Wickard Aaron S, Grimsley Bailey M, Tadlock Matthew D
Department of Surgery, Naval Medical Center San Diego, San Diego, CA 92134, USA.
Mil Med. 2025 Jun 30;190(7-8):1556-1563. doi: 10.1093/milmed/usae483.
A major fire at sea is among the most devastating events that can occur while a U.S. Navy combatant vessel is underway. Since World War II, no attack on a large U.S. Navy capital ship has occurred during combat operations. However, increasing global tensions raise the threat of future peer adversary naval combat, and shipboard medical caregivers must be prepared for mass casualty events in the deployed maritime environment. To better prepare modern naval caregivers for this possibility, we reviewed mass casualty events from major fires aboard large U.S. Navy aircraft carriers from 1950 through 2020 to summarize available objective data and identify lessons learned.
Underway fires from any cause aboard U.S. Navy aircraft carriers and large amphibious assault ships causing more than 10 casualties (injuries + deaths) were reviewed from 1950 through 2020 using available open access sources including literature review, the Naval Safety Command mishap database, and U.S. Navy Judge Advocate Manual reports.
Of 246 fires identified, 27 met inclusion criteria resulting in 1,634 casualties with a combined crew mortality of 23% of those injured. In the 16 events with at least 1 death, 2.0% of the total crew was injured with a combined mortality of 28%. All mishaps occurred while underway during routine training or combat operations; none were caused by an enemy combatant attack. Those events affecting more than 5% of the crew were particularly devastating resulting in a mortality rate of 29% of 1,056 total casualties. Given that main medical spaces may be damaged or destroyed during major fires from any cause, identified lessons learned included the need for (1) distributed medical supplies, (2) flexible medical treatment locations throughout the ship, (3) specific training to prepare non-physician caregivers and non-medical first responders to provide burn and hemorrhagic shock resuscitation, airway management, and prolonged care at or near the point of injury, and (4) the prolonged holding capability of critically ill burned and injured patients if evacuation off the ships is unavailable.
Shipboard fires underway pose a significant threat to crew safety with a mortality of nearly a quarter of those injured. These fire mass casualty events immediately overwhelm shipboard medical capabilities requiring a complex response from all hands beginning with non-medical first responders. Notably, all events occurred outside of direct enemy combat, potentially underestimating the impact and number of casualties of a shipboard fire during naval combat. Advances in peer weaponry and the threat of future conflict emphasize the need for pre-deployment burn care training for all shipboard medical caregivers as well as advanced airway and resuscitation training for non-physician caregivers. This review underscores the profound impact of shipboard fires on crew safety, highlighting the critical need for enhanced preparedness and response strategies to prepare for fire-related mishaps during routine operations and naval combat.
海上重大火灾是美国海军作战舰艇航行期间可能发生的最具毁灭性的事件之一。自第二次世界大战以来，在作战行动中没有发生过对美国海军大型主力舰的攻击。然而，全球紧张局势的加剧增加了未来同级别对手海战的威胁，舰上医疗护理人员必须为部署的海上环境中的大规模伤亡事件做好准备。为了让现代海军护理人员更好地应对这种可能性，我们回顾了1950年至2020年美国大型海军航空母舰上重大火灾导致的大规模伤亡事件，以总结可用的客观数据并吸取经验教训。
利用包括文献综述、海军安全司令部事故数据库和美国海军军法手册报告在内的可用开放获取资源，回顾了1950年至2020年美国海军航空母舰和大型两栖攻击舰上因任何原因发生的导致10人以上伤亡（受伤+死亡）的航行火灾。
在确定的246起火灾中，27起符合纳入标准，造成1634人伤亡，受伤人员的总死亡率为23%。在至少有1人死亡的16起事件中，2.0%的全体船员受伤，总死亡率为28%。所有事故均发生在日常训练或作战行动期间的航行中；没有一起是由敌方战斗人员攻击造成的。那些影响超过5%船员的事件尤其具有毁灭性，1056名总伤亡人员的死亡率为29%。鉴于主要医疗空间可能因任何原因在重大火灾中受损或被毁，吸取的经验教训包括需要（1）分散医疗用品，（2）在全舰设置灵活的医疗救治地点，（3）对非医生护理人员和非医疗急救人员进行专门培训，以便在受伤点或其附近提供烧伤和失血性休克复苏、气道管理及长期护理，以及（4）如果无法将重伤员撤离舰船，要有长时间收治重伤员的能力。
航行中的舰上火灾对船员安全构成重大威胁，受伤人员死亡率近四分之一。这些火灾导致的大规模伤亡事件会立即压垮舰上医疗能力，需要全体人员做出复杂反应，首先是由非医疗急救人员做出反应。值得注意的是，所有事件均发生在直接敌方战斗之外，这可能低估了海战中舰上火灾的影响和伤亡人数。同级别对手武器的进步以及未来冲突的威胁强调了对所有舰上医疗护理人员进行部署前烧伤护理培训以及对非医生护理人员进行高级气道和复苏培训的必要性。本综述强调了舰上火灾对船员安全的深远影响，突出了加强准备和应对策略以应对常规行动和海战中与火灾相关事故的迫切需求。
