Ophthalmologists, suicide bombings and getting it right in the emergency department

BACKGROUND: The number and extent of worldwide suicide attacks has risen sharply in recent years. The objectives of this retrospective study are: to determine the prevalence and outcome of the victims who sustained ocular injury, to describe the activities of ophthalmologists in the setting of an emergency department (ED) receiving mass casualties of a suicide bombing attack and to illustrate some of the treatment obstacles that they encountered and the protocol. METHODS: A single-centre, retrospective, interventional case series. PARTICIPANTS: Participants were the victims of 13 suicide bombing attacks (2000–2004), treated at a level I trauma center of an Israeli tertiary care, municipal medical center. MAIN OUTCOME MEASURES: The study includes a description of the ophthalmologist’s role in the setting of mass evacuation to emergency facilities, prevalence and outcome of patients managed according to the recommended guidelines, and reemphasis of logistic and therapeutic guidelines for management of ocular injuries. RESULTS: The trauma center database yielded information on a total of 352 casualties from 13 suicide bombing attacks, including 17 surviving patients with any ocular/periocular trauma resulting from suicide bombing attacks. Six eyes required and underwent urgent primary closure of laceration for primary repair of open globe, one unsalvageable eye underwent primary enucleation, and two eyes underwent exploration of subconjunctival hemorrhage. Four eyes required additional surgical intervention, which was performed within 7 days (large intravitreal foreign bodies were extracted from three eyes whose final visual acuity was poor, and an intra-lenticular foreign body was extracted from the fourth eye whose final visual acuity was 6/12). The remaining eight patients received medical treatment as indicated and were continued to be followed up. DISCUSSION: Ocular trauma management under conditions of mass injuries requires special utilization of manpower and resources. Guidelines for efficacious patient management, description of the ophthalmologist’s role, and the experience of one emergency facility are presented.