Maritime Trauma

In this episode of Frontline Surgery: Mastering Military Trauma Care hosts Dr. Joshua Dilday and Dr. Jay Yelon are joined by Dr. Matthew Tadlock, an expert in maritime surgery and operational planning, to explore one of the most underrepresented environments in combat casualty care: surgery at sea. From burns and blast injuries aboard amphibious warships to emergency general surgery on a carrier with a single surgeon and a team of corpsmen, the episode unpacks the full breadth of what naval surgeons face and why the tyranny of time and distance demands a different kind of readiness.

The conversation covers patient movement through a threatened ship, evacuation decision-making in contested environments, and the launch of the Maritime Surgery Quality Improvement Program, which is bringing monthly case conferences, mentorship, and outcomes data to a community that previously had none. Dr. Tadlock closes with a reminder that maritime surgery is a joint problem, with Army, Air Force, and allied surgical teams increasingly integrated onto naval platforms, and that preparation for those environments has never been more urgent.

Literature Mentioned:
Expeditionary Surgery at Sea

Traumatic and Burn Injury during routine operations and war at sea

Between the Devil and the Deep Blue Sea
War at Sea: Burn Care Challenges
Injury Trends on US Navy Vessels

Elective and Emergency General Surgery
Surgery at Sea Nealeigh et al.
Surgical Care at Sea a retrospective review

Maritime Prolonged Casualty and Critical Care
Maritime Applications of PCC -Sepsis
Maritime Applications of PCC - Drowning and Hypothermia
Maritime Applications of PCC - Burns

Transcript

SPEAKER_00 0:01

One important thing to remember is surgery at sea is not just for the Navy. More and more, we are training and integrating army surgical teams on our warships. We're integrating our medical services. We're practicing with Air Force units. Maritime surgery is a joint problem, and more and more we're going to be working in that environment together across the services.

SPEAKER_02 0:28

Enter the world of military trauma surgery with frontline surgery, where we bring you expert insights and real-world scenarios to help surgeons stay ready.

SPEAKER_01 0:37

Brought to you by the AST Military Committee. Join us as we engage in conversations with field experts, examine critical battlefield scenarios, and uncover the strategies that keep surgeons ready for anything.

SPEAKER_02 0:50

Stay prepared and stay sharp with Frontline Surgery, where every episode provides key insights into mastering military trauma care. And this series, just to review, this series prepares the early military surgeonists for the realities of deployed trauma care and their systems across diverse environments. And we've got one very specific system in the diversity of continuity of combat casualty care today, Dr. Yellen. I'm excited for this episode. Thanks for joining us today as co-moderating.

SPEAKER_03 1:30

Hey Josh. Being a Navy trauma surgeon, the specifics of maritime trauma care are important, unique, and have its own set of rules, I'll say. And today's guest, as you'll introduce, is an expert in all those things.

SPEAKER_02 1:51

Absolutely. And that's what we're talking about specifically today, it's maritime surgery. We're focusing on how that can provide trauma and surgical care aboard ships and in those maritime environments. And unlike land-based operations, these maritime platforms introduce unique constraints that sometimes get underrepresented when we talk about combat casualty care, the limited space, the variable resources, the evacuation challenges, and that dynamic environment of the sea. And because of that, we are joined by an expert in all of those facets, Dr. Matthew Tadlock. He's deployed in a maritime surgical role. He brings expertise in operational planning and the medical logistics of coordinating all these aspects at sea. Dr. Tadlock, thank you so much for being a guest today on Frontline Surgery. We look forward to having this conversation with you, an expert in Navy surgery.

SPEAKER_00 2:39

Hey, thanks for having me. I'm excited to be here. It's cool to be on the Frontline Surgery podcast. And just I'll say one thing. So my first uh carrier deployment as a surgeon, I brought the first edition of frontline surgery with me. So that was an aid for me. And then the second edition, I brought on my combat land-based deployment. So super excited to be here and super excited to be a part of this.

