Journal of Trauma and Injury

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

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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.; Summary

Case Reports

The voice of injury: a case report of isolated trauma to the larynx: Najeebuddin Mohammed, Ashima Sharma, Alekhya Machani, Sujata Patnaik; J Trauma Inj. 2026;39(1):85-89. Published online March 31, 2026; DOI: https://doi.org/10.20408/jti.2025.0065

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Although uncommon, laryngotracheal injuries carry a significant risk of mortality. This rare case of isolated laryngeal injury underscores the importance of recognizing the various potential presentations of such injuries and highlights the evidence-based management strategies that every emergency physician should consider when treating potential airway trauma. A 45-year-old male motorcyclist was involved in a road traffic accident during the night and presented to the emergency department the following morning. The patient complained of breathlessness, neck pain, hoarseness of voice, and noisy breathing. Examination revealed stridor, swelling in zones 1 and 2 of the neck, tenderness over the thyroid, and subcutaneous emphysema over the neck and anterior chest. A definitive airway was secured, and computed tomography imaging revealed a fracture of the thyroid cartilage. The patient was managed conservatively, extubated after 1 week, and discharged after 2 days of observation. Classification of the type of injury and the use of an algorithmic approach, involving consensus among the emergency department, trauma surgeons, and the critical care team, can help streamline and standardize management of these cases. Furthermore, a thorough understanding of the dos and don’ts in securing the airway in patients with laryngotracheal injuries increases the robustness of the approach to managing this patient population.

Summary

Citations

Citations to this article as recorded by

CHARACTERISTICS OF NON-LETAL INJURIES OF THE HYOID-LARYNGEAL COMPLEX BASED ON THE MATERIALS OF THE KHARKIV REGIONAL BUREAU OF FORENSIC-MEDICAL EXAMINATION
M. V. Gubin, O. I. Malykhina, E. O. Voitov, I. Yu. Serbinenko, L. V. Pershina
Bulletin of Problems Biology and Medicine.2026; 1(1): 486. CrossRef

Facial trauma and reconstructive surgery: insights from a case series of severe maxillofacial injuries: Harendra Kumar, Abdul Hakeem, Abdul Vakil Khan, Rachith Sridhar, Deepak Kumar, Majid Anwer; J Trauma Inj. 2026;39(1):94-103. Published online February 4, 2026; DOI: https://doi.org/10.20408/jti.2025.0080

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Abstract PDF: Facial trauma is a complex and important contributor to trauma-related morbidity, often requiring multidisciplinary management due to intricate anatomy and the dual need for functional and aesthetic restoration. This case series describes a spectrum of maxillofacial injuries treated by trauma surgeons, including soft tissue degloving, zygomaticomaxillary complex fractures, mandibular fractures, and airway compromise. All patients were managed in accordance with Advanced Trauma Life Support (ATLS) principles. Surgical interventions included layered wound closure, open reduction and internal fixation, and airway management through endotracheal intubation, cricothyroidotomy, or tracheostomy. The series underscores the critical decision-making required in airway management, the surgical expertise necessary for fracture stabilization, and the importance of early reconstruction in optimizing outcomes. It further emphasizes the role of trauma surgeons in delivering comprehensive care and highlights the value of preventive strategies such as helmet use and road safety enforcement. These cases contribute to the growing evidence that timely, coordinated surgical intervention supports optimal recovery in patients with facial trauma.; Summary

Life-threatening nasotracheal tube obstruction by a blood clot: a case report: Dajeong Lee, Chan Yong Park, Sang Wha Kim; J Trauma Inj. 2024;37(3):220-223. Published online September 3, 2024; DOI: https://doi.org/10.20408/jti.2023.0084

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Abstract PDF: The nasotracheal tube (NTT) is frequently used in oral and maxillofacial surgery and is generally considered a safe means of protecting the airway while ensuring an adequate surgical field. The most common complication associated with NTT is epistaxis, and only a few cases of foreign body obstruction have been reported. In this case report, the authors aimed to highlight the potential for NTT obstruction following surgery. A 24-year-old female patient, who underwent mandibuloplasty and rhinoplasty at a local clinic, was referred to our hospital patient due to dyspnea and edema on her right mandibular angle. Even with NTT, patient continued to experience mild dyspnea and tachypnea, so a T-piece was applied. However, tachycardia accompanied by a sudden worsening of dyspnea was observed, and bag-valve-mask ventilation was initiated promptly. But oxygen saturation remained unimproved, so an emergency cricothyroidotomy was performed. After 4 hours, the patient’s condition stabilized. Upon examination, the previously inserted NTT was identified, and a blood clot approximately 10 cm long at the NTT tip was discovered, causing lumen obstruction. The obstructions of NTT can lead to serious or life-threatening consequences if left unobserved or ignored. Therefore, when a patient with an NTT complains of dyspnea, clinicians should promptly investigate the possibility of partial NTT obstruction to ensure the airway’s security.; Summary

