It has emerged that RFA Argus, a ‘Primary Casualty Receiving Ship’ of the Royal Fleet Auxiliary, could be converted into a ‘Littoral Strike Ship’.

The information came to light during a recent evidence-gathering session held by the Defence Committee.

Defence Secretary Ben Wallace said:

“Your question about why Argus is absolutely correct, because, right now, there is a debate within the Navy about what ships should provide the littoral strike group north and south support until we get to the end of the decade when we will be replacing Albion and Bulwark. That is a live, unresolved debate by the Navy. Two years ago, it was of the view that it would convert a Bay class to give it a better capability to store helicopters. That has currently changed and I am expecting a proposal, although it has not been signed off, that RFA Argus may fulfil that function.”

Littoral Strike Ship?

Originally, a Bay class vessel was to be converted to deliver greater littoral strike capabilities at a cost of £40 million. The Defence Command Paper released last year, titled ‘Defence in a Competitive Age‘, stated:

“The Royal Navy will invest £40m more over the next four years to develop our Future Commando Force as part of the transformation of our amphibious forces, as well as more than £50m in converting a Bay class support ship to deliver a more agile and lethal littoral strike capability.

Is Argus feasible in this role?

For more on the history of this project, I recommend following the link below from the excellent as always NavyLookout.

George Allison
George Allison
George has a degree in Cyber Security from Glasgow Caledonian University and has a keen interest in naval and cyber security matters and has appeared on national radio and television to discuss current events. George is on Twitter at @geoallison
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78 COMMENTS

  1. What? More flannel. A decision should have been made by now and orders on the books. Argus is old and will have difficulty meeting modern marine safety standards. The Bays are in such high demand the Navy can ill afford to lose one. Albion and Bulwark are slated to be replaced by 2030. It’s time to stop dithering.

    • To be fair Mark, it’s a good interim option, if it isn’t of course not just more fiddling while Rome burns and no action.

      Argus might be old, but shes a lot like Triggers broom!

      • I like the Trigger’s broom analogy.

        It seems a pity that a good idea, or move forward, the LSG, is being watered down with the use of aged vessels, bodges and refits.

  2. Not sure of the wisdom of re-roling and refitting an elderly ship. Its remaining life span will be limited despite the expense.

    To me it would seem better spending the money on a new ship offering several decades of service.

        • As they have all decided (except Rishi) that tax cuts are the way to keep the conservatives in power with the general public id be shocked if the MOD gets anymore money than budgeted anytime in the near future.

          • In fairness to Rishi I think he is probably the most candid and competent candidate. His charisma and mastery of current economic systems could be enough to convince people to vote Tory at the next election. The problem is that the current economic systems themselves are the cause of the problem. They have had a good run for their money for the last 70 years but in a world that’s overheating and running out of energy, food and water ( and soon probably lithium and copper) newer economic models are needed: I’m about to research Mariana Mazzucato and Kate Raworth.
            I don’t see an increase in numbers. I do see money being spent sensibly.

          • That tax cuts thing just looked like blatant electoneering to me; there’s no feasible way to cut taxes and pay for what we need at the moment- not while the economy is still in recovery. Rishi was the only one who was realistic in what he was promising, which was refreshing.
            Yes, I know there’s an argument for cutting taxes to boost investment and all that, but we don’t have all of the bits in place for that to really work yet; no international firms are going to be looking to establish serious footprint here, regardless of tax rate, until we have a few more post-Brexit deals under our belt and they have a level of certainty about what future trade arrangements will be like. Once we have all our ducks in a row, sure, cut some taxes if we can afford it. But we already have one of the lower tax rates outside of the tax havens, when everthing is totted up. Or at least we did last time I checked.

          • BW has already pulled out. He is much too genuine a guy for that level of politics and I think he knows it. The grass roots members’ favourite is Penny Mordaunt. That would work.

          • Such a shame Paul ,as Ben would have ensured the military covenant would be enshrined and lilly liberals like the BBC would not create programmes like Tuesday nights Panorama

          • Fingers crossed, PM4PM 🙂
            I don’t do Panorama so can’t comment. To be honest I am considering cancelling my TV licence.

