Understanding Regional Trauma Centers and managing a trauma care system in South Korea: a systematic review

Clinical effect on major trauma patients during simultaneous or overlapping presentations at an urban level I trauma center in Korea

OBJECTIVE

Overcrowding in an emergency department (ED) or intensive care unit (ICU) of the trauma center (TC) is an important issue for timely acute health care of a critically injured patient. Accumulated scientific evidence has indicated the negative influence of overcrowding to the process and clinical outcome of trauma care.

METHOD

The institutional trauma registry at an urban level I TC was retrospectively evaluated for 5 years (2018-2022). Major trauma was defined as an injury severity score (ISS) of >15. We determined simultaneous or overlapping presentations of major trauma (SOMT) in two or more patients with ISS of >15 who presented within a 4-h time window. When only two patients were included within a single time window, they were classified as SOMT-2, whereas when three or more patient clusters were identified in a single time window, they were classified as SOMT-3. The outcome measurement included process and clinical variables, such as trauma team activation (TTA) ratio, ED length of stay (LOS), time to blood product transfusion (TF), time to emergency surgery or intervention (ESI), ICU LOS, and mortality.

RESULT

A total of 2,815 patients were included, of which 39.6% (N = 1,116) classified as SOMT. The SOMT group had lower TTA ratio than the non-SOMT group (69.4% vs. 73.4%, P = 0.022). The TTA ratio exhibited a decreasing trend in non-SOMT, SOMT-2, and SOMT-3 groups (P = 0.006). The time to TF was significantly delayed in the SOMT group (129 vs. 91 min, P < 0.001).

CONCLUSION

SOMT regularly occurs and results in fewer trauma team activation and a delayed time to blood transfusion. The current intensive trauma care system should be strategically modified to improve critical trauma care and enhance disaster preparedness.

Perceived trauma nursing core competency, interprofessional collaborative competency, and associated barriers among regional trauma center nurses

INTRODUCTION

As key members of interprofessional teams working in complex settings, nurses in trauma centers require trauma nursing core competency.

PURPOSE

This study sought to determine the levels and relationships of the perceived importance and performance of trauma nursing core competency, as well as the interprofessional collaborative competency and associated barriers among Korean regional trauma center nurses.

METHODS

This cross-sectional, descriptive, and correlational survey involved a convenience sample of 190 Korean trauma center nurses. Data were collected using a web-based self-reporting questionnaire about the perceived importance and performance of trauma nursing core competency, as well as the interprofessional collaborative competency and associated barriers. Data were analyzed using descriptive statistics, Pearson's correlation, and multiple regression (Enter method) analyses.

RESULTS

The perceived performance and importance of interprofessional collaborative competency, the perceived importance of trauma nursing core competency, and the perceived barriers to resources, training, competency, and interest significantly affected trauma nursing core competency performance, accounting for 64.5 % of the variance.

CONCLUSIONS

Training programs are needed to improve the core and interprofessional collaborative competencies of trauma nurses. Individual, team, and organizational approaches are essential to addressing the perceived barriers. The effects of training programs on the core competency of trauma nurses should be validated.

Observations and experiences of pediatric surgeons working on the field in the first 7 days of the Kahramanmaraş earthquake

Purpose

This study aims to share our experiences and problems, and to suggest solutions as pediatric surgeons who took part in the teams that went voluntarily to the region hit by the Kahramanmaraş earthquake during the first 7 days after the disaster.

Methods

This study conveys our observations made at Kahramanmaraş Sütçüimam University Faculty of Medicine Hospital, where we worked as a volunteer team between February 7 and 14, 2023.

Results

During the first few days, there were registration problems due to lack of electricity, water, and internet, as well as issues with sterile surgical environments. In the following days, a lack of auxiliary health personnel was revealed as the main difficulty.

Conclusion

Since coordination is important when working as a team in the aftermath of an earthquake, staff from the same center should be deployed together if possible, and a team leader should be selected. Alternative recording systems should be established in case of power outages and computer problems. Secretaries, auxiliary health staff, and technicians should be included in the team in addition to doctors and nurses.