Comfort and care: the evolution of naval medical capability 

The USNS Mercy anchored in an atoll in the western Pacific. The vessel is typical for how a hospital or medical ship is configured, although new design and payloads are being developed globally. Credit: US Navy/Mass Communication Specialist 2nd Class Kelsey L. Adams

N aval medical and hospital capabilities onboard ships are key capabilities for maritime operations in bringing forward critical care from its land-based preserve. Such naval medical capability fulfils three main roles, first and foremost being the maintenance of the health of the ship’s crew, especially when deployed far from home in potentially harsh environments.  

Secondly, they provide a useful tool for naval soft power by helping citizens of countries that have difficulties in providing medical support to remote communities, offering specialist treatments not available locally, or for Humanitarian and Disaster Relief (HADR) operations. Thirdly, they can provide urgent care for at-sea combat casualties in times of war or other incidents. 

Most naval vessels have a medical facility of some kind with differing levels of capability depending on the size and role of the ship. Frontline warships will have a medical bay, and navies in South America also operate special patrol vessels and barges designed to work in the riverine environment of the Amazon basin delivering medical services to remote communities in the jungle.  

Examples include the Peruvian Navy, which operates the Plataformas Itinerantes de Acción Social (PIAS) vessels and the Brazil Navy’s Navios de Assistência Hospitalar (NAsH) medical vessels. However, the US Navy (USN) has maximised the potential of afloat medical capabilities by supporting the operations of two specially built hospital ships, the USNS Mercy and USNS Comfort.  

The USNS Mercy and USNS Comfort have been in-service since 1986 and 1987 respectively, but the USN and US Marine Corps have emerging requirements to conduct more distributed operations and develop a forward basing and expeditionary operations capability under the Distributed Maritime Operations (DMO) and Expeditionary Advanced Base Operations (EABO) concepts. This means there is a need for an altogether different type of medical ship to support forward deployed forces and respond to a full range of naval or HADR operations, including combat operations support. 

A spokesperson from Austal USA told Global Defence Technology: “The future battlefield is more complex requiring smaller, faster maritime medical capability able to get closer to shore and provide medical treatment anywhere, any time it's needed.”

Austal USA has been contracted to build new Flight II variants of its catamaran-hulled Spearhead-class Expeditionary Fast Transport (EPF) vessels, with two ships under construction and a third under contract. EPF 14 will be delivered by the end of 2023 with EPF 15 being built and EPF 16 due to start construction in late-2023. The company is also expected to be contracted later in 2023 to build three new dedicated Expeditionary Medical Ship (EMS) also with a Role 2E facility. Further EMS are expected.

These ships have high speeds, a shallower draft and increased manoeuvrability allowing greater reach into island nations and access into austere ports that are inaccessible to large ships such as the Mercy and Comfort, which respectively displace 65,000-tonnes and 69,000-tonnes.

“Critical to treatment of modern battlefield injuries is the ability to move patients between echelons of care in an expedient manner, and EPF Flight II and EMS are core to that ability,” the Austal USA spokesperson said, adding that with more EMS vessels available than traditional hospital ships and all of them forward deployed and distributed around the world the USN can “provide better coverage than existing large platforms.”

The EMS ship will be 110m-long with a beam of 31.5m and draft of 4.6m. It can reach a top speed of more than 18kt providing a range in excess of 5,000nm, features a flight deck to host a V-22 tiltrotor, H-53 or H-60 helicopter, and can launch a recover 11m RHIBs. With a crew of 223 the EMS will have three operating rooms, 34 acute care beds, six acute isolation beds, 14 ICU beds, and six ICU isolation beds.

According to Austal USA the EMS Role 2E facilities will provide triage/critical care, operating rooms, medical laboratory, radiology capability, blood bank, dental, mental health, OB/GYN and primary care, rapid stabilisation and follow-on evacuation of multiple casualties, and combat search and rescue including recovery at sea.  

The Austal USA spokesperson said that the capability to recover personnel from damaged ships “is critical for engagements at sea under the DMO concept.” 

The EPF II ships that precede them are slightly smaller with a similar Role 2E medical mission module that can be installed. The Austal USA spokesperson said that the difference between EMS and EPF Fight II “is that EMS is a dedicated medical ship and EPF Flight II has an embarked medical capability but retains capability of Flight I to support other missions including core logistics.” 

Meanwhile Swedish defence company Saab has developed its Naval Hospitals solution for warships that can provide hospital-level medical capabilities. Most recently the company outfitted the Royal Norwegian Navy’s (RNoN’s) new auxiliary support ship, KNM Maud (A530), with an onboard hospital. 

Anders Lindström, director marketing and sales in deployed health at Saab, told Global Defence Technology that about 80% of the facilities you would find in a fixed land-based hospital can be fitted in ships, but installing medical facilities on warships does have its challenges. He explained that there are layout considerations “where to place the x-ray machines because of the radiation, and oxygen cylinders that are highly explosive, how you handle the power requirements, and that there is not much floor space for the equipment or ceiling height for surgical lamps and lighting. Air circulation is also important.” 

He also raised the issue of having an efficient flow delivering patients, usually from a helicopter or perhaps a RHIB into the medical bay, with the need to avoid travelling too far, using stairs or tight elevators. “The medical facility could be placed in the front, back or top of the ship depending on where the helicopters land and the elevators are to transport the patients,” Lindström said.  

Saab is in regular contact with ship designers and builders to find the best solution, however, Lindström said that the location of the medical facilities in a warship is not always given the priority it deserves: “Unfortunately it tends to come in rather late in the design process, it should be discussed early in the basic [warship] design,” he noted. 

On the KNM Maud project, Saab worked in partnership with the RNoN and the South Korean shipbuilder Daewoo Shipbuilding and Marine Engineering (DSME), now known as Hanwha Ocean, supporting them at the basic design level to develop the hospital capability with the expert advice of medical practitioners. The company also provided training tasks including a live exercises and training surgery. Maud is a 30,000t ship and is relatively stable compared to other vessel making it easier to do surgery in rough conditions although equipment has to be held in place by special links and attachments to prevent movement. 

Whilst Saab offers a wide-range of hospital capabilities and medical support services to all sizes of warships, Lindström said that a new trend is for container-based medical units to be installed on naval vessels. He explained that a trend for more multipurpose ships built to modular designs it means that capabilities fitted in ‘pods’ are preferred as they can be loaded on board to meet specific mission requirements as needed.  

“There is more of a focus onto that now. It is being discussed more and more both within shipyards and also with naval customers at trade shows like the recent Euronaval exhibition in particular,” he said. 

Vital for their ability to participate in humanitarian assistance and disaster relief operations during peacetime, through to their military use in times of conflict, naval medical and hospital ships are garnering a new lease of life on the ocean as countries such as the US, along with European allies, explore how to bring the capability into the 21st Century.