Capabilities of Aircraft Carrier Hospitals???

[colbgw02]

I ran across this article about the relief effort for Haiti -

http://www.sphere.com/world/article/uss-carl-vinson-awaits-patients-to-fill-empty-beds-in-haiti/19319629?icid=main|hp-laptop|dl1|link1|http%3A%2F%2Fwww.sphere.com%2Fworld%2Farticle%2Fuss-carl-vinson-awaits-patients-to-fill-empty-beds-in-haiti%2F19319629

This paragraph caught my eye:

The vessel boasts 52 doctors, nurses, technicians and staff. In addition to Shwayhat, there is a critical care nurse; a general surgeon; a family practitioner; a radiologist; lab technicians; a pharmacy stocked with anti-malaria medication; and an independent corpsman deployed with the fleet marine force to diagnose injuries on the ground.

In particular, I'm intrigued by the apparent fact that our carriers are staffed by a radiologist. Is that correct? If so, what modalities are available? That seems like an enormous waste of resources, especially in the age of teleradiology.

In general, I'm interested to know what the extent of problems that can be handled on board. What type of conditions would require AIREVAC? Has anyone ever served on a carrier and be able to shed some light on this?

I'm Army by the way, so my knowledge of the Navy is pretty much limited to general military information.

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[The White Coat Investor]

I ran across this article about the relief effort for Haiti -

http://www.sphere.com/world/article/uss-carl-vinson-awaits-patients-to-fill-empty-beds-in-haiti/19319629?icid=main|hp-laptop|dl1|link1|http%3A%2F%2Fwww.sphere.com%2Fworld%2Farticle%2Fuss-carl-vinson-awaits-patients-to-fill-empty-beds-in-haiti%2F19319629

This paragraph caught my eye:

The vessel boasts 52 doctors, nurses, technicians and staff. In addition to Shwayhat, there is a critical care nurse; a general surgeon; a family practitioner; a radiologist; lab technicians; a pharmacy stocked with anti-malaria medication; and an independent corpsman deployed with the fleet marine force to diagnose injuries on the ground.

In particular, I'm intrigued by the apparent fact that our carriers are staffed by a radiologist. Is that correct? If so, what modalities are available? That seems like an enormous waste of resources, especially in the age of teleradiology.

In general, I'm interested to know what the extent of problems that can be handled on board. What type of conditions would require AIREVAC? Has anyone ever served on a carrier and be able to shed some light on this?

I'm Army by the way, so my knowledge of the Navy is pretty much limited to general military information.

I am not Navy, but have toured the medical facilities on carriers. They are generally run by a senior medical officers, often a board certified FP. There are usually several GMOs working as well. A surgical team can be brought on board as needed. When the air wing is on board there will usually be some flight docs there. A radiologist? I didn't think that was part of the usual package. Bedside US is pretty typical with the surgical team, and x-ray is there of course. No CT scanners that I know of.

52 isn't that many medical staff. That's what you typically find in a small military emergency department. ~10 docs/P.A.s, 15 nurses, 25 techs.

The coolest part about carrier medical capabilities is their ability to spread their assets out when they go to battle stations. There are a handful of trauma bays scattered throughout the carrier where wounded can be brought. So you can't lose all your medical assets at once and so care is available as close as possible to the site of injury.

You're impressed by a pharmacy with malaria meds? I could handle the malaria meds for an entire Air Force Base with a duffle bag.

 

[NavyFP]

I am not Navy, but have toured the medical facilities on carriers. They are generally run by a senior medical officers, often a board certified FP. There are usually several GMOs working as well. A surgical team can be brought on board as needed. When the air wing is on board there will usually be some flight docs there. A radiologist? I didn't think that was part of the usual package. Bedside US is pretty typical with the surgical team, and x-ray is there of course. No CT scanners that I know of.

52 isn't that many medical staff. That's what you typically find in a small military emergency department. ~10 docs/P.A.s, 15 nurses, 25 techs.

The coolest part about carrier medical capabilities is their ability to spread their assets out when they go to battle stations. There are a handful of trauma bays scattered throughout the carrier where wounded can be brought. So you can't lose all your medical assets at once and so care is available as close as possible to the site of injury.

You're impressed by a pharmacy with malaria meds? I could handle the malaria meds for an entire Air Force Base with a duffle bag.

The SMO can be any specialty. That would be the only way a Rad doc is on a carrier. A carrier is not a medically beefy as our large deck amphibs. They have larger wards, ICU space and more ORs.

