Page 66 - JSOM Winter 2025

An Ongoing Series

Maritime Applications of
Prolonged Casualty Care Training Scenario

Burn Injury on a Destroyer During Distributed Maritime Operations

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Donald Adams, PhD, MPAS, PA-C ; Michael S. Tripp, MD ; Virginia H. Damin ;
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Jeffrey Chambers, NREMT-P ; Jermy J. Brower ; Jayson D. Aydelotte ;
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Jennifer M. Gurney ; Leopoldo C. Cancio ; Matthew D. Tadlock, MD *
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ABSTRACT
As the U.S. Navy further develops the concept of distributed Introduction
maritime operations (DMOs), where individual components
of the naval force will be more geographically dispersed, Throughout history Sailors and Marines embarked on naval
smaller vessels may be operating at a significant time and warships have been exposed to the risk of burn injury during
distance from more advanced medical capabilities. There- both naval warfare and routine operations. While this risk is
fore, Role 1 maritime caregivers will need to manage injured greatest during naval combat, deployed crewmembers have
and disease non-battle injury patients for prolonged periods suffered thermal injury from various types of ordnance during
during current and future contested DMOs. We developed attack or mishap, including equipment failure in mechanical
a hypothetical burn injury patient scenario to present an ship spaces, accidental collisions, high-pressure steam injury,
innovative approach to teaching complex operational med- electrical injury, toxic gas and smoke inhalation, chemical and
icine concepts including austere burn resuscitation, wound fuel burns, food preparation accidents, and jet blast injury
care, and Prolonged Casualty Care (PCC) to austere Role 1 during aircraft carrier flight deck operations. 1–8
maritime caregivers using the Joint Trauma System PCC and
Tactical Combat Casualty Care clinical practice guidelines This hypothetical scenario is based on real burn injuries that
(CPGs) and other standard references. The format includes have occurred on deployed naval vessels. It is part of an on-
basic epidemiology of burn injury in the operational maritime going educational series published in this journal, “Maritime
environment. The scenario includes a stem clinical vignette, Applications of Prolonged Casualty Care,” describing the man-
followed by expected clinical changes for the affected patient agement of critically ill or injured patients, using Joint Trauma
at specific time points (e.g., time 0, 1 hour, 2 hours, and 48 System (JTS) TCCC and Prolonged Casualty Care (PCC) clin-
hours) with expected interventions based on the PCC CPG, ical practice guidelines (CPGs), when evacuation to a higher
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appropriate guidelines, and available standard shipboard level of care is not possible. This scenario has two goals. First,
equipment. Through this process, opportunities to improve it is an educational tool or “road map” for isolated Role 1 mar-
both training, clinical skills sustainment, and standard ship- itime caregivers, such as Independent Duty Corpsman (IDC),
board medical supplies are identified. describing how a patient with severe burn injury should be man-
aged in an austere shipboard environment over the course of 86
hours using JTS CPGs. If a specific decision or intervention is
Keywords: Prolonged Casualty Care; Tactical Combat Casualty
Care; maritime military; critical care; burn injury; burn not addressed by these guidelines, appropriate interventions are
resuscitation recommended based on expert consensus and literature review.
A secondary goal of this scenario is to function as a clinical ta-
bletop exercise to identify capability, training, and supply gaps
*Correspondence to Matthew D. Tadlock, Department of Surgery, Navy Medical Readiness and Training Center, San Diego, 34800 Bob Wilson
Dr., San Diego, CA 92134 or matthewtadlockmd@gmail.com
1 Dr. Donald Adams is affiliated with Translational Health Science, George Washington University School of Medicine and Health Sciences,
Washington, DC. CAPT (Ret.) Michael S. Tripp is affiliated with Chest Medicine and Critical Care Medical Group, San Diego, CA. CAPT
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Virginia H. Damin is affiliated with Naval Medicine Readiness and Training Command, Guam. Jeffrey Chambers and HMCM Jermy J. Brower
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are affiliated with U.S. 3rd Fleet, San Diego, CA. Jayson D. Aydelotte is affiliated with the Department of Surgery and Perioperative Care, Dell
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Medical School, University of Texas at Austin, TX. COL Jennifer M. Gurney is affiliated with the Defense Committees on Trauma, Joint Trauma

System, JBSA Fort Sam Houston, San Antonio, TX. COL (Ret.) Leopoldo C. Cancio is affiliated with the US Army Institute of Surgical Research,
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Fort Sam Houston, San Antonio, TX. CAPT Matthew D. Tadlock is affiliated with Uniformed Services University, Department of Surgery, Naval
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Medicine Readiness and Training Command, and Surface Medical Group Pacific, San Diego, CA.
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