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Korean Trauma Centers and the 'Golden Hour'
Park Jun-a  |  soyeon2566@hanyang.ac.kr
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[340호] 승인 2018.12.03  
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Patients that are carried to a trauma center in a life-or-death situation have no other alternatives. In order to avoid missing the ‘golden hour’ for these patients, there is a group of medical centers always on stand-by to provide help. The term golden hour refers to the crucial time that must be kept immediately after a serious accident occurs. However, the medical environment in Korea is too poor to effectively treat these traumatic patients within the golden hour.

Why Is the ‘Golden Hour’ Crucial for Traumatic Patients?

Severe traumatic patients are those who have fallen from a height higher than six meters, suffered a gunshot wound, a severe cut or a deep penetration. Medical facilities fully equipped with medical devices and workforces, called ‘regional trauma centers’, deal with these patients.

Generally, most people with severe wounds have low blood levels, which lead to a shock due to serious internal bleeding. Due to the hemorrhage, the vital organs lack nourishment or oxygen, resulting in long-term damage. In this case, immediate surgery is required to prevent further organ damage by recovering blood supply in a short period of time. If the patient cannot undergo surgery within an hour, the patient’s condition deteriorates extremely, making recovery significantly difficult and death more likely.

In the current Korean medical system, it is difficult for patients with severe trauma to get into the emergency room immediately. For a surgical procedure, medical personnel including surgeons and nurses, an empty operating room, an intensive care unit, and other lifesupporting medical equipment are needed. However, most general and university hospitals have pre-scheduled operations during the day, with a small number of full-time medical staffs operating at night, a lack of intensive care facilities. In Korea, the average time it takes to get to the emergency room after an injury is four hours. If a patient visits the hospital without making a reservation beforehand, the average waiting time increases to seven hours.

Difficulties of Trauma Centers

There are many difficulties of operating an intensive care center, which are not well known. The first problem is between the trauma centers. In a 2017 parliamentary inspection by the administration, it was revealed that Ajou University Trauma Center had solely conducted 1,173 surgeries. This was as much as the total number of completed surgeries by five regional hospitals combined.

When the patients are far away or difficult to be reached, they are transported by the so-called “doctor helicopter.” Doctor helicopter is a significant facility that only trauma centers have, and is the fastest way to deliver an injured patient to a hospital. Ironically, there are too many factors that hinder the use of these helicopters. In the case of a general water bomber helicopter, which is used in firefighting, it is free from any restrictions by the Aviation Safety Law. Also, a rescue helicopter uses a rappel for rescue purposes and can hover above a location in the sky during a rescue. However, for a doctor helicopter, it is obligatory to find a space for landing.

Overall, 70% of the lands in Korea are mountainous, so there is not enough space to land doctor helicopters. Kim Jin-soo, a member of the Helicopter Management Team and working for medical emergencies in Gyeongsangbukdo, explained some of the problems. “Technically, since a doctor helicopter is a part of a leasing contract with the Ministry of Health and Welfare, it is mainly sponsored by private companies. For this reason, following the Aviation Act is mandatory and helicopters should keep the VMC (Visual Meteorological Condition) status,” said Kim. He added, “As a way to prevent damage caused by the FOD (Foreign Object Damage) from high-tension wires, dirt, sand, and rocks, when confronted with unpaved roads, special manual treatment is needed to clean up. Also, when deciding the transfer spot in Korea, there are endless complaints about the noise, and for some other petty reasons such as propellers cutting up strings or scattering sand onto food.”

Another problem was expressed by some trauma doctors: physical and verbal abuse. “Occasionally, there have  been cases of violent behavior by some angry guardians of other patients. It not only hurts the doctor but can affect the lives of other patients, so violence in hospitals should be eradicated. I became a doctor to cure sick people, not to be beaten up. It makes me feel skeptical about my job when these situations happen,” said Yoo In-sul, a Medical Professor in the Department of Emergency Medicine at Chungnam University Medical Center. Yoo elaborated that, “Despite these bad situations, my scars are cured when a patient gets well and appreciates me with a relieved smile. Those smiles are what make me feel a sense of accomplishment and pride today. This is what only emergency doctors can feel, and it keeps me on track in this difficult emergency work.”

Trauma Centers Abroad

When compared to trauma centers in other countries, Korea’s problematic situation is greatly magnified. The United States of America possesses a total of 287 trauma centers. When an accident happens, about 85% of the trauma patients are transported within an hour, and 25% use the doctor helicopter. They divide the trauma centers into four levels: Level one is for the most urgent patients who need surgery immediately, assisted by Level two. Level three and four focus more on taking care of the hospitalized patients.

Although Britain has a much larger population than South Korea by almost 15 million, they actually have a total of 26 major trauma centers. 11 are comprehensive centers, ten are adult centers, and five are just for children. Britain’s mortality rate is less than ten percent, and 99 percent of the patients are put into surgery immediately.

Many of the Korean professionals have studied abroad and have brought in some expensive medical appliances. However, expensive machines cannot solely make an advanced society. “What is actually needed is a comprehensively improved system that can promptly save more patients. This includes enough economic support, specialist cultivation, and increase of awareness,” explained Jo Yong-il, a Doctor of Medicine in the Department of Emergency Care at Hanyang University’s Medical Center.

Why Are Social Adjustments Needed?

 The solution is quite simple. “Nowadays, I feel that the media is only listening to outsiders’ opinions. In fact, we, firefighters, police, and navy personnel are the ones who acknowledge the problem best. If a hospital-public department cooperative system is made, just like in Japan, I’m sure more lives could be saved,” reasoned Kim Jin-su.

As for improving the environment of emergency centers, Jo Yong-il explains, “Rather than handling the situation after an incident occurs, it is important to prevent the unexpected violence in the first place by setting a safe environment.”

To save one’s life, countless endeavors of people are needed. We should always bear this in mind and understand that some inconveniences exist for the greater good. Keeping in Korea’s poor rescue environment in mind, greater respect from the government and the citizens towards these medics is needed. The government should no longer ignore the reality and should provide measures to fix it for the citizens’ safety and happiness.

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