six officers and have semi-private restrooms. Higher rank does mean higher levels of comfort, as the beds for officers are wider, and are only stacked two high. Still, this is no cruise ship cabin. It is easy to tell that these living quarters are generally used for sleeping only.

Despite the cramped living quarters, the quality of life on the ship is quite good for the crew. The ship features a weight room, cardio room and library with internet access, as well as a collection of games, books and video games. A large cafeteria feeds the entire crew, with meals prepared in an impressive industrial sized kitchen.

COMING UP

What’s next for the Comfort? Ware and his crew are preparing for another humanitarian civil assistance mission in the spring of 2009. The ship will visit seven countries in Central and South America, and the crew will provide medical care for 100,000 people in need. “It is something we are looking forward to doing,” Ware said. ♦