In the previous post, I looked at the importance of terminology and medical doctrine, and showed a handful of examples of hospital ships in service around the world.
For the UK specifically, and although technically not a hospital ship, RFA Argus is the afloat Primary Casualty Receiving Facility (PCRF), a Role 3 capability.
As of today, RFA Argus will remain in service past 2030, and the capability, if not the ship, will be replaced by the Multi Role Support Ship (MRSS).
Because MRSS is still in concept stage, there is not a great deal of detail on what it might look like beyond manufacturers positioning their designs.
Given there appears little appetite for a hospital ship proper, and the Role PCRF is currently likely to be distributed on MRSS, there is not all that much to discuss.
Only joking!
Role 3 facilities required include resuscitation, operating theatre, intensive care wards, advanced diagnostics (X-ray, MRI etc), recovery wards, sterilisation, pharmacy, hyperbaric facilities, and blood/blood component storage.
Medical waste disposal, command and control, laboratory, dental, isolation, medical gas handling, power generation, uninterruptible power supplies, storage space, and catering.
Medical gas handling is more of a challenge than many imagine.
Mortuary, laundry, extensive communications for telemedicine and a computing environment that supports the secure generation, storage, and processing of large volumes of data.
As telemedicine, and even robotics, mature, a Role 3 will likely consume much more power and data, and need additional technical support staff.
I don’t know whether spreading this across multiple MRSS would be optimal.
We live in an age where medical facilities are no longer sacrosanct it seems, and maybe the age of the big medical ship in a defence context is over.
Designing all of the above is far more complicated than putting together parts, patient routes, especially, are important. These should be considered for bringing patients onboard, and emergency evacuation to lifeboats.
The Role 3 at Bastion was on a single layer, approximately 120m × 60m.
Bigger is better.
And custom designed is better, not a conversion.
The Role 3 Conundrum
Arguably the biggest issue for a Role 3 capability is it is not actually used that often.
In a crowded equipment plan and a world of finite budgets, many see them as somewhat of a luxury (even though they are not)
This is perhaps one of the reasons why RFA Argus has endured, she can do plenty of other things, aviation training, disaster relief, and general support to operations.
If we are looking to the future, any Role 3 capability must have some ability to slot into a wider set of capabilities, hence the MR of MRSS.
This is not an easy challenge to resolve because it means accepting compromise.
The other elephant in the room is finding the couple of hundred medical personnel to crew the facility, can increasing telemedicine, robotics, and reach back to the UK reduce that?
Finally, is a Role 3 needed for non land focussed deployments, it seems so to me, but we don’t often see RFA Argus deployed as part of an expeditionary strike package, another one to discuss perhaps?
A Blast from the Past
In response to an established requirement for afloat maintenance and repair, that provided by RFA Diligence, BMT published a study that examined various options for then Operational Maintenance and Repair (OMAR) requirement.
Although RFA Diligence was subsequently withdrawn with no direct replacement, the study did have one component that is relevant to the hospital ship/PCRF conundrum.
That is, a non-propelled barge that could be carried by a heavy lift vessel.
The study suggested using a FLOFLO vessel of opportunity or one on a long-term charter.
The barge was 120m × 32m, with an accommodation block at one end, and a workshop at the other.
Cranes and storage in the middle.
Click here to read the paper.
The concluded
Alternatively, the use of heavy lift FLO-FLO style vessels offers a number of significant features that could make the next generation of repair and maintenance platforms more flexible and capable
This set my thinking for a Role 3 on the same path as the OMAR barge.
Proposal
My proposal is…
- Build a Role 3 afloat facility as a purpose designed module that can be carried onboard a heavy lift ship when needed. The module would be stored onshore and used as a teaching facility for the Defence Medical Services when not deployed.
- The Heavy Lift ship would form part of a future evolution of the Strategic RORO service as established today, crewed by sponsored reserves rather than RFA personnel
Role 3 Module
In the offshore sector, there are many examples of accommodation and service modules or barges at a similar scale. It is not an exotic technology.
The images below show examples of self-contained accommodation barges,
The final of the three images above shows a design that is 100m × 30m, with accommodation for 300 personnel, the middle is the Bibby Pioneer, capacity of 200 personnel, similar in capacity to the first, the Nunce.
These are just examples to demonstrate the concept.
Another option might be to approach this as a topside module, the type commonly used in the energy sector, production, or accommodation.
These do not float, but are usually craned onto offshore platforms.
There are pros and cons for each approach, a barge can be carried or towed, but a module must be carried. Barges must be maintained as ships, and subject to certification and inspection regimes.
On many accommodation modules and barges, this type of helicopter deck is common.
But it is unsuitable for a medical facility as the pathway from the helicopter (by which the majority of casualties will arrive) to treatment facilities needs to be as direct as possible, especially for wheeled stretchers, wheelchairs and similar.
In the barge images above, the working deck has a large crane and other equipment that would not be needed. The deck, in the Role 3 module, would be cleared and used as a large helicopter landing area, suitable for Chinook size helicopters.
The casualty receiving facilities could be at the same level, no lifts, no ramps, straight off the helicopters and into emergency care.
Any landing area should also be towards the stern of the module, with an unimpeded approach path, the same basic configuration as all aviation capable vessels.
By using either a barge or module, the design can be optimised for patient care, not shoe horned into a vessel that has to do many other things, or designed and built around the constraints of an existing vessel.
Heavy Lift Ship
Assuming using a tug to tow a barge to the operational area is discounted on practicality concerns, there are several options for moving the barge/module.
Examples
Lift On Lift Off
The ship has a large open deck area onto which outsize and extremely heavy cargos are lifted on and off using dockside or integral cranes.
