Page 125 - JSOM Fall 2020

care; continuous analgesia and sedation, if indicated; estab- Atlantic Ocean. Eleven rescues occurred on large ships (com-
lishing work-rest cycles; and performing teleconsultation. mercial fishing and cargo ships up to several hundred feet in
length) and three were on personal sailboats up to 35 feet
Published case reports have described medium-range ocean long. In total, 22 civilians required rescue. Six missions were
rescue by helicopter ≤200 NM from a land refueling base, executed for a single patient, and eight missions were executed
4
and unpublished anecdotal accounts of USCG rescues ≤300 for two patients.
NM exist. This corresponds with the USCG’s published re-
quirement for its medium-range helicopter (the MH-60T) to The median distance from shore at which these rescues oc-
perform rescues ≤300 NM offshore. However, of the few ex- curred was 1,300 NM (range, 600–1700 NM). In 12 of 14
2
isting reports of maritime rescue operations found in the med- missions, PJs inserted via military free fall or static-line para-
ical literature, none describe rescues beyond 300 NM from a chutes from an HC-130 aircraft. The remaining two mission
4–8
land refueling base, with the exception of one 2014 pararescue infiltrations were performed with HH-60 helicopters lowering
mission, the data from which are included in the case series the PJs directly onto the ship deck by cable hoist. During these
8
presented here. Furthermore, to our knowledge, no other pub- two hoist missions and one of the parachute missions, the HC-
lished accounts exist describing rescues at extreme distances 130 was in-air refueled by USAF KC-10 or KC-135 tankers.
that required the use of medical providers parachuting from
an airplane or air-to-air refueling to reach the patient. Helicopter hoist was used to exfiltrate patients and PJs from
the ship in 10 of the missions (71%). The other four mission
In this report, we review the pararescue experience with long- exfiltrations (29%) were performed by transfer to a second
range ocean rescue missions to describe the unusual intersec- ship (USCG vessels in three instances). Four missions required
tion of getting medical providers (PJs in every case, with the trans-loading of the patient(s) from the helicopter or docked
addition of an FS in one mission) onto ships in the ocean to ship to a fixed-wing aircraft, which then flew to a distant city
provide advanced medical care in transit and then transport with an appropriate medical facility (e.g., burn center). Table
them and the patient(s) from ships to hospitals for definitive 1 provides the distance offshore, infiltration and exfiltration
treatment. In this report, we describe the technical and medical times, and the patient-care times.
details that make this mission unique, as well as its relevance
to the military’s interest in PFC. TABLE 1 Distance Offshore, Infiltration, Exfiltration, and Total
Patient Care Time
Median Range
Methods
Distance offshore, nautical miles
We reviewed the pararescue experience for long-range ocean (n = 13) 1,300 600–1,700
rescue missions (i.e., those beyond the reach of a medium-range Time from injury to first patient 36 10–288
helicopter on a single tank of fuel) for sick or injured patients assessment, hours (n = 7)
from January 2010 to May 2019. The inclusion criterion was Infiltration time, hours (n = 10) 6 3–10
any mission tasked to AF pararescue that required rescue >300 Time on initial vessel, hours (n = 13) 48 1–72
NM from a land refueling base. Cases were excluded from Helicopter exfiltration time, hours
medical intervention analysis if there were inadequate details (n = 9) 4 2.5–5.5
regarding the medical aspects of the mission. Fixed-wing exfiltration time, hours
(n = 4) 4 2–6
After-action reports (AARs) were compiled by the Air Force Ship exfiltration time, hours (n = 4) 44 2–70
pararescue medical director for the purpose of process and Total patient care time, hours (n = 14) 51 5.5–77
quality improvement. Data collected included mission loca- NOTE: Numbers in parentheses refer to the no. of patients.
tion, environmental factors, distance from shore, use of in-air
refueling, methods of infiltration and exfiltration, time on the Patient Demographics, Injuries, and Illnesses
objective area and in transport to/from the ship, time from A total of 22 patients (median age, 39 years; range 1–60
initial injury to first medical assessment, patient age, diagno- years). The only pediatric patient was a 1-year-old girl with
ses, treatment, use of teleconsultation, patient outcomes, oper- a rash and gastrointestinal (GI) distress onboard a personal
ator injury or illness, and lessons learned. Details not available sailboat. She was the only female patient in the data set. One
from the AARs were clarified whenever possible with the PJ(s) mission (one of the 22 patients) had no specific medical in-
involved with the mission via personal correspondence. formation reported in the AAR and was excluded from the
medical interventions analysis.
Data were collected as part of an ongoing quality improve-
ment process. Data were entered into Excel (Microsoft, www. There were 15 injured patients and seven sick patients. Most
microsoft.com) and simple descriptive statistics were used to primary injures were burns (n = 10) followed by musculoskele-
describe the findings. No patient identifiers were collected for tal injuries (n = 4), and traumatic brain injury (TBI; n = 1). The
this analysis. Review and publication of the de-identified data majority of ill patients had GI complaints (n = 6) and there
is part of an institutional review board–approved project on was one case of necrotizing soft-tissue infection.
PFC.
Data on total body surface area (TBSA) burned were available
Results for four of the 10 burn patients with a median of 70% and
range of 10% to 80%. All burn missions included multiple pa-
Mission Details tients. Of note, one polytrauma patient who had a TBI, spinal
Between 2010 and 2019, 14 ocean rescue missions were iden- injury, extremity injury, and scalp laceration also had a 10%
tified. Eleven were in the Pacific Ocean and three were in the TBSA burn. This patient was not counted among the 10 burn

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