Mass casualty in an isolated environment: medical response to a submarine collision.

On January 8, 2005, the U.S.S. SAN FRANCISCO (SSN 711), a nuclear-powered submarine, collided with a seamount in a remote Pacific Ocean location. The high-speed impact resulted in injuries to 90% of the crew. Subsequent emergency medical response is described as well as the 3-month physical and psychological morbidity. Recommendations for medical training, equipment, and policy for workers in isolated environments are discussed.