Recently, Professor Lee Guk-jong of Aju University, who became a national hero to save the defector from North Korea, revealed the devastated reality of the local trauma center. A local trauma centers specializing in serious patients is still an unfamiliar concept to us. However, if emergency patients suffer fatal trauma, such as burns or car accidents, the time is the key to success or failure of treatment. As a result, medical institutions that specialize in one place, from patient transportation to emergency care, revivification, surgery, recovery, and rehabilitation are needed. That is why local trauma centers exist. Then, let’s find out why Professor Lee said such an important trauma center has no hope anymore and look for alternatives.
What is a local trauma center?
A local trauma center is a center that specializes in treating emergency patients with multiple fractures or bleeding due to a traffic accident, falling, or gunshot wounds. The center provides with facilities, equipment, and personnel to provide emergency surgery and treatment upon patient’s arrival at the hospital. Unlike usual emergency rooms in hospitals, including a lot of visits of mild cases of diseases and internal disease affairs, local trauma centers only handle critical trauma patients with fatal injuries, the main objective is to minimize patients’ waiting time. The collaboration of surgeons, thoracic surgery specialist and neurosurgery specialist are carried out immediately to enable the operation performed within at least 30 minutes.
Local trauma centers in Korea
The Emergency Medical Service Act, including the establishment of the Regional trauma center, was amended on May 14, 2012. In November of that year, the government established regional trauma centers at five general hospitals. According to the act, each center has 40 to 50 treatment beds, allowing for the treatment of about 20,000 serious trauma patients a year. Also the medical team was prescribed to work 365 days to 24 hours in a fixed arrangement with 4 medical teams of at least personnel 8 specialists and 15 nurses. Until now, 17 local trauma centers have been designated, but it has been discovered that only nine centers (Gacheon-dae Hospital, Dankook Hospital, Aju University Hospital, Busan National University Hospital and EuljI University Hospital) are functioning. Then why is it being a problem in trauma center?
The more patients, the more loss
Unlike regular hospital patients, who have a scheduled surgery or treatment, there are not many patients who are in critical condition, so the medical staff and nurses should wait for their patients to come at any time. Generally, the import of hospital is generated when there are many outpatients or physical examinations. Therefore having a highly likely long-term hospitalization patient with trauma is a great loss in terms of hospitals. At least seven people need to be admitted to operate on one of the seriously ill patients. After surgery, the patient still needs to be fully staffed by nurses and doctors to care that he or she can recover in hospital room well. Besides, if the results of CT scans (computed tomography) are found that the patient’ s physical is normal, the insurance company determines the patient as being overtreatmented and do not applies the expense as medical insurance. Therefore, the hospital has to pay all of the expenses. It’s no wonder, that in general hospitals, which are not designated local trauma centers, patients are often transferred only when their condition getting worse after being placed on standby without taking proper first steps. The centers use all kinds of equipment to save the seriously injured patient who's been carried there, but when the patient dies, the all amount of the cost of using the equipment is the hospital's responsibility.
A vicious circle of hard work and personnel shortage
According to a survey of 138 local trauma centers across the country, 60.9 percent of them worked an average of 12 hours or more per day. The highest number of night shifts during the month was 42 % (7 days to 10 days), and the number of medical teams working over 10 days was also high (24.6 %). This hard work led to the phenomenon of dodging work at the trauma center. In reality, the Busan trauma center posted an advertisement for a full-time trauma surgeon to the association of surgeons, but no doctors applied at all. In addition, in a nationwide survey of medical science students, 88.7 % answered.“ We would not choose to work in trauma center. “Moreover, in 2014, the government supported two trauma centers and provided 70 million won per patient to produce trauma doctors. However, 4 out of 11 applicants for 2015 gave up halfway, and only 4 were completed in 2016. There is a shortage of nurses as well as doctors Another example of a labor problem is that the National Center for Health and Welfare announced that 591 nurses are currently working in local trauma center in operation, which is incomparably short of the minimum number of nurse employees. Hospitals do not hire more nurses due to labor costs, and the turnover rate of hard work is 50 %, so now one nurse sees two or three patients.
The government’s insufficient support
As local trauma center operating instructions stating that the patient and operating room must be prepared for two or more surgeries. As a result, the medical team should not provide general care because it is mandatory to deal with serious patients only. But, in SBS ”We want to know it”, which is complaining against society aired in December, a medical team at the Daejeon Regional trauma center was found to have replaced one hundred million won of its staff at the trauma center without hiring an emergency medical practitioner from the hospital. The Ministry of Health and Welfare, although it knew all of this, had tolerated to avoiding the cancellation of designation of the trauma centers, out of concern that the damage would go to residents who could become trauma center users. Furthermore, there are many problems in “Doctor Helicopter”. The government recently announced the addition of five more “Doctor Helicopter”, which is first aid helicopter equipped to provide first aid and surgery. There is no clear policy on medical practice inside “Doctor Helicopter”, so the hospitals pay for all of the cost. Currently, domestic “Doctor Helicopters” are 6. It is selected and deployed in “Gachon University Gil Medical Center”, “Mokpo Hankook hospital”, “Gyeongbuk Andong hospital”, “Dankook university hospital”, etc.. But it is far from sufficient. In fact, the hospital designated as the local trauma center, Aju University Hospital have to report to the fire department's situation room that they would use fire station helicopter, which has not equipped medical equipment. Recently, the government, having recognized the severity of the trauma center, announced plans to increase the cost of labor for medical personnel and the number of “Doctor Helicopters”. Also they promised to replace the old medical equipment. However, when surveyed doctors at the trauma center to see if the improvement measures proposed by the government were effective, 94.8 % answered "No. "
Trauma center in U.S.A
How about the foreign local trauma center? “Ryder Trauma Center”, which is a hospital affiliated with the University of Miami is including the region not only in Florida but also in Central America. It has been designated as a ‘ First Level trauma center’ that is evaluated based on the number of patients with treatment, equipment, and systems. It has 16 intensive care beds, 125 critical care beds, and currently 15 trauma doctors and 50 another doctors assume emergency care 24 hours a day. The quality of hospital rooms is different from that of Korea as well as the number of hospital rooms. Inside the hospital room, doctors and nurses are assigned exclusively to each patient so they can receive intensive care. In sum up, it can say that one critical care bed serves as a separate emergency room for only one patient. In fact, many people use “Ryder Trauma Center”. In 2014, 4,353 patients were treated at the Rider trauma center, and 4,000 patients use the center every year. As 70.6 % of the patients who are injured in traffic accidents use the center, proper evacuation measures, surgery and treatment can be performed for those who need immediate emergency treatment. Hospitals in the United States, contrastively in Korea, mostly invest in trauma centers because of revenue. The revenue comes from an increase in hospital visits using “advertising effects” rather than direct revenue from treatment patients with severe illness. The system works well that one trauma specialist’s treatment reach the end of the patient's life, so the assurance of patient service, such as post-traumatic trauma recovery, is complete. As a result, the mortality rate of trauma patients in hospitals decreases and the satisfaction level of patients increases, the designated hospitals in the trauma centers will have a higher level of confidence. As the number of patients who visit hospitals increases, the state government provides some of the state's taxes to the hospital. This structure is based on the trust of local residents, state governments and “Ryder Trauma Center”.
