A Treat-on-Berth Model for Maritime Mass Casualty Incidents: A Time-Motion Analysis of System-Level Trauma Care Reconfiguration

BackgroundIn maritime mass casualty incidents, prolonged rescue and transport phases create unavoidable delays before definitive trauma care can begin.Additional post-berthing transfer processes may further prolong access to hemorrhage control, representing a potentially modifiable system-level bottleneck. ObjectiveTo characterize the post-berthing time structure of definitive trauma care and examine the potential of converting unavoidable transfer delay into structured parallel preparation time through on-site deployment of trauma center-equivalent capability (Treat-on-Berth model). MethodsA time-motion analysis was conducted during a full-scale maritime disaster response exercise in fiscal year 2025.Time to definitive treatment was defined as the interval from completion of berthing to initiation of definitive hemorrhage control or circulatory stabilization.The observed interval from berthing to commencement of CT imaging informed a design-based estimate for the proposed Treat-on-Berth workflow.This estimate was compared with a conventional transport-to-hospital model parameterized using time ranges derived from previously published analyses of prehospital and emergency department workflows. ResultsThe exercise demonstrated an approximately 10-minute interval from completion of berthing to commencement of CT imaging.Informed by this observed interval and clinical experience with emergency operations, a 10-20-minute interval to definitive treatment was proposed as a design-based estimate.This interval was not directly measured during the exercise.Comparison with a literature-parameterized conventional workflow suggested a potential time difference of 30-70 minutes; this estimate remains hypothetical and requires prospective validation. ConclusionsThe Treat-on-Berth model proposes a system-level reconfiguration of maritime trauma care by converting unavoidable transport time into parallel preparation for definitive intervention at the point of berthing.The exercise demonstrated the operational feasibility of pre-deploying trauma center-equivalent resources at the pier, while the potential reduction in time to definitive treatment remains to be validated through prospective measurement.