In a historic medical first, a multiservice, multinational team of
American and Canadian military medical professionals successfully
delivered seamless, life-saving trauma care afloat.
Operating aboard the amphibious assault ship USS Essex during
Exercise Rim of the Pacific 2026, this newly forged coalition of
doctors, nurses, medics and combined operating room technicians proved
they could run a fully functioning shipboard trauma center under the
most intense combat and disaster conditions.
Traditionally, while multiservice and multinational hospitals have
successfully operated on land during past conflicts, afloat environments
have remained strictly isolated. The administrative intricacies of
differing licensing, credentialing and clinical privileges across
nations and branches have historically posed an insurmountable barrier.
For this iteration of Exercise Rimpac, planners spent more than six
months pushing paperwork up the chain of command to grant active
clinical practice authority to Canadian and U.S. Army personnel aboard a
Navy vessel, allowing them to physically treat patients for the first
time.
"The medicine is pretty straightforward, and we all practice good,
evidence-based medicine," said Navy Capt. David Foster, the USS Essex
senior medical officer. "We didn't have to teach each other how to do
medicine. What we did have to learn how to do was integrate and
communicate as a team."
This unique integration allowed the Essex to fully flex its hospital
capabilities, running all four of its onboard operating rooms
simultaneously to manage a massive, simulated influx of critically
injured casualties.
The combined force fused the organic crew of the Essex and the Navy's
Fleet Surgical Team 5 with the Army's 147th Field Hospital and 105th
Surgical Augmentation Detachment, alongside Canada's 1 Canadian Field
Hospital and the Canadian Medical Emergency Response Team.
The joint team's capabilities were put to the ultimate test during a
massive, two-phase casualty drill simulating the aftermath of a natural
disaster. During the exercise, the integrated medical department managed
a total of 17 simulated patients presenting with severe,
life-threatening trauma — a fourfold increase from a smaller,
four-patient trial run conducted days prior.
Casualties were transported from the point of injury by a diverse fleet of partner-nation aircraft and Army helicopters.
Significantly, the Canadian Medical Emergency Response Team acted as
the en route care asset, picking up casualties from the point of injury
and treating them in the air aboard a U.S. Army CH-47 Chinook. The
Canadian team inside the cabin included emergency physician Capt.
Richard Lee, flight nurse Maj. Nadine Verwey and paramedic Sgt. Nickolas
Petuhoff performed aggressive, mid-flight resuscitations.
"The one that I was most involved in the care of was a patient who
sustained facial trauma where they had a compromised airway," Petuhoff
said. "They required some aggressive airway management ... so they had a
surgical airway."
The team also had to contend with aircraft variations that disrupted
their standard operating procedures. Verwey noted that the U.S. Army
Chinook had a large internal fuel tank, which reduced cabin space
compared to Canadian aircraft.
"We weren't able to just do what we normally do," she said. "We had
to adjust our plan, which helps to build flexibility and resilience in
the team."
Once the casualties crossed the threshold into the ship's medical
bay, they were met by a unified trauma team that spent the preceding
days actively ironing out communication and process bottlenecks.
"Somebody might call a piece of equipment a widget and somebody else
might call it a thingamabob," Foster said. "As soon as we got underway
together, we got the team leaders together, and we paired up and grouped
up the folks of the same skill types together to clarify and level-set
all of those communications."
The team also implemented a radical, bottom-up process improvement
suggested by a junior crew member to reverse the physical flow of
patients through the triage spaces. By replacing standard hand-carried
stretchers with rolling gurneys and establishing a strict, one-way
directional flow, the team drastically reduced transit time between the
flight deck, triage area and operating rooms.
"As small a difference as that might seem on the outside, it is
actually a really significant change that really improves patient flow,"
said Lt. Cmdr. Sebastian Vuong, a Canadian anesthesiologist and
transfusion medicine specialist.
Inside the operating suites, the realism of the training was elevated by hyper-realistic cut suits.
"The surgeon can actually cut through with a real scalpel. There
[are] actual organs inside that actually bleed," said Navy Cmdr. Jesse
Bandle, FST 5 officer in charge and commander of the Amphibious Task
Force-Surgeon, Amphibious Squadron 5. "It really increases the level of
fidelity of this surgical simulation."
Vuong, alongside an Army general surgeon, performed an emergency
thoracotomy on a cut suit to open a patient's chest, control massive
lung bleeding and administer blood transfusions. To manage resources
efficiently, Vuong also provided intensive care unit sedation for a
bilateral leg fasciotomy on an electrical burn patient to save the limb,
freeing up the operating rooms for other critical cases.
"It's really not about the medical clinical care; it's about how to
streamline the processes," she said. "Medicine really has no uniform."
The drill also forced the medical staff to navigate the grim
realities of mass casualty triage and resource limitations. Facing a
patient with an unsalvageable head injury and exposed brain matter,
providers pivoted to expectant care, administering pain medications for
comfort while bringing in the ship's chaplain to ensure a dignified
death.
For veteran land-based providers like Army Col. Dennis Turner, a
nurse anesthetist with 25 years of service, practicing medicine afloat
introduced unique, eye-opening challenges.
"I learned that I can do resuscitative immersion care pretty much in any environment now, even aboard ship," Turner said.
He noted that, unlike a land-based Army field hospital, where supply
replenishment is constant, shipboard medicine is far more isolated.
"It seems like it's more resource-constrained here out in the middle
of the ocean than we are on land," Turner said. "We don't have to worry
about whether we're close enough to land to be able to receive more
supplies and send away casualties."
While surgeons operated, the ship's dental crew activated a "walking
blood bank," drawing fresh whole blood from the crew to sustain the
trauma bay. Other teams managed complex abdominal laparotomies, packed
open wounds and stabilized severe pelvic fractures.
"I learned how to be a bit more fluent, control the chaos, both
outside and on the inside, a little bit better," said Navy Petty Officer
3rd Class Cole Krablin, search and rescue medical technician. "Stay
ready, be ready."
Beyond the clinical success, the exercise highlighted the strategic
advantages of using an amphibious assault ship like the USS Essex for
humanitarian aid and disaster relief missions. While dedicated hospital
ships like the USNS Mercy offer extensive clinical space, they are
slower to transit and rely heavily on civilian hospital staffing. The
Essex offers a highly mobile, tactically flexible alternative, combining
robust Role 2 surgical suites with the organic heavy-lift capabilities
of the Marine Corps.
"The Essex provides a unique ability to really incorporate the extra
assets from the Marine Corps as far as airlift, transport and being able
to put the Marines ashore to clear obstacles, restore operations at
airfields, purify water and transport food," Bandle said.
By the end of the exercise, the multiservice, multinational team
successfully rewritten the playbook for shipboard trauma care. At the
patient's bedside, the boundaries between the U.S. Navy, U.S. Army and
Canadian Armed Forces dissolved entirely, leaving behind a highly
capable, unified force ready to face the world's next crisis.
"Medicine is a language that all of us speak with the same goal of providing excellent patient care," Verwey said.
Thirty nations, 30 surface ships, 5 submarines, 15 national land
forces, more than 190 aircraft and more than 30,000 personnel
participated in Exercise Rimpac 2026 in and around the Hawaiian Islands,
June 24-31. The world's largest international maritime exercise
provides a unique training opportunity while fostering and sustaining
cooperative relationships among participants critical to ensuring the
safety of sea lanes and security on the world's oceans. The exercise is
the 30th in the series that began in 1971.
Posts
