AKSAZ NAVAL BASE, Turkey – Forty-one nations around the world operate more than 250 naval submarines in the complex and dynamic environment below the oceans around the globe. In these challenging environments, occasionally, a submarine may encounter a problem of some kind that renders the submarine unable to raise itself to the surface. In situations such as this, the sailors have a couple of options based on the situation. If in shallow water, the sailors can attempt to escape from the submarine and float to the surface themselves. In deeper water, they must await rescue from the surface. Each of these situations involves different types of medical treatments and measures.
NATO submarine escape and rescue exercise Dynamic Monarch gave medical professionals from many nations an opportunity to practice support and treatment of sailors in several different situations.
SHALLOW WATER ESCAPE
If a submarine is in distress in shallow waters, there may be an opportunity for sailors to escape and float to the surface. In addition to any physical injuries sustained in escaping the submarine, sailors may also be suffering from decompression sickness (often called "the bends”) from surfacing too fast.
As part of Dynamic Monarch, a submarine escape exercise was held on September 16 with a Turkish submarine. The first responders in this case were a specialized Turkish Navy medical team called the Submarine Parachute Assistance Group (SPAG). The group parachuted into the open ocean near the escapees with rafts, medical gear and personnel to set up a small life-raft village in which initial treatment could be administered.
In time, the Turkish submarine rescue ship TCG Alemdar arrived and the 22 escapees were transferred aboard from the raft village. Aboard TCG Alemdar, the Turkish Navy Submarine Escape and Rescue Assistance Team (SMERAT) took over and the escapees were triaged and send to concurrent treatment areas based on the patient condition. Survivors with decompression and/or gas embolisms were recompressed in onboard decompression chambers. Survivors with trauma and life threatening conditions received lifesaving interventions in one of two treatment areas including a full operating room aboard the ship.
After stabilization, some of the simulated survivors were hospitalized in a High Dependency Unit and monitored and treated accordingly by an Anesthetist and an Emergency Medicine Expert and 2 Intensive Care Unit nurses. One simulated smoke inhalation case required further evaluation and treatment, so the patient was transferred to the ship’s helicopter deck and flown via helicopter to Marmaris State Hospital in accordance with the exercise play.
DEEP WATER RESCUE
In a deeper water rescue, pressure inside the submarine can increase if leaks or other damage to the submarine have compromised the environment inside. This possibility of increased pressure leads to a need to be able to conduct rescue operations under pressure, transferring the submariners to the surface in mini submarines or diving bells at the same pressure as the inside of the submarine. This process is called Transfer Under Pressure (TUP). When the rescue vessels reach the surface, they can connect directly to hyperbaric chambers aboard the rescue ships for further treatment under pressure.
On September 18-19, as the culminating event of Dynamic Monarch, participants conducted a 48-hour coordinated mass evacuation from a submarine simulating the rescue of an entire submarine crew. Medical teams aboard TCG Alemdar and commercial ship SD Northern River with embarked NATO Submarine Rescue System (NSRS) operated by the United Kingdom, France and Norway) accepted patients directly from the TUP vehicles into a series of hyperbaric chambers aboard the ship designed to allow for stepping down pressure in various parts of the system while still maintaining high pressure for the new arrivals.
The Dynamic Monarch 2017 Medical Exercise ran under the leadership of Surg.Capt. (N) Ali Ihsan GUNERIGOK of Turkish Navy who also served as Exercise Control Senior Medical Senior Medical Officer (SMO) and SMO of Turkish Navy SMERAT. The successful medical exercise set a new standard for escape and rescue survivor management and treatment.
To enhance submarine rescue treatment knowledge, a dedicated submarine medical symposium was held in Grand Azure Hotel in Marmaris on September 17. The symposium was chaired by Surg. Capt. (N) Ali Ihsan Gunerigok of Turkish Navy and covered the history and the current medical issues in the world of submarine escape and rescue.
Forty-six medical personnel joined the symposium which included 14 lectures from 9 speakers. The first keynote lecture given by Surg.Capt. Gunerigok gave an insight about what submarine medicine is and where it is heading. The final lecture, provided by Allied Maritime Command Medical Advisor Surg. Capt. (N) Filippo La Rosa of the Italian Navy, also gave a comprehensive brief about NATO Medical Command and Control. In this remarks, Capt. La Rosa expressed his gratitude to Turkish Navy’s support to the exercise and made it clear that Allied Maritime Command will do its best to sponsor a dedicated Submarine Medicine Conference as recommended by the Submarine Escape and Rescue Working Group Medical Panel.