Shoreside cranes tend to be used less than those onboard heavy lift ships, although some ships such as that below don’t have their own cranes.
Roll On Roll Off
The payload is moved on-board using multi-wheeled heavy lift platforms called Self Propelled Modular Transporters (SPMT).
Ballasting allows a straight path to be established between the ship deck and the loading area.
One onboard, the SPTMs are lowered, allowing the payload to rest on the ship’s deck or a specially designed cradle. The SPTMs are then driven off.
Float On Float Off (FLOFLO)
A more specialised heavy lift vessel type is the FLOFLO.
These are semi submersible vessels that are ballasted down such that floating payloads can be (carefully) floated over the deck.
The vessel is then slowly raised underneath the payload, again, sometimes onto cradles.
This method is more commonly used for moving ships, submarines, yachts and other vessels.
Or even Zeppelins.
FLOFLO barges are also used in some situations.
Multi Role Heavy Lift
Some designs are more flexible, able to operate in all three modes.
Rather than a completely flat deck, they have a more conventional hold with movable deck covers and a rear ramp.
Movable deck panels are used to create a deck at one of six levels, and a temporary bulkhead can also be installed to allow the vessel to be submerged without flooding the cargo hold.
The ship’s own cranes can perform all these configuration activities.
Operators
Sample operators include GPO, SAL, AAL, Jumbo Maritime, and RollDock
Example Vessel
As you can see from above, there is a wide variety of ship designs and sizes, some will be less suited to the UK than others.
The Combidock Class is a good starting point, they are not massive, but very flexible.
She can also dock down to accept floating cargo like a barge or, in the example below, a submarine.
The cargo deck is 132m × 18m, enough space for 1,383 TEU.
The later vessels in the Combi Dock series were purchased and converted for use in the offshore industry, a few years ago.
The OIG Giant II, formerly Blue Giant, formerly Combi Dock IV, is just such a conversion.
The work included modifications to the cranes (anti heave and lift extension) and adding a helideck, moon pool, accommodation module (in yellow), additional generators and a Dynamic Positioning system using azipods and thrusters.
The 500 tonnes 13mx18m accommodation module is built across seven decks and includes facilities for 86 personnel, including leisure, sleeping, workspaces and water/waste treatment.
A new build contract at the same ‘offshore’ specification for two was reported to be €200m for the pair.
Ashore Storage and Crewing
The Role 3 module(s) could be stored onshore, at Marchwood, for example.
Crewing could be RFA, or even as part of the strategic RORO service operated by Foreland Shipping
Beyond Role 3
There would be very little point purchasing a heavy lift vessel only to use it on the infrequent occasions when a deployed afloat Role 3 capability is required, might as well have a dedicated vessel.
This is why the multi role-type such as the Combi Dock is attractive, and would allow us to extract maximum value from it.
General Transport
Over 1,300 TEU’s is a lot, but easily carried by the Combi Lift design described above.
They can be lifted on and off using harbour or the ship’s own crane.
Containers could also be off loaded whilst at sea, the heave compensated crane allows much safer operation without pendulation. The containers could be loaded onto Mexeflotes, landing craft or other lighters. With a single crane, this would not be a particularly fast option, though.
At 4m width, there is 528 Lane Metres, with vehicles using a shore based loading ramp or lifted in and out.
This would be across two decks using the standard hatch covers only, each deck being just over 4m high. There would also be space on the hatch covers if it were permissible to carry vehicles exposed to the elements.
The USMC used the MV Combi Dock III for just such a deployment, some years ago.
As with containers, vehicles could be easily lifted onto lighters whilst at sea, in reasonable sea states.
This is not as flexible as a more conventional RORO, worth recognising that.
Crewed and Uncrewed Vessel Transport
Because the vessels are semi-submersible, they can be used to transport small craft and patrol boats, and even submarines (not that we have any of the smaller types that might need a lift)
Smaller craft such as patrol boats or MCM unmanned boats could simply be lifted from the deck into the sea.
Using the two deck approach, the vessel could comfortably transport 110 Pacific 24 RHIB’s, more than we have in service.
Where this gets interesting though is with larger vessels.
A crane lift would be preferred because the lengthy docking down process would not be required.
With one crane, a 350 tonne limit allows a range of fast patrol craft, work boats and hovercraft to be transported to theatre.
We don’t actually have many of these, but with a credible deployment capability, we would be able to exploit the type of patrol craft we don’t have.
More realistic, would be to use it as simple transport for future medium-sized uncrewed vessels.
There is an increasing interest in these size vessels, and they have to move oceanic distances.
Mothership
I would not generally favour using them as a kind of ‘mothership’ because they would be civilian crewed, and neither would it be sensible to use any of the Navy PODS concepts, included here for completeness.
Summary
This is a proposal that both recognises the importance and benefits of a good afloat medical capability at Role 3, and that it is a difficult investment decision.
By looking at imaginative solutions, such as creating it as a ‘super module’, we can generate benefit and wider applicability in a realistic approach.
None of this is cutting edge, the solutions are used every day in industry.
By taking this approach, a module, and a carrier vessel, the carrier vessel can be used for the 90% of time we don’t need a Role 3 afloat.
Maximum value for money!
See you in the comments.
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Fascinating , thank you for the work that goes into your posts, a lot of them are very technical .
I am mindful that we are moving into an age of austerity but think the idea is a good one , it can easily be funded both from defence and overseas aid budgets .
Do we buy second hand and adapt it , buy a design and build under license or do we design and build from scratch . My vote would be to buy a design and build under license