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Original Article
- Impact of the emergency medical services crew size (2 vs. ≥3 personnel) on prehospital performance and survival in severe trauma: a nationwide cohort study in Korea
- Seung Hyo Lee, Won Pyo Hong, Kyoungwon Jung, Hangjoo Cho, Mi Yeon Lee, Hwan Seon Moon
- J Trauma Inj. 2026;39(3):224-233. Published online September 30, 2026
- DOI: https://doi.org/10.20408/jti.2025.0230
- 402 View
- 12 Download
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Abstract
PDF - Purpose
Timely and coordinated prehospital interventions are critical to improving outcomes in patients with severe trauma. In Korea, national discussions are underway to expand emergency medical services (EMS) crews from the standard two-person configuration to three, yet nationwide evidence supporting this policy remains limited. This study aimed to evaluate whether EMS crew size (2 vs. ≥3 personnel) is associated with differences in prehospital care performance and survival outcomes among patients with severe trauma, accounting for potential confounding factors, including the COVID-19 period.
Methods
We conducted a retrospective cohort analysis of EMS dispatches linked with trauma registry data in Korea from January 2018 to December 2023. Adults (≥18 years) with field-classified severe trauma were included. The main exposure was EMS crew size. Primary outcomes were scene time ≤10 minutes, advanced airway management among unresponsive patients, and intravenous (IV) access in hypotensive patients (systolic blood pressure ≤90 mmHg). The secondary outcome was survival to hospital discharge. Multivariable logistic regression analyses were performed, and results adjusted for potential confounders are reported.
Results
Among 78,203 severe trauma patients, 47,594 (60.9%) were treated by ≥3-person crews. After adjustment, larger crews were significantly associated with improved IV access (adjusted odds ratio [aOR], 1.47; 95% confidence interval [CI], 1.31–1.66) and higher odds of achieving on-scene time ≤10 minutes (aOR, 1.09; 95% CI, 1.05–1.13). Advanced airway management also demonstrated borderline statistical significance (aOR, 1.13; 95% CI, 1.00–1.28). Overall survival to hospital discharge was 89.0%. Although survival was slightly higher in the two-person group (89.7% vs. 88.5%, P<0.01), the difference was not significant after adjustment (aOR, 1.00; 95% CI, 0.94–1.05).
Conclusions
EMS crews of ≥3 members demonstrated improved procedural performance in severe trauma, but no significant survival advantage. System-level investments and further outcome-based research are warranted to optimize crew configurations and resource allocation. -
SummaryCase ReportTOP
- Preperitoneal pelvic packing as a salvage operation for postoperative retroperitoneal bleeding with hemodynamic instability after the Kocher-Langenbeck approach to the acetabulum: a case report
- Doo-Hun Kim, Maru Kim, Dae-Sang Lee, Tae Hwa Hong, Hangjoo Cho
- J Trauma Inj. 2025;38(3):285-289. Published online June 25, 2025
- DOI: https://doi.org/10.20408/jti.2024.0087
- 4,275 View
- 59 Download
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Abstract
PDF
- Pelvic fractures result from high-energy trauma, and when accompanied by hemorrhagic shock, the mortality rate increases to 40%. Pelvic fractures are anatomically categorized as pelvic ring disruptions and acetabular fractures, each requiring different treatment methods and approaches. Acetabular fractures, which also result from high-energy injuries, may be accompanied by hemorrhagic shock. Treatment options for pelvic fractures with hemorrhagic shock include angioembolization, preperitoneal pelvic packing (PPP), and emergency laparotomy. In hemodynamically stable patients, early total care may be attempted, and for acetabular fractures (posterior column), the Kocher-Langenbeck approach is the treatment of choice. This case report describes the use of PPP as a salvage operation for postoperative retroperitoneal bleeding with hemodynamic instability following a Kocher-Langenbeck approach for an acetabular fracture with pelvic ring injury. The patient was discharged without postoperative complications such as bone displacement or surgical site infection. While PPP is commonly employed as an initial treatment modality for pelvic fractures with hemorrhagic shock, it may also be valuable in managing postoperative retroperitoneal bleeding with hemorrhagic shock.
