This article is more than 5 years old. Information may no longer be current.
Improving the emergency care system crucial to achieve best outcomes for eye injuries
Click Here to Manage Email Alerts
 Richard L. Lindstrom |
Trauma is the leading cause of death in children and adults under the age of 44 years. Eye injuries also continue to occur frequently, and the consequences can be devastating, changing one’s life in a second. Most injuries in civilian life occur in or around the home, while pursuing sports or recreational activities, or while traveling in a motorized vehicle. It is a truism that prevention is the best medicine, but people are naturally more secure and perhaps more careless when at home than at work.
It is important for all of us to encourage protective eyewear for all our patients when their activities put them in harm’s way. This is especially critical for children and those who have only one remaining fully functional eye. Experience in the military suggests that attractive, stylish protective eyewear that is comfortable to wear is much more likely to be utilized than ugly, uncomfortable “goggles” that fog up during any activity. So, we need to make protective eyewear attractive. Our role models in professional sports can be a great help here. As a hockey player growing up, it was not cool to wear protective eyewear, even for goalies, until the college players and professionals started doing so. In the military, if the platoon leader does not use protective eyewear, no one will. We ophthalmologists and our families should set a positive example and walk the walk, wearing protective eyewear when appropriate.
Once an injury occurs, prompt and proper treatment is critical to salvage the best potential vision. Although many patients go directly to an ophthalmologist, others are seen in urgent care clinics and emergency rooms. Our hospital emergency departments and trauma centers across the country are becoming severely overcrowded, and our nation’s network for emergency care is highly fractured. Excess demand for routine care has made the typical waiting time in many emergency rooms approach 4 to 6 hours.
Due to higher medical liability exposure and lack of reimbursement for frequently uncompensated care, critical surgical specialists including ophthalmologists are often unavailable to provide the needed trauma care. This has led the Institute of Medicine to call for a complete overhaul of our nation’s emergency care system, recommending a regionalized integrated emergency department system of care modeled after the federal Trauma-EMS Systems program. It is hoped that such a system will improve patient outcomes by directing patients to facilities with optimal capability for any given type of illness or injury. It is important for ophthalmology to participate in this reorganization of the nation’s emergency care system when, and if, it is funded by Congress.
Caring for the patient with acute ocular trauma, whether blunt or penetrating, requires extensive resources and highly skilled surgeons. The military triage system provides an admirable model for civilian ophthalmologists to consider, but lack of rapid access to skilled care, fear of medical liability and inadequate surgeon compensation for an extremely challenging type of care present daunting challenges.
Americans assume that when they or a loved one are injured, whether through an everyday occurrence or a catastrophic event, vision-saving emergency care will be provided to them where and when they need it. While theoretically possible, this will only occur if our government funds a reorganization of the dysfunctional emergency care system and if ophthalmologists participate in the process.