Personally, I would not be opposed that ER docs in the private community use the Wills Eye Manual to get a ballpark of the urgency of a patient's situation and at least a general disposition of what to do. If it's something that can wait a day or two, as long as nothing ridiculous is prescribed or done, it's appropriate practice for the patient to see someone within 24-48 hours. What matters more in terms of call is that if there is a serious injury, the person on call can either come see it on the spot to determine the severity or make the decision for the patient to be transferred to a tertiary care center/ER. If the person on call is not comfortable managing complicated trauma issues on call(in which trauma can be very complex with significant injuries to multiple organs), he/she should get a colleague involved or advise transfer to higher level of care. If the OD (or whomever is on call) is not comfortable or skilled enough to handle these trauma situations and does not have any OMDs to ask for help, that person should really have not much business taking call because little is offered.
The reason I have this opinion is that I have seen many patients post trauma managed incorrectly, and unfortunately quicker diagnosis and triaging would have improved outcomes significantly. Anecdotes are a dime a dozen, but recently our center had a patient who had a metal on metal injury to the eye. The OD who managed the patient put the patient on Vigamox and just watched the patient. Eventually the patient developed a perforated infected corneal ulcer, and the OD wanted the patient to see a corneal specialist for PKP. Somehow, the patient ended up in our ER, and our first year resident picked up quickly that there was an IOFB in the anterior chamber going into the vitreous that got infected (which I had the pleasure of fishing out later and cleaning out). If that patient had been seen sooner a week ago when it happened, I'm positive the prognosis would have been much better.
No, I am not making an argument that ODs should not be seeing trauma patients or that they are not trained well enough to manage them, so put your bloody pitchforks down. All I am saying is that if an ER doc is comfortable enough managing traumatic eye issues, they can at least disposition them and get them to see someone appropriately and quickly. If they need a consultant to help with managing a patient and it's an OD, that OD should have experience diagnosing and managing ocular trauma, especially if its complex. That, or the OD has OMDs working with him/her so if there is a question, the OMDs can be curbsided to get their opinion or even a quick exam. If the ED is relying solely on an optometrist, that's where I have hesitations.
