It is a great pleasure and privilege for me to attend the 29th annual
meeting of The Japanese Association for The Surgery of Trauma, in
Hokkaido. This is truly the most beautiful place to be in, especially atthis time of year.
My talk is about the current status of trauma care system in Korea.

1Until the early 90’s, there were no emergency medicine specialists inKorea. After I served as president of the Korean Society of Traumatology
from 2003 to 2005, I founded the department of emergency medicine
at Seoul National University Hospital in February 2006. Furthermore, Iserved as president of the Korean Society of Emergency Medicine(2005-2007), and the Korean Association for Disaster and Emergency
Medicine (2007-2009). I think this is why I was given the opportunity totalk about my experience in this great meeting.
Let’s move on the main topic.

2#2. This slide shows preventable death rate in Korea. Blue bar is prehospital
preventable death rate, purple bar is hospital preventable death rate, and red
bar is total preventable death rate, that is prehospital + hospital death reate.
As you can see, Preventable death rate was 50.4% in 1998. It was so highcompared with those of the developed countries, such as US or European
countries which is 10 to 20%. Fortunatelly, the preventable death rate has
gradually decreased, and it was 32.6% in 2008. The decrease of thepreventable death rate was due to the introduction of National EMS fundwhich was made for the improvement of emergency medical service system.
However, after then, the preventable death rate has slightly increased again to35.2% in 2011. The main cause of the increase in the preventable death rate
was lack of trauma care system and trauma center in Korean.

3#3. Problems in trauma care system in Korean can be categorized as follows:
prehospital, hospital and fragmentation problems.
Prehospital problems were shortage of dedicated EMS personnel such asparamedics, absence of training programs for paramedic and air medical
physicians, and insufficient helicopter transport system. Hospital problems
were lack of Level 1 trauma center and manpowers including dedicatedtrauma surgeons, and insufficient government financial and legal support.
Fragmentation is another problem which means lack of coordination between
EMS and trauma service providers.

4#4. To solve these problems, we need to have pre-planned trauma caredelivery system.
A trauma care system has many components such as injury prevention,
standardized EMS protocol, ER resuscitation, OR, ICU and rehabilitation, which
require a multidisciplinary team approach. Trauma data collection and analysis
are also needed for the trauma system performance improvement.

5#5. What is the direction of trauma care system in Korea? It should develop
1. Prehospital trauma management & transpor t
2. Designaton & operation of trauma center s
3. Training of dedicated manpower s
4. Government financial & legal suppor t
From now, I will briefly introduce the current status of Korean
trauma care system.

6#6. First, I will talk about our effort to improve Prehospital trauma care andtransport system7#7. Surprisingly In 2005, a famous research
institute reported very low appropriateness ofprehospital intervention for the emergency
conditions. As you can see, in cardiac arrest,
there was no appropriate intervention for thevictim. Among 80 hypoglycemic patients, there
was no case who glucose was infused. This result
gave a shock to all Korea EMS system as well as
fire department which is responsible for theprehospital care.

8#8. In 2005, Ministry of Health and welfare decided to establish theEMT-B training program for the quality improvement at the scene. 20
regional emergency centers were assigned as a EMT training centers in2006. Eligible EMTs have been trained in the ED for 9 weeks. Emergency
physicians should teach EMTs on prehospital assessment andintervention such as PHTLS, Shock management, and Field triage.

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#9.
We also developed EMS protocols such standadized dispatch protocol, field
triage protocol and medical direction.

10#10. Doctor Heli was introduced by the Ministry of Health and Welfarein Sep. 2011. At first, 2 doctor heli were operated at Mokpo andIncheon area to transport emergency patients at numerous islands.
After July 2013, another two doctor heli were operated at Wonju andAndong. Round flight time is usually within 60min, and flight distancewithin 100 km. Until May this year, there were 1353 flight transports.

11#11. In addition to Doctor Heli, we have 27 EMS helicopters which areoperated by 119 fire department. Red dots show the distribution of HEMS. Atpresent, 270 personnel are working at 119 HEMS.
The number of HEMS transport has been gradually increased from 2700 in2012 to 3200 in 2013.

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#12. Next, I will talk about trauma center.

13#13. What is ideal trauma center?
I think that Ideal trauma center should be rapid, organized, coordinated, andaccountable14#14. In May 2012, EMS law was revised. It contains the designation of trauma
centers. Regional trauma centers should be designated by minister of Healthand Welfare, and Local trauma centers should be designated by governor ofcity or province. Revised EMS law also states dedicated medical staffs,facilities, equipments, and financial and administrative support from central
and local government.

15#15. The Ministry of Health & Welfare has planned to develop trauma system
until 2016. In this plan, 2 exclusive (it means independent) trauma centers and
15 inclusive trauma centers. Among 15 inclusive trauma centers, 5 trauma
centers will be more bigger than other 10 centers.
In addition, the ministry of National defense are planning to set up theinclusive type trauma center in military hospital (Korean Armed Forces Capital
Hospital) which is located near Seoul.

