Effective Transport for Trauma Patients under Current Circumstances in Korea: A Single Institution Analysis of Treatment Outcomes for Trauma Patients Transported via the Domestic 119 Service

Abstract

In Korea, which still lacks a well-established trauma care system, the inability to transport patients to adequate treatment sites in a timely manner is a cause of low trauma patient survival. As such, this study was conducted to serve as a basis for the establishment of a future trauma transport system. We performed a comparative analysis of the transport time, and treatment outcomes between trauma victims transported by ground ambulance (GAMB) and those transported via the helicopter emergency medical service (HEMS) through the National Emergency Management Agency's 119 reporting system, which is similar to the 911 system of the United States, from March 2011 to May 2014. The HEMS-transported patients received treatment instructions, by remote communication, from our trauma specialists from the time of accident reporting; in certain instances, members of the trauma medical staff provided treatment at the scene. A total of 1,626 patients were included in the study; the GAMB and HEMS groups had 1,547 and 79 patients, respectively. The median transport time was different between 2 groups (HEMS, 60 min vs. GAMB, 47 min, P<0.001) but for all patients was 49 min (less than the golden hour). Outcomes were significantly better in the HEMS compared to the GAMB, using the trauma and injury severity score (survival rate, 94.9% vs. 90.5%; Z score, 2.83 vs. -1.96; W score, 6.7 vs. -0.8). A unified 119 service transport system, which includes helicopter transport, and the adoption of a trauma care system that allows active initial involvement of trauma medical personnel, could improve the treatment outcome of trauma patients.Graphical Abstract

Reduced Mortality in Severely Injured Patients Using Hospital-based Helicopter Emergency Medical Services in Interhospital Transport

“…In the present study, the median transport time by GEMS was 65 minutes, exceeding the so-called golden hour, which is the time from the accident to the definitive treatment. Although Kim et al ( 35 ) reported that the mean transport time by GEMS was 57 minutes, they did not report any information on patient transfer distance contrary to our study, and whether the study population was comparable with the population transported via H-HEMS was unclear. Diaz et al ( 36 ) showed that helicopter transport was faster than ground transport when requested by scene personnel for a patient who was 45 miles from the trauma center, making patients in this distance range the most likely to benefit from more rapid transport to definitive care centers by helicopter.…”

“…Kim et al ( 35 ) reported the advantage of helicopter transportation based on the fire department system over ground transportation. However, the median helicopter transport time in that study was 60 minutes.…”

Positive correlation between regional emergency medical resources and mortality in severely injured patients: results from the Korean National Hospital Discharge In-depth Survey

“…These results support several studies that reported that surviving a major injury was strongly associated with reaching definitive care (that is, a hospital that could provide optimal treatment) as quickly as possible. 16,23,24 However, in this study, the number of emergency medicine specialists and total specialists per ED did not have a significant relationship with the mortality rate, unlike the results of previous studies. 12,13,25 Regional emergency medical resources and mortality…”

“…As a result, only two regional trauma centres have opened nationwide as of July 2014. 24 Therefore, the government's policy to double the number of regional emergency medical centres and improve the criteria of facilities, equipment, and personnel seems to have been only partially effective. A more effective way to improve the emergency medical system may be to not only increase the quantity of emergency medical resources, but also focus on increasing their quality.…”

“…[29][30][31] Another problem is that most trauma patients are transported to the nearest local hospital as opposed to a trauma centre. 24 Many local emergency medical institutions do not meet even the basic personnel requirements and do not have physician staffing at all times. As a result, patients fail to receive critical trauma care during this first hour.…”