Mass Casualty aboard USS Kitty Hawk (CV 63) January 2005-Lessons Learned

Military Medicine, Jul 2005 by Chavez, Temujin, Cubano, Miguel, Hovijitra, Ray

[The opinions or assertions contained herein are the private Mews of the authors and are not to be construed as official or as reflecting the views of the Department of the Navy or the Department of Defense.]

A mass casualty situation is one in which injuries exceed available medical resources. Aboard a conventional aircraft carrier, those medical resources consist of the medical and dental departments, approximately 60 personnel. Damage Control dictum states that five injuries exceed an aircraft carrier medical department's capabilities. The permanently forward deployed aircraft carrier, USS Kitty Hawk (CV 63), experienced such a mass casualty on January 29th 2005 while performing carrier qualification (CQ) flight operations.

That Saturday evening, the USS Kitty Hawk was deployed off the southern coast of Japan and preparing to operate in a training environment for a General Quarters (GQ) drill. At 1833. an F/A-18F "Rhino" landed and severed an arresting wire. The parted wire snapped and abruptly struck several flight deck personnel while the aircraft continued forward off the angle deck. The two aviators ejected safely from the aircraft as it rolled off the port edge and into the ocean. These two aircrew members were soon rescued by helicopter. However, 26 personnel were working on the flight deck at the time of this mishap. Six of these sailors were victims of the severed wire. Three sailors experienced major injuries while another three experienced minor injuries. We define a major injury as an immediate or delayed triage patient.

The USS Kitty Hawk's crew of over 5,000 sailors was initially unaware of the traumatic experience that just occurred on the flight deck. A IMC announcement prepared the ship for an "aircraft in the water" scenario. While the medical department prepared the emergency room for the two aviators, the airmen and corpsmen on the flight deck were initiating advanced first aid for the six casualties.

Fifteen minutes elapsed from the time the bridge announced "aircraft in the water" until they called "mass casualty." The corpsmen and dental technicians then prepared the hangar bay with their respective triage receiving stations: red (immediate), yellow (delayed), green (walking wounded), and black (expectant or deceased). Thirty minutes after the mishap began, the air department lowered the flight deck elevator carrying the first group of casualties. The ship's surgeon examined the initial group of casualties and identified the most immediate casualty to have a traumatic lower extremity amputation and possible abdominal trauma. An air department chief had utilized his belt to place a tourniquet on the victim's amputated leg at the scene. This sailor was the first person transported from the hangar bay to the operating room.

The injury summary includes three major and five minor injuries. The major injuries were: (1) a petty officer with a left below-the-knee amputation, right fibula fracture, and left ulna fracture, (2) a petty officer with a right patella fracture with complete multiligament tear and full thickness scalp laceration, and (3) an airman with a left shoulder dislocation and left ankle sprain. The minor injuries were: (1) an aviator with a minor left thigh strain, (2) a pilot with a minor back strain, (3) an airman with a small ''chip'' talus fracture, (4) a petty officer with multiple abrasions, and (5) a petty officer with a right lower extremity abrasion.

All major injuries were medically evacuated (MEDEVAC) to the Yokosuka Naval Hospital (a level II trauma center) the evening of the mass casualty. The remaining casualties, excluding the two aviators, were routinely transported the following morning to the Atsugi Naval Air Station. Each of the major casualties was initially hospitalized in the ICU while all minor casualties were evaluated at the Atsugi Medical Clinic. The two aircrew members were evaluated by a flight surgeon aboard the USS Kitty Hawk. The petty officer who suffered the below-the-knee amputation was eventually MEDEVACed to the continental United States (CONUS) for definitive care at Brooks Army Hospital. The petty officer who suffered the right patella fracture with a complete multi-ligament tear required several extensive repairs to include vascular bypass and skin graft surgeries.

There were five major lessons learned from this single mishap. The first lesson was that more than five casualties is truly a mass casualty situation. The USS Kitty Hawk's available medical resources were exceeded by the eight total injuries despite the onboard presence of six medical doctors at the time of the mishap. The six medical doctors present that day were the senior medical officer (SMO), ship's surgeon, maxillofacial surgeon, anesthesiologist, one flight surgeon (FS) and general medical officer (GMO).

The SMO was thoroughly invested with communicating and coordinating the care and disposition of the injured to the medical officers, ship's Commanding Officer, Carrier Air Group commander, and Yokosuka Naval Hospital. The operative amputation casualty alone utilized three medical doctors (surgeon, maxillofacial surgeon, and anesthesiologist), one independent duty corpsman (IDC) and three surgical corpsmen. The airman with the left shoulder dislocation and left ankle sprain was one of two casualties relocated to the emergency room. There, he required the care of one nurse, one medical officer, one IDC, and two corpsmen. This appropriation of resources left two medical doctors (FS and GMO), one nurse (TAD during CQs), and one IDC to care for the remaining major injury and five minor injuries located in the ward and sickbay.