Ten years ago, there was only one institution in Incheon dedicated to severe trauma patients nationwide. The Gachon University Gil Medical Center's regional trauma center, responsible for severe trauma cases in the Incheon area, opened its doors in 2014 as the first of its kind in the country. Now, that number has increased to 17, including Ajou University Hospital (southern Gyeonggi), Dankook University Hospital (Chungcheongnam), and Wonju Severance Christian Hospital (Gangwon).
The daily routines of medical staff at the Gachon University Gil Medical Center, Ajou University Hospital, and Dankook University Hospital's regional trauma centers visited by ChosunBiz were almost identical. They are on standby 24 hours a day, not knowing when or what kind of accidents might occur. Medical staff split their shifts into day and night, and they also have a doctor helicopter on standby for emergency dispatch.
Severe trauma patients can occur individually, but many patients often present simultaneously due to major traffic accidents. Patients can flood in at once, necessitating additional shifts during the day. It creates a brutally demanding work environment, but there are no signs of improvement. Medical staff lamented, "The reality of the regional trauma center is that it continues to operate because people are enduring it," adding, "If even one person is absent, it would have significant repercussions, and I don’t know how long we can keep enduring like this."
◇Brutal working conditions, unable to leave even after shifts
The Dankook University Hospital's regional trauma center has 12 trauma specialists who form teams of 3 to 4 to stand by 24 hours a day. This means they are attending to patients for 24 hours on eight occasions within a month. The hotline used for calls from 119 for transporting patients or notifying nurses when trauma patients' conditions worsen is effectively one and the same.
Professor Heo Yoon-jeong of Dankook University Hospital's regional trauma center said, "The sleep patterns of the medical staff at the regional trauma center are wrecked," noting, "They take naps whenever there’s a lull in incoming patients." He added, "Just saving a patient’s life doesn’t end the job; monitoring the patient's condition and progress is also extremely important."
The emergency medicine team at Ajou University Hospital's regional trauma center consists of 18 members working in teams of 3. There are also 9 specialists in orthopedics, neurosurgery, anesthesia, and pain medicine on call for surgeries. After working a full night shift, they cannot simply leave the next day.
Jeong Gyeong-won, director of Ajou University Hospital's regional trauma center, stated, "The regional trauma center does not end with just performing immediate surgery on transported patients; it is not all concluded at that point." He noted that as many as 80 patients are currently hospitalized and receiving treatment in their center.
◇Wide operational disparities based on the size of medical staff
The government has established 17 trauma centers nationwide in various regions to treat severe trauma patients who are at a crossroads of life and death within the golden time (the critical hours post-accident when a patient can be saved). Each center must keep the operating room empty and have medical staff on standby at all times.
However, many places struggle to adhere to these principles. While Ajou University Hospital and Gachon University Gil Medical Center have separate buildings and facilities for their regional trauma centers, others must share treatment and operating rooms with their emergency departments. This indicates a disparity in the facilities and working conditions among the trauma centers nationwide.
There are also significant disparities in personnel. The Gachon University Gil Medical Center's regional trauma center has 21 trauma specialists. Ajou University Hospital and Dankook University Hospital each employ 18 and 12 trauma specialists, respectively. However, excluding these hospitals, most regional trauma centers have fewer than 10 trauma specialists. Although trauma centers were established evenly across the country to meet the golden time, the shortage of personnel is making it challenging to achieve that goal.
Medical staff noted that as trauma centers are located further from the metropolitan area, the shortage of medical personnel tends to worsen. This often results in patients originating from those regions being transferred to areas where they can receive care. Hyun Seong-yeol, director of Gachon University Gil Medical Center's regional trauma center, stated, "The principle is to prioritize Incheon area patients, but if possible, we also accept patients from other regions as much as we can," adding, "If we don’t accept them, that patient essentially has nowhere else to go."
Assistant Professor Heo Yoon-jeong of Dankook University Hospital's regional trauma center remarked, "While it's correct in terms of the purpose and intent of establishing the regional trauma centers to only accept severe trauma patients from within the region, it is sadly not the reality." He elaborated, "When the paramedics from accident scenes in the region can’t find a hospital to take in the patient, they plead, and it’s hard to refuse them."
◇"Consolidation of region centers due to manpower shortages should be considered"
The medical staff at regional trauma centers expressed that: "It is practically difficult for hospitals to operate regional trauma centers without policy backing. For the regional trauma center to become a sustainable system, it is crucial for the government to continuously develop regulations and provide support."
Regional trauma centers operate with government support for personnel costs, facilities, and equipment. This year's budget for supporting the operations of 17 regional trauma centers nationwide has increased by approximately 15% compared to the previous year to a total of 66.37 billion won. However, there are still limitations.
A particular example is the support criteria for nurses coordinating collaboration between trauma surgery and other departments. Currently, except for Gachon University Gil Medical Center and Ajou University Hospital, most trauma collaboration coordinators consist of just 3 staff members. The Ministry of Health and Welfare limits the number of coordinators to three at each regional trauma center, and any additional must be borne by the hospital.
Professor Heo Yoon-jeong commented, "In a situation lacking specialized doctors, the roles of nursing staff and trauma coordinators are extremely significant, but there are limitations to increasing the necessary personnel due to the government’s personnel cost support criteria," adding, "Hospitals are struggling as well, so we can’t solely blame them."
In the field, there are voices suggesting the need to merge some regional centers due to a shortage of personnel. While the rationale for having trauma centers evenly distributed across the country is understood, it has been suggested that the option of consolidating them based on personnel availability should be considered to allocate budget and human resources efficiently.