ABSTRACT

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 a significant time and distance 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 a hypothetical burn injury patient scenario to present an innovative approach to teaching complex operational medicine concepts including austere burn resuscitation, wound care, and Prolonged Casualty Care (PCC) to austere Role 1 maritime caregivers using the Joint Trauma System PCC and Tactical Combat Casualty Care clinical practice guidelines (CPGs) and other standard references. The format includes basic epidemiology of burn injury 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 CPG, appropriate guidelines, and available standard shipboard equipment. Through this process, opportunities to improve both training, clinical skills sustainment, and standard shipboard medical supplies are identified.

Keywords: prolonged casualty care; Tactical Combat Casualty Care; maritime military; critical care; burn injury; burn resuscitation

Medical Considerations in High-Risk Maritime Operations: A Narrative Review

Granholm F, Lauria MJ, Melau J, Tin D

(Ahead of Print)

Abstract:

Maritime operations conducted by military Special Operations Forces and civilian special weapons and tactics (SWAT) units present unique medical challenges. These missions often occur in unpredictable environments, far from immediate medical resources and with exposure to waterborne threats. This article examines the medical aspects critical to maritime operations, including hypothermia management, trauma care in confined and moving spaces, management of drowning and respiratory issues, and specialized training for maritime-specific injuries. A narrative review of literature from 2005-2024 was conducted across major databases and grey sources, with studies included by author consensus. The review identified core maritime medical challenges, hypothermia, drowning, confined-space trauma, respiratory hazards, motion sickness, and impact injuries. Medical support tailored to these environments is essential for maintaining operational effectiveness and responder safety. By examining both preventive and responsive medical approaches, this article highlights the need for maritimespecific medical protocols and training

Keywords: maritime; tactical medicine; naval; prehospital; trauma; performance; counter terrorism medicine; SWAT; SOF; Special Operations

ABSTRACT

Objectives: Intraosseous (IO) access is a medical procedure primarily used in emergencies when peripheral venous access is unobtainable or delayed. The IO procedure is commonly performed using the EZ-IO, a battery-powered intraosseous driver. In contrast, the newer SAM IO is a less costly and manually powered driver. Our objective was to compare the EZ-IO and SAM IO by examining insertion times and EMS clinicians’ preferences. Methods: This randomized prospective trial was performed with EMS clinicians after watching in-structional videos. Participants practiced insertions with both drivers on plastic task trainers and porcine bones until they self-reported proficiency. Participants were randomized to one of the drivers, and insertion times into a porcine humeral bone were analyzed. All participants completed a post-study survey. Results: Study participants (n=106) using the EZ-IO had faster insertion times, mean 1.1 seconds (s) (95% CI 0.8-1.4), versus the SAM IO, mean 2.8s (95% CI 2.5-3.1), P<.001. The mean difference was less than 2s and unlikely to be clinically signif-icant. All attempts were deemed successful. Most considered the SAM IO easy to use 68.6% (74/106), and 80.0% (85/106) reported confidence in patient use. Despite this, participants expressed some reservations. Conclusions: In the largest ran-domized controlled trial to date, we found that the EZ-IO had a faster insertion time compared to the SAM IO, but the time difference was unlikely to be clinically meaningful. Although participant responses indicated a preference for the EZ-IO, most felt confident using the SAM IO in an EMS setting.

Keywords: EZ-IO; SAM IO; intraosseous; prehospital; emergency medical service; emergency vascular access; porcine bone model

Current Episode is Fall 2025

Our JSOM podcast team will be reviewing the following articles for our newest podcast: 

Penetrating Axilla Injuries in Ceramic Plate Coverage: Matthew unpacks a compelling case series on the effectiveness of four-plate body armor systems in protecting vital axillary structures, drawing from his own experience as a Ranger medic.

https://jsomonline.org/product/penetrating-axilla-injuries-and-ceramic-plate-coverage-a-special-operations-case-series/

Mitigating Heat Loss in IV Tubing During Austere Blood Transfusions: Sydney reviews a West Point study quantifying how cold environments impact transfusion safety—and what innovations might help preserve blood temperature in the field.

https://jsomonline.org/product/mitigating-heat-loss-in-iv-tubing-during-austere-blood-transfusions/

Lab Evaluation of Four Ukrainian-Manufactured Tourniquets: Jessica breaks down a comparative study assessing the performance, durability, and design of Ukrainian tourniquets under simulated battlefield conditions.

https://jsomonline.org/product/lab-evaluation-of-four-ukrainian-manufactured-tourniquets/

Plus, Dr. Dan Godbee highlights two additional must-read articles on prehospital blood use and JSOM’s ongoing commitment to mentoring medics through the publishing process.



