A Life Saved, A Limb Healed with Navy Undersea Medicine, Navy Divers

Story by Douglas Stutz

Naval Hospital Bremerton/Navy Medicine Readiness and Training Command Bremerton

A routine cycling ride for a U.S. naval officer unexpectantly became a harrowing injury which threatened both his life and limb.

Recovering from the gruesome ordeal was fraught with unknowns and uncertainties for Lt. Lyman Woollens, family medicine physician assigned to Naval Hospital Bremerton’s Urgent Care Clinic.

He was unexpectantly hammered by a vehicle, which also pulverized a lower limb. After being emergency airlifted to Harborview Medical Center for level one trauma care, there were umpteen surgeries, multiple weeks confined to a wheelchair, and the distinct possibility of having his leg amputated.

Until collaboration between Navy Medicine, Commander, Submarine Development Squadron 5 and the Navy diver community teamed up to provide Woollens with extensive rehabilitation treatment to help him along the road to recovery.

“My duty as a Navy physician is to provide necessary medical care and treatment so our active duty personnel like Lt. Woollens are ready to deploy,” said Capt. Juan Dapena, Commander, Submarine Development Squadron 5 Undersea Medical Officer, who was contacted by NHB’s orthopedic surgeons Cmdr. Kenneth Needham and Lt. Cmdr. Clarence Steele for assistance.

Dapena in turn reached out to the Navy divers assigned to Naval Undersea Warfare Center Keyport Dive Locker for their support in using the Navy’s oldest certified dive chamber, affectionally known as ‘The Whale,’ for hyperbaric oxygen therapy to improve Woollens recuperation process.

“There has been an amazing amount of support. We are very thankful. All the post-traumatic care is such a testament to the Navy’s commitment to do as much as possible for a servicemember in need,” shared Woollens.

Hyperbaric oxygen therapy – a specialty of Navy undersea medicine – can help with treatment for a host of ailments, illnesses and medical conditions. Research has shown that it is a well-established treatment for fighting infections and wounds that haven’t been able to heal from severe injuries.

According to Dapena, Woollens was a prime candidate.

“The wound sustained, and multiple subsequent surgeries, resulted in the loss of a major arterial supply to the affected area. This area required skin grafts, two of which previously failed due to decreased arterial supply of oxygen-rich blood. While on his third graft he also shows delayed wound healing at the lower aspect of the graft where it attaches to normal and scarred tissue and a pressure ulcer on the posterior aspect of the heel of the same leg secondary to prolonged prostration,” explained Dapena, noting that Woollens surgical and medical care, nutritional status, and physical therapy were being maximized.

“This is where hyperbaric oxygen therapy comes into play as an adjuvant to standard medical care,” Dapena continued. “HBOT increases the partial pressure of oxygen ten-fold throughout all tissues of the body.”

The complex workings of The Whale are manually controlled by the Navy diver team. They simulate setting to a depth of 45 feet of sea water pressure with the air pressure increased higher than normal, with Woollens entire body receiving 100 percent oxygen through a mask – instead of the normal 21 percent – for three 30 minute sessions. There’s a five minute break between the sessions to prevent side effects such as oxygen toxicity, lung tissue damage and seizures.

The treatment plan has him receiving 20 such treatments.

Before actually entering the chamber, a complete medical assessment was done to ensure he was capable to be in such a compression chamber.

“Once in there, Woollens is immersed in a setting that he’s not accustomed, which is why someone is always in there with him and the UMO always present,” Dapena said, noting that the use of HBOT is covered as adjunctive therapy only after there are no measurable signs of healing after at least 30 days of treatment with standard wound therapy. Even then, it must be used in addition to the standard wound care.

The U.S. Navy has such chambers located throughout the world, assigned to Navy Dive Lockers and other operational units at risk for barotrauma or decompression injuries. The availability for the treatment depends on the current and future operational requirements of that unit, and the availability of an undersea medical officer like Dapena on site during the treatment sessions.

“Lyman is fortunate to have all requirements lined up to be able to take advantage of this treatment option,” added Dapena, stressing that the planned treatment is like giving him a prescription for pure oxygen along with having a well-disciplined group of cross-trained Navy divers there to provide constant support.

“Evolutions like these are extremely beneficial for maintaining our proficiency in using our chamber for emergency, diving-related treatments. While we do drills regularly, having an actual patient to care for gives supervisors, tenders, and medical personnel really good experience in these hyperbaric operations without having an actual emergency occurring. We’re able to find out areas for improvement in our training and equipment that might not be apparent during the shorter duration of a drill,” said Navy Diver 1st Class Gregory Murphy (Diving Warfare Specialist qualified), assigned to Naval Undersea Warfare Center Division Keyport Range Support Operations and Dive Locker.

“The predive checks are vital. When you put someone under that much pressure, it’s no joke. We rely on the Navy diver community to help us provide the treatment. Their support is incredibly critical,” added Dapena.

Murphy shared that providing treatments in the chamber requires qualified divers for specific positions.

“While doing a series of treatments over weeks like we’re doing now, our dive locker still has to support the command’s primary mission, our own maintenance, and other scheduling challenges. We have to stay flexible with personnel to be able to support all of these operations,” Murphy said.

Yet despite being stretched thin in balancing manpower with current operational responsibilities, the Navy Divers take great pride in adhering to their Latin motto, “Aut Viam Inveniam, Aut Faciam,” which translates to, “I will either find a way or make one.”

“I’ve been involved on hyperbaric treatments following a surgery for similar injuries in the past and the improvement over the course of treatment is significant. We train to do treatments for diving-related casualties and are fortunate that we rarely need to put those skills to use in a real-life scenario. Being able to take those skills and use them for therapeutic purposes gives us a lot of pride,” stated Murphy.

“The dive team has been upbeat and very professional in assisting with the treatment,” remarked Woollens, noting that the swelling on his injured leg has already improved.

HBOT is regulated by the Undersea and Hyperbaric Medical Society, approved by the Centers for Medicare and Medical Services for such medical indications as acute carbon monoxide intoxication; crush injuries and suturing of severed limbs where the therapy would be an adjunctive treatment when loss of function, limb, or life is threatened.

Woollens continues to augment his recovery process with physical therapy and occupational therapy to also help improve mobility and function. He also squeezes in fitness center strength and flexibility exercise on his own. He’s even advocated on his own behalf to return to work.

“I’ve been cleared to work a full shift,” declared Woollens, deflecting attention from his own mental and physical challenge over the past months to lauding his wife, Lt. Cmdr. Karli Woollens, also a Navy physician. “She’s been carrying the load for us. She’s had to literally handle work, our baby and Navy Medicine responsibilities. The hyperbaric oxygen therapy is all for her and family.”

Once considered a quaint and outdated product, The Whale – 94 years and counting – under the capable guidance of the Navy dive community with Navy undersea medicine, continues to help restore broken bodies to deployable status.

As Lt. Lyman Woollens can attest, one session at a time.