          • Let the SAS clean sweep the BBC if they’ve gone native whilst out in Afghanistan as we’ve been lead too believe by Panorama, then they the right people too dot the Is and cross the Ts when it comes too cleaning up the Beeb and we then would not have to pay some Irish nationals or ex footballers over the top wages for for drivel

          • I tend not to take everything in the media at face value these days. If anything did happen I trust the army to deal with it properly.

  4. This would be a spectacularly bad shout.
    1) We’d loose the Role 3 aboard Argus, no way she can continue to operate with a permanent onboard medical facility and be a LSS, the refit wouldn’t acommodate both.
    2) Lets face it Argus is bloody old.
    3) Surely it would cost just as much to just convert a new merchantman?

    The only advantage is her big flight deck… but I mean that can be achieved easily enough from other ships.

    • I read this with a high degree of disbelief and scratching my head as to wether I was imagining things.

      Argus was very solidly built but must be reaching the end game of various elements. Whilst, I am sure, she passes class rules and currently works well enough starting to cut her about is almost bound to end in tears a various issues will rear their heads.

      The other issue is taking a ship of that age out of commission and having all the systems down for that long is also bound to create a lot of recommissioning issues.

      Best left well enough alone.

      • She has been extended in service recently, and has just come out of a decent refit, but the disbelief for me would be the loss of the only R3 afloat in the UK. That’s not a capability we should divest ourselves from lightly (even if I obviously think an RAMC land R3 is better 😉 )

    • Old and increasingly costly to keep at sea. Cumulative effects of the sea on the hull alone must be an issue by now. I’m not a maritime engineer so I might be talking rubbish.

        • I do know that critical medical care very quickly after injury can be pivotal in terms of long term recovery. So perhaps you are right.

        • it was mooted in engineering circles that the type 42’s went too early, despite the ages of the hulls means of retoring the entire hull was entirely feasable option. which wouldn’t neccissarily cost as much as yu’d imagine, but the admiralty, was still fixated on finding ways to fund the t45, the issue never reached anybody willing to look or consider it. t22’s were sold before they were run in. my son was on the trafalgar ssn when it was withdrawn from service. everyone from the captain down to the dock yard cat knew there was still a good five years service left in her, but as usual the MOD went for the vastly overpriced, overhyped, astute class,ark royal, was retired 5 years before her sell by date and her aircraft were given away to the aericans for £16 million each.losing the R.N its fixed wing capability for ten long years. we’ve reduced the navy’s size with gross incompetence. when it needent have been.£1 billion submarines when up to a dozen conventional submarines could have been bought for less isn’t just incompetent its borderline criminal its certainly reckless,

          • Agree with you ,Andy was Drafted to Dolphin in 88 whilst the P and O boats were reaching the end of the Hull integratie lifespan and the Lads were all looking fwd too being on the new ssk Upholder class what a waste the MOD let’s all go ssn and ditch ssk so all those lads had too mostly retrain for Nukes the upholders didn’t even do 10yrs now Navies are again looking at diesel electrics

          • The story of the upholder were a total disaster with 4 boats making 4years In service the proposed 12 boats together would have been a close thing between them and 1astute is unbelievable. And to see that all4t went to Canada are still in service just emphasis the cross incompetence of all involved in the whole fiasco head’s should have rolled,but they weren’t the same amateurish thoughts still exist and can be still one of the reasons that the RN is so small.

          • Cheers Andy it was upsetting for the diesel boys and too cap it all with the loss of the P and O boats and the demise of the Upholders the MOD saw no future use of HMS Dolphin renamed Fort Blockhouse not even the Harbour entrance Saluting Guns were spared top camp and SETT remain along with HMS Allience , and the final blow was RNH Haslar was deemed
            surplus too requirements poor old Turk Town

    • My point exactly, what are they thinking of, it makes no sense at all which is probably the intention. Argus has done a splendid job and if she is to stay in the fleet she should stay as a primary casualty relieving ship. Drawback for Argus is it will be very very expensive to keep her current to future maritime standards.
      If the Navy has the budget earmarked for these replacement ships, Then all I can say is get on with it.