The Journal of Special Operations Medicine is proud to have the support of many great sponsors and media partners. Our sponsors are leaders in the field of military medical technology. Please help support these companies by following the links below to learn more about their missions and the products they offer.

The Mission

To fulfill our duty to serve Veterans and first responders by improving the evaluation and treatment of traumatic brain injuries through clinical practice, research, and education. We will execute this mission by providing participant-centered interdisciplinary care focused on interconnecting brain and body health to allow Veterans and first responders to better serve themselves, their families, and their communities while they live a healthy, high-quality life. Our goal is to help our Veterans and first responders THRIVE in all aspects of their lives.

Learn More

Visit the organization's website at https://tbicenter.unc.edu/thrive-program-overview/

The JSOM is incredibly grateful to have the support of many institutions around the world. We would like to thank our recent institutional subscribers and re-subscribers for their support by acknowledging them in our eNewsletter and, when applicable, sharing their social media information.

Visit https://jsom.us/Library for a full list of institutions currently subscribing to the JSOM. We are beginning a campaign to expand our institutional subscriptions. If you think your company would benefit from an institutional subscription, let us know! We'll be happy to talk to you and get the ball rolling. You don't have to be a university or medical center to subscribe - we have many EMS units, government agencies, and military medical units in the United States and abroad.

Are you on the list? Great! Need to know how to access our resources? You can either contact your head librarian or shoot an email to subscriptions@JSOMonline.org.

Institutions receive a print copy of our journal, digital access, or both. Digital subscribers have unlimited access to our full compendium of articles, journals, and the ATP-P. If you are a student, researcher, doctor, or other medical professionals at one of these institutions, please contact your librarian for login details. Additionally, the digital resources are typically available 2-3 weeks ahead of print publication.

If your institution is not on the list and you want more information about our institutional access, please contact Carol McBride in our subscriptions department by utilizing the link below.

For over 20 years, the Journal of Special Operations Medicine (JSOM) has brought important, lifesaving information to the Special Operations Forces (SOF) community. And over the years, as our audience and readership has expanded into over 80 countries, physicians, military and tactical medics, and other medical professionals working in unconventional environments rely on the JSOM for breakthrough research at the intersection of operational medicine and tactical casualty care. Our peer-reviewed research and interactive clinical content make the JSOM a must-read for:

• Physicians
• Medics
• Educators
• Law Enforcement
• The military and civilian global medical community

For these reasons, many of the world’s top medical technology companies and medical device distributors make the JSOM a cornerstone of their advertising programs. And with a strong multichannel and social media presence, the JSOM offers the most dynamic print and digital media options at cost-effective prices. For medical marketers worldwide looking to reach our niche audience, the JSOM is the gold standard. For more information, please see our attached media kit.

Breakaway Media, LLC, is a woman service-disabled veteran-owned small business (WOSB and SDVOSB) registered with the Central Contracting Office of the Department of Defense

DUNS #070397122 / Cage #6F0Z6

Primary SIC Code - 2721

Journal of Special Operations Medicine 

www.jsomonline.org 

subscriptions@jsomonline.org 

This disclaimer pertains to any publication (aka, "publications") written or electronic set forth by Breakaway Media, LLC (BAM) and includes, but is not limited to: The Journal of Special Operations Medicine (JSOM), social media posts to Facebook, Twitter, Instagram, LinkedIn, the JSOM eNewsletter, the JSOM website, and any promotional materials published by BAM. The views and opinions expressed in these publications are those of the authors, contributors, and sponsors of the JSOM and BAM, and do not necessarily reflect those of the JSOM, the JSOM Editorial Board ("the editorial board"), BAM, or its affiliates. Neither the JSOM, the editorial board, BAM, nor its affiliates hold themselves responsible for statements or products discussed in any BAM publications. Unless so stated, material in BAM publications does not reflect endorsement, official attitude, or position of the JSOM, the editorial board, BAM, or affiliates. Products advertised have not been tested by the JSOM, the editorial board, BAM, or its affiliates, and, as such, cannot be held liable for any injury or death caused by the use or misuse of the products contained herein. Neither BAM, the editorial board, nor its affiliates, make any warranty, representation, endorsement, or guarantee of products advertised, discussed, tweeted, retweeted, or shared any publication, to include the assumption of any liability whatsoever arising out of the application, use, or misuse of any product. As a medical publication, we are committed to sharing new technology and products we feel may be of interest to our readers, and encourage all readers and users of said products to use with caution and under proper authorization and professional guidance.

Tagging the JSOM on Instagram / Disclaimer

We assume by tagging us on Instagram, you are authorized to disseminate the photograph you are sharing with us. If you are a photographer whose image has been used or shared without authorization, please notify us immediately so we may give you proper credit.