“A male patient in his 60s suffered a pelvic fracture from a traffic accident. Blood pressure (BP) was 40 with severe bleeding, and there was an arrest (cardiac arrest). The hospital in Bucheon requested a transfer as they found it difficult to treat him.”
On the morning of the 17th at 10:30 a.m., at the regional trauma center of Gachon University Gil Medical Center in Namdong District, Incheon. Nurse manager Choi Yoon-hee informed Director Hyun Sung-yeol (a professor of trauma surgery) about the patient's condition after receiving a call from an emergency medical technician. Director Hyun immediately stated, “Reik (trauma surgery fellow) and Nurse Park are on their way with two units of blood in the doctor vehicle,” and got into his surgical gown.
The operating room nurses immediately prepared cardiopulmonary resuscitation (CPR) equipment, angiography devices, surgical instruments, and other necessary items. Professor Yoo Byeong-cheol, who was on standby, also began preparing for surgery. It was just like the scenes shown repeatedly in ‘The Trauma Code: Heroes on Call,’ which was aired last month on Netflix.
◇Patients whose lives are decided within an hour
Regional trauma centers operate 24/7 throughout the year to provide immediate surgery and treatment for critically injured patients who suffer multiple fractures, excessive bleeding, etc., due to traffic accidents, falls, blunt force trauma, and stab wounds. There are 17 designated regional trauma centers operating nationwide, including Gachon University Gil Medical Center (Incheon), Ajou University Hospital (Gyeonggi Southern), and Dankook University Hospital (Chungnam).
Regional trauma centers differ from general emergency rooms in terms of systems and operations. General emergency medical centers (emergency rooms) receive patients via ambulance or by direct visits. Patients’ conditions vary from mild to severe to moderate. Among them, patients classified as critically injured trauma patients account for only about 5%. Patients arriving at the emergency room undergo basic examinations as there is no information available about them.
In contrast, regional trauma centers specialize in critically injured trauma patients. Before the patient arrives, emergency medical technicians and other hospitals relay patient information, allowing them to prepare for the necessary treatment and surgery. They have a system in place to provide immediate treatment upon the patient's arrival, ensuring the patient receives appropriate care within the critical one-hour golden hour.
On that day, the medical team departed for Bucheon in the doctor vehicle and arrived at the scene within 20 minutes. The doctor vehicle, which resembles a regular ambulance on the outside, is actually a medical vehicle that transports a surgical specialist and a nurse instead of emergency medical technicians. It performs procedures such as intubation with a plastic tube to secure airways and blood transfusions, and even actual surgeries, thus being referred to as a 'mobile emergency room.' It departs within 5 minutes of the incident being reported and must speed more than a typical ambulance to arrive on the scene within 30 minutes. All occupants must wear helmets as a precaution.
◇Patients from various accidents undergo surgery
The doctor vehicle arrived at the trauma center with the patient at 12 p.m. The patient suffered another cardiac arrest during transport. The medical team continued treatment while holding onto the patient's lifeline. Due to significant blood loss, several blood transfusion packs were administered, and the patient was moved to the operating table while receiving CPR.
A total of 10 medical staff, including Director Hyun, Professor Yoo, Fellow Jang, and 7 nurses, were fully mobilized to conduct CPR and an emergency operation to control the bleeding for about 30 minutes. Despite the medical team's efforts, the patient sadly passed away during surgery that day. Director Hyun noted with a somber expression, “Generally, pelvic fractures are challenging cases due to excessive bleeding, and because the arrest (cardiac arrest) continued, we could do no more,” as he turned to the patient's family.
Before the operating table could be cleaned up at 1 p.m., the trauma center's phone rang again. This time it was concerning a male patient in his 60s who fell from a 1.7-meter tall ladder while welding. Director Hyun immediately summoned a neurosurgery professor to the center to await the patient.
The patient, who arrived 30 minutes later, fortunately had consciousness. A computed tomography (CT) scan revealed injuries to the cervical spine at level 2 and a concussion, leading to his transfer to the intensive care unit. Director Hyun explained, “Had we been even a little later, the risk of paralysis would have been significant. Although his life is not in immediate danger, the relevant department needs to conduct detailed examinations and treatment.”
