Currently, no comprehensive practical surgical textbook or other reference exists for the management of injured and other surgical patients at sea. This text focuses on the increasingly important field of medical and surgical management of patients in the modern expeditionary maritime environment. The editors and contributors to this new handbook are a group of physicians, nurses, and corpsmen with extensive experience in caring for patients in the expeditionary maritime environment, designing and implementing current doctrine and policy, and publishing peer-reviewed articles focused on these topics.
This handbook takes the approach of a "how to" manual for the management of combat or disaster victims, beginning at the point of injury and proceeding through each stage of care until they leave the maritime environment. This includes sections on prehospital care, triage, en-route care, and maritime mass casualty management, as well as additional chapters covering unique aspects of maritime platforms, capabilities, and missions. The bulk of the book focuses on the initial patient evaluation and resuscitation as well as the operative and perioperative phases of care including prolonged casualty care. The primary focus throughout the book is on simple, practical, and proven practices that can be easily understood and implemented by physicians and independent providers of any experience level who may find themselves in similar situations. For the clinical chapters, each begins with a clinical vignette relevant to the chapter based on actual patients or maritime scenarios experienced by the authors demonstrating the various challenges that can occur caring for injured and surgical patients at sea while deployed on maritime and amphibious platforms. When appropriate, each clinical chapter will conclude by describing the recommended management and outcome of the patient(s) presented in the vignette that opened the chapter. The style is plain and direct language, avoiding scientific jargon and unnecessary complexity whenever possible. Each chapter begins with 5 to 10 bullet points that summarize the key information or “BLUF” (bottom line up front) from that chapter and conclude with common tips and pitfalls, as well as recommended high-yield resources for the entire maritime surgical team.
Author(s): Matthew D. Tadlock, Amy A. Hernandez
Publisher: Springer
Year: 2023
Language: English
Pages: 749
City: Cham
Disclaimer
Foreword
Preface
Preface
Expeditionary Surgery at Sea: Top 10 Lessons Learned
Contents
Part I: Maritime Surgery Overview
Chapter 1: Overview of Current Maritime Surgical Platforms and Operational Environments: Part 1—United States Navy and Marine Corps
Introduction
Continuum of Care
Role 1 (First Responder Care)
Role 2 (Forward Resuscitative Care)
Role 3 (Theater Hospitalization Capability)
Role 4 (Definitive Care)
Patient Movement and En Route Care (ERC) Capability
Maritime Surgical Platforms
Aircraft Carrier (CVN)
Fleet Surgical Team (FST)
Expeditionary Resuscitative Surgical System (ERSS)
Hospital Ship (T-AH)
United States Marine Corps (USMC) Surgical Platoon
The Future Is Now: Distributed Maritime Operations (DMO) and Expeditionary Advanced Base Operations (EABO)
Maritime Single-Surgeon Team Limitations
Conclusion
References
Chapter 2: Overview of Current Maritime Surgical Platforms and Operational Environments Part 2: United Kingdom and The Royal Navy
Introduction
Operational Patient Care Pathway (OPCP)
Role 2 Afloat (R2A)
Maritime Role 3 (MR3)
Commando Forces Surgical Group (CFSG)
Platforms
Conclusion
References
Chapter 3: The Ship’s Surgeon and Surgery at Sea: A Brief History
Introduction
The Age of Manpower (~800 bc to ad 1450)
Ancient Greece (~800–322 bc)
The Imperial Roman Navy (~27 bc to ad 180)
The Middle Ages (ad ~476–1453)
The Age of Discovery (~1450–1600)
British Sea Power
The Father of Sea Surgery
The Age of Sail (~1600–1850)
The American Revolutionary War
The Age of Steam and Iron (~1850–1915)
The American Civil War
Battleships and Blood Transfusions
World War II (1939–1945)
Normandy
Iwo Jima
Korean (1950–1953) and Vietnam (1955–1975) Wars
Women Surgeons at Sea
Conclusion
References
Chapter 4: Mechanisms of Injury During Modern Naval Operations
Introduction
Non-flight Deck Injuries
Flight Deck Injuries
Injuries During Naval Warfare
Conclusion
References
Chapter 5: I’m Deploying on a Ship, Now What?
