Mr. Buff is a novelist working in the national security field with a specialty in submarine~related subjects. He has contributed several articles to THE SUBMARINE REVIEW. His first was requested by the Editor to illustrate the “Jules Verne” method of requirement definition, and appeared in the June and October issues in 1998, titled Looking Fonvard-Submarines in 2050. He has published several novels about submarines including Crush Depth which made the Military Book Club top 20 bestseller list.
Two technological developments, well known in the submariner community and both of them significant force multipliers, are together revolutionizing Navy capabilities to project power onto land. The modification of several Ohio class SSBNs into an SSGN configuration presents a new order of mission-flexible, forward deployed, and stealthy land-attack cruise missile launch platforms blended with Special Warfare commando transport. The Advanced SEAL Delivery System minisub (ASDS) enhances that forward deployed transport and staging even further, by being able to enter the littorals as a very low signature vehicle. Because of its small size, the ASDS can penetrate shallow waters and yet serve as an undersea base of operations for a SEAL team or other combat swimmers, with an autonomous endurance of several days. Each new SSGN is projected to be able to carry two ASDSs as dorsal loads, plus a complement of as many as 66 Special Warfare personnel (close to twice that in an emergency).
At a luncheon during 2002 of the Nautilus Chapter of the Naval Submarine League (Groton/New London, CT), a status report on the SSGN project was presented. One attendee asked a question which the present writer also wished to ask: “What provision is being made for commandos wounded in action?” The response given was that WIAs would be transported directly to a shore facility or surface ship for immediate medical treatment. This makes eminent sense in many possible Special Warfare mission scenarios.
The purpose of this article is to address the matter of situations where the concept of operations does not permit such rapid, high signature evacuation of WIAs to a hospital or vessel other than the SSGN itself. A suggestion will be offered that in certain circumstances it might be appropriate, even necessary, to deploy on the SSGN a medical doctor with experience in combat trauma surgery. In addition, a suggestion will be offered of an undersea Stokes litter that might be used to transport a wounded person from the atmosphere into the ASDS as stealthily as possible, yet with minimum added stress and trauma to the patient in the process of this transfer.
No specific bibliographical references are offered with this article, because the discussion derives from a combination of open-source materials and general reasoning. Also, this discussion applies equally well to an SSN deploying commandos via an ASDS, or older SDV, or even via inflatable rubber boat.
Concept of Operations
To be concise, let us refer to Navy SEALs when we mean to include any personnel who might stage ashore from an ASDS and go in harm’s way, including for instance Marine Recon troops or CIA espionage operatives. Those personnel in fact need not be American; they could come from our allies or coalition partners.
There are, clearly, many different mission scenarios and tasks to which Navy SEALs can be assigned in war and in peacetime. There are at least two dimensions to the parameters of any specific mission: level of secrecy, and level of nearby support from less-stealthy friendly forces.
Secrecy can apply on at least three levels:
1. Direct Action-destruction of enemy assets, capture of prisoners or of international fugitives from justice, or other tasks where the SEAL team’s presence might be instantly detected.
2. Clandestine Action-tasks such as delayed demolitions, or certain forms of enemy facility penetration and intelligence gathering, which are meant to remain undetected in the near-term but which may be detected after some delay.
3. Covert Action-tasks, such as certain forms of espionage or psychological warfare, which are intended to remain undetected forever.
Friendly support is always a significant but potentially difficult issue in Special Warfare operations. In real world tactical situations, the danger is always present that the mission may become compromised while in progress. Retaliation by armed enemy forces may occur. SEAL team members might become wounded in combat. In fact, for a mission to produce a WIA almost by definition means the action has been compromised, and enemy troops could be in hot pursuit of the withdrawing Special Warfare team. Heavy enemy weapons might be brought to bear, either on the team, or to repel friendly rescue/extraction platforms, or both. It is conceivable that the team may be operating in a certain place under certain circumstances such that the only conceivable sanctuary and casualty aid station available is the ASDS and the SSGN on which the SEAL team arrived.
Special Warfare commandos, like many military personnel, certainly receive training in combat first aid. A member of the team will ordinarily be designated as the primary care giver, i.e., the battle corpsman or medic.
