Page 12 - JSOM Summer 2022

1. “Damage Control,” as we know it in medicine today was 6. Transport of casualties from the stricken vessel to the
adopted from the Navy. Damage control as performed on CRTS may be delayed by conditions on the casualty ship
a stricken ship is a priority in maritime operations and and their potential impact on flight operations. Other chal-
maintaining the integrity of the ship will ultimately save lenges to ship-to-ship casualty evacuation may include ad-
the most lives. TCCC emphasizes that good medicine may verse weather conditions, a high sea state, and the presence
sometimes be bad operational tactics; this is true for the of hostile combatant craft or aircraft.
maritime environment as well as ground combat. A ship
that has sustained damage from hostile fire or a mine ex- Shipboard Casualty Scenario – Missile Strike on a
plosion may be in danger of sinking. This means that dam- Guided Missile Destroyer Followed by a Second
age control efforts to fight fires and control flooding must Missile That Misses the Ship but Causes an
be the top priority for the ship’s crew. Underwater Explosion
2. As damage control parties are working to control fire and – A United States Arleigh Burke-class guided missile de-
flooding, crew members are providing Tier 1 TCCC care stroyer (DDG) (Figure 1) is conducting peacetime naval op-
where and when that is feasible. Simultaneously, trained erations, steaming independently in the approximate center
stretcher bearers will be working to transport casualties to of the Gulf of Oman (Figure 2) during the month of July.
the designated treatment area(s), where the ship’s corpsmen
will be evaluating and treating them. The ship’s Damage FIGURE 1 Arleigh Burke-Class Guided Missile Destroyer (DDG)
Control Assistant is responsible for coordinating dam-
age control for the ship and for determining safe routes
through which the stretcher bearers can reach the identified
casualties so that they can be moved to a designated treat-
ment area. Therefore, when a ship’s survival is threatened,
initial triage and casualty care will occur in parallel with
damage control efforts. Damage control efforts may them-
selves produce additional casualties and introduce unique
challenges not covered in the standard TCCC curriculum.
3. A small combatant vessel — in the scenario below, an Arleigh
Burke-class Guided Missile Destroyer (DDG) — will have
an Independent Duty Corpsman (IDC) as the senior medical
representative onboard. Typically, there will also be two ju-
nior corpsmen in the approximately 350-person crew. These (US Navy Photo)
individuals may or may not survive the casualty incident.
Independent Duty Corpsmen for the Surface Fleet are
trained in a 12-month course taught in San Diego, Cali-
fornia. During this 12-month course, IDC students will be Operational Considerations
taught a combination of Anatomy and Physiology; Physical – The air temperature is 95 degrees F and the water tempera-
Diagnosis; Clinical Lab; Pharmacy; Chemical, Biological, ture is 93 degrees F. Sea state is Level 1 (calm) and there is
and Nuclear Medicine; Preventive Medicine; Supply; Food no storm activity in the area.
Service Sanitation; Substance Abuse; Medical Department – An anti-ship missile is launched from a Reaper-type un-
Responsibilities; Medical Diagnosis and Treatment; Pest manned aircraft of unknown origin. 13
Control; Naval and Shipboard Organization; Management – The missile impacts the ship near its bridge and explodes.
of Medical/Surgical Emergency Dental Conditions; the Na- There is a fire on the bridge after the explosion.
val Occupational Safety and Health program; ACLS; TCCC; – The missile strike does not cause any flooding on the ship.
Maintenance Material Management (3M); Dive Medicine; There are several additional fires near the bridge, but none
certification as a Basic Life Support Instructor and registra- in the other spaces of the ship.
tion for a National Provider Identification (NPI) number. – There are multiple casualties onboard the ship. Addition-
Completion of IDC School results in the student receiving ally, several sailors fell or were thrown overboard by the
Navy Enlisted Classification HM-8425/HM-8494. 12 force of the explosion.
4. Transport of shipboard casualties to a location where the – Approximately 3 minutes after the missile strike, a second
IDC can evaluate them and provide care may be made more missile is fired but misses the ship and explodes underwater
challenging by fires and flooding spaces. Additionally, ship- near the immersed crew members.
board scenarios will often entail a challenge not usually – The flight deck (Figure 3) and the hangar bay (Figure 4) are
encountered in ground-based combat medicine; vertical re- both undamaged. A mass casualty receiving area has been
sponse and vertical casualty evacuation. Injured and some- set up in the hangar bay.
times unconscious casualties may need to be extracted and – A small Rigid Hull Inflatable Boat (RHIB) is launched to
transported vertically through narrow ladder wells (stair- pick up the sailors in the water.
ways on a ship that connect different levels of the vessel). – There are no other missiles fired and there are no other
All Navy enlisted recruits are required to successfully com- hostile force threats to the ship identified.
plete shipboard damage control and mass casualty training Clinical Information
as part of their initial Navy training. – Shortly after the missile strike, rescue parties begin to arrive
5. Naval combatant vessels operating independently may not at the casualty receiving area established in the hangar bay.
have a Casualty Receiving and Treatment Ship (CRTS) in – The Independent Duty Corpsman supervising combat ca-
the immediate vicinity. Typically, the CRTS is where the sualty care in the hangar bay receives five casualties in the
initial damage control surgery team would be located. first few minutes:

10 | JSOM Volume 22, Edition 2 / Summer 2022