SPEAKER_03 3:03

So, Captain Tadlock, uh, again, thank you for joining us. Uh, we look forward to our conversation today. Um, I'll I'll just remind all of us that we are talking to uh a joint uh group of uh surgeons and other clinical specialists. And so some of the things that we talk about may not be uh crystal clear to everyone. So feel free to provide some context so that it's not just you and I as sailors talking, but rather providing an educational base for all our listeners. So let me let me start with a clinical scenario. You're underway on a LHD, a landing helicopter dock, under alert conditions. In the galley, there's a stovetop fire, and a culinary specialist sustains burns to his hands, upper extremities, and anterior torso when his clos clothing catches fire. His shipmates are quick and assist him and extinguish the CS's clothing. He's brought to medical and on initial assessment, the corpsman estimates that this sailor has a 25% total body surface area, a deep partial thickness burn. So that's the scenario. Matt, if you can give us your sense of what are your immediate priorities in dealing with this uh patient, dealing with the alert conditions at sea, and how this may differ somewhat from land-based trauma care.

SPEAKER_00 4:51

Sure. I I guess you know, for the audience, an LHD is one of our larger amphibious warships. And specifically, it's got a it's got a flat-top flight deck for vertical takeoff aircraft, so helicopters, vertical takeoff jets, ospreys. And then the LHD specifically also has a large weld deck that can be flooded for amphibious craft to to to send them off. And so the amphibs are designed to take Marines anywhere in the world and get them where they need to be. So that's that's the setting we're talking about. Normally, an LHD, um, you know, during routine operations, deploys with uh something called a fleet surgical team. It's an 18-person team that augments the medical department. There also are medical providers from the the marine expeditionary unit that's on board too. But the the important thing to understand is you got all these medical providers, it's still just a single surgeon team. So there's really during routine operations, there's one one surgeon on that team, usually one cRNA. Um so that's the setting. I guess the first thing I would say is you mentioned alert conditions, and I think the, you know, it depends on what that means. But if the ship is threatened in any way, either under attack or there's a mishap, and the ship's crew is roaring about integrity and saving the ship, the first thing I'm thinking about is where did this injury occur? And can they even get to medical? Because when the ship's threatened, medical doesn't have a say on casualty movement or how they get there. So if they can't get to medical, where is the closest dispersed battle dressing station? And every ship has essentially like a little ER where care can happen in their supplies. So that's the first thing I'm thinking of. Can they get to me? Is the ship under threat? How are they gonna get to me? When are they gonna get to me? And if they can't, who is gonna be taking care of them in that battle dressing station? Um, you know, once they're to me, I don't think that the priorities are any different than any other trauma center. You know, you mentioned this is a burn injury. Obviously, I want to make sure that there's no trauma associated with it, too. So they're gonna get a standard primary and secondary survey and make sure that there's no trauma associated with this. Um, and and and you know, you want to stop the burning process, remove clothes, um, get a determine the extent of the burn. This, you know, this is a 25% TBSA, they're gonna need crystalloid resuscitation. So we teach people to use the joint trauma system CPGs, so you need to start crystalloid resuscitation. And then, you know, I'm really concerned uh about you know his extremity, well, the whole thing, but are are his extremity wounds circumferential, you know, monitoring those, the risk of compartment syndrome. And then do I have comms? Because, you know, most naval providers, in fact, G, I think you might be the only surgeon on active duty who is burn-trained and burned experience in the Navy. So there's not a wealth of knowledge and experience about burns. And so I would emphasize to people once you've got things stabilized, you really need to reach out, if you have comms, to the U.S. Army Burn Center and discuss the patient and make sure you're doing all the right things. So those are my first sort of thoughts. And then the next thing is when, how, and where um are we gonna get this sailor off the ship so they get the best care possible? And I can talk a little bit more about that, but those are my initial thoughts, Jay.

SPEAKER_03 8:33

Those are great uh comments and I appreciate that. You know, you have written um quite a bit on uh maritime trauma. So when we talk about that, what are the injuries that that the that the surgeon or the whole uh team might be seeing when at sea?

