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  • The United States Navy is traditionally known for its military might.

  • It is, by far, the largest and potentially most capable Navy in the world thanks to its

  • innumerable aircraft carriers, destroyers, and submarines.

  • But, beyond those, and beyond all the cruisers and patrol boats and other combat ships, there

  • are two more that lurk in the shadows of the 490 ship fleetthe USNS Mercy and Comfort.

  • These are America's hospital ships.

  • Hospital ships are more or less a forgotten relic of a time when wars were far deadlier

  • and the world was far larger.

  • During those times, when fighting a war abroad, just like today, one had to consider where

  • casualties would go, but unlike today, there were no capabilities to quickly fly injured

  • personnel away from a battlefield.

  • One had to treat close to the conflict and for that, the most viable option was often

  • to bring a hospital-ship to the fight.

  • These ships were once so significant that, when nations came together to write the Geneva

  • Conventions, defining the rules of war, hospital ships were a significant focus.

  • They specifically denote these as any that specifically and solely work to assist the

  • wounded or sick, with the important distinction that they cannot carry any arms or ammunition.

  • These ships also must be painted white with red crosses to identify themselves, but assuming

  • these requirements are met, they are officially classed as a hospital ship.

  • Those with this classification cannot, under the Geneva Conventions, be attacked or fired

  • upon.

  • This was all plenty useful at the time the Geneva Conventions were signed, but today,

  • land-based warfare is increasingly obsolete, and it just doesn't make sense to float

  • a hospital to a conflict zone when field hospitals are more capable, and medical evacuation is

  • easy.

  • That's why only eight nations' navies still include hospital ships.

  • Most of these are rather small and primarily deployed for humanitarian purposes, but the

  • US' two hospital ships, meanwhile, are massive.

  • They're the size of cruise ships and comparable in capability to the largest land-based hospitals.

  • Each holds 1,000 hospital beds including 80 intensive care beds.

  • In comparison, the entire state of Maine has 1,061 total and 64 ICU beds.

  • To have an entire state's worth of medical facilities available anywhere in the world

  • is an immensely useful strategic power, but not entirely for the purpose of actually treating

  • US soldiers.

  • Within the military, the Comfort and Mercy are officially classified as, “flexible

  • deterrent options.”

  • That's to say, they're an option for, “show of force.”

  • In wartime, sending a ship with capacity for a thousand patients sends a message that the

  • US is willing to accept an immense amount of casualties.

  • That may or may not be true, but the message is there.

  • In peacetime, parading a hospital ship around the world for humanitarian missions both fosters

  • good will for the US military, and also shows countries the capabilities of the US' military

  • health system.

  • The effectiveness of these ships asflexible deterrent optionscould be debatable, but

  • in the military's mind, this is the purpose behind these ships.

  • They're an option for deterrence or escalation.

  • That's part of the reason why they've seen so little deployment to combat zones.

  • That's just not the primary purpose.

  • Each ship has only seen one deployment primarily treating casualties of warthe Mercy to

  • Operation Desert Shield and Storm in 1990, and the Comfort to the Iraq War in 2002.

  • For the rest of their 30 year histories, they have spent their time deployed on humanitarian

  • missions to disasters or impoverished nations, or in reduced operating status at their home

  • ports in San Diego and Norfolk.

  • While during active service the Mercy houses well over 1,000 crew, most of its time is

  • spent in port, in that reduced operating status.

  • At such times, the massive ships will house just 70 crew members who will keep it ready

  • to go at a moment's notice.

  • By the nature of their service, expediency of deployment is key.

  • Therefore, they're designed so that they can go from reduced operating status to leaving

  • San Diego or Norfolk in just five days.

  • But while they can leave quickly, that doesn't mean they can necessarily get to their destination

  • quickly.

  • The Mercy and Comfort are both converted oil tankers that originally launched in 1975 and

  • 1976, respectively.

  • Oil tankers are not designed for speed, as it's just not necessary, so the ships can

  • only travel at about 20 miles or 31 kilometers per hour.

  • Compare that to a Nimitz-class aircraft carrier which, at almost twice the size, can travel

  • at 35 miles or 56 kilometers per hour.

  • If there was, say, a disaster in Sri Lanka, it would take five days to get the ship into

  • full operating status, and then 20 to sail all the way to the Indian Ocean.

  • By that time, nearly a month after the disaster, the trauma phase of medical response would

  • be largely done.

