Navy Medicine in Araby (Episode 6)

Gina and I have been away, culminating a 6 month-long celebration of our 50th wedding Anniversary, this time with a couple of couple-friends. We cruised the Seine to Normandy, where we walked the long flat beaches and appreciated what our men faced as they came ashore. The American Cemetery is a quietly majestic reminder of the sacrifices made there. We also visited Giverny, the living memorial to Claude Monet, and then later, the l’Orangerie museum that houses 8 very large Monet renderings of his famous water lillies. They brought tears to my eyes.

Now, back to part 6 of my 8 part series on Navy medicine in the middle east.

As a result of past experience and from learning in our middle east combat zones, the system of levels of care has evolved as follows: Level 1 is the simplest and most basic care; our soldiers and Marines each carry a tourniquet with them, and are taught how to apply it to stop bleeding from injured extremities. Level 2 facilities, located as close to the combat zone as is safe, offer basic capabilities to provide what is referred to as “damage-control” surgery. Level 3 facilities are fully capable hospitals with most major specialties, ICUs, and specialized nursing care. Level 4 facilities are specialized hospitals, research facilities and teaching hospitals with the highest levels of sophistication of care and facilities available.[1]


Medical facilities aboard U.S. ships range from simple sick bays in Destroyers and  Frigates that have nothing more than an examining table, rudimentary instrument sets and an autoclave for sterilizing dressings and instruments. With perhaps two navy corpsmen aboard, medical capabilities in these smaller ships is limited to simple surgical procedures, routine care of simple medical problems like upper respiratory infections, and first aid – echelon 1 level care – for more serious industrial-type and combat injuries. Patients in these ships would need to be evacuated by helicopter or boat to larger, more capable ships or facilities ashore. Our aircraft carriers and amphibious landing ships can offer, when fully staffed, Echelon 2+ to Echelon 3 levels of care. They have complete surgical teams aboard, in the instance of U.S.S. Nimitz, 2 General Medical Officers, a General Surgeon, 2 Registered Nurses (one trained in intensive care, one an anesthetist), a psychologist, physical therapist, 20 corpsmen and a dental department. [2] Patients treated there would need transport to higher levels of care only if their recovery time exceeds the time permitted by local so-called evacuation policy, or if they have suffered massive injuries that will require prompt advanced surgical and medical management.

The U.S. has two hospital ships in active service. USNS Comfort, homeported in Baltimore at the outset of the wars in the Middle East, but now in Norfolk; and the USNS Mercy, homeported then in Oakland, and now in San Diego. Each has a bed capacity of 1000, both have 12 operating rooms and a radiology suite including CT scanners. They are kept in custodial status with skeleton crews, but can be activated on a five-day schedule, their medical staffs brought together from military hospitals throughout the U.S. Both ships deployed to the Persian Gulf during Operation Desert Storm / Shield. Between them, they admitted nearly 1400 patients and performed over 600 surgeries during their 6 month deployments. Comfort again deployed in 2003 to support Operation Iraqi Freedom. In her 56 days in the Persian Gulf, she cared for 700 patients, performing 590 surgeries and administering 600 units of blood. Her medical staff also cared for nearly 200 Iraqi civilians and POWs. These floating hospitals are capable of Echelon 3 level care.


Navy Fleet Hospitals began during WW II as tent hospitals set up on remote Pacific Islands to provide definitive care for injured and sick warriors in theater. The fleet hospital concept grew as medical care became more sophisticated, and Fleet Hospitals became large, heavy hospitals-in-shipping-containers that could be prepositioned, then moved to places of need. In August 1991, FHs 3, 5 and 15, each with 500 beds, were mobilized to support Operations Desert Shield / Storm. By the time they were demobilized eight or nine months later, the medical people assigned to them had cared for more than 32,000 patients, most importantly providing top level combat casualty care.[3]

By 2003, the Fleet Hospital concept had evolved to smaller, more easily transportable modular hospitals that could be configured for specific missions. Between April and July 2003, Four Fleet Hospitals were stood up to support Operation Iraqi Freedom. Fleet Hospital 3, designated an Expeditionary Medical Facility of 116 beds, was the first such Echelon 3 hospital to be set up in a theater of combat, in southern Iraq. Within two weeks of its opening, its 300 personnel had already cared for 500 patients and performed more than 280 surgical operations.[4] A second Expeditionary Medical Facility, FH 8, was located in Rota Spain to provide Echelon 3 care as well. Later expanded to a 250 bed Fleet Hospital, its medical personnel cared for 1400 patients and performed around 250 surgical operations in support of Operations Enduring Freedom and Iraqi Freedom.[5]

[1] Pruitt, Basil A, Combat Casualty Care and Surgical Progress, Ann. Surg., 2006, Jun; 243 (6): 715-729.

[2] Frosolone, Charles A, General Surgery in the United States Navy, slide show presentation,, no date, accessed 27 September 2016.

[3]Navy Expeditionary Medical Support Command, Williamsburg, VA, Command History, Fleet Hospitals – the Beginning,, accessed 30 September 2016.

[4] Website “America’s Navy”, Fleet Hospital 3 – Best Care in Iraq,, accessed 30 September 2016

[5] Website “America’s Navy”, Ten Year After – Fleet Hospital 8 Returned Home to Naval Hospital Bremerton,, accessed 30 September 2016.

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  • Ray M Johnson  On 05 Oct 2017 at 07:02

    I was the Deputy Program Director of PML-500. At that time, I thought that the layout of the hospitals to be too large. But couldn’t argue with the Surgeon General of the Navy at that time. I figure out that in order to move these so-called mobile medical facilities from one place to another would require all of the trucking transport in that theater of operation. All of this planning took place long before I came to PML-500 in 1985. My job was to carry the plans despite my misgivings. I always thought that the size should be no larger than 100 beds that could be located close to the action. The closer the better as the wounds from any conflict from 1987 would be different than the wounds before that time as the ground troops would be wearing body armor. In earlier conflicts, wounds to the chest and abdomen were more predominant. With the body armor, the wounds were going to be to the head and neck plus extremities. I do not think that the people designing the hospitals thought of that or even considered that. The Fulda gap was high in their thinking.
    Planners did not consider low level conflict wars, even in the war colleges ( I am a graduate of the National War College). The conflict was going to be a major conflict in the planners’ minds.
    Viet Nam should have taught us that lesson.

    • thomaslsnyder  On 07 Oct 2017 at 06:17

      Thanks, Ray Johnson, for these thoughts. Failure to learn, or retain, lessons from previous wars is a recurrent theme, in my experience. One need only to recall how long it took us to reinstitute the convoy system against U-boats in WW II, despite its proven success in WW I. The same thing happens in medicine. I remember reading that during the Falklands conflict British surgeons received many Argrntine soldiers who’d had their contaminated founds closed primarily. Of course they all festered and had to be reopened. Argentine surgeons had simply forgotten an ancient principle of combat surgery: leave contaminated wounds open, then close them by secondary intention once they’re cleaned up and are granulating in. Think about our own surgeons’ reluctance / debate around the use of tourniquets early in the Gulf Wars. It’s a timeless question: How many people have to suffer and die while we re-learn old lessons?

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