Maritime Applications of Prolonged Casualty Care: Drowning and Hypothermia on an Amphibious Warship.

As the U.S. Navy further develops the concept of distributed maritime operations (DMOs), where individual components of the Naval Force will be more geographically dispersed, smaller vessels may be operating at significant time and distance away from more advanced medical capabilities. Therefore, Role 1 maritime caregivers will need to manage injured and disease non-battle injury patients for prolonged periods during current and future contested DMOs. We developed hypothetical drowning and hypothermia patient scenarios to present an innovative approach to teaching complex operational medicine concepts, including the management of hypothermia and acute respiratory distress syndrome, as well as Prolonged Casualty Care (PCC) to austere Role 1 maritime caregivers using the Joint Trauma System PCC Clinical Practice Guidelines (CPGs) and other standard references. The format includes basic epidemiology of drowning and hypothermia in the operational maritime environment. The scenario includes a stem clinical vignette, followed by expected clinical changes for the affected patient at specific time points (e.g., time 0, 1 hour, 2 hours, and 48 hours) with expected interventions based on the PCC CPGs, appropriate guidelines, and available shipboard equipment. Through this process, opportunities to improve both training and clinical skills sustainment, as well as standard shipboard medical supplies, are identified.