Page 72 - JSOM Winter 2025

• Continuing current care. or nuclear reactors resulting in steam or scald injuries and
• Avoiding over resuscitation (goal UOP: 45mL/h (0.5mL/kg/h). boiler room explosions. Accidental collisions with other ships
• Titrating oxygen to >92% SpO , continuing to encourage or mishaps with the storage or transport of explosive ordi-
2
deep breathing position changes. nance can also result in major burn injuries. During periods
• Checking blood sugar. of relative peace, a naval warship is most at risk of major fire
while in port during scheduled maintenance periods as evi-
Recommended nursing care: denced by the loss of the USS Bonhomme Richard (LHD 6)
• Changing IV dressings if needed. If the IVs were not placed in 2020. 2,6,8,22 The true incidence of minor burn injuries is un-
under sterile conditions, they should be definitively re- known, but anecdotally, maritime caregivers manage them fre-
placed now (or sooner) because of the risk of superficial quently. One study of 196 extended submarine patrols from
thrombophlebitis. 1997 to 1998 identified 915 medical events and injuries, of
• Continuing daily wound care, debridement (if necessary), which 5.6% were categorized as burns. Most were relatively
and dressing changes. minor and occurred in food preparation areas, engine rooms,
• Maintaining the head of the bed elevated >30°. trash disposal areas, and other mechanical areas; 3.2% were
• Checking BP readings and pulses every hour or more fre- categorized as electrical injuries, typically occurring in engine
quently if needed. rooms and other mechanical areas. 7
• Flushing any unused IV line every 12 hours and checking
the IV sites. While infrequent, major burn injuries during routine opera-
• Performing urinary catheter care. tions are associated with high mortality when they occur. An
• Documenting strict I&Os to track the patient’s fluid status. analysis of all major mishaps on U.S. Navy surface warships
• Ensuring the patient is repositioned or ambulates every 2 between 1970 and 2020 found an overall decrease in the in-
hours. cidence of thermal injury over each decade of the 50-year
• Encouraging coughing and deep breathing hourly when study period. When comparing the first decade of the study
awake. (1970–1979) to the last (2010–2019) thermal injury rates de-
• Assisting the patient with oral/dental care. creased, specifically the incidence of fire-/burn-/smoke- (14.8
to 0.126 per 100,000 person-years), electric- (0.451 to 0.126
Recommendations to prepare the patient for MEDEVAC in- per 100,000 person-years) and explosion-related injuries (1.25
clude the following: to 0 per 100,000 person-years). Over 50 years, there were 103
• Making copies of all documentation and labs to send with fire, burn, or smoke inhalation injury events on surface ships
the En Route Care (ERC) team. and submarines resulting in 923 casualties, of whom 13%
• Providing the patient with eye and ear protection. died. There were 16 explosion events with 106 casualties, 27
• Dressing all wounds with silver-impregnated nylon. chemical exposure/inhalation injury events with 104 casual-
• Reinforcing all tubes and lines with sutures or staples. Use ties, and 32 electric injury casualties with mortality rates of
cotton ties around the head for NGT or endotracheal tubes 60.4%, 27.9%, and 90.6%, respectively. There was a more
6
(if patient has them). than two-fold higher mortality rate (19% vs. 8.3%, P<.5)
• Ensuring all fluids/medication bags are labeled. from all chemical-, fire-, and burn-related injuries on Role
• Labeling all lines with tape approximately 6 inches from the 1 (no surgical capability) surface ships (e.g., DDG) and sub-
IV site with medication or type of fluid infusing to the site. marines when compared to Role 2 (with surgical capability)
• Empty urinary catheter bag. ships. The reason for this mortality discrepancy is unclear, but
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• Considering administering 4mg IV ondansetron before the severity of thermal injury, available shipboard supplies and
flight. medical capability, and time/distance from a higher level of
• Checking blood sugar before the flight. care may all be factors.
• Re-dosing pain medication before the flight, anticipating
that pain will increase due to the stressors of flight. Burn Injury During Naval Warfare
• Reviewing the Medication Administration Record with the During naval warfare, the risk of burn injury on surface war-
ERC team. ships and submarines is significant. Most of what is known
about burn injury during war at sea relevant to modern com-
bat operations comes from the Allied experiences during
Discussion
World War II and the 10-week long war between the United
This maritime PCC scenario describes the management of a Kingdom and Argentina over the Falklands in 1982. Maritime
single patient with a 32% TBSA burn after an isolated mishap caregivers must be prepared to manage multiple patients with
on a DDG during DMOs. As there is currently no standardized severe burn-related injuries for both short and long periods,
PCC training curriculum for Role 1 maritime caregivers, this including burn shock resuscitation, inhalation injury, and con-
scenario was created as a training tool to demonstrate how JTS comitant traumatic injuries. While allied navies are performing
CPG–based burn care and resuscitation would be performed DMOs now to develop tactics and techniques for the poten-
during DMOs. This DDG-based clinical burn scenario identi- tial of future large-scale multi-domain combat operations,
fied several education, training, and supply gaps. What follows a missile attack on U.S. and allied naval vessels is a current
is a review of naval burn epidemiology followed by analysis of threat. At the time of this writing, open-source news outlets
these gaps that, if improved, may increase the survivability of have reported multiple drone missile targeting of allied war-
burn injury in austere maritime environments. ships and successful attacks of commercial vessels in the Red
Sea region. Burn injury was the second most common type
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Burn Injury During Routine Naval Operations of injury pattern (22%–26% of injuries) after penetrating in-
Common mechanisms of a major burn during routine naval juries in survivors of air and submarine attacks on U.S. Navy
operations include propulsion casualties from engines, boilers, vessels in World War II. The 1987 Exocet missile attack on

70 | JSOM Volume 25, Edition 4 / Winter 2025