 

[ftrflyr29]

"One reason beds are empty is that the ship doesn't have the authority to pick up victims; it has to wait for the Air Force to call and request a Medevac."

This quote from the article is so typical!

 

[Gastrapathy]

Al is an endocrinologist.

 

[colbgw02]

I am not Navy, but have toured the medical facilities on carriers. They are generally run by a senior medical officers, often a board certified FP. There are usually several GMOs working as well. A surgical team can be brought on board as needed. When the air wing is on board there will usually be some flight docs there. A radiologist? I didn't think that was part of the usual package. Bedside US is pretty typical with the surgical team, and x-ray is there of course. No CT scanners that I know of.

52 isn't that many medical staff. That's what you typically find in a small military emergency department. ~10 docs/P.A.s, 15 nurses, 25 techs.

The coolest part about carrier medical capabilities is their ability to spread their assets out when they go to battle stations. There are a handful of trauma bays scattered throughout the carrier where wounded can be brought. So you can't lose all your medical assets at once and so care is available as close as possible to the site of injury.

You're impressed by a pharmacy with malaria meds? I could handle the malaria meds for an entire Air Force Base with a duffle bag.

Thanks for the info, but why would you think that I'm impressed by anything in that article? Just because I want to learn more about a topic doesn't mean I have to be impressed with it.

 

[i want out]

"One reason beds are empty is that the ship doesn't have the authority to pick up victims; it has to wait for the Air Force to call and request a Medevac."

This quote from the article is so typical!

Its more complicated than it may seem. If your on a ground mission as part of the Army, or AF, then you can bring locals into your tents and treat them. There are probably local protocols for who can be treated and what they can treat, but these are mostly done at the local command level.

On board a ship, you are on US soil (there is usually enough dirt to substantiate this) That means if you bring a patient on board to just evaluate them, they can then ask for political asylum and create an international incident.

So you can't just bring pts on board without question, you have to get state department approval to make it happen. Now if you have a physician on the ground who can evaluate the pt, and say with some level of certainty that this pt is at risk of losing life limb or eyesight, you can probably ask for state department permission after the fact, but its a hard case to make if you haven't first evaluated the patient.

There are some situations where you can bring locals on board without state department approval, but I won't get into those.

i want out (of IRR)

 

[ftrflyr29]

Its more complicated than it may seem. If your on a ground mission as part of the Army, or AF, then you can bring locals into your tents and treat them. There are probably local protocols for who can be treated and what they can treat, but these are mostly done at the local command level.

On board a ship, you are on US soil (there is usually enough dirt to substantiate this) That means if you bring a patient on board to just evaluate them, they can then ask for political asylum and create an international incident.

So you can't just bring pts on board without question, you have to get state department approval to make it happen. Now if you have a physician on the ground who can evaluate the pt, and say with some level of certainty that this pt is at risk of losing life limb or eyesight, you can probably ask for state department permission after the fact, but its a hard case to make if you haven't first evaluated the patient.

There are some situations where you can bring locals on board without state department approval, but I won't get into those.

i want out (of IRR)

I'm not commenting as some random American reading an article in a biased American media outlet. I'm commenting because I've seen this many times in many other situations and the bureaucracy of the military.

Your comments could very well be the case, but I do remember when I was on cruise, we did bring some injured civilians (non-US) aboard from their damaged vessel as one needed medical attention.

I'm going to guess the asylum issue isn't the problem. I'm only basing my opinion on the following excerpt from this article:
http://www.time.com/time/specials/p...1953379_1953494_1954262,00.html#ixzz0cucBZPZI

".............On Friday, the third day after the earthquake, Homeland Security Secretary Janet Napolitano announced that the estimated 100,000 to 200,000 Haitians "not legally in the United States" as of Jan. 12 would be granted a form of asylum called Temporary Protected Status (TPS), which would allow them to work in the U.S. for the next 18 months............"

I won't get into a debate of Marine Corps or Navy is better than this service or that service, but I personally do have a bad taste in my mouth about the Air Force in general due to many dealings in combat operations and here at my current assignment.

That being said, I think my above post just demonstrates the ridiculous bureaucracy that seems to exist. I promise the HS squadron on the Vinson is prepped and ready to pick up as many as possible, and the medical staff is ready and waiting. They probably have the hangar deck cleared and waiting for people, but the ship can't do anything until the USAF says it's okay.

I've also attached an article that may be of interest to you that is another example of ridiculous bureaucracy during disasters. I knew the members of this unit.

http://www.nytimes.com/2005/09/07/national/nationalspecial/07navy.html

So....tangent aside, this is my opinion, take it for what it's worth.