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SummaryOriginal Articles
- Vulnerability of the border area: analysis of the Traffic Accident Analysis System in Korea
- Doo-Hun Kim, Hangjoo Cho, Sung Yub Jeong, Maru Kim
- J Trauma Inj. 2025;38(2):91-96. Published online June 19, 2025
- DOI: https://doi.org/10.20408/jti.2024.0100
- 3,368 View
- 58 Download
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Abstract
PDF
- Purpose
This study assessed patient vulnerability following traffic accidents (TAs) in Korea’s border area (BA).
Methods
The BA includes cities and counties directly adjacent to the demilitarized zone with North Korea. The rear area (RA) is defined as the area immediately adjacent to the BA. TA data from 2017 to 2021 were obtained from the Traffic Accident Analysis System in Korea. Information on road length, population, number of TAs, injured patients, and fatalities was collected. The number of TAs and fatalities per 1 km of road length and per 100,000 people was calculated. Severity (number of fatalities per 100 TA cases) and lethality (number of fatalities divided by the sum of fatalities and injured patients) were used to assess the vulnerability of each area.
Results
A total of 55,463 TAs were analyzed. Although the RA exhibited higher numbers of TAs and deceased patients per 1 km of road length and per 100,000 people, the BA showed significantly higher fatalities per 100,000 people as well as increased severity and lethality.
Conclusions
The BA is more likely to be associated with death following TAs, despite a lower overall TA incidence compared to the RA. Further analysis is needed to address and mitigate this vulnerability. -
Summary
- Characteristics and Outcomes of Patients with Bicycle-Related Injuries at a Regional Trauma Center in Korea
- Yoonhyun Lee, Min Ho Lee, Dae Sang Lee, Maru Kim, Dae Hyun Jo, Hyosun Park, Hangjoo Cho
- J Trauma Inj. 2021;34(3):147-154. Published online June 4, 2021
- DOI: https://doi.org/10.20408/jti.2020.0066
- 7,853 View
- 144 Download
- 1 Citations
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Abstract
PDF
Purpose We analyzed the characteristics and outcomes of patients with bicycle-related injuries at a regional trauma center in northern Gyeonggi Province as a first step toward the development of improved prevention measures and treatments.
Methods The records of 239 patients who were injured in different types of bicycle-related accidents and transported to a single regional trauma center between January 2017 and December 2018 were examined. This retrospective single-center study used data from the Korea Trauma Database.
Results In total, 239 patients experienced bicycle-related accidents, most of whom were males (204, 85.4%), and 46.9% of the accidents were on roads for automobiles. Forty patients (16.7%) had an Injury Severity Score (ISS) of 16 or more. There were 125 patients (52.3%) with head/neck/face injuries, 97 patients (40.6%) with injuries to the extremities, 59 patients (24.7%) with chest injuries, and 21 patients (8.8%) with abdominal injuries. Patients who had head/neck/face injuries and an Abbreviated Injury Score (AIS) ≥3 were more likely to experience severe trauma (ISS ≥16). In addition, only 13 of 125 patients (10.4%) with head/neck/face injuries were wearing helmets, and patients with injuries in this region who were not wearing helmets had a 3.9-fold increased odds ratio of severe injury (AIS ≥2).
Conclusions We suggest that comprehensive accident prevention measures, including safety training and expansion of safety facilities, should be implemented at the governmental level, and that helmet wearing should be more strictly enforced to prevent injuries to the head, neck, and face.
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Summary
Citations
Citations to this article as recorded by
- Characteristics of Bicycle-Related Maxillofacial Injuries Between 2019–2023—Retrospective Study from Poznan, Poland
Kacper Nijakowski, Szymon Rzepczyk, Maria Szczepaniak, Jakub Majewski, Jakub Jankowski, Czesław Żaba, Maciej Okła
Journal of Clinical Medicine.2025; 14(17): 6075. CrossRef
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