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

Abstract

BACKGROUND Maritime activities have been associated with unique dangers to civilian and military sailors. We performed a retrospective cohort study analyzing injury mechanisms and clinical outcomes of casualties onboard US naval ships to determine common injury mechanisms, trends, and outcomes. We hypothesized there would be a downward trend of injuries and fatalities on US naval ships during the study period. METHODS All mishaps recorded by the Naval Safety Command aboard active service US naval ships from 1970 through 2020 were reviewed. Only mishaps resulting in injury or fatality were included. Over time, injury mechanisms and casualty incidence rates were trended and compared based on medical capabilities. Ships without surgical capabilities were categorized as Role 1, and those with surgical capabilities as Role 2. RESULTS There were a total of 3,127 casualties identified and analyzed, with 1,048 fatalities and 2,079 injuries. The injury mechanisms associated with the highest mortality included electrocution, blunt head trauma, fall from height, man overboard, and explosion. There was a decrease in the trend of mishaps resulting in casualties, fatalities, and injuries over the 50-year study period. The mortality rate for select severe injury mechanisms was higher on Role 1 capable platforms, compared with Role 2 (0.334 vs. 0.250, p < 0.05). CONCLUSION Casualty incidences decreased over 50 years. However, mortality still remains high for certain mechanisms no matter the operational platform. Furthermore, Role 1 capable vessels have a higher overall mortality rate for severe injuries compared with Role 2. The authors propose training, process improvement, and technology-related solutions to improve outcomes on Role 1 capable naval vessels. LEVEL OF EVIDENCE Prognostic and Epidemiological; Level IV.

War at Sea: Burn Care Challenges—Past, Present and Future

“…In 90% of Role 1 capable ships, the medical department is led by a non-physician Independent Duty Corpsman. Overall chemical, fire, and burn-related injuries occurring on these Role 1 capable ships were associated with a higher overall mortality compared to Role 2 vessels (19% vs. 8.3%, p < 0.05) [4]. While it is difficult to infer the cause, the clinical experience of Role 1 providers, limited supplies, reliance on crystalloid-based resuscitation, severity of thermal injury, and time/distance to a higher level of care could all be factors in this differential.…”

“…Table 2 demonstrates causes of burn injury and associated mortality from all U.S. Navy vessels (1970-2020), including 103 different fire, burn, or smoke inhalation events causing 923 casualties with a 13% mortality. Explosions and electrocution were the deadliest, with associated mortalities of 60.4% and 90.6%, respectively [4].…”

“…The true incidence of minor thermal injury in the deployed maritime environment is unknown, especially those burns primarily managed on deployment. The Benham et al study reviewing 50 years of injury focused on reported mishaps that resulted in injury causing some type of disability, property damage, or loss of life; data on most minor injuries was not available [4]. A recent comprehensive analysis of burn injuries in deployed military service members from 2001-2018 did not specifically include events that occurred at sea [31].…”

“…While serious burn-related injuries are an infrequent occurrence during routine naval operations, the risk of thermal injury from high-pressure steam, electrical injuries, flash burns, toxic gas inhalation, smoke inhalation, chemical-related burns, jet-blast, and explosions remains ever-present for those going to sea [1][2][3][4][5][6][7]. Since the first seafarers began navigating the world's oceans, the naval warship has been an instrument of diplomacy and war, either transporting combatants or engaging in direct action on the high seas [8][9][10][11][12][13].…”

Systematic Review of Injuries and Chronic Musculoskeletal Pain Among High-speed Boat Operators

“…1 Maritime occupational hazard-mitigation programs are designed to address these hazards and are followed meticulously. 2 Naval vessels often operate at displacement speeds; however, depending on the craft design and engine power, planing speeds may be reached. Compared to displacement vessels that move by displacing water, planing vessels move faster by skimming over the water surface.…”