Submental intubation using laparoscopic trocar in zygomaticomaxillary complex fracture surgery in Korea: a case report: Hyejin Do, Chunui Lee, Hyeon Don Hong, Hyejin Hong, Hyun Kyo Lim, Sujin Kim; J Trauma Inj. 2023;36(2):128-132. Published online December 21, 2022; DOI: https://doi.org/10.20408/jti.2022.0036

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Abstract PDF

Submental intubation is an effective alternative technique for airway management in patients with maxillofacial trauma. Compared with tracheostomy, it is less invasive, but has risks associated with potential airway compromise such as hypoxia due to tube obstruction, collapse, and kinking. To shorten procedure time and ensure a reinforced tube lumen, we used a laparoscopic trocar as a new device for submental intubation. A 54-year-old male patient sustained a zygomaticomaxillary complex fracture and was scheduled to undergo open reduction and internal fixation. We performed intraoral intubation and made a small 1-cm incision at the submandibular midline. After dissection of the tissue from the incision site, a reinforced tube was passed using a 12-mm laparoscopic trocar. The procedure took about 5 minutes, and apnea time from disconnecting the breathing circuit and passing through the internal lumen of the trocar until it was reconnected to the ventilator was 1 minute 5 seconds. Using a laparoscopic trocar for submental intubation can reduce the time required for dissection, prevent luminal occlusion complications due to soft tissues or blood clots in the endotracheal tube, and decrease soft tissue damage.

Summary

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A Novel Tube Tie Technique for Submental Intubation Using Non-Absorbable Suture Guidance
Akshay Toshniwal, Shallu Bansal
Journal of Maxillofacial and Oral Surgery.2026;[Epub] CrossRef
Revisiting submental intubation with modification, for complex maxillomandibular surgical repair: A case report
Sashini Kaushalya Godage, Samuel Peter Ang, Elie Ramly, Indranil Sinha, Kheng-Sze Chan
JCA Advances.2025; 2(2): 100114. CrossRef

A case report of complete cricotracheal separation: an experience from the east coast of Malaysia: Atikah Rozhan, Adam Mohamad, Khairul Azhar M. Rajet, Mohd Zaki Ahmad, Suhaimi Bin Yusof, Wan Emelda Wan Mohamed, Bathma Devi Susibalan, Nik Mohd Syukra Nik Abd Ghani, Zamzil Amin Bin Asha’ari; J Trauma Inj. 2022;35(4):282-286. Published online May 26, 2022; DOI: https://doi.org/10.20408/jti.2021.0071

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1 Citations

Abstract PDF

Complete cricotracheal separation, which is the most severe type of laryngeal trauma, is an uncommonly seen injury that clinicians have limited experience in managing. However, it is potentially fatal. Due to limited exposure to this condition, mismanagement can occur, which may further aggravate the patient’s condition. The most crucial part of managing this injury is to establish a secure airway. Tracheostomy under local anesthesia is the preferred method of airway stabilization, in order to avoid further injuries to the airway caused by endotracheal intubation. Here, we discuss the management of complete cricotracheal separation based on a case experienced in the east coast region of Malaysia, where this type of injury is rarely encountered.

Summary

Citations

Citations to this article as recorded by

Management of Complete Cricotracheal Separation: A Case Report From a Level 1 Trauma Center
Madhur Uniyal, Santhosh Balachandra, Ruby Kataria
Cureus.2025;[Epub] CrossRef

Severe Airway Obstruction due to Massive Retropharyngeal Hematoma in a Warfarin-Taking Patient with a Normal International Normalized Ratio: Hyun Young Cho, Hyung Il Kim; J Trauma Inj. 2021;34(1):57-60. Published online January 14, 2021; DOI: https://doi.org/10.20408/jti.2020.0028

