• Journal of Trauma and Injury
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• 제28권4호
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• pp.241-247
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• 2015

Purpose: To evaluate the influence of how the trauma care system is applied on the management of trauma patients. Methods: We divided the patients into a pre-trauma system group and a post-trauma system group according to the time when we began to apply the trauma care system in our institution. We compared the general characteristics, injury severity score, initial response time to the trauma patients, number of preventable deaths, and clinical outcomes between the two groups. Results: The numbers of patients in the pre-trauma system group and the post-trauma system group were 188 and 257, respectively. No differences in the patient's median ages, trauma scores (ISS, RTS, TRISS) and proportions of severe trauma patients (ISS>15) were observed between the two groups. The number and the proportion of patients who were admitted to our hospital were increased in the post-trauma system group. The time interval from trauma CP activation to emergency surgery or angio-embolization, and the patient's time spent in emergency room were shortened in the post-trauma system group. However, the lengths of the ICU stay and the hospital stay, and the number of in-hospital mortalities were not improved in the post-trauma system group. In severe trauma patients (ISS>15), there were no differences between the two groups in the number and the proportion of admitted patients, and the time interval from trauma CP activation to performing a diagnostic and therapeutic procedure was not shortened in the post-trauma system group. Conclusion: Application of the trauma care system has shortened the time between the initial response and patient management. However, this improvement was not enough to result in better clinical outcomes. More trauma physicians, multidisciplinary cooperation, and a well-organized trauma management process will be needed if the maximum efficacy of the trauma system is to be achieved.

• Journal of Trauma and Injury
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• 제18권1호
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• pp.1-16
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• 2005

An ideal trauma care system would include all the components identified with optimal trauma care, such as prevention, access, acute hospital care, rehabilitation, and research activities. Central to an ideal system is a large resource-rich trauma center. The need for resources is primarily based on the concept of being able to provide immediate medical care for unlimited numbers of injured patients at any time. Optimal resources at such a trauma center would include inhouse board-certified emergency medicine physicians, general surgeons, anesthesiologists, neurosurgeons, and orthopedic surgeons. Other board-certified specialists would be available, within a short time frame, to all patients who require their expertise. This center would require a certain volume of injured patients to be admitted each year, and these patients would include the most severely injured patients within the system. Additionally, certain injuries that are infrequently seen would be concentrated in this special center to ensure that these patients could be properly treated and studied, providing the opportunity to improve the care of these patients. These research activities are necessary to enhance our knowledge of the care of the injured. Basic science research in areas such as shock, brain edema, organ failure, and rehabilitation would also be present in the ideal center. This trauma center would have an integrated concurrent performance improvement program to ensure optimal care and continuous improvement in care. This center would not only be responsible for assessing care delivered within its trauma program, but for helping to organize the assessment of care within the entire trauma system. This ideal trauma center would serve as a total resource for all organizations dealing with the injured patient in the regional area.

• Journal of Trauma and Injury
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• 제21권1호
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• pp.1-7
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• 2008

When man first walked on this planet, injury must have been a close encounter of the first kind. The outbreak of World War I, during a period of rapid scientific growth in the basic sciences, demonstrated the need to develop better methods of care for the wounded, methods that were later applicable to the civilian population. Trauma is a multisystem disease and, as such, benefits from almost any advance in medical science. As we learn more about the physiology and the biochemistry of various organ systems, we can provide better management for trauma victims. Improved imaging techniques, better appreciation of physiologic tolerance, and increased understanding of the side effects of specific surgical procedures have combined to reduce operative intervention as a component of trauma patient care. On the other hand, because of this rapid development of medical science, only a few doctors still have the ability to treat multisystem injuries because almost doctor has his or her specialty, which means a doctor tends to see only patients with diagnoses in the doctor's specialty. Trauma Surgeons are physicians who have completed the typical general surgery residency and who usually continue with a one to two year fellowship leading to additional board certification in Surgical Critical Care. It is important to note that trauma surgeons do not need to do all kinds of operations, such as neurosurgery and orthopedic surgery. Trauma surgeons are not only a surgeon but also general medical practitioners who are very good at critical care and coordination of patient. In order to achieve the best patient outcomes, trauma surgeons should be involved in prehospital Emergency Medical Services, the Trauma Resuscitation Room, the Operating Room, the Surgical Intensive Care and Trauma Unit, the Trauma Ward, the Rehabilitation Department, and the Trauma Outpatient Clinic. In conclusion, according to worldwide experience and research, the trauma surgeon is the key factor in the trauma care system, so the trauma surgeon should receive strong support to accomplish his or her role successfully.

