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Aircraft
Carrier-Based Medicine*
Carrier
Medical Department Organization
Aircraft
carriers maintain the same functional organizational relationships traditional
on all naval vessels. All department heads report to the commanding officer
regarding their specific function. They report via the executive officer to the
Commanding Officer for administrative matters pertaining to the health of the
crew. Within the medical department
the administrative organization typically follows that of other departments
onboard, similar to the chart below.
Medical
Department Manning
Naval personnel command typical
apply certain health care provider/ patient ratio when determining the most
appropriate manpower manning requirements for a carrier medical department.
Typically a ratio of one physician per 1200 personnel and one corpsman per 150
personnel aboard ship are utilized. Specific
requirements for both medical officers and corpsman needs are determined and
documented within the Activity Manning
Document. This document lists all
billets and associated specialty codes for the entire medical department staff.
Listings of the typical senior medical staff leadership within the
Activity Manning Document (to include their associated duties) are listed below.
a. Senior Medical Officer (SMO).
The head of the Medical Department aboard an aircraft carrier is required to be
both a Medical Corps officer and a designated Naval Flight Surgeon.
It is preferable that the SMO has completed a residency in aerospace
medicine. The SMO is required to
hold an active staff appointment with clinical privileges in primary care
medicine and operational medicine. In addition to those general duties prescribed by Navy
Regulations for a Head of Department, the SMO shall be responsible for
maintaining the health of the crew, conducting inspections incident thereto and
advising the Commanding Officer as to the hygiene, habitability, sanitation and
safety matters within his purview which affect the command.
He is responsible for the administrative and material readiness of the
Medical Department. He directly
supervises the General Medical Officer, Medical Administrative Officer,
Physician Assistant, Ship's Surgeon, Anesthesiologist/Nurse Anesthetist,
Clinical Psychologist (if assigned), Physical Therapist (if assigned), and Air
Wing Flight Surgeons (when embarked).
b.
Ship’s Surgeon. The
Ship’s Surgeon is required to be a medical officer who has completed residency
training in general surgery, and hold an active staff appointment with clinical
privileges in general surgery, primary care medicine, and operational medicine.
He/she is responsible for the evaluation and management of all patients
with surgical pathology. The Ship's
Surgeon will also serve as the Ward Medical Officer, ensuring the operating
room; emergency treatment room and ward are maintained in a high state of
readiness to receive patients.
c. Anesthesia.
When deployed, Anesthesia support is provided by an anesthesia
department at a specific BUMED assigned medical treatment facility per the
current BUMED (Code 31) "Anesthesia Support to Carriers" message.
This support is normally provided by a nurse anesthetist and provides
additional nursing support to assist the health care providers in the
professional treatment and care of the sick and injured.
d. General Medical Officer (GMO).
The GMO is required to be a medical officer who has completed an
internship and holds an active staff appointment with clinical privileges in
primary care medicine and operational medicine. The GMO serves as supervisor of
sick call, oversees the professional treatment and care of the sick and injured
as directed by the SMO, and makes recommendations concerning policies, standards
and practices of the Medical Department.
e.
Medical Administrative Officer (MAO).
The MAO shall be a Medical Service Corps Officer (Health Care
Administrator), and if serving aboard a nuclear-powered vessel, a graduate of
the Radiation Health Indoctrination course. The MAO shall assist the Senior
Medical Officer in the details of Medical Department administration.
f.
Ship’s Nurse. The
Ship’s Nurse shall be a Nurse Corps officer with subspecialty training and
experience in critical care nursing (subspecialty code 1960).
He/she will serve as nursing supervisor for the Medical Department and in
the capacity as Ward Nursing Supervisor and the Medical Training Officer.
The nurse will assist the health care providers in the professional
treatment and care of the sick and injured.
g.
Physician Assistant (PA). The
Physician Assistant shall be a Medical Service Corps officer (Allied Health
Specialist) who has completed a physician assistant training program recognized
by BUMED and is certified by the National Commission for the Certification of
Physician Assistants. He/she shall
possess Physician Assistant core privileges.