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Abstract PDF: Warfarin is used as part of the treatment of various diseases, and laboratory monitoring of its effects is required. Airway hematoma secondary to warfarin is rare, but can be fatal because of potential airway obstruction. Rapid definitive airway establishment is crucial if airway obstruction is suspected. This complication is more likely to occur in those with elevated coagulation laboratory values. However, we experienced a patient in whom a massive retropharyngeal hematoma caused airway obstruction after a non-severe motor vehicle collision. The patient had been taking warfarin, and had coagulation parameter values within the normal ranges. A major fracture or hemorrhage was not anticipated. Upon examination, a massive retropharyngeal hematoma was noted. Orotracheal intubation failed due to an airway obstruction. Emergency tracheostomy and an operation for hematoma removal were performed. Physicians must always consider the possibility of airway hematoma in warfarin-taking patients with normal coagulation values regardless of the severity of mechanism of injury; Summary

Special Article

Part 3. Clinical Practice Guideline for Airway Management and Emergency Thoracotomy for Trauma Patients from the Korean Society of Traumatology: Chan Yong Park, O Hyun Kim, Sung Wook Chang, Kang Kook Choi, Kyung Hak Lee, Seong Yup Kim, Maru Kim, Gil Jae Lee; J Trauma Inj. 2020;33(3):195-203. Published online September 30, 2020; DOI: https://doi.org/10.20408/jti.2020.0050

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Abstract PDF

The following key questions and recommendations are presented herein: when is airway intubation initiated in severe trauma? Airway intubation must be initiated in severe trauma patients with a GCS of 8 or lower (1B). Should rapid sequence intubation (RSI) be performed in trauma patients? RSI should be performed in trauma patients to secure the airway unless it is determined that securing the airway will be problematic (1B). What should be used as an induction drug for airway intubation? Ketamine or etomidate can be used as a sedative induction drug when RSI is being performed in a trauma patient (2B). If cervical spine damage is suspected, how is cervical protection achieved during airway intubation? When intubating a patient with a cervical spine injury, the extraction collar can be temporarily removed while the neck is fixed and protected manually (1C). What alternative method should be used if securing the airway fails more than three times? If three or more attempts to intubate the airway fail, other methods should be considered to secure the airway (1B). Should trauma patients maintain normal ventilation after intubation? It is recommended that trauma patients who have undergone airway intubation maintain normal ventilation rather than hyperventilation or hypoventilation (1C). When should resuscitative thoracotomy be considered for trauma patients? Resuscitative thoracotomy is recommended for trauma patients with penetrating injuries undergoing cardiac arrest or shock in the emergency room (1B).

Summary

Citations

Citations to this article as recorded by

Glasgow coma scale score before prehospital tracheal intubation in trauma vs. nontrauma patients
Urs Pietsch, Benedick Satari, Julian Klug, Pedro David Wendel-Garcia, Martin Müller, Lea Weber, Roland Albrecht, Robert Greif, Alexander Fuchs
European Journal of Anaesthesiology.2026; 43(3): 245. CrossRef

Original Article

Clinical Aanalysis of Airway Trauma: Hyun Min Cho, Young Jin Kim, Han Young Ryu, Jung Joo Hwang; J Korean Soc Traumatol. 2011;24(1):7-11.

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Abstract PDF: PURPOSE
Traumatic airway injuries have high rates of mortality and morbidity. Thus, we evaluated the clinical results of trauma-related airway-injury patients.
METHODS
A clinical analysis was performed for patients with airway trauma who were admitted and treated at the Department of Thoracic and Cardiovascular Surgery, Konyang University Hospital from Dec. 2002 to Dec. 2009.
RESULTS
Sixteen patients were admitted and treated. Fourteen patients were male, and the ages of the patients ranged from 16 to 75 years. Six cases were penetrating injuries, 4 were traffic-accident injuries. 3 were fall injuries, and. 3 were other blunt trauma injuries. Anato- mic injuries included 14 trachea cases (87.5%), 1 Rt. main bronchus (6.25%), and 1 Lt. main bronchus cases (6.25%). Diagnosis was made by using computed tomography and bronchoscopy. Five patients were treated with an explothoracotomy, and 7 underwent neck exploration with primary repair. Three patients simply needed conservative management, and 1 patient was treated with a closed thoracostomy. The post-operative mortality rate was 6.25 % (1 patient).
CONCLUSION
Airway trauma is dangerous and should be treated as an emergency, so a high index of suspicion is essential for rapid diagnosis and successful surgical intervention in patients with airway injuries.; Summary

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