In a narrow sense, the trauma team is intra-hospital organization that perform the initial assessment and resuscitation for the victims. Cooperation with the administrative and governance body of the hospital is essential for the function as a trauma center. The hospital could be as a core of the trauma care system with this support. Essential to this core position is a hospital trauma program that regulates and supports the trauma team activities. This trauma program consists of the hospital governance, administration, the trauma team and leader, trauma program manager, the registrar and the multidisciplinary committee of the performance improvement program. The essential elements of the trauma team include a trauma surgeon, an emergency physician, emergency department nurses, a laboratory and radiology technician, an anesthesiologist and a scribe. The team leader should be a trauma surgeon and coordinate the multidisciplinary professions in the team during the entire trauma care process. Clear criteria for the trauma team activation should be defined in advance. The composition of the team and the activation criteria may vary with the hospital capacity, the severity of injury, and the level of activation. The tiered criteria are based on clinical information from the field: physiologic and anatomic conditions and mechanism of injury and are recommended. The multidisciplinary committee for the performance improvement should monitor and assess trauma program outcomes. These activities will lead to trauma care improvements.
Emergencies ; Emergency Service, Hospital ; Resuscitation ; Trauma Centers ; Triage

From 2011 to 2016, 16 regional trauma centers were designated throughout the country and 9 of the 16 centers have been operating their own trauma facilities. At present, there are some differences in treatment experiences and levels according to the type and size of the trauma centers. Treating the trauma system as a part of emergency medical service, while the field of severe trauma is clearly different from the rest of emergency medical service in particular, has become a serious problem in Korea. First of all, the role of trauma centers should have been established before they are added to the trauma care system. Beyond that, manpower is the most important factor in building a trauma center. Pusan National University Hospital offers the ideal environment for a study on the relationship between trauma centers and emergency centers. Pusan National University Hospital has 2 independent emergency rooms: one each in the trauma center and emergency center. Therefore, it is possible to compare the outcomes of 2 different emergency rooms and identify the proportion of the trauma population who is transferred from the emergency center to the trauma center due to trauma severity index. Ultimately, the government and individual hospitals must support personnel in each trauma centers administratively and financially to sustain trauma centers over the long term. The purpose of this proposal is to suggest some resolutions to the problems associated with the trauma care system in Korea.
Busan ; Emergencies ; Emergency Medical Services ; Emergency Service, Hospital ; Korea* ; Trauma Centers* ; Trauma Severity Indices

PURPOSE: The Ministry of Health and Welfare recently designated 35 major trauma-specified centers (MTSC). The purpose of this study is to determine changes in patient flow and designated hospitals, and to describe the role of the emergency medical information center (EMIC) in a regional trauma care system. METHODS: Data of trauma patient inter-facility transfer arrangement by one EMIC were reviewed for 2 months before and after the designation of MTSC. The data included success or failure rates of the arrangement, time used for arrangement, and inquiring and accepting facility. RESULTS: At pre- and post-designation study period, there were 540 and 433 trauma patient inter-facility transfers arranged by EMIC, respectively. The median time used for arrangement decreased from 9.3 to 7.7 minutes (P = 0.007). Arrangement failure rate was 3.5% and 2.5%, respectively, with no significant interval change (P = 0.377). The percentage of inquiring MTSC decreased from 49.1 to 36.9% (P < 0.001). The percentage of accepting MTSC increased from 20.2 to 37.4% (P < 0.001). CONCLUSION: With the designation of MTSC, EMIC could arrange inter-facility transfers more quickly. The hospitals wanted more trauma patients after the designation. There would be a concentration of trauma patients to MTSCs in our region. Further studies are needed for scientific evidence on patient outcome.
Emergencies ; Emergency Service, Hospital ; Humans ; Information Centers ; Information Services ; Referral and Consultation ; Trauma Centers

Ketamine hydrochloride is a unique dissociative anesthetic agent that has been used in children for more than 20 years. Ketamine is devoid of sedation and hypnotic properties but has profound analgesic and amnesic characteristics even in low doses. It is recommended to use with benzodiazepines for the alleviation of ketamine-induced emergence reaction and with anticholinergic agent for the antisialogogue affect. We used the intramuscular ketamine, midazolam, and glycopyrrolate in thirty pediatric patients who were uncontrolled by conventional behaviour management in the OPD of Chungbuk National University Hospital Oral & Maxillofacial Surgery and Emergency Room. The results were as follows: 1. 20 males and 10 females were involved and the average age was 3 years(range, 19 months to 6 years). 2. The anesthetic technique was used for the following reasons: 10 for the I & D of submandibular abscess, 2 for the post operative wound care of cleft lip, and 4 for the other causes. 3. Average onset time of anesthesia was 5.1 minutes(range, 2 to 10 minutes) and average working time was 26 minutes(range, 12 to 50 minutes). 4. 24(80%) of 30 children were rated as 'Cooperative of sleeping' within an average 4.8, and the other children(20%) were rated as 'Intermittent crying or fighting'. 5. Emesis occurred during the recovery period in 2 children, but there was no airway compromise or aspiration. Other side effects were a transient rash(10%), and random movement(7%). 6. The recovery room behavior was quite and uneventful in 23(77%) children and mild agitation in 7(23%) ones.
Abscess ; Anesthesia ; Anesthetics* ; Benzodiazepines ; Child ; Chungcheongbuk-do ; Cleft Lip ; Crying ; Dihydroergotamine ; Emergency Service, Hospital ; Female ; Glycopyrrolate ; Humans ; Ketamine* ; Male ; Midazolam* ; Recovery Room ; Surgery, Oral ; Vomiting ; Wounds and Injuries