SPEAKER_00 8:54

Yeah, they they they fall under two categories. So there's there's injuries that you're gonna typically manage during naval combat. And that's not something any Navy has really faced any time recently. Really the last time the United Kingdom in the Falklands War, that that's the last time there's been any evidence of total war at sea. But really for the U.S. Navy, you really got to look at World War II, um, and particularly in the Pacific theater. And so, you know, when you look at data from World War II, you know, when ships are they hit a mine, a bomb is dropped on them, naval gunfire, or kamikaze attack, and that's as closely akin to an interballistic missile. The kind of injuries that you see are, you know, when ships blow up, you're gonna get penetrating wounds from shrapnel, you're gonna get blast injuries, you're gonna get that concussive effect. And a large percentage, depending on the on the war is 40 to 50 percent, you're gonna see some kind of penetrating wound. And and you don't, I don't have the exact data of exactly what they were managing at that time, other than to say that there were penetrating wounds. But you can think about it, you can you know, you can have penetrating chest trauma, penetrating abdominal trauma, blood solid organ injury, all the things that you would think about when things blow up. And then a significant percentage is burn and inhalation injury. And if you look at, you know, combat at sea, there's about a 25 to 30 percent burn injury rate. And when you look at the kamikaze attacks of World War II, which I would think would be more similar to missile attacks now, um, there's an even higher burn injury rate. And so um, those are really things that you have to think about. You have to think about traumatic brain injury, you have to think about fractures. Um, and then, you know, if particularly for these penetrating wounds, if it's a long time before these patients get to medical care, depending on where they are in the world, you need to be thinking about wound infections and managing sepsis. When you look at routine operations, so now that's pretty much what we've been doing in the Navy since World War II. It's very rarely, other than a mishap, that a ship is significantly threatened. The surgeon at sea has got to manage, you know, basic emergency general surgery, um, the occasional urologic or gynecologic emergency. And then specific to the shipboard environment, you know, minor burns, usually not as bad as you've described here. And then hand injuries are very, very frequent. Hand finger crushes, lacerations, flexor tennis inivitis. Those are things that the maritime surgeon, anybody going to see, needs to have an algorithm and be prepared to manage. And the interesting thing about during routine operations, you know, things happen. We we um we looked at this a couple years ago. We looked at 50 years of data from the Naval Safety Center. They track every mishap that's happened on every naval vessel. And we we looked at injury rates and they've significantly decreased over the last 50 years. And when you compare the injury rates to other high-risk professions, you know, mining, construction, boat building, it's actually pretty safe to be a sailor on a U.S. Navy vessel. The injury rates are far less. So that's a general overview of things that you need to think about, depending on whether you're doing routine operations or, you know, your your ships under threat.

SPEAKER_03 12:27

Yeah, thank you for that. Those are great insights to both the um operational environment, but also routine maritime operations, because the ship is a high-risk environment, right? There's a lot of things that go on that are um at at significant risk or potential risk for injury. So those insights are really, are really great, and I appreciate those. You know, one of the things that's different than land-based care is the tyranny of distance and time. And so, how how does the surgeon prepare themselves to deal with those situations? You have a patient on board that is going to need a higher echelon of care. What are the strategies, the outside the tenth skills that that surgeon needs to facilitate the movement of that sailor?

