JULY 27, 2026 – 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.
By Navy Chief Petty Officer Kathryn Macdonald
Commander, U.S. 3rd Fleet