When a man in his 70s died after being seriously injured and transported for more than two hours to a hospital about 100 kilometres away last month, three hospitals closer to him, including a trauma centre 35 kilometres away (a 25-minute ambulance ride), had no surgeons and intensive care beds available. It has been pointed out that the golden time to save the patient was lost due to the inadequate number of essential medical personnel and the lack of a system to connect infrastructure to emergency patients in real time.
According to a report by the Donga Ilbo on the 31st, the 119 ambulance rescued Mr Koo Mo, 74, who was involved in an accident in Yongin, Gyeonggi Province, at 0:38 the previous day. At the time, two trauma surgeons were on duty at the Armed Forces Trauma Centre at the Armed Forces Capital Hospital, 35 kilometres away, and four beds in the “civilian” intensive care unit were empty. At the same time, Kookmin University Guro Hospital and the Korea National University Medical Center, both designated by Seoul as “final treatment centres for severe trauma,” had medical staff and beds to operate on severe trauma patients. These hospitals are about 60 kilometres away from the crash site.
However, the caller did not call the Armed Forces Trauma Centre or the Seoul Severe Trauma Final Treatment Centre while asking 12 nearby hospitals if they could accept Koo. “These centres were often unable to accept patients on a normal day,” a fire authority official claimed.
The ruling party has come up with measures to prevent a repeat of the “drifting” of emergency patients without proper treatment. The ministries of People’s Power and Health and Welfare held a meeting at the National Assembly on the afternoon of the 31st and decided to implement measures such as establishing a “one-stop emergency transport system” to identify surgeons and empty beds from the transport stage, and mandating the acceptance of patients through local emergency medical situation rooms.
5 trauma centres with beds, missing inquiries… 119-hospital communication system needs to be improved
Paramedics rescue a patient in his 70s in Yongin
Calling a nearby hospital with no trauma centre
2 empty beds in Seoul even when transferred to Uijeongbu
Golden time missed… Improve the transport system
The death of Mr Koo Mo (74), who was hit by a passenger car on the 30th of last month and ‘drifted’ for 138 minutes in search of a surgeon, is fundamentally due to the lack of medical staff guarding operating theatres and intensive care units. Even a small number of medical staff can save lives if they are immediately connected to emergency patients, but even this system was not functioning properly at the scene. In Koo’s case, five trauma centres with available beds and vacant ICU beds were unable to reach him in time.
Failure to contact available trauma centres
When paramedics arrived at the scene of the accident at 0:38 on the day of the accident, the nearest regional trauma centre, Ajou University Hospital in Suwon, Gyeonggi Province, had no vacant beds in the ICU. Patients with multiple organ damage and low blood pressure, such as Koo, are admitted to the ICU after opening their chest or stomach to stop the immediate bleeding and leaving the incision unclosed. Then, when the condition is stabilised, a second or third operation is performed. There were no beds in the intensive care unit, which is why they couldn’t start with surgery.
At the time, there were four other trauma centres within an hour’s ambulance ride of the accident site, in addition to Ajou University Hospital. They were Dankook University Hospital, Wonju Severance Christian Hospital, Gacheon University Gil Hospital, and Uijeongbu St. Mary’s Hospital. According to the standard guidelines for field first aid for 119 paramedics, severe trauma patients should be transferred to the nearest regional trauma centre or trauma specialist training centre.
At the same time, the “bed status board” shared between the 119 dispatch room and field paramedics through the Central Emergency Medical Center indicated that there were intensive care beds available at Wonju Severance Christian Hospital and Uijeongbu St. Mary’s Hospital Regional Trauma Center. Nevertheless, 119 made additional calls to nearby hospitals that did not have trauma centres. Including the Armed Forces Trauma Centre and the Seoul Severe Trauma Final Treatment Centre, five trauma centres were missed immediately after the rescue.
It wasn’t until 1:43 a.m., about an hour after rescuing Koo안전놀이터, that the ambulance service received an “acceptable” response from Wonju Severance Christian Hospital, and three minutes later from Uijeongbu St. Mary’s Hospital. The 119 ambulance team left for Uijeongbu St Mary’s Hospital, but Mr Koo went into cardiac arrest on the way. It’s unfortunate that she was connected to a regional trauma centre instead of a regular emergency room.
“The transport system needs to be overhauled”
However, it is difficult to place the blame for the delay solely on the fire authorities, given the situation of the 119 paramedics and the Gyeonggi-do Fire and Disaster Headquarters 119 Situation Room, which were responsible for finding a hospital to accept Mr Koo at the time. The 119 ambulance that transported Mr Koo had only two paramedics, including the driver. They had to drive and call hospitals while providing first aid to Mr Gu, whose blood pressure and oxygen saturation were rapidly dropping. Each call to the hospital took up golden time as they verbally described Mr Gu’s condition and waited for a response to see if he could be treated.
“Mr. Koo’s condition was getting worse by the minute, so we had to find a nearby hospital that could provide first aid,” said a fire department official, explaining why they didn’t contact another regional trauma centre or a relatively nearby military trauma centre on the day of the accident. As for not contacting the final treatment centre for severe trauma in Seoul, about 60 kilometres away, he said, “I skipped it because they often don’t accept patients.”
Ultimately, without a system in place to communicate in real time between the emergency services, the situation room, emergency room staff, and surgeons, tragic sacrifices like Koo’s are bound to happen again and again. “Even if we say that increasing the number of essential medical personnel is a time-consuming task, the system that connects patients with insufficient medical personnel is something that can be solved immediately,” said an emergency medicine specialist.