Introduction
Preparation: Ship/Surgical
Credentials/Privileges
Inventory, Supply, and Maintenance
Identify Resources
Establish Capabilities
Preparation: Shore/Surgical
USAISR Burn Center
Preparation: Ship/Nonsurgical
Checking in/Sponsor
Warfare Qualifications
Goals
Preparation: Shore/Nonsurgical
Professional Requirements
Expectations for Loved Ones
Affairs in Order
Packing
Conclusion
Further Reading
Chapter 6: Leadership and Communication 101
Introduction
In Depth: Aircraft Carrier (CVN) Ship’s Surgeon
Team Personnel
Preoperative Communication
Postoperative Communication
MEDEVAC/CASEVAC
Trauma and Mass Casualty (MASCAL)
Closing Thoughts
In Depth: Fleet Surgical Team (FST) Staff Surgeon
Team Personnel
Chain of Command (COC)
Perioperative Communication
MASCAL
Closing Thoughts
In Depth: Expeditionary Resuscitative Surgical System (ERSS) OIC
Team Personnel
Perioperative Communication and MASCAL
Closing Thoughts
In Depth: Forward Resuscitative Surgical System (FRSS) Staff Surgeon
Team Personnel
Perioperative Communication and MASCAL
MEDEVAC/CASEVAC
Team Training
Closing Thoughts: A Senior Surgeon’s Perspective
Conclusion
Further Reading
Part II: Before the Operating Room
Chapter 7: Shipboard Triage and Mass Casualty
Introduction
Initial Triage
Immediate/Delayed Treatment Areas
Special Considerations for Shipboard Triage: Limited Resources
Communication
“What Do I Know? Who Needs to Know? Have I Told Them?”
Training and Drills
Conclusion
References
Further Reading
Chapter 8: Shipboard Diagnostics: Laboratory and Radiology
Introduction
Shipboard Laboratory: Historical Perspective
Shipboard Laboratory: Current Overview
Laboratory Suite
Regulation
Shipboard Laboratory: Common Technology and Tests
Hematology
Chemistry
Blood Gases
Additional Tests
Shipboard Radiology: Historical Perspective
Shipboard Radiology: Current Overview and Technology
Radiology Suite
Radiography Technology Advances
Shipboard Ultrasound
Shipboard Radiology: Common Exams
Conclusion
Chapter 9: Principles of Shipboard Ultrasound
Introduction
Extended Focused Assessment with Sonography in Trauma (eFAST)
Introduction and Indications
Technique
Subxiphoid Cardiac Views (Fig. 9.1)
Right Upper Quadrant (RUQ) Views (Fig. 9.2)
Left Upper Quadrant (LUQ) Views (Fig. 9.3)
Pelvic/Bladder Views (Figs. 9.4 and 9.5)
Anterior Right and Left Chest Views
Keys to Success
Limited Echocardiography
Introduction and Indications
Technique
Parasternal Long Axis (PLAX) View (Fig. 9.9)
Parasternal Short Axis (PSAX) View (Fig. 9.10)
Apical 4 Chamber (A4Ch) View (Fig. 9.11)
Subxiphoid View
Inferior Vena Cava (IVC) View (Fig. 9.12)
Cardiac Tamponade
Right Heart Strain
Cardiac Contractility and Ejection Fraction (EF) Estimation
Cardiac Arrest
Keys to Success
Right Upper Quadrant (RUQ) Ultrasound
Introduction and Indications
Technique
Keys to Success
Appendicitis
Introduction and Indications
Technique
Keys to Success
Testicular Torsion
Introduction and Indications
Technique
Keys to Success
Lower Extremity Deep Vein Thrombosis (DVT)
Introduction and Indications
Technique
Keys to Success
Pregnancy
Introduction and Indications
Technique
Keys to Success
Ovarian Torsion
Introduction and Indications
Technique
Keys to Success
Central Venous Catheter (CVC) Placement
Introduction and Indications
Technique
Keys to Success
Conclusion
References
Chapter 10: Practical Nursing Principles Afloat
Introduction
Aircraft Carrier (CVN) Nursing
