• Journal of The Korea Institute of Healthcare Architecture
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• v.23 no.3
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• pp.81-90
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• 2017

Purpose: The regional trauma center should be a trauma treatment center equipped with facilities, equipment, and manpower capable of providing optimal treatment such as emergency surgery to a severely traumatized patient upon arrival at the hospital. In order to establish a medical system for effective severe diseases, it is necessary to prepare architectural planning guidelines for the regional trauma centers. Methods:: Analyze the spatial configuration, and the area composition of the regional trauma center, And to provide basic data for building a more efficient regional trauma center. The spatial composition analysis divides the space into initial care, resuscitation, patient area, nursing area, diagnostic test, staff training, staff support, public, and analyzes the area and interconnection of each space. Results: The area that must be included in the regional trauma center is the resuscitation area, the patient area, the diagnostic examination area, architectural planning should be designed to enhance the interconnection of the areas. IIn addition, a regional trauma center should be planned as a separate from the existing facility so that it can be installed and operated independently. Implications: A regional trauma center should be built as a stand alone operation and the space should be planned as a more efficient route.

• Journal of Trauma and Injury
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• v.35 no.4
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• pp.261-267
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• 2022

Purpose: With the increasing number of polytrauma patients treated at high-level trauma centers, plastic surgery has entered the specialty of traumatology. Plastic surgeons specialize in the simultaneous surgical care of patients with facial or hand trauma and soft tissue injuries requiring microsurgery. The purpose of this study was to introduce the role of plastic surgery in a high-level trauma center. Methods: Between January 2020 and December 2020, 5,712 patients with traumatic injuries were admitted to the emergency department of a tertiary hospital. Of these 5,712 patients, 1,578 patients were hospitalized for surgical treatment and/or critical care. Among the 1,578 hospitalized trauma patients, 551 patients (35%) required at least one plastic surgery procedure. The patient variables included age, sex, etiology, the injured area, and injury characteristics. We also retrospectively investigated surgical data such as the duration of the operation, hospital stay, length of time from injury to surgery, and collaboration with other departments. Results: The most common injury referred to plastic surgery was facial trauma (41%), followed by hand trauma (36%), and soft tissue injuries requiring microsurgery in various parts of the body other than the hand (7%). The majority of facial and hand traumas were concomitant injuries. Sixteen percent of patients underwent collaborative surgical management for polytrauma involving both plastic surgery and another department. Conclusions: The role of plastic surgery in multidisciplinary teams at high-level trauma centers has become increasingly important. The results of this study may help in the development of multidisciplinary trauma team strategies and future workforce planning.

• Journal of Trauma and Injury
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• v.29 no.4
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• pp.116-123
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• 2016

Purpose: To develop an inclusive and sustainable trauma system as the assessment of burden of injuries is very much important. The purpose of this study was to evaluate the estimates and characteristics of abdominal traumatic injuries. Methods: The data were extracted from the National Emergency Department Information System. Based on Korean Standard Classification for Disease 6th version, which is the Korean version of International Classification of Disease 10th revision, abdominal injuries were identified and abdominal surgeries were evaluated with electronic data interchange codes. Demographic factors, numbers of surgeries and clinical outcomes were also investigated. Results: From 2011 to 2014, about 24,696 patients with abdominal trauma were admitted to the hospitals annually in South Korea. The number of patients who were admitted to regional and local emergency medical centers was 8,622 (34.91%) and 15,564(63.02%), respectively. Based on National Emergency Department Information System, liver was identified as the most commonly injured abdominal solid organ (39.50%, 9,754/24,696, followed by spleen (17.57%, 4,338/24,696) and kidney (12.94%, 3,195/24,696). Conclusion: This study shows that the demand for abdominal trauma care is considerable in South Korea and most of the patients with abdominal trauma were admitted to regional or local emergency centers. The results of this study can be used as good source of information for staffs to ensure proper delivery of abdominal trauma care in trauma centers nationally.

• Journal of Trauma and Injury
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• v.28 no.4
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• pp.262-265
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• 2015

An arteriovenous fistula (AVF) from the renal artery following a penetrating abdominal trauma is not common. We report the case of a 19-year-old male who presented with a knife stab wound in the right upper quadrant. Due to unstable vital signs and to the protrusion of the mesentery through the stab wound, providing definite evidence of peritoneal violation, an emergent exploratory laparotomy was carried out. There were injuries at the proximal transverse mesocolon and the second portion of the duodenum, with bile leakage. There was also a mild amount of retroperitoneal hematoma near the right kidney, without signs of expansion or pulsation. The mesocolon and the duodenum were repaired. After the operation, abdominal computerized tomography (CT) was performed, which revealed contrast from the right renal artery shunting directly into the vena cava. Transcatheter arterial embolization with a coil and vascular plug was performed, and the fistula was repaired. The patient recovered completely and was discharged without complication. For further and thorough evaluation of an abdominal trauma, especially one involving the retroperitoneum, a CT scan is recommended, when possible, either prior to surgery or after surgery when the patient is stabile. Furthermore, a lateral retroperitoneal hematoma and an AVF after a penetrating trauma may not always require exploration. Sometimes, it may be safely treated non-operatively or with embolization.