 

[i want out]

I'm not commenting as some random American reading an article in a biased American media outlet. I'm commenting because I've seen this many times in many other situations and the bureaucracy of the military.

Your comments could very well be the case, but I do remember when I was on cruise, we did bring some injured civilians (non-US) aboard from their damaged vessel as one needed medical attention.

I'm going to guess the asylum issue isn't the problem. I'm only basing my opinion on the following excerpt from this article:
http://www.time.com/time/specials/p...1953379_1953494_1954262,00.html#ixzz0cucBZPZI

".............On Friday, the third day after the earthquake, Homeland Security Secretary Janet Napolitano announced that the estimated 100,000 to 200,000 Haitians "not legally in the United States" as of Jan. 12 would be granted a form of asylum called Temporary Protected Status (TPS), which would allow them to work in the U.S. for the next 18 months............"

I won't get into a debate of Marine Corps or Navy is better than this service or that service, but I personally do have a bad taste in my mouth about the Air Force in general due to many dealings in combat operations and here at my current assignment.

That being said, I think my above post just demonstrates the ridiculous bureaucracy that seems to exist. I promise the HSC squadron on the Vinson is prepped and ready to pick up as many as possible, and the medical staff is ready and waiting. They probably have the hangar deck cleared and waiting for people, but the ship can't do anything until the USAF says it's okay.

I've also attached an article that may be of interest to you that is another example of ridiculous bureaucracy during disasters. I knew the members of this unit.

http://www.nytimes.com/2005/09/07/national/nationalspecial/07navy.html

So....tangent aside, this is my opinion, take it for what it's worth.

You won't get any argument from me about how ridiculous the Navy is when it come to stuff like this.

i want out (of IRR)

 

[The White Coat Investor]

Thanks for the info, but why would you think that I'm impressed by anything in that article? Just because I want to learn more about a topic doesn't mean I have to be impressed with it.

I mistook your quote for something you'd written.

 

[Mackey]

On board a ship, you are on US soil (there is usually enough dirt to substantiate this)

Amazing.

 

[HollywoodCole]

In particular, I'm intrigued by the apparent fact that our carriers are staffed by a radiologist. Is that correct? If so, what modalities are available? That seems like an enormous waste of resources, especially in the age of teleradiology.

No radiologist. They have a radiology tech who is a corpsman and plain films (the only modality) are read be teleradiology as you might expect. Maybe a portable ultrasound would be available too. The total staff may be 52 in a CVN medical department, but there are usually only two physicians (Senior Medical Officer and General Medical Officer). For a humanitarian relief mission, they can augment the medical department with more personnel, but the point is well taken that they can't bring patients onboard (with jets?) so what good would this be?

 

[PostLessOne]

Wonder why they can't cram a CT scanner aboard.

 

[Apollyon]

Wonder why they can't cram a CT scanner aboard.

Why would you need one? The patient base is remarkably healthy, and the use of the scanner would be rare - symptomatic treatment for suspected renal colic, observation for head injuries, and send off the ship for appys.

I make do without a CT scanner in a standalone ED without an attached hospital in the hinterlands of O'ahu. My patient base is much less healthy and compliant, and, only rarely, do I have to send a patient to the closest hospital for a CT scan.

 

[HollywoodCole]

Wonder why they can't cram a CT scanner aboard.

You shouldn't need a CT to dx an appy. Otherwise, if you need a CT, the patient should already be off of your ship.

 

[NavyFP]

You shouldn't need a CT to dx an appy. Otherwise, if you need a CT, the patient should already be off of your ship.

Whatever happened to the days of dx an appy with Hx and PE? Standard surgical thought was if you didn't take out 25% neg appys you weren't doing enough.

 

[AF M4]

Whatever happened to the days of dx an appy with Hx and PE? Standard surgical thought was if you didn't take out 25% neg appys you weren't doing enough.

Because the hospital bought these scanners with the understanding that they would be used a certain amount of time for a certain amount of scans to make a certain amount of money so that they could compensate for all the money that they're losing by having so many Medicare patients on the wards and in the ICU. An acute abdominal CT is an easy test to justify and get paid for, and these days the legal teams always ask why someone didn't get a scan if there were any possible justification for it.

C'mon man, radiologists got kids to feed too.

 

[Apollyon]

Whatever happened to the days of dx an appy with Hx and PE? Standard surgical thought was if you didn't take out 25% neg appys you weren't doing enough.

