Psychiatric medevacs during a 6-month aircraft carrier battle group deployment to the Persian Gulf: A Navy force health protection preliminary report

Military Medicine, Jan 2003 by Wood, Dennis Patrick

In considering the Clinical Psychology At-Sea Program's costs, in addition to assessing the identified therapeutic outcomes provided by the clinical psychologist, we also recommend that one important ethical concern be considered. This concern is that the process of the identification, disposition, treatment, and/or medevac of sailors experiencing psychiatric crises has previously worked well on board aircraft carriers without the benefit of a clinical psychologist. However, conservatively and within the ethical constraints of operating within the scope of a clinician's expertise, it is conceivable that many general medical officers and physician assistants would prefer to defer a psychiatric diagnosis and disposition of a sailor, presenting with psychiatric crisis, in favor of an appropriate referral to a mental health professional.

With today's reality concerning the nature and severity of psychological difficulties in many young female and male sailors,2-17 the importance of having mental health professionals available to effect emergency and routine psychological evaluations, of sailors onboard operational platforms at sea takes on increased importance. In the case of the USS Vinson's battle group, sailors who presented with suicidal ideation and/or suicidal intent, not having a ship's clinical psychologist available could have resulted in as many as 40 or more additional medevacs and/or inpatient admissions to the ship's ward. With 48 sailors admitted to the USS Kitty Hawk's inpatient ward without the benefit of a clinical psychologist, it is conceivable that many more than eight sailors would have been medevaced to the Continental United States for definitive psychiatric evaluation and treatment. These additional medevacs, should they have occurred, would have been effected only at an enormous cost and risks to the personnel and missions of both the USS Vinson and Kitty Hawk.

Furthermore, without the presence of a skilled clinical psychologist, the evaluation, treatment, and disposition of personality disordered individuals, particularly those who were prone to recurrent crises, would have proven unwieldy and likely would have exceeded the comfort and competency thresholds of most general medical officers and physician assistants. Also conceivable would be instances when medical providers would erroneously defer evaluation and treatment to a later time, retain a sailor with a serious personality disorder aboard the ship or in the battle group, which possibly could lead to a serious or fatal suicide attempt.

By having a clinical psychologist report as a full-time member of the USS Vinson's medical department prior to WESTPAC, the sailors and officers in the USS Vinson's battle group gained the benefits from this independent practitioner's evaluation, treatment, consultation, and educational acumen. Furthermore, the USS Vinson's battle group was able to enjoy the reduced risks to aircrew, airframes, and flight deck personnel from the resulting reduced number of psychiatric medevacs. The USS Vinson's battle group was also able to profit from the retained man-days gained from those sailors who were retained onboard the USS Vinson and onboard the other battle group ships following their psychiatric hospitalization. These sailors also had the satisfaction of fulfilling a commitment to themselves and their county for service that would have been impossible had they been medevaced to a stateside Naval hospital due to the fact that they would not have been returned to the USS Vinson during her WESTPAC.