After a terrorist attack, an armed robbery; following successfully terminated negotiations with pirates seeking a ransom, or after their displacement by force all kinds of support, including medical, become feasible as there will be no longer any hostility to this support.
During forceful termination of a hijacking, hostile elements first have to be neutralized before medical aid can be provided. As a forceful termination may itself cause severe injuries medical help should be pre-positioned at the closest range possible and it should be trained to cooperate with the forces involved in the liberation. Ideally such a team should consist of sufficient physicians trained in emergency medicine and paramedics to provide urgent treatment both for new casualties and for serious cases known to be on board.
If a submarine is used as forward base embarkation of a medical team is recommended so that they can board the hijacked ship from a boat as soon as the situation there is secured. If the decision is made to use descent from helicopters they should stand by for evacuation of critical patients who are in a suitable state for transport. The medic of the assault team will need to decide whether further medical teams need to be brought in. While liberation is underway a ship, preferably with a hospital facility that is manned and equipped for primary surgery and intensive care should proceed towards the hijacked ship at highest speed possible to render life saving treatment as necessary. Ideally, helicopters should be able to operate from this ship.
In case of infectious disease among those evacuated minimal isolation including sanitary installations should be provided aboard receiving ships. All personnel coming from an infested ship need be disinfected (see also: handling of boat people; chapter 15). The means of transport for infected patients and equipment used will have to go through an adequate procedure to avoid dissemination of any infectious disease. Authorities in the next port of call need to be informed and consulted prior to entering with patients who have suspected infections.
Even if there is no sign of acute disease crewmembers exposed should receive a medical check after three to six months in order to make sure that there has not been an infection . Their medical records should note any exposure to a risk of infection.
If the liberated crew are to take the ship to the next port it may be appropriate to embark a team experienced in crisis response, including health professionals and psychologists. They should assess if it is safe or beneficial for the crew to operate the ship and there should be ample time for debriefing as well as individual conversation. If decision is made to replace the crew, the debriefing should be done on landing and prior to releasing the crew to their homes.