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.

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)

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