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Mass-casualty incidents highlight need for integration of ocular trauma care
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Potentially blinding ocular injuries from incidents such as the Boston Marathon bombing and the fertilizer plant explosion in West, Texas, are common, making the integration of ophthalmologists into regional trauma teams critical, according to researchers.
As part of a multicenter, cross-sectional, retrospective, comparative case series, researchers collected ocular and systemic trauma data from the medical records of individuals injured during the Boston Marathon bombing and West fertilizer plant explosion. In all, 72 eyes of 36 patients treated at one of 12 institutions were included in the study.
Among the individuals in the Boston cohort, 164 of 264 casualties were transported to level 1 trauma centers, with 22 individuals in need of ophthalmology consultations, compared with 218 of 263 casualties transported to participating treatment centers and 14 requiring ophthalmology consultations in the West cohort.
The distance to treatment centers was significantly shorter in Boston than in West, according to the researchers.
In all but one case in the West cohort, the researchers found that rigid eye shields were not provided to any of the patients at the point of injury.
Among patients in the Boston cohort, 19 patients had periocular injuries, 13 had conjunctival or corneal injuries, three had posterior-segment injuries, and one had an open-globe injury. Patients were more likely to have sustained lower-extremity injuries due to the ground-level bomb, according to the researchers.
Within the West cohort, isolated upper-body and facial wounds were more common due to shattered windows, therefore causing more open-globe wounds.
Between the two cohorts, 27.8% of ophthalmic consultations were called from the emergency room, whereas all others occurred afterward.
Aside from the need for increased public education to stay away from windows during disasters, the researchers concluded that the use of rigid eye shields by first responders, reliable communications, deepening of the ophthalmology call algorithm, improving early detection rates for ocular injuries in emergency departments and integrating ophthalmology services into trauma teams are all critical to community disaster planning.
Disclosure: The authors have no relevant financial disclosures.
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