Nuclear submarine crews, as a matter of normal routine, include a hospital corpsman and assistants; medical instruments and supplies are embarked on the submarine for every deployment; the wardroom with its dining table can be rapidly transformed into a surgical operating theater if necessary.
However, as skilled as such personnel are, there will be limitations to their abilities to save the life of a seriously wounded comrade. Combat medics, working in the field and possibly under enemy fire, can only hope to stabilize the patient for urgent transfer to better facilities, by taking basic steps to hold back blood loss and treat symptoms of shock. Submariner corpsman are trained and equipped, for the most part, to handle wounds and injuries generally less severe and life threatening than those which might be inflicted on SEALs in contact with enemy troops.
As an example, there is a famous case in Silent Service history in which a corpsman on a submarine on patrol during World War II performed a successful emergency appendectomy on a member of the crew. In general, to the extent that a submarine has been rightfully compared in some ways to an industrial site, serious cuts or crush injuries to body extremities can occur which call upon the corpsman’s maximum skill. For instance, a crewman might drop an extremely heavy filled garbage container onto his foot. Or, a crewman might accidentally place his hand too close to the hydraulic mechanism which controls the ship’s rudder.
However, in all these cases there are potentially significant differences between the extent of the wounds and the degree to which the wounds are life-threatening (or even permanently disabling), and the wounds a SEAL might receive from enemy fire. To perform an appendectomy is to follow established procedures which intentionally avoid lasting damage to muscles, organs, nerves, and major blood vessels. Conventional weapons of all sorts, however, including firearms, mortars and artillery shells, bayonets, and anti-personnel mines, inflict trauma which is far more chaotic within the human body, far more dangerous to the victim’s survival, and vastly more challenging to treat medically. Similarly, to suture and splint a crushed finger or toe, while of vital importance and demanding of excellent training, skill, and, yes, courage and dedication, is nowhere near as difficult as treating a limb maimed by shrapnel, an abdomen pierced by a twisting bayonet, or a chest cavity hit by multiple small-or large-caliber firearm rounds.
To save the lives of WIAs, additional medical devices and materials, as well as additional and more highly trained medical personnel, would appear to be essential. And their availability to the wounded man is time-sensitive indeed, because adequate care not rendered soon enough might come too late. A WIA might tragically become a KIA: an immediately available medical doctor combat trauma surgeon might mean the difference between life and death. Since some of the adapted Ohios’ former SLBM launch tubes are intended as SEAL equipment lockers, for certain missions part of this space might hold the surgeon’s instruments and supplies.
Atmosphere/Ocean Transfer Capsule
Having established above that in some military concepts of operations, the only recourse for effective treatment of combat wounds may have to be available on the SSGN, the problem then arises of transporting the patient from the scene of combat to the host submarine. The combat. presumably. occurred on land or in the surf zone along the shore. The ASDS, the SEAL team’s taxi, is the obvious means of bringing wounded persons to the SSGN.
The ASDS can permit people to enter and exit in one of two ways. The ASDS has a top hatch. However, freeboard is extremely low, and flotation collars may not be available to either increase freeboard or to protect the open top hatch from being swamped by seas. In addition, use of the top hatch requires the ASDS to surface, and if the SEAL team has been compromised and is under enemy fire, surfacing the high-value and vulnerable ASDS in order to evacuate a wounded man might not be an acceptable option.
The other way in which to enter and exit an ASDS is through the bottom hatch in the hyperbaric lock-in/lock-out chamber. To do so requires either free diving, i.e., holding one’s breath while swimming down underwater, or using scuba equipment, such as the Draeger rebreather.
A wounded man may have extreme difficulty in surviving a free dive, and, especially if unconscious or going into shock, may be unable to properly use a Draeger. These concerns apply even if the man is carefully helped by teammate dive buddies. Recall that a serious risk while using the Draeger is that to lose the mouthpiece without first sealing it closed admits seawater into the rig, creating a caustic cocktail which makes the Draeger useless and may cause severe respiratory injury to the diver. Furthermore, any form of movement down the water column from the surface to below the ASDS, and then into the lock-in chamber whose atmospheric pressure has been equalized to the minisub’s depth at the keel, will inflict considerable stress on the wounded man’s body-subsequent decompression will add further stress. Blood clots or embolisms, or even a drop in body temperature due to sudden immersion in frigid seawater, may prove fatal. There is also the problem of blood entering the water from the man’s wounds, if sea creatures such as sharks or barracudas frequent the area of operations.
