Page 96 - JSOM Summer 2024

An Ongoing Series

Maritime Applications of Prolonged Casualty Care

Sepsis on a Destroyer During Distributed Maritime Operations

Matthew D. Tadlock, MD *; Ryan C. Maves, MD ; Dana M. Flieger, MSN ;
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Tyler J. Baldino, DO ; Donald Adams, PhD, MPAS, PA-C ; Jamie C. Riesberg, MD ;
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Levi K. Kitchen, MD ; Jermy J. Brower ; Michael S. Tripp, MD 9
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ABSTRACT
During distributed maritime operations, individual components the concept of Distributed Maritime Operations to prepare for
of the naval force are more geographically dispersed. As the future multidomain and large-scale combat operations (LSCO)
U.S. Navy further develops this concept, smaller vessels may be with peer competitors. In contrast to previous doctrine, where
operating at a significant time and distance away from more naval forces deploy within a strike group, individual compo-
advanced medical capabilities. Therefore, during both current nents of the naval force are more geographically dispersed
and future contested Distributed Maritime Operations, Role 1 during Distributed Maritime Operations, operating at a sig-
maritime caregivers such as Independent Duty Corpsman will nificant time and distance from each other and form higher
have to manage patients for prolonged periods of time. This levels of medical care. This is the first in a series of teaching
manuscript presents an innovative approach to teaching com- scenarios demonstrating the practical application of the Joint
plex operational medicine concepts (including Prolonged Casu- Trauma System (JTS) Prolonged Casualty Care (PCC) Clinical
alty Care [PCC]) to austere Role 1 maritime caregivers using a Practice Guidelines (CPG) in the deployed maritime environ-
hypothetical scenario involving a patient with sepsis and septic ment to help prepare shipboard Independent Duty Corpsmen
shock. The scenario incorporates the Joint Trauma System PCC (IDC) and other Role 1 maritime caregivers to provide com-
Clinical Practice Guidelines (CPG) and other standard refer- plex medical care in the distributed maritime environment.
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ences. The scenario includes a stem clinical vignette, expected The PCC CPG introduction emphasizes key principles that
clinical changes for the affected patient at specific time points “make the care of a critically ill patient more efficient” for
(e.g., time 0, 1, 2, and 48h), and expected interventions based on Role 1 caregivers in any austere environment. These include
the PCC CPG and available shipboard equipment. Epidemiol- first following the Committee on Tactical Combat Casualty
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ogy of sepsis in the deployed environment is also reviewed. This Care (CoTCCC) guidelines, performing a comprehensive
process also identifies opportunities to improve training, clinical physical exam and detailed history with a problem list and
skills sustainment, and standard shipboard medical supplies. care plan, recording and trending vital signs, creating a nursing
care plan, obtaining and interpreting lab studies, performing
Keywords: prolonged casualty care; tactical combat casualty necessary surgical procedures, and preparing for transporta-
care; maritime operations; critical care; sepsis; septic shock; tion or medical evacuation (MEDEVAC). The PCC CPG also
appendicitis describes periodic mini-rounds to assess patient stability and
recognition of a patient who is “sick or not sick.” 3

Sepsis was chosen first because its management involves core
Introduction
clinical competencies required for effective PCC. The Surviv-
Current United States (U.S.) Navy and North Atlantic Treaty ing Sepsis Guidelines (first published in 2004) include many
Organization (NATO) maritime strategy is coalescing around key evidence-based critical care competencies foundational to
*Correspondence to Matthew D. Tadlock, Department of Surgery, Navy Medical Readiness and Training Center, San Diego, 34800 Bob Wilson
Dr., San Diego, CA 92134 or matthewtadlockmd@gmail.com
1 CAPT Matthew D. Tadlock is the Simulation Fellowship Director and Trauma/Critical Care Surgeon at the Naval Medicine Readiness and

Training Command, San Diego, CA. CAPT (R) Ryan C. Maves is an Infectious Disease and Critical Care Physician at the Sections of Infectious
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Diseases and Critical Care Medicine, Wake Forest University School of Medicine, Winston-Salem, NC. LCDR Dana M. Flieger is a critical care
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nurse at the Naval Medicine Readiness and Training Command, Camp Lejeune, NC. LT Tyler J. Baldino is a Resident Physician at the Depart-
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ment of Emergency Medicine, Naval Medicine Readiness and Training Command, Portsmouth, VA. Dr. Donald Adams is an Adjunct Assistant
Professor of Clinical Research and Leadership at the George Washington University School of Medicine and Health Sciences, Washington, DC.
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6 COL (R) Jamie C. Riesberg is the Director of Military Medicine at Montana College of Osteopathic Medicine, Billings, MT. CDR Levi K.
Kitchen is an emergency medicine physician in the Department of Emergency Medicine and Director, Healthcare Simulation and Bioskills Train-

ing Center at Naval Medicine Readiness and Training Command, Portsmouth, VA. HMCM Jermy J. Brower is an Independent Duty Corpsman
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at U.S. 3rd Fleet, San Diego, CA. CAPT (R) Michael S. Tripp is a critical care physician at the Chest Medicine and Critical Care Medical Group,
San Diego, CA.
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