Nursing Supervisor and Medical Training Team (MTT) Leader
Aircraft Carrier (CVN) Medical and Surgical Capabilities
Medical Evacuation (MEDEVAC)
Clinical Pearls
Fleet Surgical Team (FST) Nursing
Certified Registered Nurse Anesthetist (CRNA)
Critical Care Registered Nurse (CCRN)
Certified Perioperative Nurse (CNOR)
Expeditionary Resuscitative Surgical System (ERSS) Nursing
Preoperative: Trauma Resuscitation
Intraoperative: Operating Room (OR)
Postoperative: Intensive Care Unit (ICU) & Medical Evacuation (MEDEVAC)
General Practical Tips
Conclusion
Further Reading
Chapter 11: Alone and Unafraid: The Independent Duty Corpsman at Sea
Introduction
Clinical Vignette 11.1
Clinical Vignette 11.2
Being Prepared with Medical Knowledge
Training Your Junior Corpsmen
Safe Patient Movement Throughout the Ship
Building a Relationship of Trust and Mutual Respect with Your Commanding Officer (CO)
Principles of Medical Evacuation (MEDEVAC)
Working with Your Physician Supervisor
Administration at Sea
Conclusion
Part III: Elective and Emergency Surgical Care
Chapter 12: Mess Deck, Hangar Bay, or Operating Room? The Shipboard Operating Theater
Introduction
Surgical Team Members (Table 12.1)
CVN
FST
ERSS
Equipment/Sets/Inspections
FST
ERSS
Supply
CVN/FST
ERSS
Maintenance
CVN/FST
ERSS
Decontamination, Sterile Processing, and Storage
CVN/FST
ERSS
OR Capabilities Outside of Primary OR
CVN
FST
ERSS
Conclusion
Further Reading
Chapter 13: Principles of Maritime Expeditionary Anesthesiology
Introduction
Pre-deployment Considerations
Leadership and Administration
Logistics and Preparation
Deployment Considerations
Mechanism of Injury
Prehospital Treatment (i.e., Tactical Combat Casualty Care (TCCC))
Triage/Receiving Casualties
Resuscitation
Intravenous (IV) Access
Blood Products
Hemostatic Pharmacologic Adjuncts
The Lethal Triad
Airway Management
Non-surgical Airway Management
Surgical Airway Management
Anesthesia in the Deployed Setting
General Anesthesia
Regional Anesthesia
Prolonged Patient Holding and Austere Critical Care
Platform-Based Considerations for Maritime Expeditionary Anesthesia
CVN
Fleet Surgical Team (FST)
Expeditionary Resuscitative Surgical System (ERSS) or Role 2 Light Maneuver (R2LM)
Conclusion
References
Chapter 14: Elective and Emergency Surgery: Operate, Observe, or Transfer? (If You Can)
Introduction
Operate, Observe, or Transfer: Factors to Consider
Communication and Mission
Quality of Life/Quality of Work
Training
Pathology
Inactivity
Nearby Ships
Ancillary Studies (Laboratory and Radiology)
Timing
A Captive Audience for Observation
General Surgery Emergencies
Nephrolithiasis
Appendicitis
Diverticulitis
Small Bowel Obstruction (SBO)
Peptic Ulcer Disease (PUD)
Upper Gastrointestinal Bleeding (UGIB)
Lower Gastrointestinal Bleeding (LGIB)
Inflammatory Bowel Disease (IBD)
Foreign Bodies
Non-general Surgery Emergencies
Vascular
Pneumothorax
Ophthalmologic Emergencies
Otolaryngology (ENT)
Testicular Mass
Elective/Non-urgent
Hernias
Biliary Disease
Benign Anorectal Disease
Pilonidal Disease
Breast Disease
Urologic Elective Procedures
Conclusion
References
Chapter 15: The Tyranny of Distance and the Difficult Gallbladder
Introduction
Diagnosis
Management
Complications
Filling Defects on Intraoperative Cholangiogram (IOC)
Common Bile Duct injury (CBDI)
Intraoperative or Postoperative bleeding
Management of Other Acute Biliary Diseases
Gallstone Pancreatitis
Mirizzi Syndrome