SPEAKER_00 13:33

Yeah, one of the things to think about, if if you look at like the history of of the navies of the world and naval combat casualty care, particularly at the age of sail, being a surgeon at sea is originally one of the original sort of austere forward surgical teams. It's less so now because ships aren't under threat. But but I've mentioned that because your primary mission of that warship is not to take on casualties, is not combat casualty care, is to serve whatever mission you're serving and maintain combat effectiveness. And so for that reason, any decision to operate or to do anything has to be approved, and it's ultimately the commanding officer's decision. So you mentioned outside the tent skills, so whether it be routine operations or not, you know, your ability to clearly communicate, um, to recommend to pull the trigger for a Medevac at night if you think that's necessary, because that's a dangerous evolution. Your ability to clearly communicate with your senior medical officer and the leadership of that ship. And oftentimes, like in my experience, you as the surgeon, you're the only surgeon on the ship, usually, you often are directly advising the commanding officer. It depends on the structure. And so really clearly understanding the operational environment that you're in and clearly communicating is so critical and important because if you're a surgeon who sort of is only around when needed and not part of the medical department and not part of the ship's crew, well, when it matters, you may not, your recommendations may not be listened to. So that that's a, I guess, a really important part. And we as trauma surgeons understand that because you know we work in systems, we work in, we work, what we may be a trauma medical director, that that communication with our colleagues is so critical. The other thing that you have to think about. So if you have a patient, whether it's a traumatic injury, it's a burn, it's emergency general surgery, whatever it is, you really need to understand the options of where they're gonna go. And is the expected best and worst outcome what that's gonna be at say a civilian hospital in a foreign country? Like, is that hospital really gonna be able to provide better care than you can until that you can get them to an allied or US-based facility? And so that's a really hard thing to do, and it it varies depending on where you are. I'll give you an example. So I there was recently uh I know of on a ship recently, there was a fire, sailor had an inhalational injury, and the surgeon and the and the medical department had to decide hey, do we put this patient on a short Hilo ride to a country where we've sent people before, but they don't really have a burn capability, um, and they have a small ICU? Or do we take the risk and put that patient, who is intubated, by the way, on one of the fixed wings. It's called a COD, a fixed wing plane, catapult them off the carrier, and then send them to a country where we have people, we know we can communicate with the hospital, and we have a better idea of the care. And those are those are sometimes difficult decisions to make. In this case, they they decided to send them to the known quantity once the patient was stabilized and they catapulted them off the carrier. And so that's the that's the constant decision. Can I provide the care needed? And if I send them off the ship, um, is that care gonna be better than what I can provide?

SPEAKER_03 17:10

Yeah, I I want to go a little bit further on that, Matt. So I think um you highlighted some of the operational issues. And I think the only way to orient oneself as the surgeon to provide advice and counsel to the commanding officer is really having a solid understanding of the pathophysiology and natural history of the disease that you're dealing with. So it's incumbent upon the surgeon to really understand what the disease process is and then provide, then bring those other observations into your, I'll call it your OODA loop in decision making about host nation hospital, US Role Three facility, and all those other decision makings. So, you know, we we typically see relatively junior surgeons in these roles on these large platforms. I just want to sort of emphasize and get your take on really understanding the natural history of trauma, the disease process, and the pathophysiology, all while understanding the resources that you have on the ship.

SPEAKER_00 18:34

Yeah, you know, you could talk a lot about all of that. So, yes, 100% I agree with you. Um, one of the first things that you need to do as a surgeon on any kind of maritime platform, whatever you're on, whether you're supporting an aircraft carrier, one of our AMF vessels, or you're on one of our Navy austere surgical teams that is meant to provide a surgical capability on ships that usually don't have it, you you really it's incumbent upon you to uh have a really good understanding of not just whether you have the right surgical instruments and staples and all that kind of stuff, but what's your blood capability? What is your ICU capability? When are you going to run out of drips, etc.? Because you need to have a swag of that before advising anybody. And some of that's a lot of that's your senior medical officer's responsibility on your ship. But often those those caregivers, they're great, but they don't have a lot of injury experience, critical care experience. And often the person with the majority of that experience is the surgeon. So you need to also understand when you're gonna run out of resources.

SPEAKER_03 19:45

Yeah, I'll I'll I'll I'll interrupt you there for a moment, Matt, because part of the resources is your crew and crew resource management and how you're gonna deal with uh with the personnel that you have to provide this austere care for the patient. And that really gets us into the next lane that I I want your comments on is about prolonged care, keeping a patient on the ship, and providing prolonged casualty care for the patient at sea.