• Journal of Trauma and Injury
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• 제35권2호
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• pp.71-75
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• 2022

Trauma care is evolving throughout the world to meet the demand resulting from rapidly increasing rates of mortality and morbidity related to external injuries. The State Major Trauma Service was designated to Royal Perth Hospital in 2004 to provide comprehensive care for trauma patients in Western Australia (WA), which is the largest state by area in the country. The State Major Trauma Unit, which was established in 2008, functions as a level I center and admits over 1,000 major trauma patients per year, making it the second busiest trauma center in Australia. The importance of recording data related to trauma was identified by the trauma service in WA to inspire higher standards of patient care and injury prevention. In 1994, the service established a trauma registry, which has undergone significant changes over the last two decades. The current State Trauma Registry is linked to a statewide database called the Data Linkage System. The linked data are available for policy development, quality assurance, and research. This article discusses the evolution of the trauma service and the registry database in the WA health system. The State Trauma Registry has enormous potential to contribute to research and quality improvement studies along with its ability to link with other databases.

• Health Policy and Management
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• 제31권4호
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• pp.399-408
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• 2021

The emergency medical service system in Korea was built upon the Emergency Medical Service Act, 1995 to respond adequately to be much in demand for emergency medical services. In addition, the government recognized the importance of the trauma care system and set out to plan for the designation and establishment of the regional trauma center by 2012. This study aimed to investigate features of quality management and trauma fee schedule on better understanding of trauma care system. First, quality management of the regional trauma center has been implemented by several quality programs involved in quality assessment, committee on trauma quality management, and mortality and morbidity conference. Second, the trauma fee schedule has reflected a specific quality of severe traumatic conditions and added the result to it, which are graded A, B, and C according to quality assessment. Although the government has contributed to instituting a trauma quality assessment program and trauma fee schedule for the regional trauma center, it could not lead to such a fixed standard for quality management of them. Therefore, it will promote discussion on the sustainability of the regional trauma center that requires reducing preventable trauma death rate and the way to apply comprehensive quality management.

• Journal of Trauma and Injury
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• 제32권1호
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• pp.1-7
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• 2019

Purpose: The present study aimed to evaluate the influence of how the trauma care system applied on the management of trauma patient within the region. Methods: We divided the patients in a pre-trauma system group and a post-trauma system group according to the time when we began to apply the trauma care system in the Halla Hospital after designation of a trauma center. We compared annual general characteristics, injury severity score, the average numbers of the major trauma patients, clinical outcomes of the emergency department, and mortality rates between the two groups. Results: No significant differences were found in the annual patients' average age ($54.1{\pm}20.0$ vs. $52.8{\pm}18.2$, p=0.201), transportation pathways (p=0.462), injury mechanism (p=0.486), injury severity score (22.93 vs. 23.96, p=0.877), emergency room (ER) stay in minutes (199.17 vs. 194.29, p=0.935), time to operation or procedure in minutes (154.07 vs. 142.1, p=0.767), time interval to intensive care unit (ICU) in minutes (219.54 vs. 237.13, p=0.662). The W score and Z score indicated better outcomes in post-trauma system group than in pre-trauma system group (W scores, 2.186 vs. 2.027; Z scores, 2.189 vs. 1.928). However, when analyzing survival rates for each department, in the neurosurgery department, in comparison with W score and Z score, both W score were positive and Z core was higher than +1.96. (pre-trauma group: 3.426, 2.335 vs. post-trauma group: 4.17, 1.967). In other than the neurosurgery department, W score was positive after selection, but Z score was less than +1.96, which is not a meaningful outcome of treatment (pre-trauma group: -0.358, -0.271 vs. post-trauma group: 1.071, 0.958). Conclusions: There were significant increases in patient numbers and improvement in survival rate after the introduction of the trauma system. However, there were no remarkable change in ER stay, time to ICU admission, time interval to emergent procedure or operation, and survival rates except neurosurgery. To achieve meaningful survival rates and the result of the rise of the trauma index, we will need to secure sufficient manpower, including specialists in various surgical area as well as rapid establishment of the trauma center.

