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

For patients who cannot be intubated, he said that use of the laryngeal mask airway (LMA) saves the most lives. However, he cautioned about safety concerns with these masks, given that they may not prevent aspiration or reflux.

Acute Management of Facial Fractures

Another lesson learned from the battlefield is that high-velocity facial wounds can be treated immediately, versus the traditional delayed approach.

According to Dr. Lopez, he and his colleagues who have deployed to Iraq and Afghanistan have treated thousands of soldiers with this approach. The assumption that the soft tissue in a high-velocity facial wound had to heal for about a week prior to closing it is not borne out by the good results they have seen in patients in whom their facial wounds are closed immediately.

Fortunately, we don’t see a lot of high-velocity facial wounds in civilian life, he said, adding that he would treat these types of wounds immediately in a civilian setting as well should it arise.

Socioeconomic Issues

Providing trauma care is not easy, and the challenges are great. 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, said Marion Couch, MD, PhD, of the Department of Otolaryngology-Head and Neck Surgery at University of North Carolina School of Medicine in Chapel Hill.

Of the several socioeconomic issues that make trauma care challenging, Dr. Couch emphasized that the large number of people without health insurance is a key factor.

The issue of uninsured patients is intimately associated with the sustainability of trauma, she said, adding that it is becoming more difficult for surgeons, as well as institutions and hospitals, to handle trauma injuries because the reimbursement rate is so low. To take on these cases, she said, you often have to take a financial hit.

One solution proposed to address these challenges is for otolaryngologists to use a standardized daily progress note to increase coding accuracy and associated billing. Data show a 394% average revenue increase when standardizing documentation.

Given the difficulties of providing trauma services, Dr. Couch said that efforts are under way to provide education and support for otolaryngologists and to advocate within the specialty, with the American College of Surgeons, and with local and federal government to improve ways to deliver trauma services. To this end, a Head and Neck Trauma Study Group is working toward becoming a full committee within the AAO-HNS.