Shipboard Injuries and
Rehabilitation of United
States Sailors
Kristin R. Hodapp, MS, PT, CSCS
LCDR, MSC, USN
Presentation Overview
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Navy Medicine Assets
Role of Aircraft Carrier Medical
Department
Role of Shipboard Physical Therapy
Physical Therapy Cases
Navy Medicine Overview
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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
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Navy Medicine Overview
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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
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Cruiser/Destroyer
Medical Staffing
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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.
Amphibious Assault Ship
Medical Staffing
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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
Amphibious Assault Ship
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Largest dental
component for any
combat ship
Medical: most
extensive medical
support of combat
ship with 600 beds
and 6 operating
rooms.
Hospital Ships: USNS
Comfort and Mercy
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USNS Mercy is west coast based.
USNS Comfort is east coast based.
Staff includes all major specialties, but
will customize staffing depending on
mission
Hospital Ship Mission
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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.
Hospital Ship Facts
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Total Bed capacity:
1000
ICU beds: 80
Minimal care beds: 500
Recovery Beds: 20
Intermittent care beds:
400
Operating Rooms: 12
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Surgical Capabilities:
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ENT
Orthopedic
OB/GYN
Ophthalmic
Dental and Maxillofacial
General
Urology
Neurosurgery
Plastic
Cardiothoracic
Non-Surgical Capabilities
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Internal Medicine
Pediatrics
Dermatology
Respiratory Therapy
Physical Therapy
Patient Transport
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Patients primarily
arrive either by
helicopter or small
boat
USNS Comfort
Humanitarian Mission
• 4 month South
American Tour
• Training
Opportunity:
CPR/BLS
ACLS
intubations
USNS Comfort
Humanitarian Mission
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Physical Therapy
– Gait training
– Ergonomics/Patient
transport techniques
to hospital staff
– Burns/Wound Care
– Splinting
– Typical
Sprains/Strains
Aircraft Carrier Medical
Staffing
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Total Medical/Dental Staff: 97
Staff:
– Senior Medical Officer (SMO)
– General Medical Officer (GMO)
– Nurse
– Surgeon
– Nurse Anesthetist
– Physical Therapist
Aircraft Carrier Medical
Staffing
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Clinical Psychologist
Physician Assistant
Radiation Health Officer (nuclear)
Medical Administration Officer (MAO)
Flight Surgeon (2-3)
Role of Aircraft Carrier
Medical Department
USS RONALD REAGAN
CVN-76
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Peace Thru Strength motto
About 4.5 acres of sovereign US
territory
One of the most dangerous jobs:
working on the Flight Deck.
USS RONALD REAGAN
(CVN-76)
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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
USS RONALD REAGAN
(CVN 76)
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Crew size: 5300+
As tall as the Empire State Building
Over 80 aircraft attached to ship
Can operate 24/7
Aircraft Carrier Medical
Capability
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Basic Laboratory
services
Basic Radiology
services
– Radiographs
– Ultrasound
– Unable to have MRI
onboard due to the
constant motion on
ship and metal in
ship
Aircraft Carrier Medical
Capabilities
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Able to manufacture eye glasses
Basic casting and splinting
Pharmacy technician
USS RONALD REAGAN
CVN-76
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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.
USS RONALD REAGAN
CVN 76
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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.
Shipboard 911: Medical
Emergency
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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
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Shipboard Medical
Emergency Response
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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.
Reasons for Actual
Medical Emergency
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Chest pain/MI
Electrical Burns
Smoke Inhalation
Heat Stress
Fall
– down ladder
– Flight deck
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Stroke
Drug Overdose
Steam Burn
Syncope
Ramp strike with
pilot ejection
Man Overboard
Emergency Medical
Training
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All crew members are to be BLS and
stretcher bearer certified
– Three types of stretchers
– Reeves sleeve only one safe for ladder
transport
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Unique transportation challenges:
– Island of ship
– Main engineering spaces
Emergency Patient
Transport
Mass Casualty Definition
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Five or more injuries that taxes
medical resources
Most likely scenarios:
– Flight Deck accident
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Called Mass Casualty by the Air Boss
– Main space fire
– Hangar bay explosion
Mass Casualty
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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
Mass Casualty
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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
Mass Casualty
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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
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Blood bank initiated by
either the SMO or
surgeon
Communication with
Commanding Officer
Primary goal is to
“Fight the ship”
Mass Casualty
Mass Casualty Training
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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
Related Occupational
Health Issues
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Low Back Pain/Injuries tracked by Safety
department.
