Maritime Trauma

Maritime Trauma

In this episode of Frontline Surgery: Mastering Military Trauma Care hosts Dr. Joshua Dilday and Dr. Jay Yelon are joined by Dr. Matthew Tadlock, an expert in maritime surgery and operational planning, to explore one of the most underrepresented environments in combat casualty care: surgery at sea. From burns and blast injuries aboard amphibious warships to emergency general surgery on a carrier with a single surgeon and a team of corpsmen, the episode unpacks the full breadth of what naval surgeons face and why the tyranny of time and distance demands a different kind of readiness. The conversation covers patient movement through a threatened ship, evacuation decision-making in contested environments, and the launch of the Maritime Surgery Quality Improvement Program, which is bringing monthly case conferences, mentorship, and outcomes data to a community that previously had none. Dr. Tadlock closes with a reminder that maritime surgery is a joint problem, with Army, Air Force, and allied surgical teams increasingly integrated onto naval platforms, and that preparation for those environments has never been more urgent. Literature Mentioned: Expeditionary Surgery at Sea [https://link.springer.com/book/10.1007/978-3-031-21893-4] Traumatic and Burn Injury during routine operations and war at sea Between the Devil and the Deep Blue Sea [https://www.aast.org/asset/399ED6E9%2DC029%2D4F4A%2DA67CA7BF5183CBE0/] War at Sea: Burn Care Challenges [https://www.aast.org/asset/AF3E0439%2D616E%2D4672%2DB2DB01EAB1447DE4/] Injury Trends on US Navy Vessels [https://www.aast.org/asset/0502F167%2DE64D%2D4B56%2D88D209F2146215AD/] Elective and Emergency General Surgery Surgery at Sea Nealeigh et al. [https://www.aast.org/asset/8E7B20E9%2D52E3%2D45AE%2D83900B09398F351A/] Surgical Care at Sea a retrospective review [https://www.aast.org/asset/F471AD7C%2DF923%2D4E65%2D8CAC80331D9232DD/] Maritime Prolonged Casualty and Critical Care Maritime Applications of PCC -Sepsis [https://www.aast.org/asset/319D7B16%2D9806%2D4E37%2D8C9896DEC0203BEF/] Maritime Applications of PCC - Drowning and Hypothermia [https://www.aast.org/asset/177BDE16%2D9D58%2D4E49%2D898AA27FE175386B/] Maritime Applications of PCC - Burns [https://www.aast.org/asset/6D5D6BEC%2D3922%2D4598%2DA418624ED8DF886F/]

Managing Infection in Combat Casualty Care

In this episode of Frontline Surgery: Mastering Military Trauma Care, hosts Dr. Joshua Dilday and Dr. Jeff Connor are joined by Dr. Mary Ford, infectious disease expert and the podcast's first non-surgeon guest, to tackle one of the most persistent threats in combat casualty care: battlefield infections. From contaminated blast wounds at the point of injury to multi-drug resistant organisms acquired along the evacuation chain, the episode breaks down why infection risk evolves at every stage of care and why what is in the wound on day one looks very different from what threatens the patient on day ten. Dr. Ford walks through the spectrum of pathogens surgeons will encounter, the growing threat of invasive fungal infections in blast trauma, and why the fundamentals of infection prevention including hand hygiene and bundle-based care remain the most powerful tools available even in austere environments. The episode closes with clear takeaways for deploying surgeons: prevention is key, common things are common, operate early and often, and advocate at the command level because that is where the standards are set and where they fall apart.