  5. We would be better off taking a leaf out of the Iranian’s book and convert an oil tanker lets face it £40 mil spent on a relatively new vessel taken up from trade would go a long way but to take RFA Argus out of her present role/s and convert her you would not get too long out of her before you will be spending serious amounts of money just keeping her active also which vessel is going to be used as a casualty evacuation/fleet air support.

    • If you are going to convert a tanker, there are a couple of Wave class sitting doing nothing. It would be expensive though. Possibly a new build might be cheaper.

      If you want something old already kitted for helicopter support, I wonder if anyone’s put in a bid for Garibaldi yet?

      • Oooof can you imagine the reaction from Mail readers if it turned out the RN was using a second hand Italian ship?

      • There are a number of new tankers tied up due to the lack of investment in the oil industry, The Wave class are also getting on a bit and the RFA needs every vessel it can get as they are particularly thin on the ground. As for buying foriegn we had a good chance when the French were selling off the hulls they built for the Russians but we let them go the Algeria.

    • Tankers are not a bad shout, most are double skinned, plenty of deck and storage. Purchase price of 10-15m USD for a similar size to Argus, more likely the higher end to get something newer. Other alternative is Offshore support vessels but these tend to be smaller but larger vessels are out there. Also need to be non Chinese built.

  6. It wouldn’t take much or long to convert Argos to a basic LSS able to embark a “strike company” of RM’s plus a few helos. The essentials are already there, it would be a case of adapting some of the compartments currently used by the medical facility; upgrading the aviation facilities to maintain Marlin’s and Wildcat’s, improve the C3I fit, adding DS30M light cannon or Phalanx CIWS mounts, and replacing the lifeboats with davits/cranes for LCVPs and raiding craft. Not ideal, but potentially a cheap, short-term, quick fix.

    The loss of the PCRS capability is bad news, but maybe there would be a bit of change from £40M which could be put towards chartering a civilian hospital ship.

  7. As a ‘medical’ vessel, she’s low priority on any adversary’s targeting list. However, once it becomes a strike loaded vessel, she’s going to move up exponentially on the first hit items. Unless she’s able to defend herself (detection suite, massed missile intercepts), all the strike capability would be for naught if she’s sitting at the bottom.

    • Argus has arguably been the RN/RFA’s best value ship of the last 50 years, closely followed by the Bay’s – even though those cost a lot more than originally contracted. The later T23’s were also a bargain – a top of the range frigate for about £100m in 2000 money! It shows the advantage of a long production run.

  9. Losing the role 3 maritime medical medical treatment facility would be a massive loss of capability that will be very costly to replace and one ship cannot be everything so I cannot see it being able to maintain its role 3 function as well as act as a key amphibious ship.

    There seems to be a lot of chopping and changing as only last week it was reported they would keep Argus going into the 2030s until they could replace its role 3 functions.

    if they are happy with a cut up and repurposed merchant hull, just pick up a newish couple of hulls and convert them as it’s going to a very long time before we get all the new amphibious hulls.

    • Ben Wallace told the Defence Select Committee that the RN needs to make up its mind on Argus (although he kept saying Argos), Bays or Albions for this conversion. It was very much directed at the officers sat either side of him. Nothing has been decided. I imagine they don’t really want to convert any of them and are perhaps waiting for a possible uplift following the Tory party leadership contest.

      • Manning is the issue. Albion and Bulwark are manpower intensive. So we go down the route of new hulls. Competition, cancel Competition, tender, slow build.

    • Argus might not be able to support the numbers of patients it can now, but it doesn’t mean it has to give up its Role 3 capability in a MRSS conversion. Arguably if you want that capability anywhere then you want it in multiples in your MRSS fleet in support of amphibious operations, not just one ship.

