Wednesday, September 24, 2008

Open SSBN /SSGN Question Raised by USS Nebraska (SSBN-739) Tragedy

The following comment was made on Bubblehead's TSSBP Tragedy Onboard USS Nebraska posting:

Parent said...
Our son was one of the initial medical providers for this sailor and he said that he and the other providers managed to keep this sailor conscious for over 4 1/2 hours, but ran out of time just as the helicopter arrived. Obviously, they are all very traumatized for what they experienced. The only consolation is that doctors have told them that it was remarkable that they managed to keep him alive for over an hour with those severe injuries. ... [emphasis added]

No doubt whatever that the injuries were severe and the onboard medical response top notch in the circumstances.

When I read the comment, however, it dawned on me that a submarine medical officer may not have been among the onboard first responders. Regardless, the trauma was severe and there could be no guarantees a sailor's life might be saved.

There is an incapacity to replace major blood loss. Reading between the lines, I am almost certain that inability to replace blood was contributory to the brave submarine sailor's death.

Thinking back, our chief corpsman had once volunteered that he was trained and prepared to amputate a leg in any emergency. That would obviously entail suturing arteries, but (and I never thought about this at the time, because he had brought the subject up seemingly out of the blue) how would he have compensated for blood loss?

Until this day, I took Doc at his word. Wish I had cared enough to ask him about that one little detail.

Never reluctant to ask questions, I will ask this one now:

Do SSGNs and SSBNs have assigned submarine medical officers (MDs) who make patrols with the crew. SSBNs did in my day, and into the 1980's at least. With all of the cut backs and emphasis on I.T. solutions nowadays, one has to wonder if the submarine force eliminated onboard MDs. Probably justified, because serious submarine accidents have been rare and health is almost a non-issue.

Depending upon necessity, even some SSN crews included medical officers in the past. Mine had had at least two before my day, but all were gone years before my service.

Our hearts certainly go out to the family and friends of a fine, young USS Nebraska sailor who, while already making a truly remarkable sacrifice for his country, wound up paying a terrible price.



At 24 September, 2008 19:05, Blogger Lou said...

Early 90s SSBN, we had a Chief Corpsman on board, no MD.

At 24 September, 2008 19:44, Blogger cheezstake said...

Geez, I served on subs for 11 years and never once had a thought as to if we carried blood on board.

I guess we all got used to no one getting seriously hurt. The most I ever witnessed were steam burns in the engine room and one broken tooth. (Which Doc fixed with a Dremel!)

At 24 September, 2008 20:06, Blogger esryle said...

No medical officers on any of my boats either, always a Chief Corpsman. Late 80's thru 90's. Submariners are some of the best people on the planet for solving problems in a crisis. You can bet everything possible was done for thier injured shipmate with the equipment and training they had at their disposal.

At 24 September, 2008 20:54, Blogger Unknown said...

My understanding is that the Corpsman has the ability to take donated blood from shipmates to use in an emergency.

At 25 September, 2008 08:28, Blogger Volstang said...

During my time riding LA class boats in the 90s we never had an MD on board. We either had a 1st or a Chief. I had seen other boats in Squadron 8 with a 2nd. I would hope that any corpsman would have the supplies needed to draw blood from shipmates that had the same blood type and wanted to donate to a shipmate in need of blood. The only possible shortcoming I can see is if you had a shipmate who had a rare blood type and there was nobody else on board with that blood type. That raises the question, should BUPERS ensure that each seagoing vessel have multiple people on board with each blood type? This would only potentially be an issue on vessels with smaller crews and may not be an issue at all. Just a thought.

At 25 September, 2008 10:09, Blogger Unknown said...

I just retiired 2 years ago from Trident Subs as a Nuc CPO.....never a doctor on subs anymore...just a corpsman....might as well have an eagle scout for all the good they do. I once went an entire patrol with a hernia because my corpsman would not beleive me nor could he diagnose it. I can't imagine one trying to save my life!
For much of my time at Kings Bay, the Submarine Medical Officer for all the sub sailors at the clinic was a Gynocologist...imagine that and only men on subs. This was the worst thing about the navy.