A 67 year old male patients was anesthetized with halothane for a open reduction of the fractured right femur shaft. The patient was admitted to the emergency room after he had cerebra1 contusion and fracture of the femoral shaft by a traffic, accident. Anesthesia was continued for one and a, half hours without any problem. At around one and a half hours of anesthesia, the patient developed cardiac arrest and resuscitation was performed immediately. The patient's life was saved by resuscitation and the operation was completed without any further problem. At the time of the resuscitation, a tension pneumothorax was recognized but anesthesia was continued with immediate, proper management. Closed thoracotomy was performed at the recovery room after anesthesia and the patient recovered from anesthesia without any other problem.
Aged ; Anesthesia ; Anesthesia, General* ; Cardiopulmonary Resuscitation* ; Contusions ; Emergency Service, Hospital ; Femur ; Halothane ; Heart Arrest ; Humans ; Male ; Pneumothorax* ; Recovery Room ; Resuscitation ; Thoracotomy

We analyzed 1468 cases of anesthesia for emergency operation which were performed at the department of anesthesiology, Yongsan hospital from January 199l to December 1992. The patients were evaluated according to clinical department, age, sex, disease, ASA classification of physical status, day month, beginning time of operation, anesthetic method, duration of operation or anesthesia, perioperative patient care, past history of operation, operator and insurance. The results were as follows; 1) The percentage of anesthesia for emergency operation was 17.8 % of total anesthetic cases. 2) The departmental distribution was general surgery(47.3%), obstetrics and gynecology(19.0%), neurosurgery(14.6%) and orthopedic surgery(l1.2%). The greatest number of patients was found in the 20-29 years of age consisting of 30.9% of the patients. The male patients comprised of 51.6% while the female patients comprised of 48.4 % of the patients. 3) Most common diseases were appendicitis(57.8%) in general surgery, Cesarean section(50.2%) and ectopic pregnancy(30.8%) in obstetrics and gynecology, ICH(38.3%), EDH(20.1%) and SDH(20.l%) in neurosurgery, tendon rupture(11.0%) and tibia frature(9.8%) in orthopedic surgery. 4) The majority of patients were classified as ASA 2E comprising of 58.6% of the patients. 5) The greatest number of emergency operations was performed on Saturday(16.8%) and in August(10.3%). 6) 45% of emergency operations was performed during 12-18 oclock. 7) The anesthetic methods for emergency operation were inhalational anesthesia(94.3%), regional anesthesia(4.6%) and intravenous anesthesia(l.1%). 8) The percentage of duration of anesthesia and operation which was less than one hour was 70.1% and 77.7%, respectively. 9) 81.1% of patients who underwent the emergency operation was cared in the emergency room preoperatively, and 78.3% of operated patients was transferred to ward. 10) Concerning the past operation history 66.3% of patients never had the operation history, and 26.0% of them underwent operation once, 11) 84.6% of emergency operations was performed by staff doctors, arid 15.4% of them was performed by residents. 12) Concerning the classification of insurance the percentage of medical insurance was 83.4%, and 10.1% of the patients didnt reeeive favors of any type of insurance. Conclusively, in proportion as patients for emergency operation are incresing, the importance of anesthetic management for them is being emphasued. Therefore anesthesiologists have to focus on perioperative anesthetic management and postoperative care in recovery room and ICU to decrease the incidence of complications, morbidity and mortality of emergency operation.
Anesthesia* ; Anesthesiology ; Classification ; Emergencies* ; Emergency Service, Hospital ; Female ; Gynecology ; Humans ; Incidence ; Insurance ; Male ; Mortality ; Neurosurgery ; Obstetrics ; Orthopedics ; Patient Care ; Postoperative Care ; Recovery Room ; Tendons ; Tibia

To describe the profile of adult foreign patients seen at the Emergency Room, Manila Doctors Hospital from January 2008 to December 2009 and their level of satisfaction. Background: Medical tourism is a term initially coined by travel agencies and the mass media to describe the rapidly growing practice of traveling across international boarders to obtain health care. The Philippines is one of a few countries that send qualified physicians and dentists to the US, a testament to its quality of medical education. Procedures can be performed at a fraction of the amount that a patient would spend on the same procedure in the US or Europe. Method: This is a descriptive study done in the Department of Emergency Medicine of a tertiary hospital. All adult foreign patients who consulted at the E.R. were given survey questionnaires to answer prior to discharge. Answers of the patients to the items in the questionnaires were collected and described. Results: In terms of the number of consultations at the Emergency Medicine, the most common nationalities of foreign patients are Asians, specifically, Koreans, Chinese and Japanese in that order. Americans and Saudi Arabians immediately follow. Most of the subjects learned about Manila Doctors Hospital thru their friends, some were referred by hotels, agencies and former patients. The subjects were satisfied with courteous and prompt services given to them by the E.R. staff; they were attended to in less than 30 minutes. Most patients find the cost of medical services reasonable. They felt safe inside the hospital. There is a good level of satisfaction among foreign adult patients consulting at the DEM. Conclusion: Among all patients who were included in the study, Koreans rank as top foreign adult patients consulting at the DEM. Overall, patients were satisfied with the medical services rendered to them by the E.R. staff.
EMERGENCY ROOM ; MEDICAL TOURISM

