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Shipboard Injuries and Rehabilitation of United States Sailors

Shipboard Injuries and Rehabilitation of United States Sailors. Kristin R. Hodapp, MS, PT, CSCS LCDR, MSC, USN. Presentation Overview. Navy Medicine Assets Role of Aircraft Carrier Medical Department Role of Shipboard Physical Therapy Physical Therapy Cases. Navy Medicine Overview.

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Shipboard Injuries and Rehabilitation of United States Sailors

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  1. Shipboard Injuries and Rehabilitation of United States Sailors Kristin R. Hodapp, MS, PT, CSCS LCDR, MSC, USN

  2. Presentation Overview • Navy Medicine Assets • Role of Aircraft Carrier Medical Department • Role of Shipboard Physical Therapy • Physical Therapy Cases

  3. Navy Medicine Overview • Medical Treatment Facilities (MTFs): variable level of services depending on size. Typically, patients will be medically evacuated to the larger MTFs. • “The Big Three” • National Medical Center Bethesda • Naval Medical Center San Diego • Naval Hospital Portsmouth

  4. Navy Medicine Overview • Forward deployed medical assets • Land based: Fleet Hospital • Shipboard: depends on mission/size of crew • Submarines • Cruisers/Destroyer or “small boys” • Amphibious Assault Ship • Hospital Ship • Aircraft Carriers

  5. Cruiser/Destroyer Medical Staffing • Medical staff: two junior hospital corpsmen and one Independent Duty Corpsmen. • Will MEDEVAC patients to either the amphibious ship or aircraft carrier depending on the Battlegroup assignment.

  6. Amphibious Assault Ship Medical Staffing • Mission: to transport and deploy elements of a Marine landing force during amphibious assault operations via helicopter, amphibious vehicles, and/or landing craft. • Ship’s crew: 100+ officers and 1,000+ enlisted. Marine detachment: 1,900

  7. Amphibious Assault Ship • Largest dental component for any combat ship • Medical: most extensive medical support of combat ship with 600 beds and 6 operating rooms.

  8. Hospital Ships: USNS Comfort and Mercy • USNS Mercy is west coast based. • USNS Comfort is east coast based. • Staff includes all major specialties, but will customize staffing depending on mission

  9. Hospital Ship Mission • Provide afloat acute surgical care to the U.S. military that is flexible and uniquely adaptable to support expeditionary forces. • Secondary mission is to provide medical care for U.S. disaster relief and world-wide humanitarian operations.

  10. Total Bed capacity: 1000 ICU beds: 80 Minimal care beds: 500 Recovery Beds: 20 Intermittent care beds: 400 Operating Rooms: 12 Surgical Capabilities: ENT Orthopedic OB/GYN Ophthalmic Dental and Maxillofacial General Urology Neurosurgery Plastic Cardiothoracic Hospital Ship Facts

  11. Non-Surgical Capabilities • Internal Medicine • Pediatrics • Dermatology • Respiratory Therapy • Physical Therapy

  12. Patient Transport • Patients primarily arrive either by helicopter or small boat

  13. USNS Comfort Humanitarian Mission • 4 month South American Tour • Training Opportunity: CPR/BLS ACLS intubations

  14. USNS Comfort Humanitarian Mission • Physical Therapy • Gait training • Ergonomics/Patient transport techniques to hospital staff • Burns/Wound Care • Splinting • Typical Sprains/Strains

  15. Aircraft Carrier Medical Staffing • Total Medical/Dental Staff: 97 • Staff: • Senior Medical Officer (SMO) • General Medical Officer (GMO) • Nurse • Surgeon • Nurse Anesthetist • Physical Therapist

  16. Aircraft Carrier Medical Staffing • Clinical Psychologist • Physician Assistant • Radiation Health Officer (nuclear) • Medical Administration Officer (MAO) • Flight Surgeon (2-3)

  17. Role of Aircraft Carrier Medical Department

  18. USS RONALD REAGAN CVN-76 • Peace Thru Strength motto • About 4.5 acres of sovereign US territory • One of the most dangerous jobs: working on the Flight Deck.

  19. USS RONALD REAGAN (CVN-76) • Commissioned on 12 July 2003 • Ship was built in Newport News, VA • Homeport change “around the horn” cruise • Maiden Deployment January-July 2007 • Surge Deployment

  20. USS RONALD REAGAN (CVN 76) • Crew size: 5300+ • As tall as the Empire State Building • Over 80 aircraft attached to ship • Can operate 24/7

  21. Aircraft Carrier Medical Capability • Basic Laboratory services • Basic Radiology services • Radiographs • Ultrasound • Unable to have MRI onboard due to the constant motion on ship and metal in ship

  22. Aircraft Carrier Medical Capabilities • Able to manufacture eye glasses • Basic casting and splinting • Pharmacy technician

  23. USS RONALD REAGAN CVN-76 • Medical resources are primarily located in the main medical spaces (2nd deck below the Hangar Bay). • During flight operations, special manning of the Flight Deck Battle Dressing Station (BDS) required. • Flight Deck BDS have special communications with Main Medical.