16#16. Two exclusive type regional trauma center will open at Pusan and Seoulin 2015 and 2018, respectively. These centers have more than 50 ICU beds
and 200 admission ward beds.
During last 2 years, 9 Inclusive type regional trauma centers were designated.
5 in 2012, 4 in 2013, respectively.
Another 6 regional center will be designated until 2015. Until now, 3 trauma
center were opened. Each inclusive type regional trauma centers receives
financial support from government. ($8,000,000 for facility support , and$2,700,000 for annual manpower support, respectively)

17#17. This slide shows the difference between exclusive and inclusive typeregional trauma centers.
And at least, half of medical doctors should be certified trauma surgeons.

18#19. This slide shows example of regional trauma centers which alreadyopened.

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#20.

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#21

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#22

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#24.

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#26. Previously, when trauma pts was brought to hospital, initially intern or
EM resident saw the patient, and reported to EM physician or residents in arelated department. EM physician or related residents then, reported to staffs
in a related department, who finally decided treatment plan. In this process,treatment plan was delayed. In contrast, when trauma team see the trauma
patient, decision of treatment plan should be done rapidly within golden hour.

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# 27. The ministry of Health and Welfare released guidelines for trauma
team at regional trauma centers.
Trauma team is usually composed of GS, TS, OS, and NS.
Primary trauma team should be present in-hospital to meet all trauma
patients in the trauma resuscitation area at the time of the trauma
patient's arrival. Primary trauma team should not perform no electivesurgery or procedures, during the on-call period.
When primary trauma team takes a trauma patient, backup trauma
team shall become the primary trauma team and shall arrive promptly
when summoned.
Support team is usually composed of EM, Anes, radiology, and so on.
They also should be available within 30 min when called.

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#28.

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#29.

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#30. In 2008, the Korean Society of Traumatology planned to introduce
certified Board System of Trauma Surgeon. So, it made draft for training
program of trauma surgeon. The agreement by related societies including GS,OS, NS, TS, EM, and Urology and the accreditation from the Korean Academyof Medical Sciences were done. At last, In Dec. 2010, 1st certified board oftrauma surgeons were produced. In Feb. 2011, 22 training hospitals fortrauma surgeon were designated by the Korean Society of Traumatology. Now,The number of training hospital is increased to 35. Each training hospitalshould be evaluated every year for designation.

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#31. This slide shows the distribution of certified board of trauma surgeonsaccording to the clinical department. As you can see, most of traumasurgeons are GS and TS.
Until now, 171 trauma surgeons have been produced.
85 1st and 48 2nd certified board of trauma surgeons were produced in 2010
and 2011, respectively. They were produced only by Document screening &oral test without written examination because there was no training program
for trauma surgeon until 2010.

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#32. Training program is composed of Essential skill & Recommended skill
part program. Essential skills should be done by all trauma surgeons.

30#33. Applicants who become to be trauma surgeon should have certified
board in GS, TS, OS, NS, URO, PS, ENT and Oph. and finish 2 years offellowship program. Two years of fellows program is composed of 22monthsof obligation course and 2 months of elective course, respectively. In
obligation course, trauma surgeons should do for 6 months in-depth training
in SICU, 10 months at one’s department, and 6 months at other departments(among GS, TS, OS, NS). Elective course can be done at other hospital
including oversea training.

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#34. Another fellowship program is supported financially by EMS fund. This
program was introduced in 2011 by the Ministry of Health & Welfare. About
70,000$/year is supported from Nation EMS fund for 2 years. As obligation,
however, certified trauma surgeons should work at the designated trauma
centers for 2 years after the acquisition of certified board.

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This is a textbook of KTAT

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This is pictures of 1st ATOM which was held at Pusan National University
Yangsan Hospital last year.

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#36

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#37. 1st version of Korean Trauma Data Bank was developed by National
Emergency Medical Center and the Korean Society of Traumatology, andcompleted on the end of Feb. 2013. At present 10 regional trauma centers aresubmitting data to KTDB, and all trauma centers will submitting data until
2017.

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#38. This is a part of KTDB. Type of injury, mechanism of injury, Intention ofinjury, vital sign, Response on arrival in ED, and so on should be input intrauma registry.

38#39. GCS (eye opening , verbal, and motor response), RTS, AIS at discharge,
ISS, Glasgow outcome score at discharge also be input.

39#40. Now, 10 regional trauma center are submitting data to KTDB. As you cansee, data submission rates are different among trauma centers. Especially, 4trauma centers which were designated last year show low data submission
rate. To improve the data submission rate and quality of KTDB, we need
dedicated personnel and education.

40#41. Until now, the preventable death rate in Korea is 35.2%. However,through our effort to improve trauma care system, the preventable death rate
will go down below 20% in the near future.

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#. The mission of Trauma care system can be summarized as 3 R, right
person, right time and right place.
Right person means that severity of trauma patients should be assessed byfield triage protocol. Right time means that severe trauma patient should betransported to trauma center rapidly (usually within 1 hr). Right place meansthat trauma patient should be transported to the different level of trauma
center for human resources and facilities, that is, severe trauma patient shouldbe transported to level 1 trauma center. In conclusion, desirable trauma caresystem should be coordinated, regionalized, and accountable.

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