Page 70 - JSOM Summer 2025

An Ongoing Series

Maritime Applications of Prolonged Casualty Care

Drowning and Hypothermia on an Amphibious Warship

Kennen D. Less, MD ; Jermy J. Brower ;
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Virginia H. Damin, MS, MHA, BSN, RN, CCRN ; Matthew D. Tadlock, MD *
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ABSTRACT
As the U.S. Navy further develops the concept of distributed impairment from submersion/immersion in liquid.” Aspiration
maritime operations (DMOs), where individual components of results and can cause significant airway and lung injury, hy-
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the Naval Force will be more geographically dispersed, smaller poxia, and acute respiratory distress syndrome (ARDS). The
vessels may be operating at significant time and distance away terms “near drowning” and “secondary drowning” are fre-
from more advanced medical capabilities. Therefore, Role 1 quently used to describe situations where a person is immersed
maritime caregivers will need to manage injured and disease in water or aspirates a small volume of water. But these are not
non-battle injury patients for prolonged periods during cur- accepted terms, and death due to drowning, drowning with
rent and future contested DMOs. We developed hypothetical morbidity, or drowning without morbidity are the preferred
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drowning and hypothermia patient scenarios to present an in- terms. Previous studies have found as little as 1–2mL/kg of
novative approach to teaching complex operational medicine fluid aspirate can cause hypoxemia and increased morbidity,
concepts, including the management of hypothermia and acute while most severe drownings involve aspirations of 3–4mL/kg
respiratory distress syndrome, as well as Prolonged Casualty and are associated with much higher morbidity and mortality.
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Care (PCC) to austere Role 1 maritime caregivers using the Drowning is a devastating cause of death around the world,
Joint Trauma System PCC Clinical Practice Guidelines (CPGs) particularly in the developing countries and in youth, taking
and other standard references. The format includes basic ep- approximately 372,000 lives globally each year. Drowning
idemiology of drowning and hypothermia in the operational prevention has become the main focus of many maritime safety
maritime environment. The scenario includes a stem clinical organizations globally, as up to 90% of drownings are deter-
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vignette, followed by expected clinical changes for the affected mined to be preventable ; it also has prompted the WHO to
patient at specific time points (e.g., time 0, 1 hour, 2 hours, create a World Drowning Prevention Day (July 25th) to bring
and 48 hours) with expected interventions based on the PCC more attention to the devastation wrought by drowning. 5,6
CPGs, appropriate guidelines, and available shipboard equip-
ment. Through this process, opportunities to improve both In military personnel, drowning can occur under a variety of
training and clinical skills sustainment, as well as standard situations, including but not limited to training incidents in
shipboard medical supplies, are identified. open water or pools, aviation mishaps over water, vehicle roll-
overs on combat patrols near bodies of water, ship collisions
Keywords: prolonged casualty care; tactical combat casualty causing hull breach, man-overboard events during maritime
care; military; maritime; critical care; drowning; hypothermia; mishaps and recreational accidents while attempting to en-
acute respiratory distress syndrome joy a sunny day at a nearby source of water. 2,7–14 To prepare
military caregivers to manage the care of drowned patients
while forward deployed or in training environments, the Joint
Trauma System (JTS) has recently updated its drowning clini-
Introduction
cal practice guideline (CPG). 15
Naval warships are floating industrial environments, and em-
barked Sailors and Marines face occupational hazards during A frequent consequence of water immersion/submersion is
both routine operations and naval warfare; none more danger- hypothermia, which can be deadly when associated with
ous than drowning. The World Health Organization (WHO) concomitant traumatic injury, particularly in austere and op-
defines drowning as “the process of experiencing respiratory erational military environments. Hypothermia can occur in
*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
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1 LCDR Kennen D. Less is associated with the 1st Medical Battalion, 1st Marine Logistics Group, Camp Pendleton, Oceanside, CA. HMCM
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Jermy J. Brower is associated with the U.S. 3rd Fleet, San Diego, CA. CAPT Virginia H. Damin is associated with the Naval Medicine Readiness
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and Training Command, Guam. CAPT Matthew D. Tadlock is associated with Fleet Surgical Team NINE, Naval Base 32nd Street and the De-
partment of Surgery, Naval Medicine Readiness and Training Command, San Diego, CA.
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