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Ocular injuries from mass-casualty events underscore need for preparedness, effective communication
Ophthalmologists should be mentally prepared for manmade or natural disasters that could affect the eye.
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Two recent mass-casualty incidents, just 2 days apart, shed light on how the ophthalmic community can better respond to future catastrophic events.
The ocular casualties sustained in the April 15, 2013, Boston Marathon bombing and the April 17, 2013, fertilizer plant explosion in West, Texas, were detailed in a study in Ophthalmology of 72 eyes of 36 patients treated at 12 institutions.
According to senior author Jorge G. Arroyo, MD, MPH, associate professor of ophthalmology at Harvard Medical School, who tended to one of the more severe cases of ocular injury in the bombing, “Given the magnitude of the bombing and the state of shock that everyone was in at the time and immediately following the blast, and being obviously a part of the response to the blast, it felt like an experience that needed to be studied and analyzed in order to derive the most important points and how we can share what we learned throughout the experience for another similar episode.”
The Texas plant explosion was included because it occurred soon after the Boston event, and both incidents required a similar ocular response.
Mental preparedness
Arroyo said that ophthalmologists in general need to be mentally prepared for either manmade or natural disasters that affect the eye.
“In most blast events, the eyes are usually involved, so if ophthalmologists hear of a blast event like the marathon bombing or the fertilizer plant explosion, they should activate their emergency plan and be ready to help,” Arroyo told Ocular Surgery News.
A major difference between the two disasters is that the Boston bombing occurred within a densely populated group of people and that the detonation site of the two improvised explosive devices was at floor level. This caused relatively fewer projectiles hitting the eyes and thus fewer open-globe injuries compared with the fertilizer plant explosion, in which many of the injuries were due to people standing behind windows, with glass breaking and entering their faces and eyes.
Arroyo was surprised that there were not more intraocular foreign bodies from both disasters. “Maybe it is luck,” he said.
Still, for the fertilizer plant explosion, there were many more intraocular foreign bodies. And although some patients from both disasters lost most of their vision in one eye, no patient was completely blinded.
Immediate treatment
Arroyo believes proximity to hospitals and trauma centers affects final outcomes.
“In Boston, patients benefited from a very short duration [of time] between the injury and treatment,” he said.
Arroyo said it is important that first responders protect the patient’s eye with a rigid eye shield during transit to a treatment center to prevent worsening of the injury.
“In both cities, the use of shields was alarmingly low,” he said. “In fact, in Boston, there was a 0% use of rigid eye shields. The military, on the other hand, has shields readily available, and they have been quite successful. Shields are very simple and very efficacious in preventing worsening of the injury.”
A secondary challenge that was discovered was the adequate stocking of spectacles.
“Optical dispensaries should be aware of the fact that blast injuries can result in the loss of spectacles and that many of the victims may need to follow up with new spectacles as soon as possible,” Arroyo said. Something as simple as a pair of prescription sunglasses is sometimes valuable to patients in order to make them feel more comfortable in public.
“Ophthalmologists need to be integrated into trauma services and responses to mass-casualty events,” Arroyo said. “They need to be prepared and know exactly what the protocol is in the case of a disaster.”
Communication between the trauma teams is also key, which may be hampered if cell phone service is temporarily out of order.
“When an entire city goes into a state of lockdown, normal communication between doctors is inhibited,” Arroyo said.
The involvement of the media during the Boston bombing was disturbing to Arroyo.
“It is really important for physicians who do not normally interact with the media to be careful what is shared publicly and to be very cognizant of the need for patient privacy,” he said. – by Bob Kronemyer
Reference:
Yonekawa Y, et al. Ophthalmology. 2014;doi:10.1016/j.ophtha.2014.04.004.For more information:
Jorge G. Arroyo, MD, MPH, can be reached at Division of Ophthalmology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave., Shapiro Fifth Floor, Boston, MA 02215; 617-667-3391; email: jarroyo@bidmc.harvard.edu. Disclosure: Arroyo has no relevant financial disclosures.