Bouveret’s Syndrome and Gallstone Ileus
Conclusion
References
Chapter 16: Infectious Disease Pearls for Maritime Surgical Teams
Introduction
Diagnostic Tools at Hand
The Maritime Pharmacy
Neurological Infections
Penetrating Central Nervous System (CNS) Trauma
Meningitis
Encephalitis
Infections of the Head and Neck
Facial Trauma
Peritonsillar Cellulitis and Abscess
Submandibular Abscess and Ludwig’s Angina
Pulmonary Infections
Penetrating Thoracic Trauma
Pneumonia
Tuberculosis (TB)
Coronavirus Disease 2019 (COVID-19)
Gastrointestinal Infections
Penetrating Abdominal Trauma
Common Surgical Diagnoses
Diarrhea in the Returning Traveler
Ophthalmologic Injuries
Skin Injuries and Infections
Burns
Lacerations
Necrotizing Soft Tissue Infections (NSTI)
Vector-Borne Infections
Conclusion
References
Chapter 17: But…I’m a General Surgeon! Obstetric, Gynecologic, and Urologic Emergencies
Introduction
Female Reproductive Anatomy
Pregnancy at Sea
Spontaneous Vaginal Delivery
Perineal Laceration Repair
Breech Presentations
Postpartum Hemorrhage (PPH)
Delayed Placental Removal or Avulsed Cord
Cesarean Delivery
Gynecologic Emergencies
Ectopic Pregnancy
Ovarian Torsion and Ruptured Hemorrhagic Cysts
Straddle Injuries/Vaginal Lacerations
Bartholin’s Cyst and Abscess
Male Genital Emergencies
Testicular Torsion
Testicular Injury
Urethral Injury
Conclusion
References
Further Reading
Chapter 18: Haze, Gray, and Endoscopy Underway
Introduction
Endoscopy Equipment
The “Equipment Tower”
Endoscopes
Electrocautery Unit and Argon Plasma Coagulation (APC)
Preparing Equipment for a Case
Equipment Set-Up
Endoscopic Instruments
Risks of Esophagogastroduodenoscopy (EGD) and Colonoscopy
Moderate Sedation/Monitored Anesthesia Care (MAC)
Techniques for Performing Esophagogastroduodenoscopy (EGD) and Colonoscopy
Esophagogastroduodenoscopy (EGD)
Colonoscopy
Common Pathologies: Dysphagia and Odynophagia
Esophageal Foreign Body
Eosinophilic Esophagitis (EoE)
Drug-Induced Esophagitis
Infectious Esophagitis
Erosive Esophagitis
Common Pathologies: Gastrointestinal (GI) Bleeding
Peptic Ulcer Disease (PUD)
Dieulafoy Lesion
Angiodysplasia (AD)
Colonic Ischemia
Diverticulosis
Inflammatory Bowel Disease (IBD)
Internal Hemorrhoids
Incidental Findings
Gastric Inlet Patch
Barrett’s Esophagus
Schatzki Ring
Pancreatic Rest
Polyp
Lipoma
Colorectal Cancer (CRC) Screening
Conclusion
References
Chapter 19: Of Hatches and Hands: Management of Hand Injuries
Introduction
Basic Anatomy and Terminology
Management of Urgent/Emergent Hand Injuries
Hatch Hand: Urgent/Emergent Hand Injuries: Likely Medical Evacuation (MEDEVAC)
Lacerations and Tendon Injuries: Likely Medical Evacuation (MEDEVAC)
Digital Nerve Injury: Likely Medical Evacuation (MEDEVAC)
Amputations: Likely Medical Evacuation (MEDEVAC)
Dysvascular or Crushed Limbs: Likely Medical Evacuation (MEDEVAC)
High-Pressure Injection, Burns, and Degloving Injuries: Likely Medical Evacuation (MEDEVAC)
A Word on Damage Control Orthopedics (DCO)
Management of Lower Acuity Hand Injuries
Carpal, Metacarpal, and Phalangeal Fractures: Likely Nonoperative Management
Carpal Fractures: Likely Nonoperative Management Versus Routine Medical Evacuation (MEDEVAC)
Metacarpal Fractures: Likely Nonoperative Management Versus Routine Medical Evacuation (MEDEVAC)
Phalangeal Fractures and Dislocations: Likely Shipboard Nonoperative Management
Fingertip Injuries: Likely Shipboard Nonoperative Management