Multiple medical surveillance programs
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Radiation
Fuels
Heavy Metals
Hearing
TB
STD
Shipboard Physical
Therapy
Physical Therapy
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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.
Shipboard Physical
Therapy
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Neuromuscular expert
Casting/splinting skills
Evaluation, treatment, and
management for a return to duty
Manual therapy skills
Health Promotions Officer
Neuromuscular Screener
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Role of Physical Therapists as a
Physician Extender.
Additional training in evaluation and
therapeutic management.
Credentials
Casting/Splinting
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Physical Therapy AMMAL (supplies)
include materials and prefabricated
splints
Training
Fracture management
Return to Full Duty
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Over 90% of patients returned to full
duty within two weeks.
Manual therapy
Light duty recommendations
Patient education
Barriers to return to full duty
Barriers to Return to Full
Duty
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Psychosocial
Crutches
Splints
Casts
Operational Tempo
Patient Compliance
Psychosocial Factors
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Depression
Anxiety
Stress
Fatigue
Work Center
Dynamics
Shipboard Physical
Therapy
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Top Diagnoses:
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Sacroiliac Dysfunction and Low Back Pain
Patellofemoral Syndrome
Plantar Fasciitis
Shoulder Impingement
Neck Pain
Shipboard Physical
Therapy
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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).
Factors that influence the
effectiveness of PT
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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
Unique Shipboard Jobs
Unique Shipboard Jobs
Unique Shipboard Jobs
Shipboard Physical
Therapy
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Role of manual therapy
Patient and supervisor education
Prevention programs
Role of Manual Therapy
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Key in the treatment of LBP and SI
pain
Evidence based
45% of all PT patients required
manual therapy.
Patient and Supervisor
Education
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Crucial in compliance with program
and successful rehabilitation.
Fine balance between mission and
patient goals
Use of light duty recommendations
– Work restrictions for max of 30-day
intervals and may be extended for three
months
Prevention Programs
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Basic Weight-lifting gym program and
core stabilization program
Back and Knee Schools
Running clinic
Health Promotion programs
Deployment, Physical
Therapy and Psychology
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32% of all Physical Therapy patients
also seen by Clinical Psychologist.
Of those patients, 21% were
diagnosed with depression.
About 15% of all Physical Therapy
patients had chronic pain.
Physical Therapy Cases
Physical Therapy Cases
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19 y/o Seaman (Deck Department)
with sudden onset of right hand
weakness
Was using sandpaper to prep steel for
painting the ceiling
NSAIDs, light duty, wrist and hand
bracing
Radial Nerve Palsy
EMG
Physical Therapy Cases
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52 y/o active duty male with left UE
and LE pain and weakness
Social h/x: occasional cigar and ETOH
use
60 pounds overweight
Significant medical h/x: HTN and high
cholesterol
Family h/x: MI, hypertension
MEDEVAC for suspected CVA
Physical Therapy Cases
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36 y/o AD male
Basketball injury with “pop”
+ Thompson, Absent Achilles reflex
Watershed Achilles tendon rupture
Blue water operations
Casted in plantar flexed position
before MEDEVAC.
Physical Therapy Cases
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39 y/o pilot with right chest/UE pain
MOI: Bench pressing with sudden weakness
Main complaints: unable to do pushups,
open and close watertight doors.
Notable muscle defect insertion pectoralis
major with associated weakness and
deformity
Pectoralis Major insertion complete tear
Sling, ice, and ortho consult
Physical Therapy Cases
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22 y/o AD male s/p maxilla fracture (hit in
face with bat)
Pain 8/10 with HA. No dizziness.
Exam: significant restriction 75% all cervical
motions. Passive range of motion limited
due to significant guarding. TTP C3-4
spinous processes.
MRI while in port.
Infectious Disease admission for epidural
abscess.
Physical Therapy Cases
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32 y/o AD EOD technician with neck
pain, weakness, numbness & tingling.
MVA: unrestrained driver and ejected
with head strike. Initially seen in
civilian ER and released.
Abnormal AROM. TTP C3, C4, and C5
spinous processes.
MEDEVAC for fracture with subluxation
of C3, C4, and C6.
Questions?
Thank you for your time and
attention.