Page 80 - JSOM Winter 2025

Medical Considerations in High-Risk Maritime Operations

A Narrative Review

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Fredrik Granholm, MD *; Michael Lauria, MD ;
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Jørgen Melau, PhD ; Derrick Tin, MBBS 4

ABSTRACT
Maritime operations conducted by military Special Operations to medical emergencies during these missions. Implementing
Forces and civilian special weapons and tactics (SWAT) units TCCC in the maritime domain differs significantly from its
present unique medical challenges. These missions often occur application in land-based operations. 1
in unpredictable environments, far from immediate medical re-
sources and with exposure to waterborne threats. This article Although official data on maritime operations in cold and
examines the medical aspects critical to maritime operations, Arctic conditions remain limited, recent events in the Baltic
including hypothermia management, trauma care in confined Sea underscore the growing significance of such missions. For
and moving spaces, management of drowning and respiratory instance, the re-occurring sabotage of critical energy and com-
issues, and specialized training for maritime- specific injuries. A munication infrastructure in the Baltic Sea last year highlights
narrative review of literature from 2005–2024 was conducted the rising prevalence of hybrid warfare in the context of on-
across major databases and grey sources, with studies included going great-power competition. The continued use of hybrid
by author consensus. The review identified core maritime tactics by Russia and China has heightened concerns regarding
medical challenges, hypothermia, drowning, confined-space the vulnerability of vital maritime assets and the cascading ef-
trauma, respiratory hazards, motion sickness, and impact inju- fects on civilian populations. 2
ries. Medical support tailored to these environments is essen-
tial for maintaining operational effectiveness and responder In response to these threats, part of Germany’s premier count-
safety. By examining both preventive and responsive medi- er-terrorism unit, GSG-9, will now be stationed in Neustadt,
cal approaches, this article highlights the need for maritime- a city in the coastal state of Schleswig-Holstein. This strategic
specific medical protocols and training. deployment aims to enhance the protection of critical infra-
structure and reflects Germany’s adaptation to emerging mar-
Keywords: maritime; tactical medicine; naval; prehospital; itime security challenges. 3
trauma; performance; counter terrorism medicine; SWAT;
SOF; Special Operations Objectives
This paper aims to serve as a foundational resource for clini-
cians, researchers, and police or military managers. It offers
insights into the fundamental aspects of tactical medicine in
Introduction
maritime environments and how they may affect a favorable
Special Operations Forces (SOF) and special weapons and outcome related to mission success and medical care. It also
tactics (SWAT) units are increasingly tasked with maritime seeks to provide a framework to guide future advancements in
missions involving high-stakes scenarios such as counter ter- both clinical practice and research.
rorism, hostage rescue, smuggling interdiction, anti-piracy op-
erations, and countering hybrid warfare activities like deep-sea Methods
sabotage. These operations expose personnel to demanding
environments that require not only exceptional tactical skills The narrative review methodology was chosen given the spar-
but also advanced medical readiness. sity of scientific research regarding this topic. The Medline
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(PubMed) and Google Scholar were searched on November 1,
Maritime missions pose unique hazards rarely encountered 2024, for English language articles from 2005-01-01 to 2024-
in land-based operations: motion sickness, drowning, decom- 11-01. Keywords used included “maritime,” “naval,” “naval
pression sickness, and the challenges of delivering trauma medicine,” “tactical medicine,” “TCCC,” “TECC,” “Special
care in confined and moving environments. Effective medical Forces,” “Special Operations Forces,” “SWAT,” “counter
management is crucial to safeguard the immediate and long- terrorism-medicine,” “trauma” and combinations of these key-
term well-being of Operators and to facilitate rapid responses words. In addition, on November 1, 2024, Google was used
*Correspondence to Sundsvall County Hospital, Sundsvall, Sweden or fredrik.granholm@rvn.se
1 Lt (Ret) Fredrik Granholm is a physician affiliated with the Department of Anesthesia and Intensive Care, Sundsvall County Hospital, Sundsvall,
Sweden. Capt Michael Lauria is affiliated with the United States Air Force Reserve, 624th Aeromedical Staging Squadron, Critical Care Air
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Transport Team, Oahu, HI, and is an assistant professor affiliated with the Department of Emergency Medicine, Sections of Critical Care and
EMS, University of Washington, Seattle, WA. CDR Jørgen Melau is a researcher affiliated with the Cold Weather Operations Medical Research
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Office, Joint Medical Services, Norwegian Armed Forces, Oslo, Norway. Dr. Derrick Tin is an Associate Professor of Critical Care Medicine
affiliated with the University of Melbourne and the Disaster Medicine Fellowship at BIDMC/ Harvard Medical School, Boston, MA.
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