The PA works under the supervision and direction of a credentialed
physician and must have a supervisor appointed in writing by the Commanding
Officer.
h.
Clinical Psychologist.
The Clinical Psychologist shall be a Medical Service Corps officer
(Allied Health Specialist) who has completed a doctoral degree in Clinical or
Counseling Psychology (or an acceptable equivalent) from an accredited
university or professional school, a one year clinical internship, and possesses
a current state license in psychology. He
shall possess Clinical Psychology core privileges.
i. Physical Therapist.
The Physical Therapist shall be a Medical Service Corps officer
(Allied Health Specialist) who has completed a baccalaureate degree in Physical
Therapy from an accredited university or professional school, and possesses a
current state license in physical therapy.
He shall possess physical therapy core privileges.
The Physical Therapist works under the professional direction of the
Senior Medical Officer.
j. Air
Wing Flight Surgeons. Carrier
Air Wing Flight Surgeons are required to be medical officers who have completed
an internship and have been designated as a Naval Flight Surgeon.
In addition, they shall hold an active staff appointment with clinical
privileges in primary care medicine, operational medicine and flight surgery.
Carrier Air Wing Flight Surgeons remain under the primary administrative
control of the Air Wing Commander while embarked, but shall be under the
cognizance of the Senior Medical Officer as fully integrated members of the
ship's Medical Department. Carrier
Air Wing Flight Surgeons shall perform such duties as the SMO may direct,
including routine shipboard watch standing assignments in support of the
ship/air wing mission.
k.
Leading Chief Hospital Corpsman (LCPO). The senior Chief Hospital
Corpsman assigned to the Medical Department is designated the division Leading
Chief Petty Officer (LCPO). He/she
is the primary assistant to the H-Division Officer in the administration,
supervision, and training of enlisted personnel of the Medical Department.
The LCPO shall also perform the Division Officer functions in the absence
of the MAO.
l. Division Leading Petty Officer (LPO).
Normally, the senior First Class Hospital Corpsman shall be designated
the Division Leading Petty Officer and shall assist the Medical Administrative
Officer and the Leading Chief Petty Officer in the administration, training and
overall supervision of the personnel of H-Division.
m. Hospital Corpsmen.
Typically, 29 enlisted Hospital Corps personnel performs duties as
prescribed by the Commanding Officer, Senior Medical Officer and other competent
authority. These duties will include any and all care of the sick and injured,
prevention of disease and injury, and the administration of the medical
department. Enlisted specialists
are required in the fields of Aerospace Medicine Technician, Medical services
Technician, Preventive Medicine Technician, X-Ray Technician, Operating Room
Technician, Laboratory Technician, Physical Therapy Technician, Optical Repair
Technician, and multiple general duty corpmen.
n. Hospital Corps
Strikers. In order that the
Navy may maintain an adequate number of Hospital Corpsmen, volunteers from the
fleet are necessary. Only those personnel who possess the requirements as
specified by current instructions and are highly motivated to become Hospital
Corpsmen should be selected and recommended for assignment to Class
"A" Hospital Corps School. When
assigned, Hospital Corps Strikers are rotated throughout each medical department
in order to ascertain their capabilities prior to requesting as assignment to
Hospital Corps School. Hospital
Corps Strikers are ALWAYS be under direct supervision when conducting any
patient care procedures.
Medical
Department Facilities
The
figure below depicts a carrier profile and the location of the main medical
department (Sickbay) aboard ship. All current carriers have their medical
department on the second deck, just below the hangar deck (main deck), between
frames 90 and 120. Access is from the port or starboard side. The medical
department was located amidships for patient accessibility, surgical procedure
stability, and for interior protection from battle damage.
In addition to detailing the main medical space it also reveals the six
dispersed and peripherally located medical aid stations on aircraft carriers
called "battle dressing stations (BDS)". When the ship is in Readiness
Condition I (general quarters), and all hands are at "battle
stations," the ship is entirely closed. All water-tight doors are secured
in order to enhance the ship's survivability. This can make casualty movement a
tedious and difficult process. In order to avoid unnecessary delays in the
primary treatment of injured personnel, the battle dressing stations are manned
by physicians, dentists, and corpsmen so that casualties that occur within their
areas of responsibility can be given primary emergency care and stabilization
until movement to the main sickbay can be effected.