Supplies and Prevention
Conclusion
References
Further Reading
Part IV: Critical Care, Trauma, and Burn Management
Chapter 20: The Floating Intensive Care Unit: Capabilities and Limitations
Introduction
Staff, Space, and Supplies
Staff
Space
Supplies
Medical Evacuation (MEDEVAC)
Critical Care Emergencies at Sea
Sepsis
Acute Coronary Syndromes (ACS)
Hypertensive Crisis
Hyperglycemic Crisis
Nonsurgical Neurologic Emergencies
Venous Thromboembolism (VTE)
Gastrointestinal (GI) Bleeding
Anaphylaxis
Conclusion
References
Further Reading
Chapter 21: Acute Respiratory Failure and Ventilator Management Afloat
Introduction
Respiratory Failure in the Operational Environment
Diagnosis of Respiratory Failure with Limited Equipment
Laboratory and Monitoring
Diagnostic Imaging
Airway and Ventilator Management in the Operational Theater or Deployed Unit
Acute Hypoxemic Respiratory Failure
Pathophysiology of Hypoxemia
Acute Respiratory Distress Syndrome (ARDS)
Treatment of Acute Hypoxemic Respiratory Failure
Low Tidal Volume (LTV) Ventilation
Proning
Dexamethasone
Aggressive Euvolemia
Hypercapnic and Mixed Respiratory Failure
Pathophysiology of Hypercapnia
Treatment of Acute Hypercapnic Respiratory Failure
Conclusion
References
Chapter 22: Damage Control Surgery at Sea
Introduction
“Damage Control Zero” and Advanced Resuscitative Care Afloat
Indications for Damage Control Surgery (DCS)
Hypothermia
Acidosis
Coagulopathy
Abdominal Damage Control Surgery (DCS)
Vascular Damage Control Surgery (DCS)
Damage Control Resuscitation (DCR)
Definitive Surgical Repairs
Aircraft Carrier (CVN) Considerations
Large Deck Amphibious Assault Ship Considerations
Austere Resuscitative Surgical Team Considerations
Conclusion
References
Chapter 23: Damage Control Resuscitation and the Walking Blood Bank
Introduction
Damage Control Resuscitation (DCR)
Platform-Specific Capabilities
Aircraft Carrier (CVN)
Fleet Surgical Team (FST)
Expeditionary Resuscitative Surgery System (ERSS)
Frozen Blood Product Capabilities
FWB: Fresh Whole Blood; PRBC: Packed Red Blood Cells; FFP: Fresh Frozen Plasma
Walking Blood Bank (WBB)
Preparation
Activation/Screening
Delivery
Post-delivery
Special Considerations for Austere Role 2 Surgical Teams
Conclusion
References
Chapter 24: Orthopaedic Damage Control at Sea
Introduction
Fracture Care
Extremity Fractures
Pelvic Fractures
Infection Control
Acute Compartment Syndrome (ACS)
Pathophysiology
Associated Conditions
Signs and Symptoms
Treatment
Dislocations
Shoulder
Ankle
Conclusion
References
Chapter 25: Austere Neurosurgical Emergencies
Introduction
Traumatic Brain Injury (TBI) Pathophysiology
Intracranial Dynamics
Primary and Secondary Brain Injury
Neurocritical Care
Evaluation
Medical Management
Neurological Exam
Anti-epileptic Drugs (AEDs)
Elevated Intracranial Pressure (ICP)
Hyperosmolar Therapy
Surgical Management
External Ventricular Drain (EVD) and Intracranial Pressure (ICP) Monitor Placement
Decompressive Hemicraniectomy
Conclusion
References
Chapter 26: Burn, Inhalation, and Electrical Injuries
Introduction
Mechanism of Injury
Severity of Burn Injury
Anatomy
Depth of Burn Injury and Corresponding Treatment Modalities
Total Body Surface Area (TBSA) of Burn Injury
Phases of Burn Care
Stop the Burning and Initial First Aid “Buddy Care” in the Field
Initial Evaluation and Management at a Medical Facility
Evaluation
Airway
The Difficult Surgical Airway
Resuscitation
Burn Wound Care
Clean
