The analysis of personnel workload on navy hospital ships using the NASA-TLX method

Navy Ships A is a Republic of Indonesia Ship type LPD (Landing Platform Dock) which has the main task and additional duties as a Naval Hospital Auxiliary Ship. In their daily life, Navy Ships A carries out maritime security operations to maintain the sovereignty of the Republic of Indonesia, as well as carry out humanitarian social activities. This makes the workload of Navy Ships A personnel in the high category. And it causes a decrease in productivity and morale of personnel which will result in work accidents and not achieving the main tasks assigned to Navy Ships A. This study aims to calculate the workload of Navy Ships A personnel using the NASA TLX (Task Load Index) method under conditions the current number of personnel. This research is expected to be able to calculate the workload of Navy Ships A personnel with the condition that the proper Personnel Composition List (DSP) has not been fulfilled. As well as being able to provide workload calculations according to the number of existing DSPs, so that they can provide recommendations for the right solution to the problem of high workload experienced by Navy Ships A personnel.

17 The Law of Armed Conflict at Sea

This chapter evaluates legal developments and practice with respect to armed conflict at sea. The Third United Nations Conference on the Law of the Sea has progressively developed the law and contributed to the emergence of multiple differing regimes, some of which are now customary in character. The San Remo Manual on International Law Applicable to Armed Conflicts at Sea (1995) provides a contemporary restatement of the law of armed conflict at sea, together with some progressive development. The chapter provides an overview of the different acts of naval warfare, comments on special provisions concerning means and methods of naval warfare, and explains the legal status of hospital ships including conditions of their protection.

CONCEPT OF THE SYSTEM OF MARINE MOBILE MEDICAL COMPLEXES

The modern strategy for the development of health care includes as one of the priorities maximum approach of medical services to the consumer. To solve this problem in the conditions of the Navy, it is advisable to create mobile medical complexes placed on specially equipped vessels. For the full and operational medical support of the fleet forces in specified areas of the world’s ocean at different distances from the main base sites, a system of marine mobile medical complexes should be created. In peacetime the system should include hospital ships, multipurpose vessels with a hospital on board, mobile polyclinic mobile complexes and high-speed ambulance boats. During the period of danger, the possibility should be provided for the rapid re-equipment of hospital and multifunctional vessels, as well as polyclinic complexes with an increase in evacuation capacity and an increase in the volume of medical care. For medical support of an amphibious assault operation on universal amphibious ships, a quick re-equipment of the premises specially allocated during the design process to medical facilities for emergency medical assistance and evacuation of the wounded to coastal medical institutions should be provided. In wartime, for the provision of medical care and evacuation of the wounded, vessels of various purposes must be used, the projects of which contain the capabilities and algorithms for their quick conversion into sanitary transports. Variants of the main tactical and technical characteristics of vessels of various classes intended for medical support of the fleet forces are proposed. A significant problem in the operation of medical vessels is their low patient load in the inter-transit period, which leads to the disqualification of full-time medical staff and reduces the quality of the maintenance of the vessel. When forming the operational-tactical model of operation of medical vessels, special attention should be paid to the staffing algorithms and ensuring that the courts are always ready to perform their tasks.

Health Characteristics of the Madeira Riverine Population

Introduction The Amazon River Basin is the largest and the most complex fluvial system in the world. The Brazilian government provides dental and medical care to the riverine populations in this region in part through medical assistance missions, conducted by four hospital ships. The Brazilian Navy invited U.S. Navy medical personnel to join the February 2019 mission aboard Navio de Assistência Hospitalar (NAsH) Carlos Chagas to provide care along the Madeira River. Materials and Methods In the course of providing primary care services, demographic, health, and dental data of the Madeira Riverine population were collected. Descriptive statistics were used to generate average health and dental data. Chi-square tests were used to compare population prevalence data. Linear regression was used to evaluate dental caries per patient with proximity to nearest large population center and village population. This project was approved by Naval Medical Center Portsmouth Institutional Review Board. Results The Madeira Riverine population has similar dental health to Brazilians living in urban centers. Their prevalence of hypertension and diabetes compared favorably with the U.S. averages (17.7% vs. 34.3% [P < 0.001] and 3% vs. 9.4% [P < 0.001], respectively). Based on the most prevalent ICD-10 code diagnoses, future missions can expect high volumes of patients with intestinal parasites, hypertension, common skin infections, women’s health concerns, and musculoskeletal complaints. Conclusions This study adds to the limited health data currently available on Brazilian Riverine populations. It demonstrates the effectiveness of the Hospital Assistance missions in providing dental care and documents some unique aspects of Riverine health that warrant further study.