      It wouldn’t surprise me if the plan isn’t to leverage the Army’s Role 3 modular approach philosophy for the MRSS. So any MRSS might then be capable of hosting a Role 3 facility.
      https://marshall-landsystems.com/insights-news/uk-mod-purchases-deployable-hospital-system-from-marshall

      • Hi Glass there a a couple of what I consider insurmountable issues with mixing and matching role 3 with other core amphibious functions ( now my expertise is designing, managing and derisking emergency care pathways so I’m only able to really speak about one end of that balancing act). but:

        1) I don’t see how you could ever fit an active role 3 and amphibious assault function on the same ship unless it’s the size of an Elizabeth. You are talking a lot of people 200-300 to staff a role 3 as well as 100 patients. By the nature of role there and emergency care pathways you need everything clear and fully functioning. If your in the middle of an amphibious operation and you end up having patients on the role three emergency pathway they are going to clash and one or the other will give ( you end up with a preventably dead casualty or you compromise your operation).

        2) you cannot just assemble a role three out of defused parts…you need to have everything ready and practiced to set up role three and it takes a lot of space, so if you were having role three ready on each MRSS you are basically taking a third of the ship out of commission, you cannot just chop and change the functions, the theatres, diagnostics, labs, wards and rehab centres all need to be in place and keep ready to run.you also need a staff to keep them maintained and functional ( you cannot mothball something as complex as a role three facility) .you cannot use them for other things and you cannot just add them to a ship as you want to activate them.

        3) staff your staff need to practice in their environment to ensure all the pathways work, all individual teams work and they the. need to be a functional cohesive whole across the emergency care pathway…from the immediate care team/casualty evac team to ED team to diagnosis team the anaesthetic team, to theatre team onward to recovery team, ward team ( more diagnostics as well) then onto rehab team. You can think of an emergency care pathway very much like and ultra complex kill chain ( or life chain in this case) any bit that is not fully aligned with every other and practiced will kill or harm the casualty.

        The army don’t have a modular approach to role three ( they do for role 2) what they do is have a single complete role three unit ready to go, that has everything ready In one place and deploys as a single unit. It’s also a massive undertaking to deploy the role 3 and their preferred option is within the structure of an already set up base structure.

        There is actually a whole academic paper on how to set up an army role three casualty receiving centre which I will send a link for ( it’s really interesting).

        But all in all in my view it’s not possible to mix something as complex as a role 3 facility and all its pathways into a ship that is also undertake amphibious opps ( you could do this for role 2 but not role 3). I also don’t see how (without spaffing a ton of money and compromising their function) you put the required infrastructure (and maintain its readiness) for role 3 in all the MRSS. It’s just more sensible to have a role 3 casualty receiving ship ( to be honest you could just remove the self defence weapons and have a role 3/hospital ship and paint it white) , that’s the cheapest way to have an afloat role 3.

        • Hi Jonathan, thanks for detailed response. A few thoughts …

          Ref point 1.
          Is a Role 3 defined by headcount of staff and patients or by capabilities? It seems a number of the staff would scale with the number of beds supported, so it doesn’t have to be the size of of the Argus current capability?

          Also the term amphibious ops means different things to different folks. Some still imagine it to be storming up a beach in an opposed landing, D-Day type op, which is never going to happen, not even by the USMC; whereas the UK littoral strike concept seems to be a much smaller and much lighter force, based around a single MRSS, at least as the norm.

          Those two littoral strike groups are going to be geographically a long way apart though, so what happens if both need comprehensive medical support if we only have one casualty receiving/hospital ship? If we are involved in a larger operation with multiple MRSSs at a single location then one Role 3 ship could be largely dedicated to casualty receiving, while the others are focused on the amphibious ops.

          Ref point 2. The new Army Role 3 I linked to is designed to be a scalable, modular, self supporting facility. It doesn’t mean that the Role 3 capability as practiced is constantly being changed with different modules being put together and taken apart like LEGO. Similar modularity in the RN doesn’t mean we need to keep moving it about between ships, or that all MRSS will have a Role 3 capability. It would only be likely to change or move when a ship goes into longer maintenance or refits. It does mean that any one of up to six ships might be a host for a Role 3 though if necessary.

          Your comment wrt the Army’s Role 3 doesn’t seem to take into account the capability they purchased from Marshall? I am sure the Army would prefer to deploy a full Role 3 capability into a base structure but that isn’t always possible or practical, hence the Marshall modular facility. Would they choose to deploy only parts of the Role 3 system? Maybe, maybe not, but at least with the Marshall system they have the option to do so if it makes sense. The RN might not need or want an ability to scale up and down, although the dis-aggregation comment suggests its at least being entertained. Regardless, having the facility be constructed from modules makes it easier to move from ship to ship, or even potentially host outside a ship if required.

