Journal of Trauma and Injury

The Korean Society of Traumatology (대한외상학회)
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Delayed Transfer of Major Trauma Patients Under the Current Emergency Medical System in Korea

현재의 국내 응급의료체계에서 중증외상환자의 이송 지연

  • Jung, Kyoung-Won (Department of Emergency Medicine, Ajou University School of Medicine) ;
  • Jang, Jeong-Moon (Department of Emergency Medicine, Ajou University School of Medicine) ;
  • Kim, Ji-Young (Department of Emergency Medicine, Ajou University School of Medicine) ;
  • Baek, Suk-Ja (Department of Emergency Medicine, Ajou University School of Medicine) ;
  • Song, Seo-Young (Department of Emergency Medicine, Ajou University School of Medicine) ;
  • Gang, Chan-Suk (Department of Emergency Medicine, Ajou University School of Medicine) ;
  • Lee, Kug-Jong (Department of Emergency Medicine, Ajou University School of Medicine)
  • 정경원 (아주대학교 의과대학 응급의학교실) ;
  • 장정문 (아주대학교 의과대학 응급의학교실) ;
  • 김지영 (아주대학교 의과대학 응급의학교실) ;
  • 백숙자 (아주대학교 의과대학 응급의학교실) ;
  • 송서영 (아주대학교 의과대학 응급의학교실) ;
  • 강찬숙 (아주대학교 의과대학 응급의학교실) ;
  • 이국종 (아주대학교 의과대학 응급의학교실)
  • Received : 2011.02.23
  • Accepted : 2011.05.26
  • Published : 2011.06.30
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Abstract

Purpose: Major trauma patients should be transferred to a definitive care facility as early as possible because prompt management will prevent death. This study was designed to discover the obstacles leading to delayed transfers under the current emergency medical system in Korea and whether there are any negative outcomes associated with conducting procedures at primary care hospitals prior to transferring patients to higher levels of care. Methods: The medical records of major trauma patients with an Injury Severity Score above 15 within the past year were reviewed. Patients were divided three groups as follows: (A) came directly to our emergency center, (B) were transferred without CT or MRI scan at the primary care hospital and (C) transferred with CT or MRI scans. The transfer time of each group were compared and analyzed statistically. Additionally, the number and type of imaging performed at the primary care hospital were analyzed. Results: All qualified patients (n=276) were enrolled in this study: 121 patients in group A; 104 in group B; 51 in group C. There was a statistically significant difference in the transfer time between the three groups (p-value<0.001), and 79 (28.6%) were transferred to an emergency medical center within one hour. In group C, CT or MRI scans were performed an average of 1.86 times at the primary care hospital, and the median transfer time was 4 hours 5 minutes. Conclusion: Only 28.6% of the cases in the study arrived within the golden hour at a definitive care facility. Such delays are in part the result of prolonged times at the primary care hospital for radiologic examinations, such as CT or MRI scans. Major multiple trauma patients should be transferred to a definitive care facility directly or as soon as the primary survey and the resuscitation of Advanced Trauma Life Support guideline are completed at the primary care hospital.

Keywords

References

  1. Hoyt DB, Coimbra R, Acosta J. Management of Acute Trauma. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL eds. Textbook of Surgery. 18th ed. Philadelphia: Elsevier Saunders; 2008: 477-520.
  2. Petri RW, Dyer A, Lumpkin J. The effect of prehospital transport time on the mortality from traumatic injury. Prehospital & Disaster Medicine 1995;10:24-9. https://doi.org/10.1017/S1049023X00041625
  3. Sampalis JS, Lavoie A, Williams JI, et al. Impact of on-site care, prehospital time, and level of in-hospital care on survival in severely injured patients. J Trauma 1993;34:252-61. https://doi.org/10.1097/00005373-199302000-00014
  4. Feero S, Hedges J, Simmons E, Irwin L. Does out-ofhospital EMS time affect trauma survival? AJEM 1995;16:133-5.
  5. Jung KY, Kim JS, Kim Y. Problems in trauma care and preventable deaths. J Korean Soc Emerg Med 2001;12:45-56.
  6. Kim Y, Jung KY, Cho KH, Kim H, Ahn HC, Oh SH, et al. Preventable trauma deaths rates and management errors in emergency medical system in Korea. J Korean Soc Emerg Med 2006;17:385-94.
  7. Jung KY, Kim SP, Kim SH, Kim H, Noh H, Jang HY. A study on emergency medical system performance indicators. Ministry of Health and Welfare, National Emergency Medical Center; 2008: 72-4.
  8. Kunihiro Mashiko. Trauma system in Japan: History, present status and future perspectives. J Nippon Med Sch 2005;72:194-202. https://doi.org/10.1272/jnms.72.194
  9. American College of Surgeons Committee on Trauma. Initial Assessment and Management. In: ATLS student course manual. 8th ed. Chicago: ACS COT; 2008: 1-24.
  10. Korean Society of Emergency Medicine, Korean Society of Traumatology. Trauma transportation. Patient assessment and management. In: Korean Trauma Assessment and Treatment course, KTAT. 1st ed. Seoul: Koonza; 2011: 1-38.
  11. Sampalis JS, Denis R, Lavoie A, et al. Trauma care regionalization: a process-outcome evaluation. J Trauma 1999;46:565-81. https://doi.org/10.1097/00005373-199904000-00004
  12. Lee JH, Lim KS, Ahn R, Seo DW, Ahn S, Kim W, et al. The evaluation of the hospital transfer adequacy to the tertiary hospital in trauma patients. J Korean Soc Trauma 2003;16:37-42.
  13. Harrington DT, Connolly M, Biffle WL, Majercik SD, Cioffi WG. Transfer times to definitive care facilities are too long: a consequence of an immature trauma system. Ann Surg 2005;241:961-8. https://doi.org/10.1097/01.sla.0000164178.62726.f1
  14. Lee KJ, Kum JY, Lee KH, Suh GJ, YounYK. General scheme for the level I trauma center in South Korea. J Korean Soc Trauma 2005;18:1-16.
  15. Lee WC, Jo CH, Jung KW, Min YG, Choi SC, Kim KW, et al. Current state and problem of the transfer of severely injured patients in one regional emergency medical center. J Korean Soc Trauma 2010;23:6-15.
  16. Lee KJ. The necessity for a trauma surgeon and the trauma surgeon's role in the trauma care system. J Korean Soc Trauma 2008;21:1-7.
  17. Gupta R, Greer SE, Martin ED. Inefficiencies in a rural trauma system: the burden of repeat imaging in interfacility transfers. J Trauma 2010;69:253-5. https://doi.org/10.1097/TA.0b013e3181e4d579
  18. Wang CL, Cohan RH, Ellis JH, Adusumilli S, Dunnick NR. Frequency, management, and outcome of extravasation of nonionic iodinated contrast medium in 69,657 intravenous injections. Radiology 2007;243:80-7. https://doi.org/10.1148/radiol.2431060554
  19. Brenner DJ, Hall EJ, Computed tomography-an increasing source of radiation exposure. N Engl J Med 2007;357:2277-84. https://doi.org/10.1056/NEJMra072149
  20. Thomas SH, Orf J, Peterson C, Wedel SK. Frequency and costs of laboratory and radiograph repetition in trauma patients undergoing interfacility transfer. Am J Emerg Med 2000;18:156-8. https://doi.org/10.1016/S0735-6757(00)90008-1
  21. Available at: http://www.nemc.or.kr/cyber/cyber_statistics.jsp