Page 82 - JSOM Winter 2025

and hemoptysis with pink, frothy sputum, along with possible Provision of care in PCC and the maritime setting presents
hypoxemia. Physical exams may reveal crackles or wheezing. a number of challenges. First, these environments engender
SIPE symptoms usually improve within 24 to 48 hours with unique clinical logistics. Providing care to critically injured
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removal from the water, supplemental oxygen, and warmth. personnel for many days is simply not feasible out of a single
Early recognition of SIPE and prompt medical intervention are light assault backpack carried by a medic. Additional equip-
crucial for optimizing patient outcomes in high-risk training ment and medications may need to be initially delivered or
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environments. SOF medics are trained to identify and manage possibly restocked. It may even be necessary for operators
waterborne respiratory issues and chemical exposures using to take on additional equipment in their individual first aid
oxygen therapy, bronchodilators, and advanced airway inter- kits to offset the possible need of more medical equipment on
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ventions, including intubation in severe cases. board the vessel. Also, PCC requires initial and continuing
training that is typically beyond the scope of TCCC or other
Motion Sickness tactical medical training. This might include unique planning
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Motion sickness can impair operators’ concentration, coordi- and logistics for prolonged field care, special techniques or in-
nation, and situational awareness, significantly reducing their terventions, and medical knowledge that highlights the needs
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effectiveness in a mission. Medics must anticipate and man- of critically injured personnel hours and even days beyond
age motion sickness, especially in operators who may not have initial injury to reduce mortality and morbidity. 35,36 Consid-
prior maritime experience. Prevention strategies include be- eration of sustainment training is also important since these
havioral interventions, and medications such as scopolamine skills are less frequently utilized. Robust recommendations for
or meclizine. 24,25 It is important to understand that some medi- PCC skills sustainment are not available, but medics and op-
cations may have side effects related to alertness, sensitivity to erational leaders should recognize and make accommodations
light, and dry eyes. for this additional training.
Slamming Induced Impact Practical exercises in maritime settings simulate real-world
Slamming-induced impact refers to repetitive, high-magnitude operational conditions, enabling medics to adapt their proto-
vertical forces transmitted to the body when a high-speed boat cols to the unique demands of waterborne missions. In con-
hull strikes the water surface, primarily causing chronic muscu- trast, SWAT medic training for maritime environments shows
loskeletal and neurological strain over time. In contrast, blunt greater variability, with some teams achieving SOF-equivalent
force trauma results from a single, direct impact with a blunt proficiency while others possess more basic skills. Medical kits
object or surface, leading to acute injuries like fractures, con- for maritime operations are designed with compact, water-
tusions, or internal damage. Operators of professional high- proof packaging and sometimes corrosion-resistant materials.
speed boats frequently experience severe acute and chronic They include essential items such as hypothermia blankets,
injuries resulting from slamming-induced hull impacts. Pro- portable oxygen units, hemorrhage control supplies, and air-
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longed exposure to these impacts has also been linked to long- way management tools. The medical kits must also include res-
term neurological and cognitive impairments. 26,27 piratory support devices such as nebulizers, and continuous
positive airway pressure (CPAP) equipment for prompt treat-
Repeated mechanical shock impacts during high-speed boat ment of conditions like SIPE.
transits have been shown to significantly reduce physical per-
formance, including diminished running capability and de- During real-world operations, medical evacuation (MEDEVAC)
creased jump height and power. These impairments can hinder to a higher level of care for definitive management of inju-
operational effectiveness, especially during high-intensity tasks ries is a priority. However, the maritime environment presents
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like opposed ship boarding in rough sea conditions. Research unique challenges not encountered on land. Many vessels do
demonstrates that the use of suspension seats leads to superior not have a dedicated landing area for helicopters. This means
operator performance compared to transits without suspen- MEDEVAC platforms need to have equipment and person-
sion seating. 29 nel capable of hoisting patients; which, in and of itself, may
be difficult to accomplish on a mobile maritime vessel that
Medical Training and Protocols for Maritime Operations may have towers, wires, or other obstructions in close prox-
SOF medics undergo extensive training for maritime opera- imity to the aircraft. Furthermore, rotor wing MEDEVAC
tions, focusing on water-specific emergencies and medical pro- may not be possible at certain distances offshore given the
tocols designed for oceanic and riverine environments. Their range and performance characteristics of different airframes.
training encompasses advanced resuscitation techniques, hy- Some airframes can perform aerial refueling which may ex-
pothermia management, protocols for drowning and airway tend their operational distance, but significant planning and
obstruction, trauma care in confined spaces, and assessment of coordination are required, as well as recognition of added
environmental hazards. 30 risk. 37,38
In addition to training for maritime-specific pathologies and Hybrid Warfare
advanced resuscitative techniques, medics must also prepare to Hybrid warfare poses an increasingly multimodal threat to all
administer austere emergency and critical care for prolonged sectors of society, with SOF and SWAT units likely to play a
periods of time without medical evacuation. This prolonged strategic role in mitigating its impacts both on land and in mar-
casualty care (PCC) is medical care provided in the prehospital itime environments. Hybrid warfare is often characterized as
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environment that occurs beyond conventional and contempo- a blend of conventional warfare, irregular tactics, terrorism,
rary doctrinal time frames. In the maritime tactical environ- and criminal activity, leveraging nonconventional modalities,
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ment, it is entirely possible that teams may be geographically such as drone technology, cyberattacks, and chemical, biolog-
isolated, operating great distances from shore and out of range ical, radiological, nuclear, and explosive (CBRNE) weapons in
of air evacuation. civilian contexts. 40

80 | JSOM Volume 25, Edition 4 / Winter 2025