The Navy’s Giant Sea Base Is In The Middle East And Could Get Serious Medical Capabilities

The U.S. Navy’s new giant sea base, the USS Lewis B. Puller, is now on duty in the Middle East and the service is already experimenting with what the ship might be able to do. Currently, this includes acting a launch pad for boarding parties and special operators and serving as a platform for counter-mine operations. The ship might even eventually be able to take on the role of floating medical facility, which could be particularly important if one or both of the service’s existing hospital ships

ends up in mothballs.

Puller first arrived in the region in August 2017, at which point the U.S. Fifth Fleet took control of the ship from the Navy’s hybrid military-civilian Military Sealift Command (MSC). Officially termed an Expeditionary Sea Base, or ESB, the vessel took over for the USS Ponce, an aging amphibious ship the service converted to serve as an interim float staging platform. In September 2017, Ponce returned to Norfolk Naval Station in Virginia for decommissioning and eventual scrapping.

“This ship is a blank canvas,” U.S. Navy Captain Joseph Femino said in a March 2018 interview with USNI News. “Whoever wants to come assess what they want, develop what they want, we’ll work to try and get that.”

There’s a lot of space to work with since the ship is a whopping 764-feet long, 164-feet wide, and displaces a massive 78,000 tons. Derived from the Alaska-class oil tanker, it features a large open flight deck situated with four operating spots, two for take off and landing and two parking, that can support V-22 Osprey tiltrotors, various types of helicopters including the MH-53 Sea Dragon, and small tactical and helicopter-like drones, such as the ScanEagle and MQ-8 Fire Scout respectively.

Below that there is a large open space that can accommodate small watercraft, cargo, containerized mission spaces, and more. Underneath, in the hull, there are massive ballast tanks that, at present, are just empty space.

That feature is a holdover from Puller’s two existing cousins, the differently configured USNS Montfort Point and USNS John Glenn. Those so-called Expeditionary Transfer Docks, or ESDs, provide a way to rapidly unload roll-on/roll-off and other traditional cargo ships in the absence of established or operational port facilities and lack the upper flight deck. On those ships, the crew can flood the tanks to settle it further down in the water, allowing landing craft, amphibious vehicles, or small boats to rapidly deploy on and off the ship

The Puller‘s crew maneuvers a small mobile pier on the ship’s main open mission bay., USMC

Femino told USNI News that the ballast tanks and the capability they provide may not be necessary for ESB operations in the end. If the Navy decides this is the case, these spaces inside the hull could end up holding additional storage or mission compartments. The service already has two more of the sea base types under construction, which will receive the names Hershel “Woody” Williams and Miguel Keith.

Whatever the final configuration might look like, the ESBs will be extremely flexible ships and able take on different roles. Modular or semi-modular equipment sets will allow the crew to rapidly convert the ship from one function to another in the future. 

Special operators have tested their ability to operate from the ship using a portable mission space tucked inside a shipping container and the service has tested other different possibilities, including quickly adding extensive medical capabilities to the ship.

“I could build a hospital here; I could do anything I wanted, and it wouldn’t be at the cost of anything I’m designed to do, it would just be at the cost of what it takes to engineer it, design it, build it,” Femino said. “Our hospital ships are going away, so I actually had the force surgeon on today, I said, listen, I could build you all the beds you want across this [raised platform in the mission bay].”

The officer’s comments might be a bit presumptuous as a battle appears to be emerging between the Navy and Congress over the final fate of the USNS Mercy and USNS Comfort, the service’s two purpose-built floating hospitals. But he’s not wrong that Puller’s ample space might be able to at least physically accommodate a set of more limited capacity facilities similar to the ones on those unique ships, which can handle up to 1,000 patients at a time and have a variety of specialized care and support suites.

The USNS Mercy, one of the Navy’s two dedicated hospital ships., USN

It’s worth noting that Mercy and Comfort both started life as oil tankers from the National Steel and Shipbuilding Company (NASSCO), the same company responsible for the Alaska-class that serves as the basis for the Puller and her cousins. It’s not clear how rapidly the Navy might be able to transform an ESB to a hospital and back again.

Some equipment could fit inside containerized modules. Puller has already carried an Expeditionary Resuscitative Surgical System (ERSS) team and their portable Role 2+ medical capability in an experimental capacity. This “out of the box” arrangement includes reception and triage centers and operating theaters, as well as a blood bank and other supply storage.

Unfortunately, this particular setup doesn’t at all equal the Mercy or Comfort’s Role 3 capability, which includes additional diagnostic facilities, more specialized intensive care and surgical suites, and other resources. They are truly floating hospitals in every sense of the word, not just ships with expanded sick bays.

