Page 90 - JSOM Spring 2024

An Ongoing Series

Maritime Applications of Prolonged Casualty Care

A Series Introduction

Matthew D. Tadlock, MD *; Levi K. Kitchen, MD ;
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Jermy J. Brower ; Michael S. Tripp, MD 4
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Introduction
The current United States Navy and North Atlantic Treaty Operations, where allied military operations are coordinated
Organization (NATO) maritime strategy is coalescing around across vast distances in multiple domains including sea, land,
the concept of Distributed Maritime Operations (DMOs) to air, space, and cyberspace. Historically, operations in these do-
prepare for future large-scale combat operations with peer or mains often occurred independently or never existed in space
near-peer competitors. As a result, individual components of or cyberspace. DMOs allow naval assets to launch “massed
naval forces will be more geographically dispersed and oper- volleys of networked weapons to overwhelm adversary de-
ating at a significant time and distance from higher levels of fenses,” while simultaneously providing a defensive posture
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medical care. We developed a series of educational scenarios to overcome the significant missile firepower of peer compet-
informed by real-world events to enhance the ability of Role itors. Targeting of allied naval warships to enhance survival
1 medical caregivers to apply the principles of Prolonged Ca- is complex and mitigated by the dispersal of forces over large
sualty Care during current routine, crisis, and contingency geographic areas. As the U.S. Navy, NATO, and other allies
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DMOs. prepare for future DMOs, smaller naval vessels routinely oper-
ate at a significant time and distance from land-based medical
Keywords: prolonged casualty care; tactical combat casualty facilities or larger warships with advanced medical capabil-
care; military; maritime; critical care ities. Therefore, DMOs are not only a futuristic concept but
also represent an ongoing strategy that may alter medical
tactics when sailors develop severe DNBI-related conditions
during routine operations.
Prolonged Casualty Care
In 2021, the Joint Trauma System and the Committee on Tac- Role 1 Medical Care at Sea
tical Combat Casualty Care released the Prolonged Casualty
Care (PCC) Clinical Practice Guidelines (CPG). PCC was de- Role 1 unit-level care includes initial medical care that military
fined as “the need to provide patient care for extended periods personnel receive. It encompasses immediate life-saving mea-
when evacuation or mission requirements surpass available sures, treatment of DNBI, combat and operational stress pre-
capabilities and/or capacity to provide that care.” PCC guide- vention, patient collection, and disposition to return to duty or
1
lines address both combat casualty and disease non-battle in- evacuation to the next echelon of care. The spectrum of Role
jury (DNBI) care, encompassing a framework of contingency 1 care delivered, however, is highly variable and dependent
medical capabilities for Role 1 caregivers. These guidelines on the type of platform, the environment, and the experience
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enable Role 1 caregivers to medically manage ill or injured or training of the available Role 1 caregivers. The U.S. Navy
patients beyond the initial interventions of Tactical Combat Fleet currently comprises 238 active in-service commissioned
Casualty Care (TCCC) when expedient medical evacuation to surface and subsurface vessels. Of these, 91.6% (218) routinely
the next echelon of care is unavailable. 1,2 provide Role 1 Naval Expeditionary Health Service Support
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(NEHSS). Independent Duty Corpsmen (IDCs) are unique to
the U.S. Naval Service and represent senior enlisted caregivers
Distributed Maritime Operations
who provide protocol-based clinical care in austere environ-
The concept of Distributed Maritime Operations (DMOs) ments under distant synchronous and asynchronous physician
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is part of a broader military strategy called Multi-Domain supervision. Approximately 90% of the 218 Role 1–capable
*Correspondence to matthewtadlockmd@gmail.com
1 CAPT Mathew D. Tadlock is a Trauma/Critical Care surgeon affiliated with the Department of Surgery, Naval Medical Readiness and Training
Center, San Diego, and 1st Medical Battalion, Camp Pendleton, CA. CDR Levi K. Kitchen is an emergency medicine physician at the Naval
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Medicine Readiness and Training Command, Portsmouth, VA. HMCM Jermy J. Brower is a Commander with the U.S. 3rd Fleet, San Diego, CA.
4 CAPT (Ret) Michael S. Tripp is a pulmonologist at the Chest Medicine and Critical Care Medical Group, San Diego, CA.
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