Trauma center in Japan
Trauma center at Osaka University are also investing heavily cost in helicopter transport, equipment, and doctor waiting costs. And staff management costs are approximately 100 million yen per center (KRW 1 million), which is equivalent to the cost of 2:1:1 (Government : Local : Hospital ). The government also pays a portion of the cost of equipment. As a result, preventive trauma deaths were successfully set to 10 % which is determining the initial response rate for severe trauma patients. Compared to the current 30.5 % preventive trauma in Korea, Japan is quite low. 40 doctors (including 8 physicians) are appointed by surgeons, neurosurgeons, and orthopedics, and are cooperated by the required medical staff.
As the aging population accelerates, the number of patients in their 70s and older is growing exponentially. To respond quickly to the population structure of Korea, it is necessary to improve the trauma center and the intensive care unit system in charge of serious patients. It's a public problem. So it should proceed with active government involvement.
Top priority of System improvement
The system of checks at hospitals designated as trauma centers should be strengthened each year. The government and municipalities should monitor steadily the reduction of hospital spending by refusing treatment by patients with severe diseases or allowing trauma doctors to concurrently work with other departments. These hospitals should be canceled designating the trauma center or cutting their budget to the trauma center. Then other hospitals can receive financial aid by the last budget. Until now, as there are no hospitals to train trauma doctors in Korea, it has been replaced by training in the U.S.A. In order to recruit staff for trauma surgeons, domestic trauma surgeon needs to provide proper education. It is necessary to consider the uniqueness of the trauma center, in the case of severe patients, they must be verified generally as magnetic resonance imaging (MRI) or computed tomography(CT). Health Insurance Review and Assessment Service should reduce or eliminate the rate at which some insurance premiums are cut into device use for reducing the hospital’s burden. The emergency center implements an emergency center assessment to assess the quality of emergency medical care, emergency patient care procedures and outcomes. Using the results of this assessment, the quality of the ' higher center ' of assessment results can be used to reduce the hospital's burden rate. Finally, It is important to place an additional “Doctor Helicopter “in the appropriate hospital based on the availability of trauma center every year.
Providing reliable labor and operational costs
Although doctors receive state support of 120 million won per year, they do not have enough government support for nurses who are important. Local governments may offer support, but this is also temporary gesture. The government provides eight to 900 million won in annual support, but hospitals are reluctant to hire a designated specialist due to the structure that is updated every five years. Government and local governments agree to provide ongoing support to the Center, and provide support for the purchase or replacement of medical equipment other than 8 billion won to the hospital when selecting trauma centers, such as in Japan. The government should reduce the burden on hospitals by acknowledging health insurance treatment costs for medical practice in transferring patients with a “Doctor Helicopter.”
A call for improvement in awareness
In medical system someone still say that serious trauma patients could be handled in the emergency room enough. Preparation and waiting 24 hours for the treatment of patients with a daily life should not be regarded as a valueless inefficiency but a social safety net. As the amount of money not used out of the 2016 budget is 101 billion won for labor. It was because there is no intention to become a specialist. We can see that this is not just a budget issue. More and more doctors are required to keep their convictions about the advancement of the medical system and life. There is another example to show how urgent it is to improve awareness. An official at the 119 emergency department in Gyeonggi Province said, "The family did not know the hospital designated as the local trauma center, so they insisted on transferring to another large hospital other than the trauma center.” Eventually, hospital officials called to confirm that it was better to get treatment at the trauma center. Only then did the family allow the transfer of the patient to the local trauma center. If the patient had been seriously injured, this delay might have caused a really dangerous situation. Because the risk of an accident exists to everyone, we ought to check to see if the local trauma center is in our area. That way, when real emergencies occur, we can save our lives faster than just waiting in the emergency room waiting room.
There are doctors who are still waiting for patients in these frustrating circumstances. Everyone can become a patient by accident and the chance of survival depends on them. But I think it is better to build a reliable medical system than to expect some medical heroes. The government's concerns and support were also drawn from comments made by Professor Lee and the public's petitions, but the Korea medical system is still in its infancy. Government support is essential for the development of the system and the establishment of the system, but it also requires continued public attention and surveillance.
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