          Lastly, just to reiterate, I’m not suggesting every MRSS have a Role 3 facility. But with up to six MRSS planned, we might have say two supporting that capability. We’re never going to have the budget for a dedicated hospital ship. Even the US seems to be struggling to justify the two it has now.

          As a general comment, IMV the UK’s armed services have to be prepared to be much more flexible for the future across all their platforms and equipment. The last 30 years show that we are very bad at forecasting what types of military adventures we may get involved in. Getting equipment that is inflexible and too focused, based on erroneous estimates of future requirements, leaving capability gaps elsewhere, can cost lives and limbs. I see that philosophy for flexibility extending to medical capabilities and to the MRSS too, versus the current amphibious fleet.

          • Hi glass, one thing that’s interesting is with role three most of the resources, space and staff requirements are not really related to the bed base. If you think bastion as a role three would have around ten consultant level surgeons + ED consultants all the diagnostics, ED and surgical teams and recovery ITU teams,these would stilll be the same if the bed base was just 10 ITU beds or added on an extra 90 general beds ( you would only need a nursing establishment to support those extra Basic hospital beds ( or bunks) at around 1 nurse + care assistant per 8 beds) so all most all the resources are focused in areas other than beds, essentially most of the the extra beds are not really role three instead they are for role 2 ( as all role 3 facilities are also role 2j and for the casualties that will be staying in theatre ( war not operating) all actual role three casualty are medically evacuated home within a day or two ( the RAF medical evacuation team are some of the best in the world….well according to one of my team members who was the senior officer responsible for Setting up the service in Afghanistan so maybe bias).

            so all in all reducing the bed base would not really much reduce the foot print or staffing needs of a role 3.

            The problems I could see around mixing amphibious ops and role 3 are around the the air ops and just general level of busy. Moving a casualty from a rotor to definitive care is a very hairy thing even if you well practiced and have very clear, ways add in a busy amphibious deck and lots of marines and kit, I could see some risky interactions, when taking an trauma case from a rotor the first thing you have to do before anything is is make sure the run back is clear…lots of people and stuff can be a problem.

            Its interesting you discussed the Marshal kit, it was my understand that was specifically if you were looking to set up a medical unit in an nuclear, chemical or biology non permissive environment. I would have to check but I’m not sure if it’s role 2 or 3 as the operational patient care pathway does specifically state role 3s are not to be place in non permissive environment ( so the marshal kit may be for high risk role twos. Brilliant kit but very expensive and specialist, so would not be deployed for most deployments I would think ?

            There is obviously a question do you need a marine role 3…and for that you need to decide the risk of your having to fight without an in range permissive environment in which you could set up an army role 3 ( a role 2 should be within two hours of a role 3 and cannot be without role 3 access).

            i suspect we will get one MRSS that is set up as role three and therefore is used more in the same way as Argus…..but you never no with the MOD and tec may change in 20 years ( tele med did not exist when I started practice now we diagnos STEMIs over the phone and internet.

          • Thanks for the explanation regarding Role 3 headcount.

            Its interesting that it seems militaries are seeking more flexibility in how they put together combat medical facilities and capabilities for the ability to perform split or geographically dispersed operations. To your point perhaps the default for MRSS becomes Role 2 and then the RN are going to have to develop, perfect and practice an ability to scale that to Role 3. This US Army article seems to be discussing this – https://www.army.mil/article/210113/army_field_hospitals_and_expeditionary_hospitalization

          • Hi glass, yes role 2 is probably within easy reach of having it on each MRSS. Then you just need to be within 2 hours rotor transfer of a role 3.

          • Cheers really interesting, I was not aware the marshal system was a role 3. Having an Bio/Chem permissive role three is really a stunning capability. The fact they have added 4 extra ITU beds so they can stay sealed up for longer is pretty significant.

          • great concept but i tried counting the number of TEU i think over 200!! that would mean in total with vehicles to move that an entire Point class load? which means you must already have large secure landing area before you can deploy Role 3 hospital. Would rather have afloat capabilty for intial phase of Operation before then deploying land role 3, ship can then be used to repatriate injured.