• Journal of Trauma and Injury
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• v.33 no.3
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• pp.195-203
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• 2020

The following key questions and recommendations are presented herein: when is airway intubation initiated in severe trauma? Airway intubation must be initiated in severe trauma patients with a GCS of 8 or lower (1B). Should rapid sequence intubation (RSI) be performed in trauma patients? RSI should be performed in trauma patients to secure the airway unless it is determined that securing the airway will be problematic (1B). What should be used as an induction drug for airway intubation? Ketamine or etomidate can be used as a sedative induction drug when RSI is being performed in a trauma patient (2B). If cervical spine damage is suspected, how is cervical protection achieved during airway intubation? When intubating a patient with a cervical spine injury, the extraction collar can be temporarily removed while the neck is fixed and protected manually (1C). What alternative method should be used if securing the airway fails more than three times? If three or more attempts to intubate the airway fail, other methods should be considered to secure the airway (1B). Should trauma patients maintain normal ventilation after intubation? It is recommended that trauma patients who have undergone airway intubation maintain normal ventilation rather than hyperventilation or hypoventilation (1C). When should resuscitative thoracotomy be considered for trauma patients? Resuscitative thoracotomy is recommended for trauma patients with penetrating injuries undergoing cardiac arrest or shock in the emergency room (1B).

• Journal of Trauma and Injury
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• v.32 no.2
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• pp.93-100
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• 2019

Purpose: Penetrating vascular trauma though less common poses a challenge to all Surgeons. This study was designed to analyse the profile, management modalities of vascular trauma and the outcomes thereof at a Trauma Care Centre in a Tertiary care setting in hostile environment in India. Methods: A prospective review of all patients with arterial and venous injuries being transferred to the Trauma Center at out Tertiary Care Center between June 2015 and May 2018 was done. Demographics, admission data, treatment, and complications were reviewed. Results: There were a total of 46 patients with 65 vascular injuries, 39 arterial injuries and 26 venous injuries. The age range was 21 to 47 years. Nineteen patients had both arterial and venous injuries. A total of 42 cases presented within 12 hours of injury and complete arterial transections were found in 33 cases (80.49%). There were three mortalities (6.52%) and three amputations (8.33%). The overall limb salvage rate was 91.67% with popliteal artery being the commonest injured artery. Poor prognosticators for limb salvage were increasing time to present to the trauma centre, hypovolemic shock, multi-organ trauma and associated venous injuries. Conclusions: Penetrating missile trauma leading to vascular injuries has not been widely reported. Attempting limb salvage even in cases with delayed presentation should be weighed with the threat to life before revascularisation and should preferably be done at a centre with vascular expertise. A team approach with vascular, orthopaedic, general surgeons, and critical care anaesthesiologists all aboard improve the outcomes manifold. Use of tourniquets and early fasciotomies have been emphasized as is the use of native veins as the bypass conduit. This is probably the largest study on penetrating Vascular trauma in anti-terrorism ops from the Indian subcontinent. It highlights the significance of prompt recognition and availability of vascular expertise in optimally managing cases of vascular trauma.

• Journal of Trauma and Injury
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• v.35 no.3
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• pp.181-188
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• 2022

Purpose: Inferior vena cava (IVC) collapse is related to hypovolemia. Sonography has been used to measure the IVC diameter, but there is variation depending on the skill of the operator and it is difficult to obtain accurate measurements in patients who have a large amount of intestinal gas or are obese. As a modality to obtain accurate measurements, we measured the diameters of the IVC and aorta on trauma computed tomography scans and investigated the correlation between the IVC to aorta ratio and the shock index in blunt trauma patients. Methods: We retrospectively analyzed the medical records of 588 trauma patients who were transferred to the regional trauma center (level 1) of Wonkang University Hospital from March 2020 to February 2021. We included trauma patients 18 years or older who met the trauma activation criteria and underwent trauma computed tomography scans with intravenous contrast within 40 minutes of admission. The shock index was calculated from vital signs before trauma computed tomography scan, and measurements of the anteroposterior diameter of the IVC (AP), the transverse diameter of the IVC (T), and aorta were made 10 mm above the right renal vein in the venous phase. Results: Overall, 271 patients were included in this study, of whom 150 had a shock index ≤0.7 and 121 had a shock index >0.7. The T to AP ratio and AP to aorta ratio were significantly different between groups. Cutoffs were identified for the T to AP ratio and AP to aorta ratio (2.37 and 0.62, respectively) that produced clinically useful sensitivity and specificity for predicting a shock index >0.7, demonstrating moderate accuracy (T to AP ratio: area under the curve, 0.71; sensitivity, 59%; specificity, 87% and AP to aorta ratio: area under the curve, 0.70; sensitivity, 55%; specificity, 91%). Conclusions: The T to AP ratio and AP to aorta ratio are useful for predicting hemorrhagic shock in trauma patients.