  24. USS RONALD REAGAN CVN 76 • Medical is staffed 24/7 even when in port. • Duty Medical staff in-port: one officer and minimum of four corpsmen • Duty Medical Staff while deployed: minimum of eight corpsmen, 2 officers, and one MD.

  25. Shipboard 911: Medical Emergency • Over the 1-MC announce location of casualty • Medical response team launched and main medical sets up triage room. • Communications via radio. • Response team consists of: • 3 corpsmen • One Independent Duty Corpsmen

  26. Shipboard Medical Emergency Response • Underway, all medical staff required to report to main medical to set up. • Approximately two minute transit time to anywhere in ship. • Right of way with ladder wells and passageways • All crew members are stretcher bearer and BLS certified. Ship minimum of 90% compliance.

  27. Chest pain/MI Electrical Burns Smoke Inhalation Heat Stress Fall down ladder Flight deck Stroke Drug Overdose Steam Burn Syncope Ramp strike with pilot ejection Man Overboard Reasons for Actual Medical Emergency

  28. Emergency Medical Training • All crew members are to be BLS and stretcher bearer certified • Three types of stretchers • Reeves sleeve only one safe for ladder transport • Unique transportation challenges: • Island of ship • Main engineering spaces

  29. Emergency Patient Transport

  30. Mass Casualty Definition • Five or more injuries that taxes medical resources • Most likely scenarios: • Flight Deck accident • Called Mass Casualty by the Air Boss • Main space fire • Hangar bay explosion

  31. Mass Casualty • Dental officers serve as the initial triage officers to sort casualties on flight deck • Senior Medical Officer (SMO) and surgeon divide casualties based on acuity. • “Pods” set up to manage up to 10 patients. Staffed by 2-3 corpsmen and IDC, PA, or MD

  32. Mass Casualty • Ancillary services role with walking wounded (PT and Psychologist) • Goal to clear all patients off of flight deck in 15 minutes and to resume operations

  33. Goal to then clear hangar bay Overflow area is the mess decks Role of other staff: Chaplains Dental after initial triage Admin with patient tracking Supply Mess decks staff Blood bank initiated by either the SMO or surgeon Communication with Commanding Officer Primary goal is to “Fight the ship” Mass Casualty

  34. Mass Casualty

  35. Mass Casualty Training • Required to do a Mass Casualty Drill once a quarter. • Once a year, the ship will be graded by an independent training team. • Mass Casualty training is the surgeon’s responsibility

  36. Related Occupational Health Issues • Low Back Pain/Injuries tracked by Safety department. • Multiple medical surveillance programs • Radiation • Fuels • Heavy Metals • Hearing • TB • STD

  37. Shipboard Physical Therapy

  38. Physical Therapy • On average, 60% of sick call was for a musculoskeletal reason. • Prior to Physical Therapists onboard, over 20 MEDEVACS/deployment with an average cost of over $70,000 with the additional loss of staffing. • Since PTs onboard, average of two MEDEVACs per deployment and average cost of less than $7,000.

  39. Shipboard Physical Therapy • Neuromuscular expert • Casting/splinting skills • Evaluation, treatment, and management for a return to duty • Manual therapy skills • Health Promotions Officer

  40. Neuromuscular Screener • Role of Physical Therapists as a Physician Extender. • Additional training in evaluation and therapeutic management. • Credentials

  41. Casting/Splinting • Physical Therapy AMMAL (supplies) include materials and prefabricated splints • Training • Fracture management

  42. Return to Full Duty • Over 90% of patients returned to full duty within two weeks. • Manual therapy • Light duty recommendations • Patient education • Barriers to return to full duty

  43. Barriers to Return to Full Duty • Psychosocial • Crutches • Splints • Casts • Operational Tempo • Patient Compliance

  44. Psychosocial Factors • Depression • Anxiety • Stress • Fatigue • Work Center Dynamics

  45. Shipboard Physical Therapy • Top Diagnoses: • Sacroiliac Dysfunction and Low Back Pain • Patellofemoral Syndrome • Plantar Fasciitis • Shoulder Impingement • Neck Pain

  46. Shipboard Physical Therapy • Direct Access clinic • On deployment, clinic averaged 456 patient encounters per month. • 40% of patients were Air Wing (ship’s company approximately 3500 vs. Air wing 1700).

  47. Factors that influence the effectiveness of PT • Boots • Steel decks • Low ceilings • Poor work center ergonomics • People not screened for certain job requirements (handling lines, etc) • Fatigue/Poor sleep hygiene • Drills and work center hours

  48. Unique Shipboard Jobs

  49. Unique Shipboard Jobs

  50. Unique Shipboard Jobs

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