USS Franklin and the USS Stark—Recurrent Problems in the Prevention and Treatment of Naval Battle Casualties

Abstract

Events such as the Falklands War and naval actions in the Persian Gulf have emphasized the unique nature of battle casualty care on warships. The purpose of this paper is to describe two actions which illustrate the problems that a medical officer may confront when a warship sustains battle damage: that of the USS Franklin in March 1945 and that of the USS Stark in May 1987. Although neither ship was sunk, damage was severe and about one-quarter of each ship's crew became casualties. More than three-quarters of the casualties were killed, death being due to blast, fire and smoke inhalation.

Treatment of the Mangled Lower Extremity after a Terrorist Blast Injury

“…45,46 This phase is likely the most important iatrogenic determinant of the success of limb salvage. 39,[45][46][47][48][49]50,53 Methodical and competent wound treatment can be done with simple tools if surgical principles are respected. External fixation can be applied to provide en route stabilization before transfer to definitive care institutions if the initial treating facility is not set up for long-term limb salvage treatment.…”

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

“…11 2). [12][13][14][15][16][17] On the Stark, smoke spreading through the ship rendered the small medical spaces unusable and additional medical supplies including crystalloid had to be brought from another ship. In both, rapid triage occurred, sometimes in parallel and the injured were evacuated to advanced care within 1.5-3 hours of the attack.…”

“…12,13 Of the 21 injured on the Stark, two had second-and third-degree burns, five were rescued from the water; the remainder received minor injuries attempting to save the ship. 13 On the Cole, the flight deck 13 was utilized for initial triage and 37 survivors had the following injuries: long bone fractures (four open, two closed), concussion (5), subdural hematoma (1), rib fracture (3), clavicle fracture (1), complex ligamentous knee injuries (3), first and second degree burns of the face or extremity (4), tympanic membrane rupture (16), soft tissue injuries requiring antibiotics for cellulitis (25), inhalation injury (4), orbit fracture (1), mandible fracture (1), pulmonary contusion (1), and pulmonary blast injury (1). [15][16][17] Of the 16 deaths, two were officially categorized as potentially survivable: one died within minutes of injury from a depressed skull and basal skull fracture with subarachnoid hemorrhage; the other died from likely hemorrhagic shock 8 hours after the attack and after initial exploratory laparotomy, splenectomy and hepatorrhaphy at a local Aden hospital.…”

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

“…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 …”

“…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 Our objective was to analyze the casualties onboard US naval vessels during routine and contingency operations to determine common injury mechanisms, trends, and outcomes to better inform and develop clinical training requirements.…”