At 25 September, 2008 16:21, Blogger Unknown said...

20 some years ago a similar accident happened on my boat fellow shipmate’s leg ripped open by the rudder ram indicator, he survived luckily. Our guy was in the middle of a field day the navy could use a dose of common sense “deep dirt” cleaning around operating machinery is not always the safest of plans. My deepest condolences go out to the sailor’s family and crew members. --- and everyone needs to remember A veteran - whether active duty, retired, national guard or Reserve - is someone who, at one point in their life, wrote A blank check made payable to "The United States of America",
For an amount of "up to and including their life."

At 28 September, 2008 00:42, Blogger Rick "Doc" MacDonald said...

As a former whacko quacko HMCS(SS) on fast attack boats, I can tell you that HMs are not trained or permitted to perform amputations aboard submarines. (Some claim to have performed preliminary amputations (lower than where the surgeon would ultimately go)in Nam at Battalion or Regimental Aid Stations, but I never saw that happen - I served 1969 - 1989 and spend 1970 - 1973 with the 1st Marine Expeditionary Brigade as a field medic) As to blood, submarines do not carry whole blood or other blood products. What they do carry are blood volume expanders such as Ringer's lactate, normal saline and D5W or 5% Dextrose in sterile water. (I retired in 1989 and I know newer products are available on the market, but I have no idea as to their availability on ship).

These products are delivered by IV and are supplemented with oxygen by mask as they do not have oxygen carrying cells. Some of the newer synthetic blood volume product have oxygen carrying capabilities. A tourniquet is used to stop the bleeding and a big "T" is put on the person's forehead prior to medivac and he is tagged with a note indicating tourniquet, location, and release times.

Sometimes, however, a person can severe an artery and bleed out inside his thigh with no visible signs until the tissues begin to discolor or swell. Monitoring pulse, blood pressure and respirations are your first clue to a closed hemorrhage. If the tear is above the groin, say in the abdominal aorta or the common femoral artery, it is too high for a tourniquet to be effective and would require the skill of a competent vascular surgeon to deal with. Bleeds of torn veins are even more subtle and take longer to result in death. Arterial tears can lead to death in minutes. Venous tears take much longer and are much less dramatic in scope and appearance.

To the gentleman who's hernia was not diagnosed, I don't know why you had to go through what you describe. Hernia is one of the easiest diagnoses to make and one can go a long time without treatment (but with discomfort). Only in the case of an incarcerated hernia is one at risk due to lack of blood supply and death of bowel tissue, subsequent infection (peritonitis) and perhaps, death. It sounds like you had the common garden variety that was not sufficient to arrange a medivac or limit your work schedule - it's called "sucking it up for the good of the ship"

HMs aren't aboard to find things to send you home; they are there to keep you at the ready and on station or to identify when that is not possible and to provide pallative (pain and symptom relieving care) in the interim as well as prescribing things to minimize further injury or disease. Submarines aren't classified as warships for kicks.

I don't have all of the details as to what happened with this particular sailor, but should I obtain more specific information, I'll be more than happy to comment further. If you still have questions, I would suggest that you google the Naval Undersea Medical Institute and send an e-mail to the supervising medical officer or have your COB go Master Chief to Master Chief to the school's MCPOC. NUMI was very good at providing current even scenarios to its classes when I attended and I have no reason to suspect that it changed.

I hope this information helps some of you and gives better understanding to just how much risk a submariner takes going to sea. I never spent a minute at sea without feeling the weight of the world on my shoulder and admiration for each of my shipmates.

My condolences to the family of this fine, brave American sailor. He dedicated his life to serving his country and with his life, he paid more than most and will live on in the memory of many. Sailor, rest your oar.

--"Doc" MacDonald, HMCS(SS)USN Retired

At 29 September, 2008 13:13, Blogger Vigilis said...

Doc, thanks for taking your time to set things straight.

At 29 September, 2008 18:35, Blogger Rick "Doc" MacDonald said...

You're most welcome. It's nice to finally have both the time and the health get back to blogging somewhat. Thanks for your continued efforts in keeping the rest of us both well informed and highly entertained. :-)


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