OBJECTIVE: We conducted a study to validate the effectiveness of the Korean criteria for trauma team activation (TTA) and compared its results with a two-tiered system. METHODS: This observational study was based on data from the Korean Trauma Data Bank. Within the study period, 1,628 trauma patients visited our emergency department, and 739 satisfied the criteria for TTA. The rates of overtriage and undertriage in the Korean one-tiered system were compared with the two-tiered system recommended by the American College of Surgery-Committee on Trauma. RESULTS: Most of the patient’s physiologic factors reflected trauma severity levels, but anatomical factors and mechanism of injury did not show consistent results. In addition, while the rate of overtriage (64.4%) was above the recommended range according to the Korean criteria, the rate of undertriage (4.0%) was within the recommended range. In the simulated two-tiered system, the rate of overtriage was reduced by 5.5%, while undertriage was increased by 1.8% compared to the Korean activation system. CONCLUSION: The Korean criteria for TTA showed higher rates of overtriage and similar undertriage rates compared to the simulated two-tier system. Modification of the current criteria to a two-tier system with special considerations would be more effective for providing optimum patient care and medical resource utilization.
Emergency Service, Hospital ; Humans ; Observational Study ; Patient Care ; Patient Care Team ; Trauma Centers ; Triage

The educational courses for trauma care are stratified into two classes. The first is the Advanced Trauma Life Support (ATLS) course, which is sponsored by the Committee on Trauma (COT) of the American College of Surgeons (ACS) and whose target learners are the surgeons who treat the victims of major trauma. The second is the Basic Trauma Life Support (BTLS) course, which is sponsored by the American College of Emergency Physicians (ACEP) and whose target learners are the pre-hospital healthcare providers, the nurses in emergency rooms, and the emergency physicians who provide emergency care to the victims of major trauma in the accident scene or in the emergency room before the trauma surgeons. The Emergency Medical Service System (EMSS) of Korea is managing to do its work somewhat well when it functions in the medical emergency situations. However, when it encounters with major trauma patients, it can rarely keep the principles of trauma care, such as the 'Golden Hour' and 'the rapid transportation to an appropriate trauma center directly' due to its systemic failure. Therefore the Preventable Death Rate (PDR) of major trauma patients is presumed to be very high in Korea. To rebuild the EMSS of Korea into a new system suitable for major trauma, the Korean Healthcare Administrations should start to lead the legislation and the support for trauma centers and trauma experts. The spread of the educational courses for trauma care into the emergency medical societies can be a starting point to solve the problem. The BTLS course is one of them.
Advanced Trauma Life Support Care ; Delivery of Health Care ; Emergencies ; Emergency Medical Services ; Emergency Service, Hospital ; Health Personnel ; Humans ; Korea ; Mortality ; Societies, Medical ; Transportation ; Trauma Centers

PURPOSE: The committee on trauma of the american college of surgeons, in its manual resources for optimal care of the injured patients involved in falls from less than 20 feet need not be taken to trauma centers. Because triage criteria dictate less urgency for low-level falls, this classification scheme has demerits for early detection and treatment of serious problems in the emergency room. METHODS: A prospective analysis was conducted of 182 patients treated for fall-related trauma from June 2003 to March 2004. Falls were classified as group A (<3 m), group B (> or =3 m, <6 m), and group C (> or =6 m). Collected data included the patient's age, gender, site and height of fall, surface fallen upon, body area of first impact, body regions of injuries, Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), and Injury Severity Score (ISS). RESULTS: The 182 patients were classified as group A (105) 57.7%, group B (61) 33.5%, and group C (16) 8.8%. There was a weak positive correlation between the height of fall and the patients'ISS in the three groups (p<0.001). There were significant differences in GCS (p=0.017), RTS (p=0.034), and ISS (p=0.007) between group A and B. In cases that the head was the initial impact area of the body, the GCS (p<0.001) and the RTS (p=0.002) were lower, but the ISS (p<0.001) was higher than it was for other type of injuries. Hard surfaces as an impact surface type, had an influence on the GCS (p<0.001) and the ISS (p=0.025). CONCLUSION: To simply categorize patients who fall over 6 meters as severely injured patients doesn't have much meaning, and though patients may have fallen less than 6 meters, they should be categorized by using the dynamics (impact surface type, initial body-impact area) of their fall.
Body Regions ; Classification ; Emergency Service, Hospital ; Foot ; Glasgow Coma Scale ; Head ; Humans ; Injury Severity Score ; Prospective Studies ; Trauma Centers ; Triage