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Op Patwin Part 2: HMS ILLUSTRIOUS' Medical Response To J Royal Naval Medical Service 2014, Vol 100.2 205 Operational Op Patwin Part 2: HMS Illustrious’ medical response to typhoon Haiyan Surg Cdr A Dew Abstract Operation PATWIN was the United Kingdom’s (UK) response to the disaster caused by Typhoon Haiyan. The UK deployed a force including HMS DARING and HMS ILLUSTRIOUS and this article describes the medical response including the deployment of a Role 2 medical team and the hosting of a UK civilian medical team UK Med. The deployment followed humanitarian guidelines in UK doctrine and contained in the Oslo guidelines, but demonstrated a unique example of a civilian team supported by the military. Background Typhoon Op PATWIN was the UK military response to the disaster At 2040L on 7 Nov 13 Typhoon Haiyan (known locally as caused by Typhoon Haiyan. The UK deployed a force Yolanda) made landfall on the Philippine Islands; Haiyan was the strongest recorded at landfall and the deadliest including HMS DARING and HMS ILLUSTRIOUS to hit the Philippines with over 6,000 people killed (2). and this article is the second of two articles describing The typhoon followed a north-westerly course across the the Maritime contribution to OP PATWIN; the first was Philippines weakening slightly as it went. Its effect varied published in the previous issue of this journal (1). according to local conditions such as height above sea level and shelter from headland, but the greatest damage was HMS ILLUSTRIOUS (LUST) is a CVS (Carrier Vessel caused by the storm surge striking low-lying communities. Support) now re-roled as an LPH (Landing Platform Helicopter). She deployed for COUGAR 13, the annual Response Force Task Group deployment, on 10 Aug 2013. After participating in Exercise ALBANIAN LION she passed through the Suez Canal on 10 Sep to conduct exercises with Middle Eastern navies and in early November 2013 was off the coast of Somalia participating in counter- piracy operations. As the R2 (Readiness State 2) LPH she was at five days’ notice to respond to any incident and had conducted Flag Officer Sea Training earlier in the year that included a disaster relief exercise. She was due to return to the UK in early December 2013. Figure 1: The path of Typhoon Haiyan (Yolanda) through the The medical department consisted of 11 staff with a Philippines. General Duties Medical Officer (GDMO) embarked for the deployment. The Role 2 Afloat (R2A) capability, equipped One of the hardest hit areas was Tacloban, capital of Leyte to provide damage control surgery within two hours of province, and the first population centre that the typhoon wounding, had been exercised in COUGAR 12, but the hit. As the international media became aware of the disaster this area became the focus of the international response, planned embarkation for COUGAR 13 was cancelled when not least because it was most accessible to the American Exercise DJIBOUTIAN LION was cancelled. As one of the contingent approaching from the east. R2A platforms LUST holds all the Role 2 equipment at 48 hrs notice, but anticipates the R2A team to deploy with or at The international response tended to follow the course of the the same time as blood products to complete the capability. typhoon, with aid agencies arriving in the western islands 206 Operational much later than the eastern parts. The aid agencies were also on 11 Dec. LUST departed the Philippines on 12 Dec, challenged by the dispersed nature of the eastern islands (or coinciding with the end of Op PATWIN, in order to return Visayas) and their relative inaccessibility except by sea or to the UK and regenerate for COUGAR 14. air. Conversely, they were attracted to Tacloban and Cebu by their relative accessibility by air with established airports. International Medical Response This meant that HMS DARING and LUST, approaching There was a robust international medical response and from the west by sea, and with air assets, were ideally the different teams formed clusters consisting of Foreign placed to contribute to the aid effort in the eastern Visayas. Medical Teams of varying capability. Many of those on The Royal Air Force (RAF) dispatched a C130 to Cebu outlying areas were equivalent to Role 1 (i.e. small medical and assisted both the international effort and the movement teams able to provide immediate life saving treatment and of some supplies and people for DARING and LUST; pre-hospital care with some primary care) but there were exchange officers were sent to Roxas, Cebu and Manila quite sophisticated field hospitals in Tacloban and Cebu. with Joint Force Logistics Command (JFLogC) establishing The UK dispatched a civilian medical team called UK Med. a one-star headquarters in Manila to co-ordinate the British Initially they split into a surgical team that went to Tacloban response. The Canadian military established themselves in and a pre-hospital team that went to HMS