Trauma Care and the Otolaryngologist: Roles, Expectations, and Challenges

SAN DIEGO-Trauma care in the United States is on or heading toward life support. Although this may sound hyperbolic, it points to a need, seen by many otolaryngologists and other surgeons, to raise awareness of the growing gap between the numbers of people in need of trauma services and the accessibility of getting those services. Reimbursement issues, time requirements, and geographical constraints are all challenging issues that otolaryngologists and other surgeons face in providing head and neck trauma services. To continue to provide these services, otolaryngologists need to address these challenges and continually update their skills to provide the best care possible.

The need to enhance trauma systems nationwide, in every state, is illuminated by data that show that fewer than 10% of hospitals have a trauma center, only eight states have fully developed trauma systems, and up to 38% of the population may not be covered by a statewide trauma center.

There is concern that we’re not training otolaryngologists to handle trauma and that translates not only onto the battlefield but to hospitals across America.
-Marion Couch, MD, PhD

The lack of infrastructure support for trauma services comes at a time, ironically, when the nation is building a homeland security effort to be ready for mass casualties that may result from a natural disaster or terrorist attack.

To address issues related to developing optimal trauma care of head and neck injuries, a panel of experts convened during a miniseminar held at the Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) 2009 annual meeting to discuss both technical and socioeconomic issues otolaryngologists face to remain central players in trauma systems. Called Comprehensive Contemporary Management of Otolaryngologic Trauma, the miniseminar drew on the experiences gained during military and civilian trauma care to highlight essential components of a good trauma system.

Lessons from the Battlefield

G. Richard Holt, MD, of the Department of Otolaryngology-Head and Neck Surgery at the University of Texas Health Science Center at San Antonio-who, as a flight surgeon in Operation Iraqi Freedom, helped evacuate soldiers at the site of the injury, often under hostile conditions-emphasized that all physicians who treat patients with severe injuries are duty bound by their profession to step forward in time of need, such as in the face of a natural disaster or terrorist attack.

We are physicians first and can manage multiple traumas due to our training and experience, he said. Most of us are certainly trained in maintenance of the airway and trauma to the head and neck, so we all, as otolaryngologists, should be capable of stepping into the fray as needed.

Penetrating Neck Wounds

One lesson in a treatment approach to head and neck injuries drawn from the battlefield is management of penetrating neck wounds. Although Dr. Holt said that the current trend toward selective neck exploration via new imaging and other technological advances is feasible to diagnose these injuries, he cautioned that this approach should not result in anunduly nonaggressive approach to these injuries because of the risk of death from missing an injury.