NMFP augments Casualty Receiving Treatment Ship, enhances capabilities

US Navy | 2023-03-16

By Grady Fontana

SAN DIEGO, CA.: Members of various commands and the amphibious assault ship USS Boxer (LHD 4) medical department participated in a medical exercise implementing a Casualty Receiving Treatment Ship (CRTS) mission aboard Boxer at Naval Base San Diego, California, March 6-10.

Hospital Corpsman 2nd Class Jazmine Strain, assigned to Navy Medicine Readiness and Training Command San Diego (NMRTCSD) and a native of Claxton, Georgia, inserts a tracheal tube into the mouth of a simulated trauma patient during a mass casualty drill aboard USS Boxer (LHD 4). Boxer, Fleet Surgical Team Five and NMRTCSD Sailors participated in a two-day mass casualty drill simulating Boxer as a casualty receiving treatment ship. Boxer is a Wasp-class amphibious assault ship homeported in San Diego. (U.S. Navy photo by Mass Communication Specialist 1st Class Kelsey J. Hockenberger)

“We're here to exercise the CRTS mission, which is Role 2 afloat for U.S. Navy,” said Cmdr. Justin Campbell, force medical planner, Naval Surface Forces Pacific (SURFPAC). “The Marine Corps has their medical battalions, and Navy Medicine has done a lot of great work supporting the medical battalions in Iraq and Afghanistan. But as we start to pivot and look at distributed maritime operations in the Indo-Pacific, it's more important that we start to exercise the full capability of the CRTS mission.”

When called upon, such as a major conflict scenario or during a mass casualty situation, Boxer can become a CRTS. The exercise was designed to test and integrate the various entities that comprise the CRTS: a Fleet Surgical Team, an M+1 augmentation, and the medical team organic to the ship.

Boxer is an amphibious assault ship and serves as the cornerstone of an amphibious ready group (ARG). A Fleet Surgical Team (FST) is embarked to the Boxer when deployed with the ARG, to augment the ship’s medical department.

Fleet Surgical Team-5 (FST-5), which is organic to SURFPAC, is made up of approximately an 18-person team capable of operating at least one of the operating rooms on a ship like Boxer. However, Boxer has a capacity for four operating rooms requiring manning augmentation to become fully operationally capable.

“When the FST embarks on Boxer with the ship’s medical department, the only surgeons and nurses are with the FST,” said Capt. Corey Gustafson, officer in charge, FST-5. “You can quickly become overwhelmed in a mass casualty scenario, or if we’re at conflict and expect to receive casualties. The CRTS gets activated to augment this capability.”

To do so SURFPAC has a partnership with Naval Medical Forces Pacific (NMFP), who participated with developing and scheduling the exercise. NMFP sourced and embarked the M+1 out of Navy Medicine Readiness and Training Command (NMRTC) San Diego, which was designed as an augmenting force to the CRTS.

The M+1 is an 84-person team that helps bring the ship to its full capability to receive, treat and regulate casualties as a CRTS, and is a Navy Medicine platform that is referred to as CRTS-9 from NMRTC San Diego.

“Over the past few days, we've been testing how to integrate (augmentees) in with the Boxer team and the FST,” said Lt. Cmdr. Paul Flood, senior medical officer, USS Boxer. “I think we've done significant improvements and have a lot of good lessons learned on how to integrate and what things are needed to improve the platform.”

Within the 84 personnel, CRTS-9 is made up of additional general surgeons, orthopedic surgeons and oral maxillofacial surgeons; along with anesthesia and perioperative services, to provide a more robust surgical capability; and management of medical surgical patients, intensive care patients and general ward patients.

“CRTS-9 is a composition of doctors, nurses and corpsman that can be deployed and integrated with a ship such as an amphibious assault ship to help complement the medical capabilities to provide additional surgical services, Intensive Care Unit services, ward services and ancillary services,” said Cmdr. Benjamin Drew, general anesthesiologist, NMRTC San Diego, and officer-in-charge of CRTS-9. “So, it augments and also amplifies the medical capability to provide damage control surgery, and resuscitative services, both to the ship, as well as to the supported units from that ship.”

During the exercise, the CRTS personnel have been providing robust surgical response to a variety of simulated casualties.

When bringing together such a diverse field of specialties from a mix of departments within NMRTC San Diego, some of the goals are mutually understanding their capabilities, improving organization, and optimizing surgical and medical response.

In addition, the personnel assigned to the CRTS-9 work daily at Naval Medical Center San Diego, or subordinate branch medical clinics. The shipboard environment presents challenges that some may not be accustomed to.

“Living in a ship is very different than that of a hospital, or that even in an austere environment, on land,” said Drew. “In this environment, we may have less resupply and less of a capability for medical evacuation, as well. We're much more constrained by the existing infrastructure of the ship, so our team must identify those challenges and come up with solutions to effectively operate and execute our mission aboard the ship.”

The training experience has also been a great benefit to the ship’s crew, as well.

“My biggest takeaway in the training element is understanding the roles of those on the other side,” said Chief Hospital Corpsman Rochelle Cannon, Medical Leading Chief Petty Officer, USS Boxer. “We are shipboard medicine, so we never get to see that higher echelon of care. We usually give patients the best level of care that we can, then we medevac them off the ship. But having a surgeon here or having the full staff here going through everything as if we’re deployed has been very beneficial to the team.”

Military medical platforms are classified by the Military Health System roles of care to describe battlefield medical and health capabilities. The military organizes health-service support capability across the theater of operations, communications zone, and home station to provide medical care from Roles 1-4.

Role-4 capability represents the most definitive medical care available, such as those provided by U.S. and overseas-based military medical treatment facilities, while Role-3 assets usually act in a general support role to an entire theater vice a single unit.

Role-1 units are usually a direct support capability supporting their owning unit, while Role-2 units can function in a general support or direct support role.

Assigned to Expeditionary Strike Group 3, Boxer is a Wasp-class amphibious assault ship, commissioned Feb. 11, 1995, and is the sixth U.S. ship to bear the name. Boxer’s crew is made up of approximately 1,200 officers and enlisted personnel and can accommodate up to 1,800 Marines. The amphibious capability of the Navy and Marine Corps team has been demonstrated in a broad range of operations including foreign humanitarian assistance operations, noncombatant emergency evacuations, natural disaster response, the recovery of downed aircraft and personnel, counter-piracy and strike operations, and diverse support to our partner nations.

Naval Medical Forces Pacific provides oversight for 10 NMRTCs on the West Coast and Pacific Rim that train, man, and equip medical forces, primarily in military treatment facilities. Globally, NMFP oversees eight research laboratories that deliver research expertise in support of warfighter health and readiness.