ABSTRACT Introduction Current U.S. hospital ships—USNS Mercy and Comfort—are old, slow, cumbersome, and indefensible, and due for retirement. As new challenges and new threats emerge in the 21st century, the U.S. Navy should field new afloat medical platforms to potentially deal with both mass casualty scenarios and humanitarian disaster relief in a rapid and tactical manner. New hospital ships should be able to defend themselves with more modern weapons and to be interconnected with encrypted communications. They must be fast, nimble, tactical, defensible, and forward deployed in the risky global commons of the 21st century. Materials and Methods Systematic review of the literature on hospital ships, U.S. Navy policy, the Geneva Conventions, and current global threat conditions. Results Hospital ships provide medical support for U.S. forces in conflict and promote goodwill and a positive image of the U.S. abroad. Current hospital ships do not fit the operational paradigm of the current needs for forward deployed and rapidly deliverable operational medicine. There is a need for a new and more capable platform to deliver operational health care in the forward deployed setting. Conclusions Multiple high-speed medical response vessels—whether reconfigured from an existing ship, or an entirely new platform developed for more robust medical delivery—need to be urgently fielded for future combat operations, humanitarian missions, and participation in cooperative security engagements. These medical platforms need to be able to defend themselves and be tactically interconnected with the Fleet and Fleet Forces.