Theoretical Study on the Procedure for Handling Traffic Accident Patients using the Korean-Style Pre-Hospital Emergency Patient Classification Tool

Abstract

According to the Korea Road Traffic Authority, an average of 543.3 traffic accidents occurred per day in 2023, resulting in seven double fatalities and 777.5 injuries. When a traffic accident occurs, fire officials are dispatched to carry out a series of processes, including on-site safety measures and patient transport. These processes are not separate but form a cohesive system. If even one element of this system is compromised, ensuring the patient's survival becomes difficult. Fire officials perform safety management tasks upon arrival at the scene, following the Disaster Scene Standard Operation Procedure (SOP) and On-Site Safety Management Standard Guideline (SSG). First aid at the scene is administered based on patient classification using the Korean Pre-Hospital Emergency Patient Classification Tool (Pre-KTAS), implemented by the Fire and Disaster Management Agency in 2024.This study theoretically examines the procedure for handling traffic accident patients using the Korean Pre-Hospital Emergency Patient Classification Tool, referring to various documents and materials from the Fire and Disaster Management Agency. We hope that the findings will be applied to actual traffic accident scenes by firefighters and contribute significantly to saving lives. Furthermore, future studies should integrate the SOP, SSG, and Pre-KTAS into specific traffic accident cases to enhance practical applicability

1. Introduction

According to the National Fire Agency statistics, 168,846 patients were transported due to traffic accidents in 2023, including 44,210 drivers and 29,594 passengers. This accounts for 8.4% of all patients transported by paramedics, with traffic accident cases increasing annually.[1]

A traffic accident refers to a collision or non-contact incident involving a vehicle and a pedestrian or between vehicles due to driver inexperience, negligence, or adverse road and environmental conditions, resulting in injury, death, or damage to property.[2] According to the Korea Road Traffic Authority, an average of 543.3 traffic accidents occurred per day in 2023, leading to seven fatalities and 777.5 injuries.[3]

In the event of a traffic accident, the emergency response process follows a time-sequenced flow. First, the 119 Integrated Situation Room issues a dispatch order. Simultaneously, firefighters aboard ambulances and rescue vehicles verify patient information and locations. Upon arrival, they conduct secondary safety management for both patients and dispatched personnel. Once scene safety is ensured, patient rescue and emergency treatment proceed according to severity classification.[4]

Until 2023, the on-site severity classification method for traffic accident patients was outlined in the Disaster Scene Standard Operating Procedure 402, categorizing patients into four stages: urgent, emergency (delayed), non-emergency, and delayed[5]. In 2024, the National Fire Agency revised and expanded this system, implementing the Korean Pre-KTAS for on-site emergency treatment and classification. Pre-KTAS employs a five-stage system: resuscitation, emergency, urgent, semi-emergency, and non-emergency, aligning with the Korean emergency medical system.[6]

The implementation of this Korean-style pre-hospital emergency patient classification tool is expected to improve patient outcomes and enhance survival rates at traffic accident sites. However, academic research remains limited regarding on-site dispatch, emergency classification, and patient handling procedures integrated with the dispatch stage. To address this gap, this study aims to contribute to life-saving efforts by optimizing firefighter dispatch through the integration of traffic accident site protocols and the pre-hospital emergency patient classification tool.

2. Theoretical Basis

2.1. Traffic Accidents

Traffic accidents constitute a significant portion of firefighter dispatches. In such incidents, firefighters must rapidly assess and treat patients. To achieve this, emergency medical technicians must recognize various types of vehicle collisions, identify potential injury mechanisms, and establish a suspicion index for specific injuries. Analyzing impact types and events in vehicle collisions aids in forming this suspicion index. Vehicle collisions include frontal, rear-end, side, and rotational collisions, as well as rollovers.[7]

According to data from the Korea Road Traffic Authority Traffic Accident Analysis System, the number of traffic accidents over the past five years was 229,600 in 2019, 209,654 in 2020, 203,103 in 2021, 196,836 in 2022, and 198,296 in 2023(Table 1, Fig. 1).[3]

Table 1. Statistics of Ttraffic accident.

Fig. 1. Ttraffic accident.

2.2 On-site dispatch and on-site safety management

Rapid dispatch to the scene of a traffic accident scene is essential for the safety of firefighters and rescuers. In the initial dispatch order stage, personnel must clearly receive and understand the dispatch order from the 119 Comprehensive Situation Room, verify rescue information, confirm the dispatch route, and assess risk factors, including accident location, type, road and building conditions, the number and condition of rescue targets, accident severity, and potential obstacles to rescue efforts.

In the second rescue dispatch stage, responders must obtain additional information, wear personal safety equipment (with adjustments as directed by the commander), and establish an on-site response plan. They must also select appropriate equipment and review safety (life safety) measures based on the type of traffic accident. This stage requires close coordination with relevant organizations to ensure an efficient response.

In the third on-site response stage, first responders should position the vehicle at a distance proportional to the speed limit (e.g., speed limit 80 km/h → 80 m) to prevent secondary accidents.[8] For accidents on roadways, fire department vehicles should be parked at a 45° angle to the driving direction to prevent secondary accidents, and especially at intersections, extra caution is required when positioning vehicles to ensure firefighter safety.[9]

Finally, safety personnel should be stationed at the rear of fire trucks or ambulances to secure the area, gather information, and establish the rescue perimeter, including the accident site, activity area, and boundary zone. First responders must also relay rescue scene details and risk factors to second responders and request additional support from relevant organizations if necessary. It is important to recognize that the dispatch order stage, rescue dispatch stage, and on-site response stage are interconnected components of a unified traffic accident response procedure.

