title: Ophthalmologists, suicide bombings and getting it right in the emergency department.
abstract: 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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. adielbarak@gmail.com
authors.forename: Adiel
authors.initials: A
authors.lastname: Barak
authors.forename: David
authors.initials: D
authors.lastname: Verssano
authors.forename: Pinchas
authors.initials: P
authors.lastname: Halpern
authors.forename: Anat
authors.initials: A
authors.lastname: Lowenstein
mesh_terms: D000293:Adolescent; D000328:Adult; D001753:Blast Injuries / Q000145:classification / Q000601:surgery*; D004632:Emergency Medical Services / Q000458:organization & administration*; D004638:Emergency Treatment; D005107:Explosions; D005129:Eye Foreign Bodies / Q000145:classification / Q000601:surgery*; D015807:Eye Injuries, Penetrating / Q000145:classification / Q000601:surgery*; D005260:Female; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009885:Ophthalmology / Q000458:organization & administration*; D015995:Prevalence; D012189:Retrospective Studies; D023481:Terrorism; D014193:Trauma Centers / Q000458:organization & administration; D015599:Trauma Severity Indices; D014218:Triage; D014821:Vitrectomy