That's to which I alluded in my post. Hot presumed appy, off the ship.

 

[HollywoodCole]

Because the hospital bought these scanners with the understanding that they would be used a certain amount of time for a certain amount of scans to make a certain amount of money so that they could compensate for all the money that they're losing by having so many Medicare patients on the wards and in the ICU. An acute abdominal CT is an easy test to justify and get paid for, and these days the legal teams always ask why someone didn't get a scan if there were any possible justification for it.

C'mon man, radiologists got kids to feed too.

Yeah, and one day those legal teams will be having fun with ALARA. The good part about their job is that they can have it both ways.

Seriously though, there is no reason to have a CT scanner on a ship (unless its Mercy/Comfort). When your diagnostic capability far exceeds your treatment capability, you are going to get yourself into trouble.

 

[Gastrapathy]

That's to which I alluded in my post. Hot presumed appy, off the ship.

I don't think CT scanners aboard big ships is that far off (10 years max). Not so much for appys but more for trauma assessment.

Although, appys dx'd with H&P and a 25% normal appy rate just isn't the standard of care anymore. The obvious "hot" appy is, well, obvious. But lots of patients present to EDs with nonspecific abdominal pain and a history of IBS. Sometimes these folks have real acute appys too. And there is plenty of IBS aboard ship. Once you start seeing a fair bit of bad IBS in your practice, you'll discover that all these patients have had choles (for what turned out to be "chronic cholecystitis" ,ie normal GB) and appys. The dogma about abdominal pain and the acute abdomen makes it sound more clear cut than it is. A CT often keeps these functional patients out of the OR and that can be huge. Once the IBS patient has had a couple of belly surgeries, you try to figure out how to manage their pain (back to the OR for LOA?, Bentyl, etc).

I know we all role our eyes at the idea of a CT aboard a big deck but once they are there, no one will question it. The biggest obstacle will be bandwidth to export images for a telemedicine read. Theres plenty of space for one and they aren't really that expensive.

As for just flying the patient and letting someone else sort it out, there is risk in demanding a nighttime medevac in a bad sea state (plus the ship might have other things to do that are the actual reason its there). On an unrelated note, what a aircraft carrier can do to provide meaningful help is beyond me. This is a job for the gator navy and the hosptial ship (which has its own patient flow issues).

 

[Apollyon]

As for just flying the patient and letting someone else sort it out, there is risk in demanding a nighttime medevac in a bad sea state (plus the ship might have other things to do that are the actual reason its there). On an unrelated note, what a aircraft carrier can do to provide meaningful help is beyond me. This is a job for the gator navy and the hospital ship (which has its own patient flow issues).

What happens if you fall overboard during wartime ops? Sorry buddy - thanks for your service!

When it's a bad sea state, that's what it is. I don't even know stats for active duty appys, so it can't be high, but it occurs. I mean, were I a fleet surgeon, I am not doing any operations - I'm not trained. But, if the patient perfs (clinically), they get IV abx, and transferred out in a timely manner. If I have a CT scanner, but the sea state is prohibitive, or we're at general quarters, what does that change?

The war fighters need to fight. What does the sick bay do? Brings you back to a fighting level, even if it's not 100%.

 

[Gastrapathy]

What happens if you fall overboard during wartime ops? Sorry buddy - thanks for your service!

When it's a bad sea state, that's what it is. I don't even know stats for active duty appys, so it can't be high, but it occurs. I mean, were I a fleet surgeon, I am not doing any operations - I'm not trained. But, if the patient perfs (clinically), they get IV abx, and transferred out in a timely manner. If I have a CT scanner, but the sea state is prohibitive, or we're at general quarters, what does that change?

The war fighters need to fight. What does the sick bay do? Brings you back to a fighting level, even if it's not 100%.

Its never that cut and dry. If you go to the CO and say "surgical emergency", he/she is going to accept more risk to get your patient off.

They won't put them on small decks. But having a single CT on the ship with operative capabilities (again, more for trauma than for appys) is completely reasonable. Emergencies are infrequent but we've decided that we need surgeons at sea. I just don't see how a single piece of radiology equipment is really that big a deal. They'll be out there eventually.

 

[PostLessOne]

And my original query was based upon the fact that I saw a CT scanner in an airport security line! If the TSA goons can run a CT scanner, and casually use one at a small regional airport, then they could probably bolt one on somewhere in a billion dollar warship. Even if you don't "need" such a machine, I would imagine that the images it can produce are cleaner and easier to make a dx with?