Mass Casualty Incidents at Sea: Planning, Triage & Command in a Shipboard Emergency

Conference Vault, Dive & Ocean Medicine
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Recorded live at the World Extreme Medicine Conference 2024, this session is now available inside the WEM Membership portal.

In this in-depth and practical session, Liz Baugh, founder of Red Square Medical and a former Royal Navy clinician, explores one of the most complex medical scenarios imaginable: managing a mass casualty incident onboard a ship, often with limited personnel, finite resources, and delayed evacuation.

Drawing on decades of maritime, military, expedition, and commercial experience, Liz walks through real-world case studies, international maritime regulations, and practical shipboard planning considerations that underpin effective emergency response at sea.

Topics covered include:

  • Why mass casualty planning at sea is fundamentally different from land-based incidents

  • Adapting triage principles when medical teams are extremely limited

  • Shipboard command, control, and communication under pressure

  • Identifying and using secondary medical positions when primary facilities are lost

  • Crew roles, force multipliers, and credentialing medical volunteers onboard

  • Evacuation decision-making when help may be hours or days away

  • Learning from major maritime incidents including cruise ship groundings and loss of propulsion events

This session is essential viewing for clinicians working in maritime, expedition, offshore, or remote environments, and for anyone responsible for emergency planning where evacuation cannot be guaranteed.

Want more conference sessions?
If you’d like to watch sessions from WEM25, check out the WEM25 Digital Pack, which includes 37 recorded sessions from the World Extreme Medicine Conference 2025.

Going to sea as a medic?
Liz also contributed to this practical Ocean Medicine resource on the WEM blog:
Expedition Ship Medic Checklist: Essential Preparation for Short Contracts, which includes a free downloadable guide covering kit planning, indemnity, comms, evacuation pathways, and onboard preparation.
A must-read for anyone heading into maritime medical roles.

More Information

Length: 59m
Guests: Liz Baugh

Intended Learning Outcomes

By the end of this session, participants will be able to:

1. Explain the unique challenges of managing mass casualty incidents at sea

  • Understand how isolation, ship movement, weather, and delayed evacuation fundamentally alter emergency response.

  • Recognise why land-based major incident models must be adapted for maritime settings.

2. Apply adaptable triage principles in resource-limited maritime environments

  • Describe how traditional triage systems may need modification when medical staffing is minimal.

  • Evaluate decision-making strategies focused on doing the greatest good for the greatest number.

3. Identify effective command, control, and communication strategies onboard ships

  • Understand the importance of clear comms channels, simplified language, and dedicated coordination roles.

  • Recognise why medical staff must be protected from being absorbed into command roles during major incidents.

4. Assess shipboard medical infrastructure and contingency planning

  • Describe the role of secondary medical positions and Safe Return to Port regulations.

  • Evaluate how ship design, layout, and fire zones influence casualty flow and treatment areas.

5. Reflect on preparedness, rehearsal, and multidisciplinary training

  • Recognise the value of repeated drills, tabletop exercises, and cross-department collaboration.

  • Identify how proactive planning reduces risk and improves outcomes in real-world maritime emergencies.

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