Recent advances in prehospital emergency care and initial in-hospital management for critically injured trauma patients

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Background: Trauma remains a significant public health challenge in Korea, with preventable trauma-related death rate declining from 45% in 1999 to 13.9% in 2021 following advancements such as the establishment of regional trauma centers in 2012. This preventable trauma-related death rate in South Korea remains higher than that in advanced nations, highlighting the need for further refinement of trauma care. This article reviews the recent advancements and updated guidelines for prehospital emergency care and in-hospital trauma management, emphasizing evidence-based, patient-centered approaches.Current Concepts: In the prehospital phase, early and aggressive hemorrhage control is prioritized, with techniques such as tourniquet application, wound packing, and permissive hypotension becoming standard. Innovations, such as intraosseous vascular access and tranexamic acid administration, have improved outcomes. The emphasis on structured assessments, including the circulation, airway, and breathing (CAB) assessment, reflects the importance of controlling life-threatening hemorrhages. In the in-hospital phase, bleeding control is the central focus, with protocols established to emphasize the cautious use of fluids to avoid over-resuscitation and worsening coagulopathy. Efficient transfusion strategies are prioritized to address hypovolemia while maintaining balanced ratios of blood products. Additionally, streamlined interfacility transfer systems and improved communication tools, such as the situation, background, assessment, and recommendation (SBAR) tool, help to optimize patient care and minimize delays in receiving definitive treatment.Discussion and Conclusion: This review underscores the need to adopt advanced strategies that align with international standards and further reduce preventable trauma-related deaths. Enhanced education and resource allocation for prehospital and hospital-based trauma care are crucial for achieving these goals.