Navy deploys teleradiology to Indonesia tsunami zone

A U.S. Navy hospital ship with a state-of-the-art teleradiology system arrived off Indonesia's Aceh province in February to help with post-tsunami humanitarian aid efforts.

The Mercy, a former oil tanker reconfigured and recommissioned in 1986, is equipped with a 16-slice CT scanner capable of performing angiography and multiplanar reformatting, as well as fluoroscopy for image-guided procedures such as biopsies and drainages. The Mercy and its sister ship Comfort are the only Navy ships equipped with CT scanners.

The ship has four general-purpose computed radiography suites, two of which have full digital fluoroscopic towers. It also carries six portable x-ray units.

"All modalities are fully digital, with a complete Agfa PACS on board," said Dr. Stephen Ferrara, chief of Mercy's radiology department. "There is also a Web-based browser, which is used throughout the ship for clinicians to view their films."

When necessary, images can be transmitted from ship to shore for consultation with another medical center or ship to ship for fleet support.

Reports are available immediately on a digital dictation listen line system, Ferrara said. They are then transcribed into the Department of Defense's standard Composite Health Care System (CHCS), where they can be read or printed onto hard copy.

Mercy's medical information systems mirror those at the Naval Medical Center in San Diego, including hundreds of onboard terminals running CHCS.

Primary communications from the Mercy occur via a DOD Challenge Athena satellite link, which has a raw throughput of 1.54 Mb/sec, and two commercial satellite systems. The links allow the Mercy to function as another node on the San Diego medical center's network.

The ship's radiology department performed 1600 imaging exams in the first 35 days off Indonesia, including 300 CT scans and 150 angiographic studies. The moment a patient was received on board he or she-as well as any escort or kin-was given a tuberculosis screening x-ray.

"Roughly 10% to 20% of patient escorts presented with active TB requiring respiratory isolation and therapy," said Dr. Timothy A. Bemiller, a naval captain and Mercy's director of medical operations.

All patients were from Banda Aceh, and all were victims in some way of the tsunami. They were lifted aboard on Navy, CH60 helicopters. Injuries included fractures, blunt head and abdominal trauma, lacerations, dislocations, and abrasions. Most had gone untreated, often resulting in serious infection. Many victims were initially seen only by local healers, Bemiller said. The Mercy medical team also treated many cases of what physicians are calling "tsunami lung," a severe form of pneumonia caused by inhaling seawater and mud.

The ship was initially expected to make a number of stops along the western coast of Sumatra, but it became clear soon after arrival that continual movement would reduce the number of days of direct patient care.

"It was decided to continue our efforts in Banda Aceh, where most of the complicated cases were being sent from the region," Bemiller said.

The Mercy, which has 12 operating suites, 80 ICU beds, and 1000 ward beds, relieved the aircraft carrier USS Abraham Lincoln, which had been operating offshore from Sumatra immediately following the Dec. 26 disaster.

It took the 894-ft. Mercy about 30 days to reach the region from San Diego, with stops in Honolulu and Singapore. More than 100 civilian healthcare workers from nongovernmental organizations, including Project Hope and the World Health Organization, boarded the Mercy during the Singapore port call. This is the first time a Navy ship has been assigned a mixed crew of civilian and active duty military medical providers, Navy officials said.