ABOARD THE USNS COMFORT — The Navy's Baltimore-based hospital ship arrived close enough to Haiti to take aboard its first patients Tuesday night - providing urgent care to two severely injured quake victims transported from an aircraft carrier near Port-au-Prince.
Doctors were treating a 20-year-old man suffering from a spinal fracture and bleeding in the brain and a 6-year-old boy with a fractured pelvis.
The patients were brought aboard well before the ship reached its destination and hours after the crew had finished its latest round of training exercises.
"We've been waiting, ready to assist. It just happened a little earlier than we expected," said Cmdr. Tim Donahue, head of surgery on the Comfort. "But that's OK. We're ready."
Shortly before the two patients arrived, crew members had finished a full-scale medical rehearsal, simulating treatment on fictional patients and practicing an abandon-ship drill. They found some minor problems after using dummies and a fake medical script during a series of exercises but proclaimed themselves ready to implement a treatment plan crafted during the past three days at sea.
"We don't normally abandon ship in the middle of chest compressions," Donahue said. "But we did fine."
The Comfort will be the first "level 3" treatment in earthquake-stricken Port-au-Prince, offering complex surgery and intensive care that is unavailable from first-response teams or makeshift field hospitals. In combat parlance, it is akin to a military hospital such as the Army trauma center in Baghdad - the closest full-service surgical center to the action.
The ship's two helicopters are scheduled to begin flying at 7 a.m. today, and one of the first off the ship will carry an assessment team headed by Capt. Rich Sharpe, a trauma surgeon from the Navy hospital in Portsmouth, Va., and a veteran of four combat deployments. He was brought aboard the Comfort not only to serve as a surgeon but to use his experience in establishing medical systems in unknown, potentially dangerous environments.
The ship will work with military teams and relief organizations in Haiti that have critically injured patients needing a higher level of care.
"We expect Haiti to be a lot like a combat environment," said Sharpe, who returned from Afghanistan Dec. 22.
On Tuesday, it was still unclear how many patients the ship could expect and what type of treatment they would need. But crew members have been told to prepare to be overwhelmed.
With the addition of 350 medical and service personnel, who were expected to be in Guantanamo Bay, Cuba, overnight and to begin arriving on the ship today, the Comfort will exceed its capacity of 1,200 crew members. Officers were making arrangements for crew members to share berths, a practice known as "hot-racking," in which one person sleeps while another is on duty.
At the end of the drills, medical officers continued to tinker with the list of crew members that they want onboard when the ship reaches capacity - fewer surgical technicians and more nurses, for instance.
Officers warned the crew to conserve water and have contemplated rationing, out of concern that care for Haitian victims could be compromised if the crew consumes too much water. The Comfort can desalinate 300,000 gallons of seawater a day, but Port-au-Prince harbor is too polluted to use for drawing water. If the ship runs out of water, it would have to raise anchor and head out to sea, interrupting its medical mission.
Crew members were trying to maximize the space available for patient recovery and the rush of escorts and family members expected aboard. Workers began dismantling spaces reserved for a gym and public affairs to convert them into patient wards.
Throughout the ship, crew members lined up to get their daily dose of doxycycline to ward off malaria. Meanwhile, petty officers were dunking uniforms in mosquito repellent - a requirement for crew members going ashore in Haiti.
The ship's main deck, where patients can proceed, front-to-back, through the ship's emergency room, X-ray room, operating theaters and intensive-care wards, was abuzz with activity, almost as if patients were already onboard.
Challenges included pre-packaging kits for intubating patients, deciding the maximum age for patients in the pediatric wards and devising a system of makeshift identification numbers for patients.
The ship traditionally has crew members wear colored caps - red for the triage team, blue for stretcher carriers, white for pharmacy, etc. - to impose organization on a chaotic process. By midmorning Tuesday, doctors were still trying to find the caps.
Lt. Adam Cooper, an emergency room physician from Philadelphia and a Navy reservist, was called up last week to serve on the Comfort. Like everyone else, he hadn't met or worked with his colleagues aboard the Comfort before Friday night and hadn't much contemplated providing disaster relief aboard a ship. But like everyone else, he says the ship is ready.
"You don't know what's going to come off the helicopter, but we're used to that," Cooper said. "We're all just trying to put every ounce of effort that we can into it. And I think it's come together. We're ready."