From the Department of Surgery (D.A.B., M.C.V., M.D.T.), Navy Medicine Readiness and Training Command (NMRTC), San Diego, California; Fleet Surgical Team Seven (D.A.B.), Okinawa, Japan; Virtual Medical Center (J.K.), NMRTC, San Diego, California, 3rd Medical Battalion (K.D.C.), 3rd Marine Logistics Group, Camp Foster, Okinawa, Japan; NMRTC (R.M.), Portsmouth, Virginia; and 1st Medical Battalion (T.D.E., M.D.T.), 1st Marine Logistics Group, Camp Pendleton, California.
J Trauma Acute Care Surg. 2023 Aug 1;95(2S Suppl 1):S41-S49. doi: 10.1097/TA.0000000000004047. Epub 2023 May 18.
Maritime activities have been associated with unique dangers to civilian and military sailors. We performed a retrospective cohort study analyzing injury mechanisms and clinical outcomes of casualties onboard US naval ships to determine common injury mechanisms, trends, and outcomes. We hypothesized there would be a downward trend of injuries and fatalities on US naval ships during the study period.
All mishaps recorded by the Naval Safety Command aboard active service US naval ships from 1970 through 2020 were reviewed. Only mishaps resulting in injury or fatality were included. Over time, injury mechanisms and casualty incidence rates were trended and compared based on medical capabilities. Ships without surgical capabilities were categorized as Role 1, and those with surgical capabilities as Role 2.
There were a total of 3,127 casualties identified and analyzed, with 1,048 fatalities and 2,079 injuries. The injury mechanisms associated with the highest mortality included electrocution, blunt head trauma, fall from height, man overboard, and explosion. There was a decrease in the trend of mishaps resulting in casualties, fatalities, and injuries over the 50-year study period. The mortality rate for select severe injury mechanisms was higher on Role 1 capable platforms, compared with Role 2 (0.334 vs. 0.250, p < 0.05).
Casualty incidences decreased over 50 years. However, mortality still remains high for certain mechanisms no matter the operational platform. Furthermore, Role 1 capable vessels have a higher overall mortality rate for severe injuries compared with Role 2. The authors propose training, process improvement, and technology-related solutions to improve outcomes on Role 1 capable naval vessels.
Prognostic and Epidemiological; Level IV.
海上活动对民用和军用水手都存在独特的危险。我们进行了一项回顾性队列研究，分析了美国海军舰艇上人员伤亡的损伤机制和临床结果，以确定常见的损伤机制、趋势和结果。我们假设在研究期间，美国海军舰艇上的人员受伤和死亡人数会呈下降趋势。
回顾了 1970 年至 2020 年期间海军安全司令部记录的所有在役美国海军舰艇上的事故。仅包括导致受伤或死亡的事故。随着时间的推移，根据医疗能力对损伤机制和伤亡发生率进行趋势分析和比较。没有手术能力的舰艇被归类为 1 级，有手术能力的舰艇被归类为 2 级。
共确定并分析了 3127 名伤员，其中 1048 人死亡，2079 人受伤。与死亡率相关的最高损伤机制包括电击、钝性头部创伤、高处坠落、人员落水和爆炸。在 50 年的研究期间，导致人员伤亡的事故、死亡和受伤的趋势有所下降。在 1 级舰艇上，某些严重损伤机制的死亡率高于 2 级（0.334 比 0.250，p < 0.05）。
50 年来，伤员人数有所减少。然而，某些机制的死亡率仍然很高，与作战平台无关。此外，与 2 级舰艇相比，1 级舰艇上严重受伤的总死亡率更高。作者提出了培训、流程改进和技术相关的解决方案，以改善 1 级舰艇的救治效果。
预后和流行病学；四级。
