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care for these scenario patients, neither was residency trained. 5. World Health Organization. Global report on drowning: preventing
While the Navy is currently changing this paradigm, where a leading killer. World Health Organization. November 17, 2014.
the SMO on an LPD is a residency trained physician, typically Accessed October 31, 2023. https://www.who.int/publications/i/
item/global-report-on-drowning-preventing-a-leading-killer
Internal Medicine or Family Medicine, they would be unlikely 6. World Health Organization. World drowning prevention day
to have significant critical care experience beyond their ini- 2023. World Health Organization. Updated July 25, 2024. Ac-
tial exposure in residency training. While an ultrasound was cessed January 10, 2024. https://www.who.int/campaigns/world
available, no maritime caregiver currently receives routine -drowning-prevention-day
pre- deployment ultrasound training, and therefore its abil- 7. Williams VF, Oh GT, Stahlman S. Update: accidental drown-
ity to aid in treatment and diagnosis is limited by the user’s ings and near drownings, active component, U.S. Armed Forces,
experience. Other procedural skills needed (or potentially re- 2013–2017. MSMR. 2018;25(9):15–19.
quired) in this scenario that non-residency trained physicians 8. Allan PF, Fang R, Martin KD, Glenn M, Conger NG. Combat-
associated drowning. J Trauma. 2010;69 (Suppl 1):S179–S187.
have little to no experience in (depending on the specialty) in- doi:10.1097/TA.0b013e3181e45df1
clude endotracheal intubation, cricothyroidotomy, and ultra- 9. Hammett M, Watts D, Hooper T, Pearse L, Naito N. Drowning
sound-guided central venous catheter placement. Likely none deaths of U.S. Service personnel associated with motor vehicle
of the LPD caregivers have the requisite critical care nursing accidents occurring in Operation Iraqi Freedom and Operation
experience to manage this patient, highlighting another critical Enduring Freedom, 2003–2005. Mil Med. 2007;172(8):875–878.
pre- deployment training gap. doi:10.7205/milmed.172.8.875
10. Tadlock MD, Gurney J, Tripp MS, et al. Between the devil and
the deep blue sea: a review of 25 modern naval mass casualty in-
Conclusion cidents with implications for future Distributed Maritime Opera-
tions. J Trauma Acute Care Surg. 2021;91(2S Suppl 2):S46–S55.
As mentioned in preceding sections, prevention is the best doi:10.1097/TA.0000000000003199
way to treat both drowning and hypothermia. Preparation for 11. Benham DA, Vasquez MC, Kerns J, et al. Injury trends aboard
such incidents is imperative before any operational undertak- U.S. Navy vessels: a 50-year analysis of mishaps at sea. J Trauma
Acute Care Surg. 2023;95(2S):S41-S49. doi.org/10.1097/ta.
ing or ship underway period. This preparation should include 0000000000004047
material procurement, medical skill acquisition, particularly 12. U.S. Naval Institute Staff. Marine Corps investigation into 2020
regarding airway management, and medical planning for ev- Amphibious Assault Vehicle sinking. USNI News. March 26,
ery possible scenario that military personnel could encounter. 2021. Accessed October 31, 2023. https://news.usni.org/2021
Zero preventable deaths is the gold standard in operational /03/26/marine-corps-investigation-into-2020-amphibious-
medicine, and inadequate preparation comes at the cost of hu- assault-vehicle-sinking
man lives. This hypothetical drowning scenario highlights the 13. Lagrone S. Navy SEAL trainee dies following swimming exer-
cise. USNI News. May 10, 2016. Accessed January 10, 2024.
critical care and PCC skills required to support a patient with https://news.usni.org/2016/05/10/navy-seal-trainee-dies-
aspiration, hypothermia, and ARDS. following-swimming-exercise
14. Winkie D. Soldier with 10th Special Forces Group drowns while
Author Contributions training in Florida. Army Times. July 28, 2021. Accessed January
MDT conceived the study concept. KDL developed the sce- 10, 2024. https://www.armytimes.com/news/your-army/2021/
07/28/soldier-with-10th-special-forces-group-drowns-while-
nario. KDL and MDT performed the literature review and training-in-florida/
drafted the original manuscript. KDL, VHD, JJB, and MDT 15. Hughes S, Sebreros B, Thota D, et al. Drowning Management.
participated in critical revisions. Joint Trauma System Clinical Practice Guideline. Published March
17, 2025. Accessed March 17, 2025. https://jts.health.mil/assets/
Disclaimer docs/cpgs/Drowning_Management_17_Mar_2025_ID64.pdf
The views expressed in this article are those of the authors and 16. National Weather Service. Cold water hazards and safety. Na-
tional Weather Service. Accessed January 10, 2024. https://www.
do not necessarily reflect the official policy or position of the weather.gov/safety/coldwater
Department of the Navy, the Department of Defense, or the 17. Hight M, Less K. Management of hypothermia and immersion
U.S. Government. injuries. In: Tadlock MD, Hernandez AA, eds. Expeditionary Sur-
gery at Sea: A Practical Approach. Springer International Publish-
Disclosures ing; 2023: 579–597.
The authors have nothing to disclose. 18. Tabuchi H. 101°F in the ocean off Florida: was it a world re-
cord? New York Times. July 26, 2023. Accessed January 10,
2024. https://www.nytimes.com/2023/07/26/climate/florida-100-
Funding degree-water.html
No funding was received for this work. 19. Kitchen L, Tilley L, Bennett B, et al. Hypothermia: Prevention
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