Monthly Archives: February 2018

On Hospitals in Ships Redux

In 2010, I posted a piece on hospital ships. There I wrote that the first purpose-built American hospital ship was USS Relief  (AH-1), laid down in 1917. As it turns out, Relief was the first Navy hospital ship so constructed. The Army was well ahead of the Navy in this particularly nautical undertaking, as I’ll explain below.

The Navy’s first hospital ship was the legendary USS Red Rover, a sidewheeler that served the Confederacy as a barracks ship for a year before she was captured by Union forces. It was the Army that converted her to hospital use and then operated her for about a year until Congressional legislation required the transfer of the “Western Gunboat Fleet” (Red Rover actually mounted a 32 pounder gun and was expected to support military operations on the Mississippi if necessary) to the Navy. She was commissioned into the Navy on 26 December 1862, and her medical staff of doctors and nurses served with distinction until the end of the war.

Now comes the news (to me) that the truly first American purpose-built hospital ship was actually created by the Army! This revelation arrived in my inbox this morning in the form of a pretty comprehensive article in the on-line news feed gCaptainReferred to as a Hospital Transport, the ship – named after the 12th Surgeon General of the Army, J K Barnes – was described at the time as “the best adapted ship for the purpose, ever fitted up in this country” (Medical and Surgical Reporter, Vol X11 [Jan-Jul 1865], p 217). She apparently was put into service in 1864.

The Army briefly operated a hospital ship (USAHS Relief) in the Spanish American War, but none in support of the 2,000,000 doughboys who fought and served in Europe in World War I, though troops clearly were transported across the English Channel in large numbers. Navy hospital ships and Army and commercial transports brought the soldiers home. In World War II, however, the Army Transport Service had responsibility for 25 hospital ships – used mainly to transport sick and wounded troops from in-theater to rear-area hospitals or to the United States. Since then, only the Navy has operated hospital ships for the U.S. All Navy hospital ships are fully equipped to care for major surgical cases rather than as transporters – that function having been absorbed by Air Force flying ICUs and air transporters.

Worth pondering: a Navy insider tells me, though I’ve not confirmed this, that officials would like to get rid of  T-AH-19 USNS Mercy and T-AH-20 USNS Comfort with their 8 fully equipped operating suites and 1000 bed capacities, even as Mercy embarks on Pacific Partnership 18, a soft power / medical diplomacy mission to several nations in the Indo-Asia-Pacific region. In this day and age of dangerous outlaw non-state and state actors, are big white ships with red crosses simply too tempting as targets?

(c) 2018 Thomas L Snyder

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Medical Diplomacy Redux

This popped up in my U.S. Naval Institute newsfeed this morning:

Hospital Ship USNS Mercy Kicks Off Pacific Partnership Mission” – https://news.usni.org/2018/02/22/hospital-ship-usns-mercy-kicks-off-pacific-partnership-mission?utm_source=USNI+News&utm_campaign=407ad5e226-USNI_NEWS_DAILY&utm_medium=email&utm_term=0_0dd4a1450b-407ad5e226-230375425&mc_cid=407ad5e226&mc_eid=318d84df80

From the USNI news article:

This year’s Pacific Partnership marks the 13th year of the multinational mission that was prompted by the massive destruction following a 2004 earthquake and tsunami that devastated the Indian Ocean and Southeast Asia regions. With a heavy focus on humanitarian assistance and disaster response, the annual multilateral missions are seen as building and strengthening relationships with both allies and fledgling partners in a vast, global region regularly affected by natural disasters and civil unrest.

It looks like medical diplomacy, American style, is alive and well.

PEs (Physiological Events) in Navy Jets

On 5 April 2017 Navy authorities grounded its fleet of T-45 training jets, after instructor pilots vigorously expressed concerns about an apparent rise in the number of PEs (“Physiological Episodes”) experienced in that fleet of aircraft.

It turns out that the Navy has experienced a “sharp increase in hypoxia-like physiological events in the last decade” in its entire combat fleet of airplanes and T-45s, according to an article in Aviation Week’s Aerospace Weekly online. These episodes appear to take two forms: those mimicking true hypoxia – “oxygen starvation” or decreased oxygen in the blood – euphoria and loss of judgement, headache, nausea, light-headedness or dizziness, paresthesias (pins-and-needles sensations), breathlessness; and decompression sickness – from exposure to low barometric pressure, in aviation typically the result of loss of cabin pressure, which results in formation of tiny nitrogen bubbles in tissues (think what happens when you pop the top off a bottle of ginger ale) – joint pain in shoulders, elbows, knees or ankles (“the bends”), headache, confusion, dizziness, nausea, breathlessness and chest pain, paresthesias. Except for the bends, the similarity of symptoms of hypoxia and decompression sickness is striking.

Most recent data for the Navy’s operational aircraft fleet report 101.42 PEs per 100,000 flight hours in F/A-18AD aircraft, 66.52 (down from 90.83 a year earlier) in EA-19Gs and 30.37 in F/A-18EF series planes. Pilots of F-35s (from all services), the new “joint fighter”, have reported 27 PEs since the aircraft began entering service in 2011. I couldn’t find statistics for the T-45s. Since 2010, four aviator deaths have been attributed to PEs.

The Navy (and the Air Force and NASA, and Boeing, manufacturer of the F/A-18 series) are vigorously studying the matter using what’s described in a 5 April Navy release as an “unconstrained resources” approach. Investigators include aviation medicine types, flight physiologists and, of course, a plethora of engineers. It appears that, in the F/A-18 series, 75% of PEs are decompression sickness episodes are caused by the aircrafts’ Environmental Control System (“ECS”) while the remainder are hypoxia episodes attributed to the On Board Oxygen Generating System (“OBOGS”).

Finding the causes and solving the problems have not been easy, in part because of the very complicated interrelatedness of onboard aircraft systems – themselves being intricate – and the human pilot’s physiology and psychology. Slowly, however, the problems are being teased out, and they are multiple and often interrelated.

Regarding the ECS, NASA researchers think the problem – especially in the older F/A-18 AB series aircraft – is due to the fact that the system is designed to “service” the avionics, radars and other electronic systems preferentially. The amount of electronics has increased markedly over the years while key components including even the ductwork and the software haven’t really changed since the 1980s. Because the ECS is programmed to feed the electronics first, the OBOGS gets fed with air last. And that is the system that generates oxygen for the pilots.

NAVAIR is installing modifications to the equipment and software with urgency as causes are identified. So far, this has produced the previously noted short drop in PEs in the especially electronics-heavy EA-18G series. Results in the others remains to be seen. Says RADM Sarah Joyner, who heads up the PE team, “PEs are not going to go away, but we are going to try to do our best to mitigate them and make them milder in nature as best we can”.

This doesn’t sound very optimistic. Stand by for future reports.

Hat tip to my high school classmate Price Bingham, Lt Col, USAF, Retired, who has been keeping abreast of news on OBOGS and EXS.

Articles I consulted, thanks to Lt Col Bingham, include:

https://aviationweek.com/awindefense/us-navy-turning-corner-fa-18-hypoxia-crisis

http://www.navy.mil/submit/display.asp?story_id=99760

https://breakingdefense.com/2017/09/jpo-fixing-f-35-oxygen-carrier-landing-software-glitches-vadm-winter/

https://www.faa.gov/pilots/safety/pilotsafetybrochures/media/dcs.pdf

https://www.faa.gov/pilots/safety/pilotsafetybrochures/media/hypoxia.pdf