  • This is likely a reason why a majority of the ships' deployments have been near the

  • USin the Americas.

  • Of those, many have been long-planned humanitarian missions to provide advanced healthcare to

  • areas without it.

  • These are, of course, incredibly impactful for those they serve, but overall, the ships

  • just aren't designed for super-fast response to critical crises.

  • The very size that slows it does, however, have a purpose.

  • Beyond just allowing for a massive capacity, the ships are stable enough that, even when

  • floating, it is possible to conduct most types of surgery in their 12 operating rooms.

  • There are exceptionsthe floating platform doesn't allow for open-heart surgerybut

  • still, the possibility of conducting advanced medical interventions at sea is impressive.

  • There are, however, more issues related to the origins of the ships.

  • You see, hospitals are quite tricky facilities to design.

  • Small and subtle differences can mean the difference between life and death, and so

  • the accumulated experience of hundreds of years has resulted in explicit knowledge on

  • how hospitals should be built.

  • One of the myriad principles is that movement bottlenecks should be minimized.

  • That leads to features like wide hallways and doors, but it also means that, as much

  • as possible, the use of elevators should be avoided.

  • The technique to achieve that is, of course, to make hospitals wider.

  • You want as much as possible on the same floor so that there is as little need as possible

  • to put patients in elevators when transferring them from one area to the other.

  • If, for example, a patient takes a turn for the worse and needs to be rushed to an operating

  • room, the 90 seconds waiting for and riding the elevator can mean the difference between

  • life and death.

  • This also has an implication on overall hospital efficiency.

  • For example, you ideally want radiology rather close to and on the same floor as the emergency

  • room since many patients often need x-ray imaging right when they present to the ER.

  • The further away it is, the longer it takes to get a patient to and from there, and then

  • the longer they spend in the ER department overall, and the more beds are needed to serve

  • the same number of patients in the ER.

  • These principles are all why hospitals tend to be wide.

  • Even in places with incredible density and high real-estate costs like New York, most

  • hospitals are wider than they are tall.

  • In all, hospital design is a puzzle where all the elements that patients most commonly

  • are transferred between need to be as close, in travel time, to each other.

  • Looking at the outside of the USNS Mercy and Comfort, you would think that they would properly

  • follow this principle of width before height, but unfortunately, during their conversion,

  • legacies of their past lives were left behind.

  • You see, tanker ships, on the inside, are not just one big empty hull filled with oil.

  • They were when they first emerged, many years ago, but the issue there was that, with a

  • slight tilt forwards, backwards, or to a side, oil would start sloshing to that side, which

  • leads to more weight on that side, which leads to more tilt, which leads to more oil sloshing,

  • and so on and so forth until a ship capsized.

  • That was clearly an issue, but one easily solved by creating bulkheads both laterally

  • and longitudinally so that oil couldn't slosh around.

  • The problem, though, is the these were left in the Comfort and Mercy.

  • There are no doors between bulkheads on the lower floors.

  • Therefore, if one needs to get a patient from here to here, they have to be brought up an

  • elevator, across the top deck, and back down again.

  • This leads to huge movement issues, making the ship's effectiveness as a hospital more

  • limited.

  • That's just one large example, but there are plenty of other smaller issues with the

  • ship designs that make them less effective than they could be.

  • They are, after all, nearly 50 years old, and the Navy was already starting to plan

  • their retirement decades ago.

  • Their original cost, including both the ship purchase and conversion, was $275 million

  • each, which may seem like a lot, but this is the same Navy that spends billions on single

  • destroyers.

  • A couple hundred million is a bargain for a ship of this size and, yearly, its operating

  • costs are rather insignificant in the context of the Navy.

  • It's the kind of asset that makes sense to keep around just in case it becomes useful,

  • as it does every once in a while when disaster strikes in the US or abroad, but also one

  • that the US is likely to be unwilling to invest in upgrading.

  • A dedicated, purpose-built hospital ship of this size could be an enormous step up from

  • these, but when given the choice between a new destroyer or a new hospital ship, the

  • Navy's going to pick the destroyer.

  • It's for that reason why the Comfort and Mercy have stayed in service for so long,

  • and why they're likely to stay in service until the very last day possible.

  • They may not be of enormous use in the Navy's eyes, but to the thousands that they treat,

  • they're a symbol of hope in tough times and, until they're incapable of helping

  • anyone, they serve a crucial purpose.

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How the US' Hospital Ships Work

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    joey joey posted on 2021/06/10
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