“If someone shows up with money and instead of spending the money we spend on Mercy and Comfort for a year of operations, they just build me out with that,” Femino suggested. But to do so might require more serious modifications that might not be as easy to swap out when the ship needs to take on another mission set, too. And there’s apparently limited impetus to explore that level of capability at the moment, too.

Members of Expeditionary Resuscitative Surgical System (ERSS) 15 prepare for a simulated surgery after setting up inside an empty warehouse during a training exercise., USN

Femino also said the Puller “may never need a gigantic hospital,” given the relative proximity of the ship’s Middle Eastern operating area to the Landstuhl Regional Medical Center in Germany. That U.S. Army facility serves as a major medical hub for all U.S. military forces across Europe, the Middle East, and Africa.

Germany is still relatively far away though, especially during high-end conventional operations. During the first Gulf War in 1991 and against during the invasion of Iraq in 2003, the Navy deployed its actual hospital ships to support those missions.

An ESB configured as a hospital ship could help reduce the time it takes for seriously injured service members in Africa to receive adequate care, which has become an increasingly pressing issue as the United States steps up military activities across the continent. It could also support humanitarian and disaster relief missions and other “soft power” activities around the world. The latter term refers to instances where the U.S. military, often in cooperation with foreign partners and non-governmental organizations, provides free medical, humanitarian, and other civic assistance as a way of promoting American interests abroad.

Having the ability to readily turn the future Williams or Keith into afloat medical facilities could be especially useful for operations in the Western Pacific where the “tyranny of distance” is and will continue to be a major tactical barrier to overcome. This reality could easily put troops thousands of miles from anything approaching a Role 3 medical facility during intensive combat operations.

A profile view of Puller showing the ample available space in the mission bay under the main flight deck. , USN

Still, with the Navy only planning to have three of the ships for the foreseeable future, having even one set up primarily as a hospital could limit their ability to perform other missions. The ESB’s other features will be equally important for any future distributed operations, particularly in the Pacific region.

On top of that, the Navy’s plan is for sea bases to take up semi-permanent stations in certain regions, rather than move around from port to port, which could make it difficult for them to take up the same more mobile role that Mercy and Comfort now fill. At the same time, a relatively fixed, centralized medical capability might make good sense in certain areas where the United States routinely operates.

Regardless, as it stands now, Puller is preparing to take up its primary role as a staging base for MH-53E Sea Dragon mine-hunting helicopters. Femino says the ship is also exploring the possibility of acting as a mothership for the Navy’s Avenger-class minesweepers forwarded deployed in the region.

Counter-mine warfare is the ship’s primary mission in the Middle East, where those weapons could easily wreak havoc on operational movements in constrained areas such as the Strait of Hormuz leading in and out of the Persian Gulf and the Mandeb Strait between the Red Sea and the Gulf of Aden.

An MH-53E Sea Dragon on board Puller in 2016., USN

In addition, the Marine Corps has sent a Fleet Antiterrorism Security Team (FAST) platoon to examine the ship’s capabilities, while special operators in the region have conducted a number of training exercises. Puller could serve as an important mobile staging platform for either group, who could readily make use of the ship’s flexible nature in order to respond to both short-notice crises or raids and more sustained operations throughout the Middle East.

As already noted, The flight deck’s four operating spots are big enough to accommodate various tiltrotors and helicopters from the different services, to support those operations. The Marines recently used the ship as a staging platform for their MV-22 Ospreys during training exercises in the region. Helicopter or tilt-rotor type drones, including the MQ-8 and the Marine Corps’ still conceptual Marine Air Ground Task Force-Unmanned Expeditionary Capabilities unmanned aircraft, or MUX, would also be able to operate from the ship.

An US Marine Corps MV-22 Osprey sits on Puller‘s flight deck during a training exercise in April 2018., USMC

That large open flight deck could serve as a firing platform for modular weapon systems, too. The Marines recently demonstrated their ability to fire guided artillery rockets from the deck of an amphibious ship and there are various mobile or containerized missile and gun systems that could expand the sea bases capabilities in different environments, especially when working together as part of a larger, distributed force on land and at sea.

But “we are here for MCM [mine countermeasures] support,” Femino explained to USNI News. “We are not here for SOF [special operations forces] support, we are not here for Marine support,” he added, despite the obvious value the ship will provide for those operations in the future.

It seems likely that the sea bases will end up with at least some level of medical capability in the future, too. If the Navy decides that it is too expensive to retain Mercy, Comfort, or both hospital ships, Puller or her upcoming sister ships could become the most suitable platform to fill that resulting capability gap.

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Joseph Trevithick Avatar

Joseph Trevithick

Deputy Editor

Joseph has been a member of The War Zone team since early 2017. Prior to that, he was an Associate Editor at War Is Boring, and his byline has appeared in other publications, including Small Arms Review, Small Arms Defense Journal, Reuters, We Are the Mighty, and Task & Purpose.