Introduction

There are many events that require a field hospital: some are natural disasters while some are human made. Although ocular injuries are not the most common injuries in these incidents, acute eye injuries during a disaster can result in considerable disability and often require the care of an ophthalmologic surgeon. In some areas in the world, especially in developing countries, blindness resulting from untreated eye injury can cause serious economic burden and even the loss of life. This is why the first objective in the management of eye injuries is to save sight and to prevent the progression of conditions that could produce further damage. Field hospitals are deployed most often in countries with low-level medical infrastructure.

This chapter covers the preparation for treating ocular injuries in the field hospital during disasters. The role and the importance of the ophthalmologist during disasters is to provide services for both victims and relief workers during the end of the emergency phase and ongoing rehabilitation. Specific ocular patterns of injury will be described according to the type of the disaster, its geographical area, and the time elapsed from the disaster.

The ophthalmology field is a high-technology area with the need for expensive equipment and therefore is not fully established in developing countries, causing a significant gap between the needs and the treatment capabilities. This gap intensifies during a disaster and dictates the ophthalmologist’s work environment and functional capabilities in the field hospital, which are very different to those existing in a hospital in developed countries. For example, there is an absence of diagnostic tools for ocular injuries such as CT or MRI scanners, which are basic tools in modern ophthalmology, as well as more advanced diagnostic tools, such as the fluorescein angiography, optical coherence tomography, and so on.

While in other medical disciplines, basic equipment in the field hospital is sufficient, ocular trauma care relies largely on the OR. The ophthalmology instruments are very advanced and expensive, and include microscope, phaco and vitrectomy machines, and laser. The field hospital is not prepared in terms of equipment and staff, which often dictates “damage-control” treatment in penetrating ocular injuries. After the initial treatment, patients with severe injuries should be transferred to a regular medical center for definitive treatment. This difference between the ocular field and the other medical fields is even greater with the passage of the first wave of trauma victims and the arrival of the patients with chronic ocular problems. The field-hospital resources are limited in those cases, especially for elective eye surgery requiring advanced equipment. This sharp transition between the ophthalmologist’s everyday work at his or her hospital and the work at the field hospital is dramatic and therefore requires, first and foremost, a change in mental attitude. This limited framework, beyond the need for a change in mindset, also raises significant ethical questions. However, even with these limitations, the goal of the field hospital remains the provision of optimal care possible under these circumstances.

Understanding the characteristics of ocular injuries during various types of disasters in different geographical areas is important to be able to prepare for them properly, both mentally and practically[1,2]. The type and the location of the disaster dictate the needs of the affected population and the medical mission preparation[3–5].

Epidemiology

The field hospital is usually ready for work a few days after a disaster. As time passes following the disaster, the nature of the referrals to the field hospital changes. Initially, most of the referrals are trauma or disaster related, but later in the deployment the ocular problems are chronic conditions such as cataract, pterygium, dry eye, and refractive errors.

The epidemiology of ocular injuries during mass-casualty events differs significantly in terms of extent, type, and severity of the injuries, and depends on the nature of the event and its location. There are differences between the injuries sustained during the various types of disasters, as well as those made by humans. It is vital to understand the characteristics of ocular injuries during various types of disasters in different geographic areas to be able to prepare for them properly[6,7]. The type and the location of the disaster dictate the needs of the affected population and the medical mission’s preparation[8–10].

The eyes account for only 0.1% of the total body surface area, yet during an explosion as many as 10% of survivors may suffer eye trauma[11]. On September 11, 2001 – the attacks on the World Trade Center – the incidence rate for ocular injury was higher than any other type of injury, with a rate of 59.7 injuries per 100 worker-years[12]. During some types of disasters, ocular injuries may be among the most commonly encountered morbidities [6–10,13–15].

During three different disasters, the Israeli field hospitals saw a similar rate of ocular injuries: 3.96% at the Haiti earthquake, 4.98% at the Philippines typhoon, and 5.58% at the Nepal earthquake and avalanche (Figure 22.1)[16]. The ocular injuries during disasters can be divided into two main categories: disaster related and nondisaster related, since the ophthalmologist is replacing the basic infrastructures that have been destroyed as a result of the disaster.

Figure 22.1 Ocular injuries in disasters

The ocular injuries that are typical to disasters are foreign bodies, eyelid laceration, blunt trauma, and penetrating eye injuries[17–21]. The nature of the disaster and its location dictate the type of the acute ocular injuries treated in the field hospitals. There are more ocular foreign bodies and intraocular foreign bodies in urban areas compared to rural areas. Moreover, the kind of natural disaster affects the nature of the injuries: in earthquakes, face and eyelid laceration and ocular blunt trauma are usually the most common due to the collapse of buildings[22]. Typhoons, due to the strong winds, usually cause injuries characterized by ocular foreign bodies, penetrating eye injuries, and blunt trauma (Table 22.1)[23].

The geographical location of the disaster affects the type of chronic ocular problems the field hospital will deal with in the second phase of the nondisaster-related injuries. In the tropical maritime climate with high ultraviolet light exposure (the pterygium belt), cataract and pterygium are the most frequent presenting pathologies[24–26]. In underserved regions suffering from poverty and poor sanitary conditions, acute and chronic conjunctivitis are very common causes for patients to turn to the field hospitals[27].

Although one must suspect ocular injuries when a patient suffers from facial injuries, sometimes the presentation of these conditions can be more subtle, and it is often difficult to diagnose and appropriately triage these ocular conditions during the acute phase[28–30].

Preparing for Disasters

Proper preparation of the field hospital to treat ocular injuries requires meticulous planning. The field hospital’s success depends on its ability to cope with the field demand. The lack of advanced eye surgical equipment imposes a very conservative management policy for ocular injuries and a damage-control approach. Moreover, field-hospital resources, which are restricted due to transport limitations, may cause a depletion of supplies. This makes prioritization and triage the cornerstones on which the field hospital is built. Precise and accurate preparation, and selecting the right medical personnel and equipment suitable to the exact disaster guarantee the mission’s success.

Related posts:

Chapter 6 – Training and Accreditation Chapter 3 – Definitions, Needs, Scenarios, Functional Concept, and Modes of Deployment Chapter 11 – Auxiliary Medical Services in a Field Hospital Chapter 7 – Personnel Chapter 17 – Wound Management in a Field Hospital Environment Chapter 25 – Infectious Diseases and Public Health in a Field Hospital