Ethical Considerations for Surgical Planners from the Lessons Learned on USNS COMFORT (T-AH 20) Deployment 2019

Abstract

Ethical issues can arise when planning for direct patient care surgical missions. Based on the lessons learned from the USNS COMFORT Deployment 2019, the authors present concise considerations and recommendations for future hospital ship surgical mission planning.

US Navy Ship-Based Disaster Response: Lessons Learned

“…Often, complex pathology that would be too risky to attempt during an elective HCA mission will be appropriate to attempt in a disaster, because no alternatives are available. However, every effort needs to be made before leaving to ensure long-term follow-up is taken into account [ 12 , 31 , 32 ].…”

“…In addition to the provision of dignified end-of-life care, surgical teams may also be faced with challenging ethical dilemmas during all phases of disaster response [ 12 , 31 , 32 ]. While it is beyond the scope of this article to review the principles of bioethics during a disaster response, US Navy surgical teams must be prepared [ 12 , 31 , 32 ]. In the initial phases, the goal of triage is to do the most-good for the most number of patients.…”

“…In the initial phases, the goal of triage is to do the most-good for the most number of patients. Sometimes triage during a disaster response is challenging for providers who are acclimated to non-austere standards of health care [ 12 , 31 , 32 ]. A priori triage protocols should be developed and a determination of what kind of patients your team will be able to care for based on your resources.…”

“…1589 patients treated in the casualty receiving area after being screened pier-side in San Juan [ 10 ] 2020 COVID-19 New York City, NY Los Angeles, CA USNS Comfort, USNS Mercy ~ 35 days > 110 operations and procedures. (54% on COVID positive patients) [ 11 , 12 ] Responded in < 7 days. No OR personnel tested positive at the conclusion 2021 Haiti Earthquake (2021) Haiti Multiple US Navy ships Provided command and control, supported fueling for flight operations, deployed unmanned aerial systems, aided in food/resource distribution [ 13 ] …”

Intricacies and complexities of maintaining military medical readiness: The Sri Lankan Strategy, in response to “How to Maintain the Readiness of Forward Deployed Caregivers”

“…Occasional mass casualty incidents will provide training opportunities somewhat close to the battlefield with profile and number of casualties 3 . Austerity and segregated care only can be mimicked by rural and wilderness surgery through global surgery partnerships and responsible and ethically focused global health engagement 4,5 …”