SPEAKER_00 20:19

Yeah, and it it really depends on the team that you have. And so there's three general flavors, and I I kind of alluded to them just in the previous question, of surgical teams. So at any one time there's uh 20 maritime surgical teams on that are potentially on a routine deployment. And then when you add the ERSS, there could be more depending on what they're uh supporting. But like on a, for example, on aircraft carry, to your point, your your team, at least the surgical team, is you as the surgeon, two or three surgical technicians, and a CRNA. There's one nurse on the ship who is maybe ER or critical care, but they're the only nurse on the ship and they have a lot of administrative challenges. So that's what a carrier looks like. So the a lot of the people supporting you, particularly post-operatively or monitoring, are going to be corpsmen. And so, you know, we're used, I don't know, some of us in training are used to in the hospital relying on the wards and the ICUs to do their job and all those kind of things. Um, it's really incumbent upon you and the surgeon to really be involved and and track and um go see the patient, teach your cormen, um, and and and make sure that you know all the right things are happening. Fleet surgical team has a little bit more capability. It's similar, it has a CRNA, um, but you also have a perioperative nurse. And that's unique to the fleet surgical teams. And in my current role, I'm in charge of the West Coast fleet surgical teams. And I really I didn't really appreciate how important an experienced perioperative nurse both. Both in the hospital and in the operational setting can be for your surgical team. And I, and I, and comparing to the other maritime platforms I've been on, you know, on the carrier team, on the carrier and on the ERSS, or even with the Marine Corps, like you are right now, Jay, is that lack of uh of that perioperative nurse expertise in term in terms of osteo sterilization and their just level of knowledge and experience is a gap for some of these teams. And I think it's I think it's underappreciated.

SPEAKER_02 22:32

You know, that's a huge component. And please forgive me, I just have to ask this from the non-navy side. Most of the components you just talked about from both of you were a single surgeon team. And then you also said you have to understand the physiology of what's going on with your patient, casualty or not, to affect your ability for those professional leadership attributes. And then you simultaneously talked about the limited evacuation, which I feel like begs the question with a single surgeon team and a large amount of potential patients, what about non-trauma surgical care? What about emergency surgery? How does that come into play with understanding physiology, limited evacuation, and only being one surgeon? How does a newly trained surgeon pre-prepare for that breadth of potential catastrophes?

SPEAKER_00 23:23

Well, so one thing that we've done in the Navy, Navy Medicine has an operational clinical community. And for the last five or six years, I've chaired the fleet surgery surgical community or subcommunity. And we've really tried to tackle this because fundamentally, and I think it's somewhat similar in other services, you know, you're a junior surgeon, you're assigned to a maritime platform, and there's no formal mentorship available at all. And so we've created this program that does a couple of things. And it's really modeled after, you know, the JTS combat casualty care call, where we've done a couple of things. So, you know, if you're assigned to a fleet surgical team or a carrier, number one, if you do a procedure at sea or perform surgery or send somebody off the ship for surgery, you need to log that and submit it to a centralized database. Because that has never really happened until about four or five years ago, until we started this program. So, so that that's the first step. The second step is we now hold monthly uh we call them maritime surgery quality improvement program conferences where um surgeons basically, you know, if they had a difficult case or a challenging thing, they present that. And everybody, all the other surgeons all over the world, like we just had one yesterday. So we had people calling in from deployment, some in places in the news. We had people calling in from Japan, we had people calling in from Europe, East Coast, West Coast. And we converge and we talk about these challenging cases. And what happens is, um, and then often senior surgeons are on the calls too. And what happens is we've created a mechanism for that formal mentorship. And that wasn't happening before. The next thing that that program does is now we're starting to have actual outcomes data. And um we're gonna publish the first paper in the military supplement of JTEX this summer. And it's not a lot of patients, but but now we have you know 30-day outcomes and long one-year outcomes on mostly emergency general surgery stuff. So now you as a surgeon have a tool and you can use that outcomes data to communicate up your chain of command on what you should and shouldn't be doing. I'll give you one example of, and I don't know what happened here, but where the wrong decision potentially was made. You know, one of the things that we have to take care of, like I mentioned before, that is a little bit outside of our skill set as general surgeons, is, you know, hand injuries, gynecological emergencies, and urologic emergencies. You know, managing or triaging gynecological, potential gynecological emergencies are actually quite frequent. And what recently, in the last, well, recently, in the recent past, one of the surgeons had a young woman coming in with abdominal pain, and he was concerned about ovarian torsion. And he wanted to take the patient to the operating room for a diagnostic laparoscopy. And that, you know, we have endoscopy and laparoscopic capabilities on our bigger combatant vessels. And and I don't know what communication did or didn't happen, but the senior medical officer didn't agree with the surgeon's diagnosis and and and recommended to the commanding officer, no, that we not fly, that we not do this procedure, and then we wait till we pull into port the next day. And because we're gonna be able to get that patient to a U.S. emergency room. And that was the decision that was made. And thankfully, you know, when the patient got off the ship and they were seen, they did not have ovarian torsion. And so nothing happened there. But I I use this forum to sort of talk about that case because, in my opinion, the absolute wrong decision was made. And we're trying to create outcomes and case stories and resources so that surgeon can advocate and do the right thing. And so it's challenging. It can be challenging at time because most of the time, you know, during routine operations, you're not dealing with a lot of sick and injured patients or of some of these acute conditions.