Reassess
Antibiotics
Bandaging
Pain Management
Preparation for Transport
Securing Endotracheal Tube (ETT)
Burn Wound Healing
First Degree: Superficial Burns
Second Degree: Superficial Partial-Thickness Burns
Second Degree: Deep Partial-Thickness Burns
Third Degree: Full-Thickness Burns
Fourth Degree: Burns Involving Structures Deep to the Skin Including Soft Tissue and Bone
Burn Pathophysiology
Local Tissue Damage
Systemic Capillary Leak
Burn Shock
Burn Wound Infections
Burn Wound Cellulitis
Burn Wound Infection
Burn Wound Sepsis
Types of Burn Injury
Inhalation Injury
Scald Injury
Steam Injury
Flame Injury
Contact/Conduction Injury
Friction Injury
Electrical Injury
Chemical Injury
Radiation Injury
Elevated Compartment Pressures and Compartment Syndromes
Escharotomy
Lateral Orbital Canthotomy Release
Technical Procedures Used in Burn Care
Equipment
Excision of the Burn Wound
Harvesting Donor Skin Graft
Hemostasis
Skin Grafting Technique
Bandaging Postoperative Autografts and Donor Sites
Conclusion
Further Reading
Chapter 27: Management of the Drowned Patient
Introduction
Drowning
Definition of Drowning
Process of Drowning
Shallow Water Drowning
Morbidity/Mortality/Complications
Management
First Responder Care
Initial Management
In-Hospital Airway Management
Ventilator Management
Considerations in Fresh, Salt, and Contaminated Water
Fresh Water
Salt Water
Contaminated Water
Atypical Organisms
Cold Water
Conclusion
References
Further Reading
Chapter 28: Management of Hypothermia and Immersion Injuries
Introduction
Hypothermia
Pathophysiology
Staging and Symptoms
Field Passive Rewarming
Field Active External Rewarming
General Treatment Strategies
Cardiopulmonary Resuscitation (CPR) in Hypothermia
Cold Water Immersion
Pathophysiology
General Treatment Strategies
Swimming-Induced Pulmonary Edema (SIPE)
Frostbite
Pathophysiology
Staging and Symptoms
General Treatment Strategies
Chilblains
Cold Urticaria
Non-Freezing Cold Injuries (NFCI)
Pathophysiology
General Treatment Strategies
Warm Water Immersion Foot (WWIF)
Conclusion
Further Reading
Chapter 29: Acute Management of Chemical, Biological, Radiological, and Nuclear Exposure at Sea
Introduction
Operation Tomodachi
Chemical and Biologic Agent Exposure
Prevention and Planning
Containment and Decontamination
Management
Radiation and Nuclear Agent Exposure
Prevention
Containment and Decontamination
Management
Conclusion
Further Reading
Chapter 30: Maritime Prolonged Casualty Care
Introduction
Prolonged Casualty Care (PCC) Mindset
PCC Limitations
Staffing
Training
Equipment
Core Skill Sets
Minimum/Better/Best
Diagnostics/Monitoring
Resuscitation
Airway
Ventilator
Sedation/Analgesia
Common Situations
Infections/Sepsis
Cardiovascular/Thromboembolic Disease
Burn/Trauma
Brilliance in the Basics
Preparation for Medical Evacuation (MEDEVAC)
Conclusion
Chapter 31: En Route Care: Shore to Ship, Ship to Ship, and Ship to Shore
Outline Placeholder
En Route Care (ERC) Patient Preparation
En Route Care (ERC) Mission Planning
ERC Mission Execution
Transport Planning Concerns
Patient Access and Packaging
Packaging Pearls
Equipment Organization
Organization Pearls
Transportation Safety
Safety Pearls
Conclusion
References
Part V: Humanitarian and Disaster Relief Missions
Chapter 32: Principles of Elective Navy Humanitarian Missions
Introduction
Objectives of U.S. Navy Humanitarian and Civic Assistance (HCA) Missions
Small- and Medium-Scale HCA Missions
