J Korean Med Sci.  2015 Mar;30(3):336-342. 10.3346/jkms.2015.30.3.336.

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

• Kim J
• Heo Y
• Lee JC
• Baek S
• Kim Y
• Moon J
• Youn SH
• Wang H
• Huh Y
• Jung K

• KMID: 2133314
• DOI: http://doi.org/10.3346/jkms.2015.30.3.336

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.

Keyword

Trauma; Transfer; Air Ambulances; Outcome

MeSH Terms

Air Ambulances/*utilization
Emergency Service, Hospital/*statistics & numerical data
Female
Humans
Injury Severity Score
Male
Prognosis
Republic of Korea
Survival Rate
Time Factors
Trauma Centers
Treatment Outcome
Wounds, Nonpenetrating/*mortality/therapy
Wounds, Penetrating/*mortality/therapy

Reference

1. MacKenzie EJ, Rivara FP, Jurkovich GJ, Nathens AB, Frey KP, Egleston BL, Salkever DS, Scharfstein DO. A national evaluation of the effect of trauma-center care on mortality. N Engl J Med. 2006; 354:366–378.

2. Kim Y. Preliminary study on the establishment of regional trauma center and an operation model in Korea. accessed on 28 February 2011. Available at http://www.prism.go.kr/homepage/researchCommon/retrieveResearchDetailPopup.do;jsessionid=111A8C834E2F00398316B1462BC82F2F.node02?research_id=1351000-201100048.

3. National Emergency Medical Center. Emergency Medical Service Annual Report. 2012. accessed on 2 September 2013. Available at http://www.nemc.or.kr/egen/inf.emb13.do.

4. Boyd CR, Tolson MA, Copes WS. Evaluating trauma care: the TRISS method. Trauma Score and the Injury Severity Score. J Trauma. 1987; 27:370–378.

5. Champion HR, Copes WS, Sacco WJ, Lawnick MM, Keast SL, Bain LW Jr, Flanagan ME, Frey CF. The Major Trauma Outcome Study: establishing national norms for trauma care. J Trauma. 1990; 30:1356–1365.

6. Baxt WG, Moody P. The impact of a physician as part of the aeromedical prehospital team in patients with blunt trauma. JAMA. 1987; 257:3246–3250.

7. Hamman BL, Cué JI, Miller FB, O'Brien DA, House T, Polk HC Jr, Richardson JD. Helicopter transport of trauma victims: does a physician make a difference? J Trauma. 1991; 31:490–494.

8. Burney RE, Passini L, Hubert D, Maio R. Comparison of aeromedical crew performance by patient severity and outcome. Ann Emerg Med. 1992; 21:375–378.

9. Schmidt U, Frame SB, Nerlich ML, Rowe DW, Enderson BL, Maull KI, Tscherne H. On-scene helicopter transport of patients with multiple injuries--comparison of a German and an American system. J Trauma. 1992; 33:548–553. discussion 53-5.

10. Baxt WG, Moody P. The impact of a rotorcraft aeromedical emergency care service on trauma mortality. JAMA. 1983; 249:3047–3051.

11. Bartolacci RA, Munford BJ, Lee A, McDougall PA. Air medical scene response to blunt trauma: effect on early survival. Med J Aust. 1998; 169:612–616.

12. Champion HR, Sacco WJ, Carnazzo AJ, Copes W, Fouty WJ. Trauma score. Crit Care Med. 1981; 9:672–676.

13. Champion HR, Sacco WJ, Copes WS, Gann DS, Gennarelli TA, Flanagan ME. A revision of the Trauma Score. J Trauma. 1989; 29:623–629.

14. Champion HR, Sacco WJ, Copes WS. Injury severity scoring again. J Trauma. 1995; 38:94–95.

15. Younge PA, Coats TJ, Gurney D, Kirk CJ. Interpretation of the Ws statistic: application to an integrated trauma system. J Trauma. 1997; 43:511–515.

16. Jung KW, Jang JM, Kim J, Baek SJ, Song SY, Gang CS, Lee KJ. Delayed transfer of major trauma patients under the current emergency medical system in Korea. J Korean Soc Traumatol. 2011; 24:25–30.

17. Han SS, Jung K, Kwon J, Kim J, Choi SC, Lee KJ. Problems with transferring major trauma patients to emergency medical center of a university hospital from another medical center. J Korean Soc Traumatol. 2011; 24:118–124.