The Role of Critical Care Air Transport

In this episode of Frontline Surgery: Mastering Military Trauma Care, host Dr. Joshua Dilday and Dr. Rachel Russo are joined by Dr. Valerie Sams and Dr. Geoffrey Anderson to discuss Critical Care Air Transport Teams (CCAT) and their essential role in moving critically injured casualties across the theater of operations and back home. From the origins of the CCAT concept to its evolution through the global war on terror, the episode covers how a small team delivers full-spectrum ICU care, including ECMO and continuous renal replacement therapy, at altitude and across oceans. The conversation tackles the realities of sustainment and readiness for both active duty and reserve CCAT teams, the physiologic and operational stressors of flight that no simulation can fully replicate, and how task saturation demands flexibility from every member of the team. With LISCO on the horizon and evacuation timelines expected to lengthen in contested environments, the episode makes clear that CCAT is not simply transportation. It is an extension of the trauma care system itself, and understanding it is essential for every military surgeon preparing patients for the next phase of survival.

Bleeding Control Episode 1: Prehospital

In this episode of Frontline Surgery: Mastering Military Trauma, hosts Dr. Joshua Dilday and Dr. Rachel Russo are joined by Dr. Frank Butler and Dr. John Holcomb, to examine one of the most consequential shifts in battlefield medicine: tourniquet reassessment and conversion in the era of prolonged evacuation. The episode traces the evolution of tourniquet use from its controversial origins in TCCC to the hard lessons now emerging from the Russo-Ukrainian war, where contested airspace, drone threats, and ground evacuation timelines of six hours or more have fundamentally changed the risk-benefit calculus of leaving a tourniquet on. The panel is direct: up to 75% of tourniquets applied in the field are not medically necessary in hindsight, and with prolonged evacuation now the norm rather than the exception, unnecessary tourniquet time is costing limbs and lives. The message is not to stop using tourniquets but to use them smarter, reassess them as soon as tactically possible, convert them within two hours when feasible, and never remove them after six hours without surgical backup. Dr. Butler also previews a new plain-language training package designed for non-medical service members, built on the principle that the knowledge is only as good as the person holding the tourniquet. Literature Mentioned: TCCC Quick-Look:What Kind of Bleeding Requires a Tourniquet? [https://www.aast.org/asset/DADFD895%2DD295%2D4A5D%2D9F45F8D92940991C/] TCCC Quick Look: Arterial Bleeding [https://www.aast.org/static/807f9eb5-d416-461a-bff6dc18aab59665/TCCC-260521-TCCC-Quick-Look-Holcomb-Video-Arterial-BleedingMOV.mov] From application to conversion: The development of a tourniquet reassessment algorithm for nonmedical military personnel by a North Atlantic Treaty Organization specialist team [https://pubmed.ncbi.nlm.nih.gov/40622167/]

Blast Injury and New Injury Patterns from Drone Warfare

In this episode of Frontline Surgery: Mastering Military Trauma Care, Drs. Joshua Dilday and Jeff Conner are joined by COL (ret) John Holcomb, MD to examine how modern drone warfare is reshaping battlefield injury patterns and the challenges facing deployed trauma teams. Drawing on recent experience working alongside Ukrainian clinicians and multinational partners, Dr. Holcomb discusses the evolving mechanisms of injury associated with drone-delivered explosives and the operational realities of providing care in contested environments. The conversation explores how fragment injuries from aerial munitions are producing different anatomic injury patterns compared with previous conflicts, including increased head, neck, and upper extremity trauma. Dr. Holcomb highlights the importance of understanding mechanisms of injury, recognizing blast-related complications such as tympanic membrane rupture and traumatic brain injury, and managing patients with extensive fragment wounds. The episode also addresses the operational constraints affecting casualty evacuation and resuscitation timelines in drone-dominated battlefields. With evacuation delays ranging from hours to significantly longer, frontline teams must adapt their approach to hemorrhage control, resuscitation, and resource management. Dr. Holcomb emphasizes that preparation for these environments requires both clinical readiness and system-level training, noting that high-volume trauma experience and strong team coordination remain essential for military medical teams preparing for deployment. Keywords: Blast Injury, Drone Warfare, Military Trauma Care, Fragment Injuries, Combat Casualty Care, Damage Control Resuscitation, Battlefield Evacuation, Trauma Systems, Military Surgery, Austere Trauma Care