DARING. On Roxas on Panay island, co-ordinated the aid effort in that the handover to LUST the pre-hospital team changed and region and worked closely with LUST during her mission. a new team joined LUST. Both ship’s movements were co-ordinated by DfID working from Manila and by the LUST Canadian team co-ordination team working in Roxas. The Five days after the storm hit, HMS ILLUSTRIOUS was medical effort was co-ordinated by the health clusters that released from COUGAR 13, operating off Somaliland, to were content to allow LUST to move freely and deploy deploy at best speed for Relief operations in support of medical teams as necessary, while reporting back to the DfID (Department for International Development). A brief, health clusters. but intensive, logistics stop in Singapore enabled a seamless handover with HMS DARING on 25 Nov and subsequent Handover from DARING provision of humanitarian aid, primarily to the point of need The handover from DARING consisted of an afternoon of in more remote islands of the central Philippines. The 36- briefing in which the Medical Officer (MO) from DARING hour logistic stop in Singapore was key to the success of the presented to the Command Team of LUST and separately to operation and involved the embarkation of large quantities the medical team whilst a combined LUST and DARING of disaster relief stores and a few augmentees, including team were ashore conducting a Humanitarian Assistance to embarkation of Role 2 personnel and blood products. Disaster Relief (HADR) task. This enabled the LUST team Besides the Role 2 personnel the medical department to continue the work the DARING had started. The main required very little additional equipment or supplies, but difference between the two platforms was the increased used the opportunity to embark typhoid vaccines (after a capacity of LUST with its extra helicopters and personnel, period in which vaccination had been suspended because of which enabled LUST to send seven teams ashore and so a shortage of the vaccine) and a tropical medicine module. serve several islands or baranguays at once, where DARING had sent one team. LUST relieved DARING in North East Panay on 25 Nov and then spent six days delivering aid to the dispersed island Force Protection group to the east of Panay. There were up to seven teams The Command Estimate highlighted that the highest risk deployed ashore at any one time delivering humanitarian to personnel ashore would be medical. This included heat aid or helping with reconstruction. The ship was then tasked illness, biting insects, diarrhoeal disease and the risk of with assessing the need in islands to the west of Panay, trauma. Medical timelines were prolonged because of the and moved between several island groups deploying small lack of reliable host nation facilities and concern about assessment teams ashore. The need for aid was much less the transit time to them. The JFLogC Medical Estimate than in East Panay but the completed assessments allowed concluded it would take two hours from Point of Wounding the UN effort to focus efforts elsewhere. LUST then to definitive care; this was based on a rapid transit by Merlin moved back to East Panay to continue aid delivery, this helicopter to Manila where transport times to hospital can time working much more closely with Non-Governmental be extended by traffic congestion. To enable freedom of Organisations (NGOs) who had moved in to the area, before manoeuvre and remain self-reliant, deployment of Role 2 sailing for Manila to offload a residual amount of stores and was recommended by ILLUSTRIOUS and independently conduct Defence Engagement. agreed by Navy Command Headquarters, Permanent Joint Headquarters, and HQ Surgeon General (SG). Role 1 DfID tasking was completed on 10 Dec, prior to a high- medics ensured that immediate aid was always available profile Defence Engagement and logistics stop in Manila to teams ashore thus obviating the need for a designated J Royal Naval Medical Service 2014, Vol 100.2 207 CASEVAC helicopter (although one was always available The following is a quote from one of the MAs onboard: within an hour). “All the MAs on board had been trained to provide Role 1 humanitarian aid in Flag Officer Sea Training serials but With augmentation of LUST by Role 2 the Principal never thought we would have to actually do it. Once we Medical Officer assessed that he could support up to seven got told we were apprehensive about what was expected teams ashore with a BATLS (Battlefield Advanced Trauma of us as MAs, whether it was to provide aid to the locals Life Support) trained medic. This allowed a reserve of or to provide medical cover for the teams ashore. Once we trained personnel in case of an emergency, but required found out that we were to provide medical cover for the augmentation by the Medical Assistant (MA) from the Role teams ashore we were more focused on the task at hand.
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