A major advantage of the battle dressing station concept is that it
allows the dispersion of medical personnel and equipment throughout the ship.
Should one area of the ship be damaged with a loss of medical assets, there
still are more available to carry on the job.
Below
depicts the basic layout of a Nimitz-class medical department, showing the
location of the various treatment and supporting spaces. Each carrier may have
mild modification of this layout based on the arrival of new medical equipment
or the proposed long-term needs of the department. One exception to this typical
layout is the Enterprise-class carrier, which has two separate wards and a
specific area for sick call screening. Nimitz-class uses either the ward or the
the physical examination area for sick call screening and schedules all physical
examinations, eye, and ENT clinics after sick call is secured. The advantages of
the Nimitz-class layout are size, privacy, and complete access control. Other
notable features of the Nimitz-class carrier are the spacious surgical suite and
the intensive care unit (ICU).
Carrier
Medical Department Mission and Capabilities
The
intensity of carrier operations, with the 24-hour a day pace of launching and
recovering aircraft while at the same time operating the carrier itself,
combined with the ongoing need to feed and berth the crew, places heavy burdens
on manpower and materials. Good hygiene and general cleanliness are hard to
maintain and must be addressed constantly. Toxicological threats abound over the
ship, and there are a thousand ways to be injured in the carrier’s hazardous
working areas. There are 2600 spaces on an aircraft carrier designed for general
living, sleeping, eating, office work, maintenance and storage of equipment,
heavy machinery, and computers. Much heat is produced that has to be dissipated
or vented to the exterior; noise levels can be generated that must be isolated
or protected against. Thousands of miles of cables, wiring, and piping provide
power and services to all areas of the ship. Massive stores of several kinds of
fuel, ordnance, and other combustibles are maintained. In effect, the functions
of an industrial city with a military airfield are crammed into 32,525,000 cubic
feet. In every area of operation in
this floating city, the medical department has some responsibility and/or
function. The medical department’s mission in essence is support all functions
of the ship by providing medical care to the sick and injured, to insure the
health and well-being of the crew, and to provide relief and assistance to
military and civilian personnel when required and as the commanding officer may
direct. Implementation of this mission is an endless and demanding task.
a. Clinical Services Direct
patient care is the most obvious function of the medical department in the
execution of its mission. Out patient sick call is usually the initial point of
entry into the health care function of the medical department. In addition to
sick call the medical department maintains an active emergency room, general
surgery clinic, physical therapy clinic and optometric services. Inpatient
services include the ward, intensive care unit, and operating room functions.
This is the "hospital" function of a carrier medical department and
the one, which requires constant attention to ensure the highest quality health
care.
b.
Environmental Health and Preventive Medicine With
the advent of the Occupational Safety and Health Act of 1970, the preventive
role in shipboard medicine has grown significantly. Although a major concern
aboard ship has always been the prevention of disease and injury, numerous
medical findings and recently legislated safety/occupational guidelines have
provided the proper emphasis in the carrier environment. The traditional
practice of shipboard medicine emphasizes the sanitation and hygiene aspects of
a preventive medicine program. This includes potable water analysis, pest
control, food service procedures monitoring, sexually transmitted diseases, and
tuberculosis control. Since 1970, hearing conservation and heat stress
prevention have become quite important and are now operated as separate
programs. The need for baseline and
reference audiometrics on all active duty military personnel is mandated, and
careful follow-up must be maintained. This translates into approximately one
audiogram for each man aboard ship per year (6000 audiograms for a Nimitz-class
vessel). The logistics of maintaining a proper audiometric booth certification
and scheduling this patient volume are imposing. Heat stress has been a problem
aboard naval vessels since the days of sail. Adequate ventilation and proper
environmental temperature control have not been possible in even the best spaces
until the past twenty years. Habitability, as an effective program, did not
officially exist until the beginning of the 1970's. Like noise, controlling heat
at its source always is the desired approach, but this usually takes expensive
and time-consuming retrofitting. The medical department is tasked to train
non-medical sailors and monitor heat levels throughout the ship for areas at
risk for potential heat stress injuries. Hazardous materials monitoring program
has become more extensive and complex. A vessel of the size and complexity of an
aircraft carrier has many operations requiring the use of known toxic or
hazardous materials such as zinc alloys in welding, countless cleansing
solvents, Multiple petroleum distillates (including JP-5 - jet fuel),halogenated
hydrocarbons, asbestos lagging, liquefied oxygen, composite materials, and
radioactive materials are just a few of the many routine daily exposures to
hazardous agents. The need for constant awareness, supervision, and training of
personnel using these materials is obvious. Medical departments afloat must keep
track of the chemical agents aboard, as well as the toxicology of these
substances.