Wartime Repatriations and the Beginnings of Decolonization

This chapter recounts the large-scale wartime repatriations of civilians from Italian overseas territories. From the very start, demographic colonization aimed at establishing sizable and permanent settler populations in various parts of the empire had necessitated policies of both voluntary and involuntary repatriation of individual colonists and settler families. Reasons for such individual repatriations ranged from illness, to inability to work, to “immoral” behavior that could damage fascist prestige in the colonies and encourage insubordination on the part of fellow colonists. In contrast to such individual movements, the removal of Italian civilians from Italy's African territories carried out between 1940 and 1943 took place under the banner of state-sponsored humanitarianism. Once Italy joined the conflict, a number of repatriations occurred on so-called hospital ships. The three missions from Africa Orientale Italiana (AOI) to Italian ports carried out between 1942 and 1943 on the “white ships” or navi bianche—four transatlantic cruise ships painted white with the red cross—remain the best known of such efforts and brought approximately 27,778 citizens back to the peninsula.

“Soft Power” of the Indian Navy in the Pandemic Era

The article describes and analyzes the activities of the Indian Navy during the COVID-19 pandemic. The author looks at the experience of the Indian Navy at the beginning of the pandemic, noting that it mainly consisted of helping the states of the Indian Ocean region affected by hurricanes and monsoons, and evacuating Indian citizens and residents of neighboring countries from areas of hostilities. At the same time, the Indian Navy did not have specialized floating hospitals. The author analyzes the situation in which India found itself at the beginning of the pandemic: a gradual slowdown in GDP growth questioned the further expansion of the Navy, and the outbreak of conflict with China further emphasized the importance of the Air Force and the Army. In these conditions, the Indian Navy was forced to prove its value for the Indian external and domestic policy. The author then describes how the Indian Navy fought COVID-19, concluding that Indian sailors were able to prevent the pandemic from spreading to naval bases and ships. The Navy fully retained its combat capability and was able to take part in two large-scale operations: the “Samudra Setu”and “Sagar” missions. During the former, several thousand people were evacuated from Iran, Sri Lanka and the Maldives, the latter involved providing medical assistance to the population of the Maldives, Seychelles, Comoros, Madagascar and Mauritius affected by the pandemic. The author notes the high level of organization of both missions, which made it possible to avoid pandemic spreading among the ship crews. He argues that the conduct of Operation “Sagar” allowed India to increase its influence in the Indian Ocean region amid the pandemic and demonstrate its role as a security provider countering unconventional threats. The author then describes the joint exercises carried out by the Indian Navy during the pandemic and notes their significant political role. In conclusion, he analyzes the experience of the Indian Navy using soft power and proposes an original concept of “floating soft power” based on the constant presence of hospital ships in remote regions. In his opinion, this format of presence could also be suitable for projecting Russian interests in the South Pacific.

Shipboard Global Health Engagement Missions: Essential Lessons for Military Healthcare Personnel

Introduction Global health engagement missions are conducted to improve and protect the health of populations worldwide. Recognizing the strong link between health and security, the Armed Forces have increased the number of global health engagement missions over the last decade to support force health protection, medical readiness, enhance interoperability, improve host nation capacity building, combat global health threats (i.e., emerging infectious diseases), support humanitarian assistance and disaster relief efforts, as well as build trust and deepen professional medical relationships worldwide. These missions additionally support the US Global Health Security Agenda, US National Security Strategy, US National Defense Strategy and National Military Strategy. Although global health engagement missions are conducted by armed forces with numerous military units and geographical locations, military healthcare personnel assigned to US Naval hospital ships also perform a wide range of these missions. These missions comprise some of the largest global health engagement missions conducted, encompassing hundreds of subject matter expert exchanges, community health exchanges, medical symposiums, and side-by-side partnered healthcare in countries around the world. Military healthcare personnel who have completed past missions possess valuable knowledge related to ship-based global health engagement missions. Capturing and transferring this knowledge to future deployed personnel is important for future successful missions, but has remained a significant challenge. The purpose of this study was to capture and examine first-person accounts of experiential learning among active duty physicians, nurses, and hospital corpsmen who had participated in recent hospital ship-based global heath engagement missions. Materials and Methods We used the interpretive, ethnographic method of interviewing and data analysis described by Benner. Interviews elicited detailed, narrative examples of experiences from military health care personnel who had participated in previous global health engagement missions aboard hospital ships (N = 141). Our approach to gaining meaning from these narratives was guided by three central strategies: (1) identify paradigm cases, (2) identify themes within and across participant narratives of meaningful patterns, and (3) identify exemplars to represent common patterns of meaning and common situations. Additionally, we collected demographic information. Results Our findings provide firsthand descriptions of five essential elements to prepare military healthcare personnel for shipboard global health engagement missions. These essential elements are mission clarity, preparedness, experiential knowledge, lessons learned, and flexibility/adaptability. Conclusions Widespread dissemination of the lessons learned from military global health engagement missions is crucial to shaping forces that operate effectively in a rapidly changing global environment. Sharing lessons learned increases efficiency, adaptability, and agility, while decreasing variance in processes and the need to relearn mission-specific lessons.