          • Hi Steve, yes the role 3 hospitals are essentially very large endeavours, your not put an army role three into anyplace other than permissive area after a lot of planning and preparing has taken place and your talking a long term deployment, your not up and moving it. But and this is the key question are we ever going to war somewhere 2 hours rotor trip from friendly soil in which we can set up a role three facility, the only conflict I can think of since WW2 in which an afloat role 3 type capability would have been the falklands.

            Personally I think keeping an afloat role 3 is really important as it’s one of the capabilities your not ever going to regenerate in a hurry if you need it.

      • Hi Glass as promised some interesting reading around military Emergency care pathways.

        First is a really interesting short article on the emergency care pathway at the U.K. lead Baston site. It looks at mortality, but the key take out is the level of preparation to develop this role three site as well as the complexity of pathways ( the team was multinational but developed as a team in the U.K. before deployment.

        “MILITARY MEDICINE, 179, 11:1258, 2014
        Trauma Care at a Multinational United Kingdom-Led Role 3 Combat Hospital: Resuscitation Outcomes From a Multidisciplinary Approach”

        The second is an old but good paper on the design of field hospitals from a role 2 facility to a role 3 facility. It’s just interesting as it gives an idea the the complexity of just the infrastructure needed for role 3 without any care pathways or staffing/competence.

        https://pure.southwales.ac.uk/ws/portalfiles/portal/987147/2_7_Organisation_design.pdf

        The last is the operational care pathway, it’s well worth a read for anyone in the military or who has an interest in care pathways. It looks at the whole set of pathways from role one, two, three and four ( mainly NHS provided now).

        https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/377801/20140806-JSP_950_Ed_2_Operational_Patient_Care_Pathway.pdf

    • I’ve had a short sojurn in West Cumberland Infirmary. The A&E doctor spent 5 minutes after diagnosis and it came to light he’d served in LI and RAMC – I told him about the disaggregated PCR and his reply was….

      “HTF do you do that?”

      And I think he knows much more about these things, than do I.

  10. I nearly fell off my chair reading this.
    How about not taking out the only level 3 hospital ship the navy have that also can undertake aviation support.
    Get a newer ship from trade and modify that. Argus is a ship from trade after all.
    I’m not sure what they are trying to do with these littoral ships. Either you have a military spec ship with aviation facilities and a dock or you have a commercial ship modified with aviation facilities and what ever else you need.
    Using a bay or Argus is stupid. Bays are in demand. One in the gulf leaves 2 for everything else. Taking one for LSS still leaves north or south without an LSS ship!
    Get 2 commercial hulls either newish or built for purpose. Fit out in the uk if that’s what they want to do.
    Or build 2 military spec hulls built to what you require.
    I would suggest having a 3rd to cover refits but that kind of thinking is too sensible.

    • The RN doesn’t want to give up a Bay to the LSS role, whilst £40M is not enough to buy and convert a merchant ship. Assuming no more money can be found, it looks like the adaption of Argus has been deemed the least worst option. After all, since being converted to a PCRS in 2007, Argus has never been fully used in that role – although her medical facilities have proven useful on several occasions.

      • Richard beedall? Is that the same that had a website that had great info about the navy some years back? Or is it coincidence with names?
        It’s a silly situation as the conversation must of went:
        We want to set up a marine north and south group to rapidly respond from a ship in these areas.
        Reply: yes we can do that but we will need 2 new ships and some equipment to do these roles.
        Response: how about no ships and I give £40m to chop up a current ship

  13. With a new PM taking office soon, and the statement of the leading candidates to cut taxes and reduce Dept spending, I wouldn’t be holding my breath at this stage!

        • Apologies – all the candidates with a chance of winning want to raise it. Or at least claim to

        • Agreed. He is the last of that lot I would want as PM. He’s already been in the bad books for tax issues with his billionaire wife, and would be seen as just another Tory toff.

          On defence, the uplifted budget he only wanted for 1 or 2 years, not the longer term settlement that BJ pressed him on. To me this says he knows sod all on defence as we know programmes take many years and need long term funding, not knee jerks on a whim.