c.
Training Functions A medical
department has a training commitment to the ship and to itself. Damage Control
Personnel Qualifications Standardization (PQS) requires a certain level of
expertise in first aid on the part of ALL crewmen. This requires divisional
training on a scheduled basis using corpsmen as instructors and unscheduled
training of litter bearers and repair party personnel during general quarters
drills. Shipwide medical training programs in the treatment of electric shock,
the treatment of smoke inhalation, heat stress prevention, fractures, abdominal
injuries, and hemorrhage are now required and regularly evaluated by the fleet
training group prior to “deployment ready” approval. It is common for an aircraft carrier to schedule 300
man-hours of training on these topics per week, especially before an extended
deployment. There must be a
comprehensive corpsman-training program to ensure that competent and currently
qualified personnel are manning the medical department. Qualifications have been
established for 35 primary jobs and five secondary specialties. The jobs cover
such diverse activities as sick call, lifeboat duty, rescue and assistance
detail, repair party, audiogram technician, physiotherapy (including cast
application), and intensive care unit nursing. The idea of this "PQS"
program is to ensure that only qualified people perform specific tasks. To
sustain such a program requires 10 hours of instruction per man per week. To
ensure competency and continuity in specific assignments, personnel should be
rotated among the various work centers within the department. This rotation
policy includes corpsmen with specialty NEC's. The diverse training a corpsman
receives will benefit him and his future commands.
d.
Casualty Management and Disaster Support
Aircraft carriers by their very nature present potential hazards to the
personnel who operate them. All aircraft carriers have in place and routinely
drill the mass casualty plan.
e.
Patient Transfer and Medical Evacuation
As a primary care facility, often supporting a population of 10,000
within the entire battle group, an aircraft carrier is frequently utilized as a
receiving hospital and as a transferring facility for hospitals ashore. The
evacuation of sick and injured personnel is an "art." Judgement,
caution, perception, and patience are mandatory. Often, however, geographical
location, time of day, weather, or ship’s mission commitment may strongly
influence the evacuation medical officer’s decision. Constant awareness of the
ship's location, the weather, the ship's mission, and the aviation assets
available for patient transfer are required to successfully coordinate a medical
evacuation. When deployed overseas, it is imperative to know all of the details
of the Air Force Medical Evacuation System, allied health care facilities
ashore, and how to use them to the patient's best advantage.
Summary
Despite
the heavy work load, the long hours and the less than optimal living conditions
the routine daily medical mission aboard an aircraft carrier is intensely
rewarding. The ability to be in the
forefront of our national policy is something that has to be experienced to be
understood. The carrier's mission of power projection into in troubled waters
demands perfection, professionalism, and constant vigilance. Serving as a health
care professional aboard an aircraft carrier brings a close association with the
finest and most talented professionals in the world - the naval aviator, his
aircrew, and all the personnel whose efforts allow man to fly from a ship at
sea. To work with these people is a satisfying experience, and to fly with them,
an incredible pleasure.
This section was contributed by CDR Jay S. Dudley, MC, USN (FS)
*Source:
Operational Medicine 2001, Health
Care in Military Settings, NAVMED P-5139, May 1, 2001, Bureau
of Medicine and Surgery, Department of the Navy, 2300 E Street NW, Washington,
D.C., 20372-5300
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