18. Jung KY, Kim JS, Kim Y. Problems in trauma care and preventable deaths. J Korean Soc Emerg Med. 2001; 12:45–56.

19. Kim Y, Jung KY, Cho KH, Kim H, Ahn HC, Oh SH, Lee JB, Yu SJ, Lee DI, Im TH, et al. Preventable trauma deaths rates and management errors in emergency medical system in Korea. J Korean Soc Emerg Med. 2006; 17:385–394.

20. Baxt WG, Moody P, Cleveland HC, Fischer RP, Kyes FN, Leicht MJ, Rouch F, Wiest P. Hospital-based rotorcraft aeromedical emergency care services and trauma mortality: a multicenter study. Ann Emerg Med. 1985; 14:859–864.

21. Biewener A, Aschenbrenner U, Rammelt S, Grass R, Zwipp H. Impact of helicopter transport and hospital level on mortality of polytrauma patients. J Trauma. 2004; 56:94–98.

22. Phillips RT, Conaway C, Mullarkey D, Owen JL. One year's trauma mortality experience at Brooke Army Medical Center: is aeromedical transportation of trauma patients necessary? Mil Med. 1999; 164:361–365.

23. Rating the severity of tissue damage. I. The abbreviated scale. JAMA. 1971; 215:277–280.

24. Becher RD, Meredith JW, Kilgo PD. Injury severity scoring and outcomes research. In : Mattox KL, Moore EE, Feliciano DV, editors. Trauma. 7th ed. New York: McGraw-Hill;2013.

25. Baker SP, O'Neill B, Haddon W Jr, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974; 14:187–196.

26. Glance LG, Osler TM, Dick AW. Evaluating trauma center quality: does the choice of the severity-adjustment model make a difference? J Trauma. 2005; 58:1265–1271.

27. Cameron PA, Flett K, Kaan E, Atkin C, Dziukas L. Helicopter retrieval of primary trauma patients by a paramedic helicopter service. Aust N Z J Surg. 1993; 63:790–797.

28. Jacobs LM, Gabram SG, Sztajnkrycer MD, Robinson KJ, Libby MC. Helicopter air medical transport: ten-year outcomes for trauma patients in a New England program. Conn Med. 1999; 63:677–682.

29. Buntman AJ, Yeomans KA. The effect of air medical transport on survival after trauma in Johannesburg, South Africa. S Afr Med J. 2002; 92:807–811.

30. Schwartz RJ, Jacobs LM, Juda RJ. A comparison of ground paramedics and aeromedical treatment of severe blunt trauma patients. Conn Med. 1990; 54:660–662.

31. Schwartz RJ, Jacobs LM, Yaezel D. Impact of pre-trauma center care on length of stay and hospital charges. J Trauma. 1989; 29:1611–1615.

32. Butler DP, Anwar I, Willett K. Is it the H or the EMS in HEMS that has an impact on trauma patient mortality? A systematic review of the evidence. Emerg Med J. 2010; 27:692–701.

33. Thomas SH, Harrison TH, Buras WR, Ahmed W, Cheema F, Wedel SK. Helicopter transport and blunt trauma mortality: a multicenter trial. J Trauma. 2002; 52:136–145.

34. Mitchell AD, Tallon JM, Sealy B. Air versus ground transport of major trauma patients to a tertiary trauma centre: a province-wide comparison using TRISS analysis. Can J Surg. 2007; 50:129–133.

35. Mashiko K. Trauma systems in Japan: history, present status and future perspectives. J Nippon Med Sch. 2005; 72:194–202.

36. Schiller WR, Knox R, Zinnecker H, Jeevanandam M, Sayre M, Burke J, Young DH. Effect of helicopter transport of trauma victims on survival in an urban trauma center. J Trauma. 1988; 28:1127–1134.

37. Cunningham P, Rutledge R, Baker CC, Clancy TV. A comparison of the association of helicopter and ground ambulance transport with the outcome of injury in trauma patients transported from the scene. J Trauma. 1997; 43:940–946.

38. Bledsoe BE, Wesley AK, Eckstein M, Dunn TM, O'Keefe MF. Helicopter scene transport of trauma patients with nonlife-threatening injuries: a meta-analysis. J Trauma. 2006; 60:1257–1265.

39. Brown JB, Stassen NA, Bankey PE, Sangosanya AT, Cheng JD, Gestring ML. Helicopters and the civilian trauma system: national utilization patterns demonstrate improved outcomes after traumatic injury. J Trauma. 2010; 69:1030–1034.

40. Moon J, Kim J, Jung K, Kim YH, Youn SH, Kim E, Heo Y, Lee CJ. Helicopter emergency medical services for trauma patient transport: a single center experience and literature review. J Acute Care Surg. 2014; 4:24–27.