          Mordaunt or Hunt for me please, preferably M!

          • It seems as though Sunak has the most votes among Tory MPs but Mordaunt has the popular vote from members. Fingers crossed she gets to the last 2!

  14. So the original OSDs for Bulwark and Albion was the early 2030s, but as they have been rotated in and out of extended storage, surely they will have done less mileage and could actually go on until 2040 if needed: which they might be as we have 3 FSSS, Argus replacement and then 3 Bay replacements which probably are needed first.

    I’m not convinced that one ship design could replace both Auxilaries (Argus and Bays) and actual warships (Bulwark and Albion) as warships need to have damage control etc and significantly more people to operate them…

  15. A primary cas. ship
    2 LPDs
    3 Bays

    Can one hull undertake all roles given the LPDs lacked hangars?

    And also what of the raiding role? Why are people emphasising the crush loads for troop carrying when the Cde are never going to deploy as a Bde again and possibly not as a Bn?

    Questions, questions?

    What number of casevacs could Bastion handle? What was the most handled? What number went through intensive care at a peak?

    Do we need a Bay capability? Estonia suggests, yes.

    But do we need the full potential of the LPDs and Argos?

    I’ve no idea. Look forward to your thoughts.

    Personally, I think we need 3 LHP with PCR modules deployed as needed and an ability to host a TF Commander and their staff.

    • Hi David, with role three medical facility you either have it or you don’t, it’s a massive investment as what most people don’t understand is role three is the definitive care setting for a lot of specialities needed for a casualty, that means they have more resources and teams to bring to a casualty that your average district general hospital and are equivalent to a major tertiary centre like the big London hospitals.

      Its not actually great numbers that need the full resources of a role 3 centre, but the casualties that do are in a mess and need massive levels of interventions, skills and time to stop them dying.If you took the cohort of casualties that needed massive blood transfusion at baston was just over 4% studies in civilian truama centres had mortality rates for patients with massive transfusions at 15-75% averaging 34%…so you can see what a role 3 is and brings from that.

      so with bastion I would read:

      MILITARY MEDICINE, 179, 11:1258, 2014
      Trauma Care at a Multinational United Kingdom-Led Role 3 Combat Hospital: Resuscitation Outcomes From a Multidisciplinary Approach.

      Basic findings of study: From November 1, 2009 to September 30, 2011, there were 3483 military trauma admissions. Common mechanisms of injury were improvised explosive devices (48%), followed by gunshot wounds (29%). Most patients (83.1%) had an Injury Severity Score (ISS) <15. For patients with complete ISS data, 8.4% had massive transfusion and 6.1% had an initial base deficit >5. Patients admitted with signs of life had a died of wounds rate of 1.8% with an average 1.2 day hospital stay. The mortality rate for patients undergoing massive transfusion was 4.8%, and for patients with a base deficit >5, mortality was 12.3%. Severely injured patients (ISS > 24) had a mortality rate of 16.5%.

      so that’s only about 1500 patients a year, but each of those was a major trauma case which would need all the trauma and emergency surgery capability of any normal district general hospital, I would say a mid size NHS hospital would not be able to manager more than 2 such trauma cases in one go and each case would be taking many hours of trauma and surgical care ( I’ve been on 8 hour long trauma calls, but that included removal of a spleen in my ED resus room which you normally never do….surgery in ED is a do or die event)

      The study of the bastion trauma pathways and shows exactly what a role 3 brings above and beyond a standard role 2 and what difference it makes to saving lives

      Role 2 is general surgery and Trauma care( ED, consultant, diagnostics, general surgeon and orthopaedic surgery) this is what you would get in your average DGH, role 3 is what you get in a major trauma centre in a large city hospital.

      • Heavens.

        @George_Allison

        Some people deserve promotion for their pure unstintinting devotion to duty.

        Might I suggest we have someone amongst us who should be recognised for their duty.

        I can second it as you have the details.

        Anyone else out there on UKDJ who’ll write in support?

        • Agree David. I would.

          J posts some impressive, for me jaw dropping stuff, and I always listen to what he has to say.

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