Between the devil and the deep blue sea: A review of 25 modern naval mass casualty incidents with implications for future Distributed Maritime Operations

Abstract

In the future, United States Navy Role 1 and Role 2 shipboard medical departments will be caring for patients during Distributed Maritime Operations in both contested and noncontested austere environments; likely for prolonged periods of time. This literature review examines 25 modern naval mass casualty incidents over a 40-year period representative of naval warfare, routine naval operations, and ship-based health service support of air and land operations. Challenges, lessons learned, and injury patterns are identified to prepare afloat medical departments for the future fight.

Injury Trends aboard U.S. Navy Vessels: A 50-year analysis of Mishaps at Sea

“…Fire can also occur after collisions. The 1989 collision of the USS Kinkaid (DD-965) with a civilian vessel caused a berthing area to flood with seawater and a fire in the starboard torpedo magazine 17 …”

“…Throughout history, seafarers have faced unique dangers, 1–4 and the modern naval warship—part weapons systems, industrial workspace, and aerodrome conducting fixed and rotary aircraft operations—is no exception 5 . While peacetime naval deployments are generally considered safe, modern sailors face the risk of potential injury due to the associated occupational hazards, 6–14 which is significantly increased during naval warfare 15–18 …”

“…Currently, US Navy and Marine Corps operational planning is coalescing around the concept of Distributed Maritime Operations (DMO), where all components of the naval force are geographically separated and isolated across multiple domains within the maritime environment. During DMO, widely dispersed ground forces, air assets, and surface and subsurface naval vessels will be coordinated to provide sea control and sea denial over enormous geographic areas, presenting unique and challenging long-distance considerations for medical planners 17,19–22 . As Navy Medicine supports DMO, it is essential to understand and enumerate common shipboard injury patterns and associated clinical outcomes during naval operations.…”

“…To our knowledge, no modern comprehensive analysis of injuries at sea during routine US Navy deployments has been performed and the available literature is limited. Other than publications describing specific mass casualty events, 8,9,15,17,21,23,24 most published data are over 20 years old and limited to isolated deployments 6,7,14 …”

Surgical Science and the Evolution of Critical Care Medicine

“…One of those interventions is fresh whole blood as an aid in resuscitation that began in military medicine with the "walking blood bank" and has recently translated to civilian trauma care (47,326,327). Similar notions permeate naval operations to provide immediate rescue and complex care (328). Evacuation may include the now well-developed critical care air transport program that can successfully bring critically ill or injured patients-including those requiring ECMO-from anywhere in the world to a U.S. destination facility (329).…”