When first looking at the operating room, remember that this is not a tertiary care center. This is a warship. You should have all the equipment necessary to take care of common surgical emergencies and trauma. The AMMAL (Authorized Minimal Medical Allowance List) represents the minimum quantity of medical equipment and supplies required to be onboard in order to perform the medical department’s operational mission as defined in the Required Operational Capability/Projected Operational Environment (ROC/POE).Take the time needed to review the AMMAL with the department’s OR techs. Here is a list of common surgical procedures that your OR should have the capability to respond to:
- Appendectomy (Lap and Open)
- Infected sebaceous cyst
- Cholecystectomy with cholangiogram
- Exploratory laparotomy / laparoscopy
- Vascular repair
- Laceration repair
- Basic tendon repair
- Splinting and casting
- Vasectomy / Circumcision
- Testicular torsion
Visually verify that the equipment onboard reflects AMMAL. Ensure items have not expired. Ensure the supply petty officers place the necessary orders to bring levels up to par, else you may find yourself in a bind at sea. Additionally, ask for what you are used to using- specific suture, instruments, stapling devices, gloves, etc. The corpsmen may be able to order what is not on AMMAL as long as proper justification is given.Each ship maintains a list of procedures that have been done while at sea. Refer to that and ensure you have all the necessary equipment to maintain that same volume.Everyone in the navy has a primary job (e.g. ship’s surgeon), however, there are plenty of other smaller jobs that need to be filled. These jobs are called collateral duties. Some of the collateral duties traditionally held by the surgeon are the ward officer, the ICU officer, and the blood bank officer.
The afloat blood bank programs are governed by OPNAVINST 6530.4A and COMNAVSURFLANTINST 6000.10 Currently, onboard aircraft carriers, there is no blood storage. Blood for transfusion, if needed, is obtained via the walking blood bank. As the surgeon, you will likely be tasked with this as a collateral duty. It is important to understand the job and to understand its requirements.
The walking blood bank is a program that is to be activated only as a tertiary blood source when either liquid RBC’s or thawed and washed cells are available- which is the case onboard aircraft carriers. The use of walking donors and emergency blood collections, although sometimes necessary, are not encouraged due to the lack of ability to perform serological testing for infectious diseases or serum antibodies. How you run the program will likely already be outlined by the ship. You will be given some latitude to make changes as you see appropriate.
At sea, there are plenty of evolutions taking place every day. One of the most important for the ship is general quarters. The ship sounds general quarters (GQ) when going into battle or in response to attack. The ship’s surgeon’s role is in main medical. There will be corpsmen (some trained as EMT’s), IDC’s, GMO’s, and PA’s dispersed throughout the ship at various battle dressing stations.
All communications are routed through damage control central and filtered to medical as necessary. As the surgeon, you are responsible for quickly assessing all injuries and deciding the order for proceeding to the operating room. Just like what was trained at C4, patients should come with tags indicating injuries and categories (immediate, delayed, walking wounded, or expectant).
The uniform for GQ is sleeves unrolled, fire retardant gloves and hair covers on, and pant legs tucked into boots. All watertight hatches are "dogged". There is plenty of time from sounding GQ until casualties arrive. This is a good opportunity to conduct training. You will find the corpsmen eager to learn. This is also a great time to teach the department how you want to conduct traumas, etc. Make good use of this time.