At Sea Responsibilities
The medical department on an aircraft carrier is made of physicians, physician assistants, administrative officers, independent duty corpsmen, and corpsmen. All told, it can number around 30 people. A great place to start reading about the make up and responsibilities medical department personnel is the departmental Standard Operating Manual (SORM).
The head of medical is the Senior Medical Officer (SMO). The SMO is aviation medicine trained and may have residency training in internal medicine, family medicine, or psychiatry. The department’s officer roster has the following positions:
- Ship’s Surgeon
- Ship’s Psychologist
- General Medical Officer (GMO)
- Medical Administrative Officer (MAO)
- Radiation Health Officer (RHO)
- Flight Surgeons (2-3)
- Physician’s Assistant
- Ship’s Nurse (ICU qualified)
- Physical Therapist
- Anesthesiologist / Nurse Anesthetist
There will usually be 2 operating room techs assigned to the department. It is important to use them at every opportunity. Table 1 shows the overall paucity of main operating room cases you should expect during a deployment period. Involve the OR techs whenever you can. Train them in the way you like to do business. Develop a team environment; so, should an emergency present itself, you will be ready to handle it.
The ship’s surgeon is assigned to allow flight operations to be conducted. Other duties are command dependent. You may be asked to see sick call or to be the duty doctor. Some SMO’s feel that the surgeon is a 24-7 consultant, therefore, should not stand duty doctor, others rotate the surgeon right into the duty rotation.
Operating at sea presents new challenges that you probably have not faced before. First, you must ensure the spaces are “rigged for sea”. The ship may sway a bit during surgery, equipment on wheels will roll with the seas. Second, you must get permission to operate from the Captain, the patient’s chain of command, and the Officer of the Deck (OOD). The OOD will steer a straight course and minimize turning angles of the ship. Lastly, in the operating room, there is only the scrub tech, anesthesia provider, and the surgeon. Enlisting the help of the GMO or a flight surgeon, as your first assistant, may not be a bad idea.
Expect cases to last a little longer as you will be the one positioning and securing the patient to the table. In the interest of time, you may want to prep the patient as the tech sets up the back table.
Here is what has recently been done in the operating room at sea. This does not include the minor "lumps and bumps" that will consume most of your OR time.
Sig Hand Trauma
The category “Others” includes circumcisions, sub-cutaneous mastectomies, hemorrhoidectomies, testicular torsions, hydrocelectomies, peri-rectal abscesses, and exploratory laparoscopies.
Hernias and vasectomies are by far the most common procedures performed at sea. Another category which seems to recur is hand trauma. Although not in impressive absolute numbers, hand trauma is quite a common occurrence. Additionally, you are the only surgeon onboard. With that in mind, you will be required to know other surgical disciplines as well. So, bring reference books and make sure the ship's medical library is adequately loaded!
Be prepared to handle finger amputations, open fractures, tendon lacerations, and crush injuries. Depending on where in the world you are or what the mission of the ship is, you might not have the ability to medically evacuate someone. A good hand text would definitely be useful. A good urology atlas would also be helpful to aid in torsed testicles, scrotal exploration, etc.
Radiography at Sea:
There is no CT scanner at sea. Sorry, but unless you are on a hospital ship (COMFORT or MERCY), you are out of luck.
Don't worry, you will have all the necessary equipment onboard to be a functional surgical department. You have endoscopes, laparoscopes, stapling devices, etc. You also have a basic ultrasound machine which should come with 2 heads and a vaginal probe. It is a good idea to be familiar with gall bladder, testicular, pelvic, and breast ultrasound studies.
Codes at sea:
Medical or trauma codes at sea are both announced on the overhead announcing system (1MC) as “medical emergencies”. The surgeon’s responsibility is to report to main medical while the department quickly dispatches a first responder unit from the duty crew to the scene. The duty doctor (GMO, flight surgeon, or PA) will initially be in charge in medical. If the emergency is trauma related, the surgeon will take over as the medical lead.
There are no paging systems at sea. There are extensive networks of telephones and HYDRA radios. The surgeon should carry this battery powered radio (HYDRA) around to allow quick and easy contact.
The specifics of your ship's schedule are classified. They are way beyond the scope of this website. However, there are some generalities that can be discussed...
There are several distinct phases of non-deployed time: post-deployment, work-ups, ship yards, and pre-deployment. The only time the operating room is fully functional is when you are at sea. In fact, that is the only time anesthesia support is available. There is plenty of time to take leave during the pre and post-deployment periods.
Work-up periods are 1 to 2 week at sea periods where the crew irons out all the creases before putting to sea on a deployment. All shipboard emergency systems are tested. The crew conduct general quarters drills. Pilots conduct carrier qualifications- they are required a certain number of catapult shots and carrier traps to maintain proficiency per month. It is a busy time.
Shipyard and pre-deployment periods are a little different for the surgeon. You may only be required to hold clinic on the ship once per week. The other time, you will be expected to be at the local military hospital (in accordance with the medical department SORM).
The above are strictly generalities. The needs of the navy and country will dictate the specifics of your ship's schedule.