Page 137 - JSOM Fall 2020

Management of Critically Injured Burn Patients
During an Open Ocean Parachute Rescue Mission

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Brian Staak, MD ; Erik DeSoucy, DO ; Christopher Petersen, MS3 ;
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Jedediah Smith, PA-C ; Michael Hartman ; Stephen Rush, MD 6

ABSTRACT
Best practices and training for prolonged field care (PFC) are (CROs), and a flight surgeon (FS) on a civil SAR mission re-
evolving. The New York Pararescue Team has used part task quiring 37 hours of PFC to save two severely burned patients.
training, cadaver labs, clinical rotations, and a complicated sim
lab to prepare for PFC missions including critical care. This re- Mission Report
port details an Atlantic Ocean nighttime parachute insertion to
provide advanced burn care to two sailors with 50% and 60% Phase 1: Mission Development and Planning
body surface area burns. Medical mission planning included On the morning of April 24, 2017, the US Coast Guard
pack-out of ventilators, video laryngoscopes, medications, and (USCG) was notified by the Portuguese Rescue Coordination
50 L of lactated Ringer’s (LR). Over the course of 37 hours, Center of a distress call issued by the container ship motor ves-
the patients required high-volume resuscitation, analgesia, sel (MV) TAMAR located approximately 1,400 nautical miles
wound care, escharotomies, advanced airway and ventilator (NM) off the coast of Long Island, NY. An explosion and sub-
management, continuous sedation, telemedicine consultation, sequent confined space fire resulted in several burned sailors.
and complicated patient movement during evacuation. A de- At approximately 0800 EST, the USCG alerted the PJ team, re-
brief survey was obtained from the Operators highlighting questing SAR assistance. The flight surgeon confirmed the pa-
recommendation for more clinical rotations and labs, mission- tient count and status included four severely burned patients,
s pecific pack-outs, and tactical adjustments. This historic mis- two of whom had respiratory compromise. A Canadian Navy
sion represents the most sophisticated PFC ever performed by ship with a single physician assistant on board was available
PJs and serves to validate and share our approach to PFC. but would take 12–24 hours to arrive. Based on the injury
patterns and past experience, the FS advised tasking the PJs for
Keywords: prolonged field care; military medicine; austere parachute insertion to optimize chances for patient survival.
medicine; burns; critical care
The team composition included two CROs and five PJs. One
CRO was the team commander (TC) and one PJ was the
team leader (TL). The mission plan featured a 5-hour HC-
Introduction 130P flight, an open ocean parachute insertion with zodiacs,
PFC has been of growing interest within the Special Operations ocean surface travel to the TAMAR, and then ship boarding.
medical community with more operations in remote and aus- The TAMAR would remain under way to Portugal until close
tere areas. Air Force Pararescuemen (PJs) currently have the enough for helicopter extraction. The prolonged care of each
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largest documented experience in PFC, accounting for 37% patient was projected to last up to 72 hours before extraction.
(20 of 54 cases) of missions in the Joint Trauma System data
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available on this. While some missions have been in the com- Planning and pack-out consisted of preparing medical supplies
bat setting, most have occurred during civil search and rescue to treat up to four critical burn; however, sufficient critical
(SAR) in the open ocean and Alaska. Critical care training is care equipment (vents, monitors, mechanical suction, and
generally infrequent among PJs, corpsman, and medics since fluid warmers) was available for only two critical patients and
they are primarily combat trauma and/or sick call experts, 50L of LR was able to be inserted due to real-world logistical
and the intensive training requirements have been difficult to constraints.
justify given the low utilization of this skill set on missions.
However, the New York Pararescue unit has committed to the Phase 2: Infiltration
inclusion of a complex PFC lab in a medical school simulation During prelaunch planning and the 4.5-hour flight, the team
department, extensive part task training, and various full mis- was notified of fluctuating patient status via the FS and
sion profiles prior to deployments. TAMAR, including the deaths of two patients: one while in-
flight and the other immediately prior to boarding the vessel,
This case report describes the operational and medical chal- thus leaving two patients to be treated. At 2300 EST, April
lenges encountered by USAF PJs, combat rescue officers 24th, the team inserted via two passes of night static-line-square
*Correspondence to christopher.petersen.12@gmail.com
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1 Capt Staak, USAF, is a former PJ and currently affiliated with SAUSHEC as an anesthesia resident. Maj DeSoucy, USAF, is a former Pararescue
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flight surgeon and current trauma/critical care fellow at Brooke Army Medical Center, Joint Base San Antonio, TX. MSgt Petersen, USAF, is a
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Pararescueman associated with the 103RQS and currently an MS-3 at the Zucker School of Medicine. MSgt PJ Smith, USAF, a Pararescueman
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with the 103RQS and affiliated with the Geisenger Medical Center as a physician assistant. SSgt Hartman, USAF, is a Pararescueman associated
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with the 103RQS. Lt Col Rush, USAF, is the former pararescue careerfield medical director and is currently the 106MDG commander.
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