SPEAKER_03 27:35

Matt, thank you so much for giving us really a sense of the true complexity of maritime surgical care, both trauma and uh other. Uh, and and it is truly a complex environment, and you're dealing with a lot of stakeholders, which makes it even a different level of complexity that most of us don't deal with on a routine basis. So now we're sort of at the part of the discussion where I need you to provide our listeners with some advice. What kind of training is essential for surgeons practicing in the maritime environment? Understanding the tyranny of distance and time, understanding the shipboard medical capabilities. In that, what's the role of rehearsing to deal with emergencies? And what's your best advice for building relationships with the ship's leadership?

SPEAKER_00 28:44

Yeah. Um, so a couple things. Um, you know, you as a surgeon, you're a naval officer, and you really need to, you know, it's it's difficult, right? Because when you're not deployed, you need to be at the hospital and you need to be operating and taking care of patients. So one thing that you can do is really focus on getting members of your surgical team to the hospital with you and working together as a team. It does a number of things. They get to know you, you get to know them. You're making sure that they're getting skill sustainment. Um, and that's the first part, building those relationships. Really, you really need to try, particularly if you're assigned to a carrier, to be the go-to for elective surgical problems for your ship. Have a clinic on the ship. Make sure that the people know that if they've got a surgical problem, they got to come to you. It's it's just like it's just like private practice when you want people to consult you. You've got to be available and affable. And hopefully, you know, you you have the ability because you were well trained. I don't think it's too dissimilar, but you've you've got to be a presence, you've got to be, you've got to be there. And then eventually everybody in the ship will get to know you, particularly on deployment. One of the first things you have to do is you've really got to do, you know, we in the Marine Corps we call it a limited technical inspection. You've really got to understand all of your gear and consumables and trust but verify everything because during a bad day at sea, you don't have it. Um, that can be problematic. And then you talked about rehearsal. So one of the big things about the maritime surgery quality improvement program that we emphasize is appropriate surgery at sea is safe. So if you're deployed underway and somebody comes in with an appendectomy or something that you could handle easily, you really need to try to do that while underway, because that is just one aspect of getting your team ready for a bad day when a mass casualty happens or a mishap, or you know, you know, you end up taking in combat casualties for any reason. The next thing I would say is um, particularly as a single surgeon team, you need to be heavily involved in the mass casualty exercises on your ship and really understand the capabilities of each dispersed battle dressing station on your ship. During training exercises, be one of the teams that go out, goes out to those places, trains the corpsmen or their providers that are there, and really understand casualty movement through the ship, particularly if it's threatened, because it can be challenging depending on the ship that you're on. You have to carry patients up and down ladder wells. Sometimes you have to hoist them from deep down in the ship and really learn and understand that because I think it'll it'll help you better train the corpsmen and other other people working for you. Um I think those would be the first things that I would say. And one thing we haven't really talked about is the patient transport through the ship. Whether you're on a carrier, on an amphib, or on a smaller ship as part of an augmented surgical team, that can be time consuming, it can be difficult, and you need to practice it with the ship's crew and understand it.

SPEAKER_03 31:59

So, Matt, after spending over 20 years uh in Navy medicine, give our listeners uh sort of an understanding of the breadth of potential scenarios the Navy surgeon might be met with.