A potential solution to this atmosphere/ocean transfer conundrum is to develop a waterproof, pressure-proof capsule to temporarily contain the wounded man. The capsule might be completely effective while only needing to withstand sea pressure down to a depth of 20 or 30 feet-the depth limitation of the pure oxygen Draeger is ordinarily about 30 feet in any case. The capsule would require externally operated buoyancy compensator equipment, monitored and controlled by unwounded team members, to assure the capsule neither refused to submerge nor sank to dangerous depths. The capsule could be either carried inside the ASDS, or borne as an external load, but would need to be sized to fit inside the lock-in chamber. (For SEALs being recovered by the host sub from an inflatable boat or other small craft, the transfer capsule could be held until needed inside the submerged SSN’s or SSGN’s escape trunk.)
Inherent in these stated design parameters is that the victim’s body fluids-and also body temperature -would be isolated from the surrounding water, which might hold not only sharks but also toxic pollutants and virulent infectious germs. (These latter threats might be indigenous to the local environment, or might result from chemical or biological weapons being used against the team.) By making the transfer capsule pressure proof, the victim can remain at a safe, low-trauma one atmosphere absolute pressure during the entire transfer process, until the ASDS bottom hatch is shut and the hyperbaric sphere is equalized to normal. (Once inside the ASDS transport compartment, a corpsman can continue care until docking with the host SSGN.)
Furthermore, the interior of the capsule might be equipped with certain first aid and life support gear:
- An integral back board with straps, to immobilize the patient’s body during the transfer and also protect head, neck, and spine from aggravation of existing trauma.
- An oxygen bottle and breather mask, to help support the WIA ‘s vital signs.
- A blood plasma (or properly matched whole blood) intravenous supply mechanism, not dependent on gravity-drip feed, again to minimize shock and support vital signs during the undersea transfer.
None of these devices and technologies seem beyond the reach of present paramedic and diver-medicine equipment and procedures, although some special development and adaptation work might be required, with inherent additional financial cost. A feasibility study of the entire basic concept, and systems integration into existing and ongoing SSGN design and construction efforts, would also create expense and possible delay.
This article has sought to point out that, part and parcel with deployment of Special Warfare forces through the SSGN/ASDS transportation system, comes the need for adequate provision to treat combat casualties, integral to the transport system itself-at least in certain types of missions and in certain types of operating environments. A friendly hospital ashore might not exist for hundreds or thousands of miles. The nearest supporting surface ship-with its sickbay-may also lie far beyond a distant horizon. Actual or imminent enemy fire may prevent survivable air or ground movement to such alternative facilities, even when the facilities do exist. A SEAL ‘s best refuge, just like a submariner’s, has always been underwater.
It is a long-standing tradition of the U.S. Navy SEALs, as in other special forces, to never leave a man behind. Knowledge that a medevac infrastructure, perhaps as proposed above, was actually in place would heighten morale. It would also potentially aid national security and defense preparedness in a larger sense, because the ready availability of outstanding trauma care might facilitate planning of missions that can afford to take risk more aggressively, and thereby increase strategic and tactical value of those missions.
As submariners and SEALs work more and more closely together, and a partial fusion of their cultures does occur, steps should be taken for the maximum possible support of everyone our nation asks to risk their lives protecting freedom around the globe. When the very nature of war is evolving in unpredictable ways in the twenty-first century, nothing should be taken for granted about absolute air superiority and total sea control at all times every-where, or about the ability of even the most superb armed forces in the world to achieve all conceivable Special Warfare missions without sometimes suffering serious combat wounds. If the horrific events of September 11, 2001-and the prolonged, volatile aftermath of that day-have taught us and our Allies any one thing, it is that we don’t need more dead heroes. The general public’s expectation for low casualty rates in future conflicts, and our genuine craving for heroes who are very much alive, argue strongly in favor of a casualty clearing process integral to the SEAL-submariner partnership and the SSGN/ASDS warfighting revolution.