title: Healthcare delivery aboard US Navy hospital ships following earthquake disasters: implications for future disaster relief missions.
abstract: OBJECTIVE
  Since 2004, the US Navy has provided ship-borne medical assistance during three earthquake disasters. Because Navy ship deployment for disaster relief (DR) is a recent development, formal guidelines for equipping and staffing medical operations do not yet exist. The goal of this study was to inform operational planning and resource allocation for future earthquake DR missions by 1) reporting the type and volume of patient presentations, medical staff, and surgical services and 2) providing a comparative analysis of the current medical and surgical capabilities of a hospital ship and a casualty receiving and treatment ship (CRTS).
  
  
  METHODS
  The following three earthquake DR operations were reviewed retrospectively: 1) USNS Mercy to Indonesia in 2004, 2) USNS Mercy to Indonesia in 2005, and 3) USNS Comfort/USS Bataan to Haiti in 2010. (The USS Bataan was a CRTS.) Mission records and surgical logs were analyzed. Descriptive and statistical analysis was performed. Comparative analysis of hospital ship and CRTS platforms was made based on firsthand observations.
  
  
  RESULTS
  For the three missions, 986 patient encounters were documented. Of 1,204 diagnoses, 80 percent were disaster-related injuries, more than half of which were extremity trauma. Aboard hospital ships, healthcare staff provided advanced (Echelon III) care for disaster-related injuries and various nondisaster-related conditions. Aboard the CRTS, staff provided basic (Echelon II) care for disaster-related injuries.
  
  
  CONCLUSIONS
  Our data indicate that musculoskeletal extremity injuries in sex- and age-diverse populations comprised the majority of clinical diagnoses. Current capabilities and surgical staffing of hospital ships and CRTS platforms influenced their respective DR operations, including the volume and types of surgical care delivered.
authors.affiliation: Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: V Franklin
authors.initials: VF
authors.lastname: Sechriest
authors.forename: Vern
authors.initials: V
authors.lastname: Wing
authors.forename: G Jay
authors.initials: GJ
authors.lastname: Walker
authors.forename: Maureen
authors.initials: M
authors.lastname: Aubuchon
authors.forename: David W
authors.initials: DW
authors.lastname: Lhowe
mesh_terms: D004189:Disaster Planning; D004190:Disasters; D055866:Earthquakes; D006205:Haiti; D006801:Humans; D007214:Indonesia; D012767:Ships; D014481:United States