SPEAKER_00 32:17

Wow. I I mean it's it's truly anything that any expeditionary surgeon might manage. You know, if you watch the news in the last few years, the Red Sea, currently what's going on with the epic fury, the Iran conflict, and the Strait of Hormuz, you've got to be prepared for anything. I think in the maritime environment, like I've said before, hand injuries, septic joints can happen, and people have had to do open arthrotomies, particularly of the knee. I mentioned the I've mentioned the gynecological emergencies, specifically ovarian torsion, ectopic pregnancy occasionally happens. Understanding hemorrhagic ovarian cysts, testicular torsion can happen, and then the full breadth of emergency general surgery and trauma care. If you're talking about naval combat, you know, I think a big weak spot for all military services is burn care. And you really need to brush up on that. And then you need to be thinking about, you know, prolonged holding of all of these patients and how you're going to do that. Um, and and and if you don't have the long-term resources, make sure you're clearly communicating that up your chain.

SPEAKER_03 33:24

I appreciate those are great comments. I'll just follow up your comments with, you know, in your um uh career, what uh unique missions have you been on?

SPEAKER_00 33:36

Well, yeah, so I've done the full gamut. Um, you know, I've done the carrier surgical team, I've done, I've done the role three, roll three combat hospital in Afghanistan. I've been on an Ossier surgical team. So our, you know, our ERSS, the seven-person single surgeon team supporting Naval Special Warfare mission on a destroyer. That was pretty interesting. That that happened right as the world shut down for COVID. And all of our original evacuation plans went out the window because nobody was accepting patients. And so we had to sort of change our calculus if we had had casualties for what we were supporting. So that was really interesting. And I really, really came to personally understand the tyranny of time and distance because it was going to be several days before we could pull into uh a port where we could get those patients. Probably one of the most rewarding and interesting things that we did is I was able to be part of the two surgical or the medical team and the two surgical teams that participated in the Artemis recovery mission, you know, uh a few weeks ago. That was pretty interesting. Got to learn a little bit about some of the physiology of spaceflight. Um, and you know, the Air Force has a has a has a course that for pre-hospital providers that gives you basics that I recommend that you take. And then being part of planning for that. Now, thankfully it went well, but but we weren't just planning to take care of the astronauts should something happen. But really, it really is a complex operation involving, you know, helicopters and navy divers and recovering the capsule over a long period of time. And it it went flawlessly, and there was really no problems, but we were also, you know, preparing for those contingencies as well. But that that has to be one of the comes to mind as one of the most uniquely rewarding experiences that I've been able to be participate in my career in the Navy. Well, that one important thing to remember is, you know, surgery at sea is not just for the Navy. More and more we are training and integrating Army surgical teams on our warships. We're integrating, you know, the Canadian Armed Medical Services. We're we're practicing with Air Force units. So, you know, we're really maritime surgery is a joint problem. And um, more and more we're going to be working in that environment together across the services.

SPEAKER_03 36:13

Matt, I I truly appreciate your insights. I'll I'll shamelessly plug your textbook on maritime surgical care, and we'll put those in the show notes, a link to that. Maritime surgery represents a critical component of distributed operations. As future clock conflicts extend into the littoral and maritime domains, surgeons must be prepared to deliver high-quality care in these unique environments. Understanding how maritime platforms integrate into the broader trauma system is essential for readiness.

SPEAKER_02 36:52

Well, thank you so much for joining us on Frontline Surgery. And we were, we were just honored to have you, Dr. Tadlock and Dr. Yellen, just experts representing the Navy well, Navy surgical care, and that whole continuity of comeback SOD care. As you described, these maritime environments just to demand adaptability, preparation, teamwork, bringing people back from space. What a phenomenal breadth of experience you can have as a naval surgeon. And by understanding these challenges, clearly you're ready to deliver life-saving care wherever possible. And wherever the mission, whatever variation that mission takes, may take you and the surgical team. So thank you so much for all the listeners. Hope you enjoyed this on one specific aspect of unique military trauma care. Until next time, stay sharp, stay ready.

SPEAKER_01 37:35

Thank you for tuning into this episode of Frontline Surgery. We hope today's discussion has provided valuable insights into military trauma care. Be sure to join us next time for more expert perspectives and battlefield ready knowledge.

SPEAKER_02 37:47

Until then, stay ready.