• Iberoamérica
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• v.12 no.1
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• pp.187-212
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• 2010

El cine como medio de narrar el trauma histórico de los cubanos se formó especialmente en los años sesenta gracias al Instituto Cubano del Arte e Industria Cinematográficos y se sitúa en la cumbre. En el cine hecho por el director cubano Humberto Solás el discurso de historia, trauma y su memoria tiende a relatar básicamente sobre el mensaje de no olvidar el trauma histórico a través de buscar la manera eficaz e intrínseca de narrarlo. El hecho de no olvidar el trauma histórico y de poder enfrentarse con los elementos causantes del trauma significa el poder de tener la posibilidad probable de adquirir la mirada objetiva para observar la experiencia 'histórica' y la memoria 'cotidiana', y sus relaciones. Si consideramos el hecho de que la tendencia de la víctima suele querer olvidar la memoria del trauma por el miedo y dolor de enfrentarse con la representación del trauma, el enfrentarse con el trauma representado ya puede significar que la víctima esté en un trámite de conseguir la penetración con la cual supera lo negativo que le ofrece el trauma a la víctima. Este artículo se dedica especialmente para averiguar la estrategia del director cubano para realizar este fin de encontrar la manera adecuada en narrar el trauma cubano para que los cubanos puedan adquirir la penetración a través de la identificación y la simpatía entre los personajes del cine y los espectadores, enfocando con detalle en los carácteres de los protagonistas femeninas que son tres diferentes individuos en el mismo número de episodios. Cada protagonista, Lucía en cada episodio experimenta el trauma personal con diversos motivos, pero a pesar del dolor y del miedo del trauma histórico se despiertan los espectadores, quienes se identifican con la protagonista a través de la simpatía y la identificación, llegándose al momento de conseguir la penetración con la cual mira el futuro de la sociedad cubana con el objetivismo libre de los traumas históricos.

• Journal of Trauma and Injury
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• v.25 no.4
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• pp.254-260
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• 2012

Purpose: Ongoing treatment and care, as well as initial stabilization, are required for trauma patients. With increasing number of sickest trauma patients and shortage of surgeons, the need for advanced practice nurse to provide and coordinate trauma care has been greater. The purpose of this study is to analyze the effect of hiring a trauma clinical nurse specialist and its influence on the treatment of trauma patients. Methods: Based on the employment of the clinical nurse specialist in December 2010, the patients were divided into two groups: patients admitted from January 1, 2010 to November 30, 2010 and patients admitted from December 1, 2010 to December 31, 2011. Retrospectively, data were collected using electronic medical records. The general characteristics, clinical courses, and ICU re-admission rates, collaboration (transfers to other departments and collaborative surgery) were compared. Results: To have a clinical nurse specialist on the trauma team resulted in a statistically significant reductions in the length of general ward hospital stay (p<0.05), the ICU re-admission rate, (p<0.03), the lead-time before transfer to other departments (p<0.05). Conclusion: The clinical nurse specialist, as a professional practitioner, improved the quality of treatment through early detection and management of problems. In addition, as a coordinator, the clinical nurse specialist maintained a cooperative relationship with multi-disciplinary medical personnel. The trauma clinical nurse specialist contributed to the treatment of trauma patients positively through a decrease in ICU re-admission rate and length of hospital stay.

• Health Policy and Management
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• v.28 no.4
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• pp.411-422
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• 2018

Background: Whether there is a difference in outcomes for trauma patients transferring to the helicopter emergency medical service (HEMS) according to their previous team composition is controversial. The purpose of this study is to evaluate the effectiveness of trauma team-staffed-HEMS (TTS-HEMS) when transferring to a trauma center. Methods: A retrospective comparison was conducted on patients transported to a trauma center over a 6-year period by the TTS-HEMS and paramedic-staffed-HEMS (119-HEMS). Inclusion criteria were blunt trauma with age ${\geq}15years$. Patient outcomes were compared with the Trauma and Injury Severity Score (TRISS) (30-day mortality) and the Cox proportional hazard ratio of mortality (in hospital). Results: There were 321 patients of TTS-HEMS and 92 patients of 119-HEMS. The TTS-HEMS group had a higher Injury Severity Score and longer transport time but a significantly shorter time to emergency surgery. The prehospital data showed that the trauma team performed more aggressive interventions during transport. An additional 7.6 lives were saved per 100 TTS-HEMS deployments. However, the TRISS results in the 119-HEMS group were not significant. In addition, after adjusting for confounders, the hazard ratio of mortality in the 119-HEMS group was 2.83 times higher than that in the TTS-HEMS group. Conclusion: HEMS was likely to improve the survival rate of injured patients when physicians were involved in TTS-HEMS. Survival benefits in the TTS-HEMS group appeared to be related to the fact that the trauma team performed both more aggressive prehospital resuscitation and clinical decision making during transportation.