• Journal of Trauma and Injury
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• 제27권4호
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• pp.165-169
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• 2014

Purpose: Trauma is one of the most common and lethal causes of death in Korea, especially in people under the age of 40. However, a considerable percentage of trauma patients are lost each year due to the scarce resources of the trauma system. The purpose of this study was to determine the recognition of trauma and trauma system. Methods: From April 8th to 22nd, 2014, visitors and in-patients in our medical center were interviewed and surveyed with a questionnaire, which included 28 questions regarding the trauma system, such as the most common cause of death, the locations of trauma centers, the importance of trauma centers, and consent for supporting trauma centers financially. Results: The majority of the respondents recognized trauma as a common cause of death; this was particularly true for people younger than 40. Most respondents' expectancy for the optimal time for trauma patient transport was high, recognizing that major trauma patients should receive urgent care. The respondents felt that trauma centers are important and needed, just as much as police stations and libraries are. Among 178 respondents, 140 (80.5%) were willing to financially support the trauma system. Conclusion: The respondents were aware of the seriousness of trauma and generally agreed on the need for trauma centers. In order to meet the needs and the demands of the people, and to reduce preventable death rate, the trauma system should be improved not only in quality but also in quantity with better and more facilities and manpower, with the aid of publicity from trauma organizations and funding from the government.

• Journal of Trauma and Injury
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• 제20권1호
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• pp.19-25
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• 2007

Purpose: Trauma surgery is not an official medical specialty in the Republic of Korea (South Korea). Thus, a trauma victim transported to an emergency room (ER) is resuscitated and surveyed by an intern, a resident, or an emergency physician (EP) at first. Currently an operative management is decreasing because of multiple factors. Nevertheless, trauma surgery is the key for some patients. Does the EP's treatment in the ER delay the surgeon's emergency operation? Methods: A retrospective study was performed for trauma victims who underwent trauma surgery from March 2004 to February 2005 in a local emergency center of Daegu-city. We reviewed the medical records and analyzed the trauma victim's age, sex, cause of injury, method of transport, time from the trauma to the operation, EP's treatment, surgical department, mortality, and injury severity score (ISS). Results: Of the 223 trauma victims included in this study, males were predominant (83.4%). The mean age was 37.98 years of age. The main Causes of trauma were trauma NOS (not otherwise specified) and motor vehicle accidents (MVA). The main methods of transport was privately owned automobile. The mean time from trauma to operation was 617.46 min. The mean ISS was 7.67. Trauma surgery with the EP's treatment group included 40 trauma victims with higher ISS, and the time from trauma to operation was shorter than it was for the 183 trauma victims not in that group. Conclusion: The EP's treatment of high-ISS multiple-injury trauma victims can shorten the time from trauma to trauma surgery and will help the surgical department treatment. In the trauma care system of the Republic of Korea, and increased role should be encouraged for emergency physician.

• Journal of Trauma and Injury
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• 제29권4호
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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.

• Clinical and Experimental Pediatrics
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• 제54권12호
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• pp.477-480
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• 2011

In order to care for an ill or injured child, it is crucial that every emergency department (ED) has a minimum set of personnel and resources because the majority of children are brought to the geographically nearest ED. In addition to adequate preparation for basic pediatric emergency care, a comprehensive, specialized healthcare system should be in place for a critically-ill or injured victim. Regionalization of healthcare means a system providing high-quality and cost-effective care for victims who present with alow frequency, but critical condition, such as multiple trauma or cardiac arrest. Within the pediatric field, neonatal intensive care and pediatric trauma care are good examples of regionalization. For successful regionalized pediatric emergency care, all aspects of a pediatric emergency system, from pre-hospital field to hospital care, should be categorized and coordinated. Efforts to set up the pediatric emergency care regionalization program based on a nationwide healthcare system are urgently needed in Korea.