COVID ALERT: The Challenges of Transferring COVID Patients at Sea

By LT Colton Schiefer, USN

COVID-19 had already been declared a pandemic for half a a year by the time Detachment 4 of Helicopter Sea Combat (HSC) Squadron 26 began pre-deployment work up cycles with the Iwo Jima Amphibious Ready Group (IWO ARG). The virus, despite being microscopic, was the most visible threat of daily operations for Sailors underway. The IWO ARG had the complex challenge of meeting the predeployment exercise’s requirements while keeping a novel and indifferent virus at bay. One key concern was how the ship would operate while bringing thousands of Sailors and Marines together from multiple bases along the country’s eastern seaboard. All personnel were required to wear face masks, following the CDC and Navy/Marine Corps guidelines, to mitigate spread of the virus in the event it made its way onboard.

Sailors and Marines quickly became accustomed to wearing the masks day after day at all times–aside from while eating, sleeping, or showering. Breathing while conducting labor intensive tasks on the ship became a strenuous activity, and prioritizing health over comfort became a common goal. Continual masking incited supply deficits which, in turn, led to service members’ repeated use of worn and dirty masks, a new logistical dilemma of the COVID era. Eventually, it was mandated that cloth and standard blue surgical masks did not offer enough of a barrier to prevent the spread of COVID-19. Everyone on the ship, therefore, was required to wear N-95 masks. The initial mandate came in the middle of a work up; consequently, the ship had to supply all of the masks, leading to increased scarcity of approved masks on board. Any occurrence of a new confirmed COVID case would reignite the gravity of donning the mask. The ship had judicious quarantine procedures in place to keep COVID patients from spreading the virus throughout the spaces, and ensured rigorous contact tracing for all confirmed cases. Beyond the short-term solution of quarantine practices existed the longterm concern of getting COVID positive individuals off of the ship.

HSC-26’s MH-60S Knighthawks were the primary asset for answering the call of disembarkation of COVID patients during these crucial work up evolutions. The MH-60S, an extremely versatile airframe manned by crews trained in combat logistics, is perfect for this mission set. Crews were identified and annotated on the flight schedule and air plan for transporting patients from the ships to shore facilities for treatment and prevention of further spread at sea. This process was not immune to growing pains. Initially, the guidance required a downing period for both crews and aircraft involved in the transport of these exposed patients. The crews were prohibited from flying for the remainder of the day and the following day, and the aircraft was to be cleaned and left untouched for 72 hours. During the earliest days of the protocol, the aircrewmen were instructed to quarantine within a designated area of the medical department for two days. While flying, the crews donned N-95 masks, surgical gloves beneath flight gloves, and sanitized flight gear. Upon return from the flight, crews were corralled into decontamination rooms where they left all flight gear to be sanitized before being escorted to the medical showers. In-flight mitigations included the following practices: keeping doors and windows open to facilitate airflow; placing patient(s) in the aft-most row of passenger seats facing the auxiliary tank to maximize distance between patients and crew; and restricting superfluous carry-on equipment thereby limiting contamination of gear.

Chad Obermeyer, left, assigned to Fleet Surgical Team (FST) 6, explains how the COVID-19 vaccine works to Operations Specialist Seaman Kevin Howard in the Wasp-class amphibious assault ship USS Iwo Jima's (LHD 7) Medical Ward.

Protocols were adapted for continued adherence to NAVADMIN requirements, yet adjusted to overcome the limitations of a detachment manned by only 11 pilots and 9 aircrewmen–all while still meeting mission requirements for remaining air operations. Crews were limited to just one aircrewman in order to reduce potential exposure and leave more personnel for air plan execution. Once detachment members were able to obtain vaccinations, and after some negotiation between our detachment officer in charge (OIC) and IWO’s medical department, the aircrewmen quarantine protocol was lifted. Aircraft cleanings were modified to internal spraying of sanitizing solvent only, with aircraft declared “up” once the cleaning solution had dried. These adaptations were imperative for continued timely mission accomplishment, as the initial guidelines crippled the availability of both aircraft and crew for longer than was necessary.

In flight the greatest hazard was the limitation imposed on communication between the crewmembers. Wearing an N-95 mask while trying to speak–either using ICS or attempting to transmit over the radios–proved near impossible. The roar of the rotor blades paired with the muffling effect of the thick mask rendered the noise being picked up by the helmet microphones indiscernible. Voices raised to a shout produced somewhat effective communication. By sacrificing a complete seal on the mask to place the microphones inside, crews were able to talk with one another and safely operate the aircraft while coordinating with outside agencies for ATC transmissions.

Receiving parties at shore-based hospitals were oftentimes not prepared for the arrival of the patients. Each visit would present a different challenge when it came to transfer of custody. Responses ranged from an absence of receiving personnel at the hospitals (due to apparent unawareness of a pending arrival), to an absence of a plan for what to do with the patients once they did arrive. These inconsistencies were results of insufficient information sharing from one interaction to another, and of growing pains during first-time delivery of patients to new facilities.

Our detachment and squadron were diligent in expressing what went well, and what did not go well, and to address inefficiencies observed during COVID patient transfers. Such input was essential for adjustments, which created a more fluid system of transfers. Most of the fliers were able to participate in at least one of these events, and consequently understood that mission planning and restrictions called for an all-hands effort. Embarking for deployment after completion of work ups put most of the requirements for COVID transfers behind us, due to new quarantining requirements of embarked personnel and a transfer of tasking from HSC to VMM (USMC MV-22 assets). The USS Iwo Jima (LHD 7) 2021 deployment was a success, characterized by little-to-no complications. Our naval force’s emphasis on the execution of safe, COVID-mitigated work up evolutions prior to this deployment played a major role in this feat.