At 8:30 p.m., after a series of trauma patients had undergone surgery, the center fell quiet again when the phone rang once more. Someone was calling to report a patient in his 30s who had inflicted multiple stab wounds on himself in several places, including his chest, knee, and thigh. On duty that day, Director Hyun and Professor Yoo put on their surgical gowns again. The patient, who arrived shortly after, had bleeding throughout his body, but the wounds were not deep. He had enough consciousness to state his personal details. Professor Yoo noted, “This patient has significant bleeding from self-inflicted wounds, but due to a history of mental illness, further treatment from the relevant department is necessary.”
◇Unlike in the drama, a doctor cannot handle a patient alone
Perhaps because the original webtoon author is a doctor, the depiction of a day in the regional trauma center is vivid. However, there are a few fantastical elements. The protagonist, genius trauma surgeon Baek Gang-hyun (played by Joo Ji-hoon), exhibits superhuman abilities by diagnosing the patient's condition solely through sight and hearing without any medical equipment. He also manages various departments on his own.
The reality is different. Teamwork is key rather than having a single hero. Medical staff at Gachon University Gil Medical Center, Dankook University Hospital, and Ajou University Hospital are clear in stating, “It is impossible to treat a trauma patient alone.” They all echo, “While listening to the circumstances of the patient's accident and observing their appearance provides a rough estimate of their condition, precise treatment requires the use of equipment such as CT scans and magnetic resonance imaging (MRI).”
In the drama, the trauma center has four team members: Professor Baek Gang-hyun, a colorectal fellow (fellow), a trauma nurse, and a resident anesthetist. However, in reality, many more medical staff are involved. Associate Professor Huh Yoon-jung of the Dankook University Hospital Regional Trauma Center stated, “Patients arrive at the regional trauma center with injuries all over their bodies, and this requires involvement from all departments.”
At the regional trauma center of Gachon University Gil Medical Center in Incheon, a total of over 100 medical staff work as a team, including 21 specialized surgeons in thoracic surgery, orthopedic surgery, neurosurgery, and emergency medicine, five coordinating doctors, 16 physician assistants in trauma surgery, and 52 intensive care unit nurses in trauma surgery. Typically, about three doctors and seven nurses are assigned to a single patient.
A significant difference is that there are no residents in the regional trauma center. Regardless of conflicts between the medical associations, there are no residents working there. Trauma specialists require an additional two years of training after a ten-year residency spanning surgical, thoracic, orthopedic, and neurosurgery.
◇First, save lives, then treat
The mortality rate for critically injured trauma patients is 54.7%, exceeding half. Therefore, the trauma center's top priority is to save lives within the golden time (which Professor Lee Guk-jong refers to as the golden hour). Director Hyun Sung-yeol stated, “Our trauma center focuses on saving lives before treating the illness.”
In this regard, even if a life is saved through surgery, it does not end there. Director Hyun remarked, “Even if we save a life through immediate surgery, proper treatment and management from the relevant departments afterward are crucial.” This highlights the importance of the collaborative treatment system. Currently, regional trauma centers across the country employ coordinating nurses to facilitate collaboration between trauma surgery and other necessary departments when trauma patients are admitted.
Watching the drama, one might think trauma patients fill the center daily. However, the reality of the regional trauma center isn’t a continuous series of dramatic situations like in the drama. Conditions vary by region, with some days seeing as many as ten patients while on others, there might be none at all. Even when patients suffer trauma from accidents, they can sometimes be transferred directly to the relevant department if their condition is not severe.
That doesn’t mean the medical staff in reality have it easier. They remain on standby, never knowing when or where a trauma patient may arise, which adds to their tension and pressure. Nurse manager Choi Yoon-hee of the Gachon University Gil Medical Center Regional Trauma Center noted, “If the trauma center is quiet, it means that no trauma patients have occurred nearby, which is fortunate,” but also stated, “Our trauma center nurses and medical staff must stay vigilant, never knowing when the phone may ring.”