Understanding Host Nation Capabilities
Working with State and International Agencies or Organizations
Large-Scale HCA Missions
Medical Capabilities of U.S. Navy Hospital Ships
The Humanitarian Assistance Survey Team (HAST)
The Advanced Echelon or Advanced Liaison (ADVON) Teams
Providing Surgical Care
Other Aspects of Large-Scale HCA Missions
Challenges of HCA Missions
Deployment Considerations
Capabilities of the Surgical Team
Screening Criteria for Surgery
Surgical and Medical Civil Action Programs (SURGCAPS and MEDCAPS)
Subject Matter Expert Exchanges (SMEE)
Post-deployment
Lessons Learned
After Action Reports
Conclusions
References
Further Reading
Chapter 33: Disaster Relief: Lessons Learned
Introduction
The Earthquake Heard Around the World: Haiti 2010
Medical Capability Limitations of a US Aircraft Carrier
Walking Blood Bank (WBB) Activation
Translation Challenges
Absence of Training Requirements for Leaders
Supply Reconnaissance
The “Apocalyptic [12]” Aftermath of Hurricane Maria: Puerto Rico 2017
Humanitarian Assistance Versus Disaster Relief
Intensive Care Unit (ICU) Care in a Unique Environment
Beware the Ides of March: The USNS Comfort Augments New York’s Medical Care During the COVID-19 Pandemic
Activation Without Known Mission Causes Manning Shortages
Medical Capability Limitations of a Hospital Ship
Just-In-Time Supply Limitations
Ongoing Mission Execution Adaptations and Limitations
Conclusions
References
Chapter 34: Children in an Operational Environment: Forward Surgical Teams Caring for Pediatric Patients
Introduction
Clinical Vignettes
Intravenous Access
Common Medication Doses
Fluid and Blood Resuscitation
Pediatric Vitals
Anatomical Considerations
Differences in Airway
Other Key Anatomic Differences
Trauma in Pediatric Patients
Primary and Secondary Survey in Pediatric Patients
Traumatic Brain Injury (TBI) and Pediatric Glasgow Coma Scale (GCS)
Additional Trauma Surgery Considerations
Management of the Malnourished Pediatric Patient
Abdominal Surgical Incisions
Chest Tubes, Drains, Foleys
Any Special Equipment to Bring on the Ship that Is Not in the AMAL Just in Case?
Common Surgical Procedures
Inguinal Hernia
Umbilical Hernia
Incision and Drainage Abscess
Appendectomy
Malrotation/Volvulus
Conclusion
References
Chapter 35: Avast! Acute Medical Emergencies of Detained Pirates or Local Nationals
Introduction
Ethics and Level of Care
Standard Operating Procedures (SOP)
Training
Specific Medical Situations
Tuberculosis (TB)
Coronavirus Disease 2019 (COVID-19) and Other Communicable Diseases
Dehydration and Malnutrition
Dental Health
Mental Health
Chronic Medical Conditions
Provider and Crew Safety
Conclusion
References
Chapter 36: Practical Bioethical Principles in the Deployed Maritime Environment
Introduction
Justice
Autonomy
Nonmaleficence
Beneficence
Ethics Curriculum and Training
Conclusion
References
Appendix A: MacGyver or Tactically Acquire? Maritime “Alternate” Equipment
MacGyver or Tactically Acquire?
MacGyver
Tactically Acquire
References
Appendix B: Sample Packing List for Maritime Deployment
General
Uniforms
Clothing
Technology
Medical/Surgical
Paperwork/Administrative
Hygiene/Toiletries
Berthing/Stateroom
Leisure Time
Appendix C: Glossary of Common Nautical Terms
References
Appendix D: Common Acronyms and References
Common Acronyms
Common References and Resources Relevant to Combat Trauma and Expeditionary Surgery
Index
