Navy Medicine R&D Researchers Participate in National Academies Undersea Medicine Workshop

Story by Tommy Lamkin

Naval Medical Research Command

SILVER SPRING, Md. – Researchers specializing in undersea medicine from the Navy Medicine Research & Development (NMR&D) enterprise participated in a virtual workshop hosted by the National Academies of Sciences, Engineering and Medicine (NASEM), and sponsored by the Office of Naval Research (ONR) on March 21.

Workshop participants included a multi-disciplinary group of experts specializing in diving injuries, hyperbaric physiology, submarine medicine, systems engineering, DoD policy and budget and naval operations. The workshop, titled “Emerging Science and Technology to Address Naval Undersea Medicine Needs: A Workshop”, was structured to foster engagement between these subspecialties to advance undersea medicine to best meet the operational needs of the Navy.

“Brief framing talks for selected discussion topics set the stage for a broader discussion of the topic, such as dive monitoring and injury prevention or submarine medicine,” said workshop chair Dr. Kenneth W. Kizer, a 25-year member of the National Academy of Medicine, a Navy-trained diver and former undersea medical officer. “After these talks, a panel of experts from different, but related, lines of work would respond to those talks with thoughtful reflections and probing questions about the work’s implications, future directions, challenges and opportunities.”

The workshop featured NMR&D researchers from the Naval Submarine Medical Research Laboratory (NSMRL) and Naval Medical Research Command (NMRC), alongside representatives from across the undersea medicine, diving, and submarines communities within ONR, the Navy Bureau of Medicine and Surgery and Naval Sea Systems Command, among others.

“This workshop is unique,” said Dr. David Fothergill, NSMRL science director. “It brings the operational diving and the submarine line community together with researchers from both military laboratories and universities to discuss where cutting edge research in undersea medicine can best be focused to ultimately help our undersea warfighters.”

Fothergill, a Navy-trained diver with more than 30 years of experience in undersea research, was joined by fellow NSMRL colleagues: Dr. Jeffrey Bolkhovsky, winner of the 2023 Navy Emergent Scientist of the Year Award, who specializes in human performance; Dr. Justin Handy, who studies the impacts of stress and resilience on mental health; Dr. Dominica Hernandez, who is working to modernize submarine health screening and assessments; and Linda Hughes, program manager for the Undersea Health Epidemiology Research Program.

NMR&D conducts research in several areas in the undersea domain to include; understanding microbiome changes for prolonged submarine deployments; evaluating the effects of underwater exercise; evaluating technology that studies the impact of diving on vestibular reflex function, light treatment countermeasures, such as blue light to aide in circadian misalignment; sleep studies, particularly in relation to submarine watchbill rotations; ongoing atmospheric monitoring of submarines; blast exposure; the evaluation of the sensitivity and reliability of exhaled nitrous oxide as a non-invasive biomarker; psychological fitness, and the investigation of oxygen toxicity.

Dr. Aaron Hall, a research physiologist with NMRC’s Undersea Medicine Department, gave an overview of central nervous system and pulmonary oxygen toxicity, discussed identifying the role of nitric oxide in oxygen toxicity and spoke about notable achievements in the 20 years since this type of undersea medicine research program review last occurred.

“This is the most expertise in undersea medicine in one setting in a long time,” said Hall. “This workshop represents a gathering of major sponsors, performers, end users and program managers to discuss Undersea Medicine research as it stands now and where it should go in the future.”

“NMRC serves a vital role in transitioning promising basic research into more mature products for the human research labs to study” Hall added. “This workshop amplifies my research by giving an up-to-date assessment of research gaps in addition to sponsor and end user input to make my research portfolio more relevant to the diver and submariner needs.”

According to Kizer, much has changed in the two decades since the last similar review of undersea medicine research priorities. For example, the scientific understanding of some diving-related diseases has significantly changed, to include very recent data showing unexplainable marked variation in an individual’s risk of decompression sickness when diving the same dive profile on different days. Likewise, new research methods being used to investigate other medical problems, like the use of machine learning and artificial intelligence, hold promise for better understanding a variety of diving and submarine medical concerns. Similarly, there have been significant changes on the operational front, including changes in watch duration when deployed and women serving on submarines.

Hughes participated in a workshop discussion focused on potential health concerns of women divers and submariners and the unique research being conducted on those serving in these undersea roles, particularly in the areas of mental health, circadian rhythm and the female reproductive system.

“While some studies on these topics have been conducted on male submariners, and have yet to reveal any long-term effects, no studies have been conducted on female submariners,” said Hughes. “It’s been 13 years since women were assigned to U.S. subs and they’re now assigned to all sub classes and their population is growing exponentially. So now we have a somewhat robust population large enough to study, ideally, from pre-first deployment to beyond separation and long-term effects.”

For Kizer, a member of the Uniformed Services University’s Board of Regents, prioritizing research projects is key when looking for the best opportunities to lead, leverage and enable research, development, technology and engineering.

“Where might there be low-hanging fruit or which knowledge gaps should be filled first because of their likely benefit on undersea warfighter and fleet performance? These are some of the questions we explored.”

“This workshop directly relates to NSMRL’s mission to sustain the readiness and superiority of our undersea warfighters through innovative health and performance research,” added Fothergill. “This is a preeminent virtual workshop specifically focused on undersea warfighters and is so necessary to define areas of research that are sorely needed to improve warfighter performance.”

A formal report of the workshop’s proceedings will be available from NASEM later this year.

ONR’s Undersea Medicine Program’s mission is to provide research funding for the development of novel approaches to undersea biomedical issues so that the undersea warfighter can operate deeper, longer, more safely and more effectively.

The National Academies provide independent, trustworthy advice and facilitate solutions to complex challenges by mobilizing expertise, practice, and knowledge in science, engineering, and medicine.

Along with NMRC and NSMRL, the NMR&D enterprise consists of Naval Health Research Center (NHRC) and Naval Medical Research Units (NAMRU), Dayton, EURAFCENT, INDO PACIFIC, San Antonio and SOUTH. NMR&D is engaged in a broad spectrum of activity from basic science in the laboratory to field studies in austere and remote areas of the world to investigations in operational environments. In support of the Navy, Marine Corps and joint U.S. warfighters, researchers study infectious diseases, biological warfare detection and defense, combat casualty care, environmental health concerns, aerospace and undersea medicine, medical modeling, simulation, operational mission support, epidemiology and behavioral sciences.