2.3 Mechanism of injury in traffic accident patients[10]

The mechanism of injury in traffic accident patients can be categorized into body collision, organ collision, secondary collision, and additional collision. Body collision occurs when a vehicle collides with an object or when an object collides with a vehicle. The vehicle's kinetic energy converts into mechanical and thermal energy, causing damage upon impact. Mechanical energy refers to an object's energy due to motion or position, while thermal energy results from atomic or molecular movement within a substance. The force generated in a collision depends on initial speed (kinetic energy) and braking distance (deceleration source).

Body collision also occurs when a passenger collides with the vehicle's interior. While the vehicle and its interior decelerate rapidly upon impact, unrestrained passengers continue moving at the vehicle's original speed until they strike the interior, converting their kinetic energy into tissue deformation. If the vehicle caves in, passengers experience greater impact forces.

Organ collision happens when an occupant comes into contact with the vehicle's interior (control devices) and slows or stops. As the occupant stops, internal tissues collide, causing compression, stretching, and shear damage. Organs may twist or decelerate abruptly, leading to damage at attachment points or blood vessels, resulting in blunt trauma.

Secondary collisions occur when an occupant is struck by a moving object inside the vehicle. During a crash, objects such as seats, luggage, or unrestrained occupants continue moving at the vehicle's original speed and may collide with an already stationary occupant. Injury suspicion indices must account for the potential severity of a secondary impact and the impact on the occupant.

Additional collisions happen when a vehicle, after an initial impact, rebounds and strikes another stationary vehicle. These secondary impacts can exacerbate existing injuries or cause new ones. For example, a femur fracture requires significant force to break the bone initially. However, once fractured, less force is needed to displace bone fragments, potentially damaging nerves and blood vessels. Assessing the impact of additional collisions is crucial in evaluating overall patient condition. (Table 2) shows a gradual decline in injuries and fatalities due to traffic accidents over the past five years, based on data from the Korea Road Traffic Authority Traffic Accident Analysis System. To further reduce emergency cases from traffic accidents, continued on-site emergency treatment and safety measures are essential.[3]

Table 2. Statistics of Dead & Injury.

3. Application of the Korean-style pre-hospital emergency patient classification tool

3.1 Korean-style pre-hospital emergency patient classification tool

Until 2023, the classification criteria for emergency patients for firefighters on-site were divided into four stages: emergency, urgent, non-emergency, and delayed.[11] Emergency, indicated in red, refers to patients requiring immediate on-site treatment and transport to prevent life-threatening conditions or limb amputation. Examples include progressive shock, multiple severe trauma, major hemorrhage of the trunk, and tension pneumothorax. Emergency is indicated in yellow, refers to situations where immediate transport is not necessary, but hospital transport is required, such as fractures and lacerations that do not stop bleeding. Non-emergency is indicated in green, refers to conditions that require medical treatment but do not necessitate rapid transport by ambulance, such as simple lacerations, abrasions, and sprains. Delayed, indicated in black, refers to patients who have already died or show clear signs of death and fatal injuries with no possibility of recovery.[12]

The National Fire Agency will revise and supplement the current four-stage severity classification tool. Starting in 2024, all frontline dispatch agencies nationwide will use the Korean Pre-KTAS to evaluate the level of emergency for patients during patient discovery and transfer, and to determine the urgency of treatment. The development of Pre-KTAS began in 2017 through a joint study by the Ministry of Health and Welfare, the National Fire Agency, and the Korean Society of Emergency Medicine.[13] The different classifications of Pre-KTAS for pre-hospital traffic accident patients are as follows. First, in the first impression evaluation, the paramedic can immediately classify Stage 1 upon contact with the patient. In the second-stage main symptom evaluation, the patient's main symptoms are classified, allowing patients to be categorized into predefined stages. In the third-stage physiological indicator evaluation, the emergency patient classification is calculated in conjunction with physiological indicators, level of consciousness, oxygen saturation, etc., recorded in the emergency activity log and automatically calculated in the input system. The fourth-stage other indicator evaluation refers to the classification calculated by reflecting pain scores, blood sugar, etc.[14]

3.2 Patient Classification and Evaluation

The traffic accident patient classification process quickly assesses and determines the patient's emergency level. In the Korean Pre-KTAS, the pre-hospital patient classification for adults is divided into five stages: Pre-KTAS Stage 1 (resuscitation, blue), Pre-KTAS Stage 2 (urgent, red), Pre-KTAS Stage 3 (emergency, yellow), Pre-KTAS Stage 4 (quasi-emergency, green), and Pre-KTAS Stage 5 (non-emergency, gray).(Fig. 2)[15]

Fig. 2. Pre-KTAS level.

Level 1 indicates "a situation where there is a threat of loss of life or limb and requires aggressive treatment." Patients in Level 1 are in significant distress with unstable vital signs. They are in a critical condition requiring immediate, aggressive treatment, and no further evaluation is necessary. Level 2 refers to "a situation where there is a potential threat of loss of life or limb and requires rapid treatment under the direction of a physician." Patients in Level 2 must be closely monitored, as they may deteriorate rapidly and require resuscitation. Level 3 represents "a condition that requires emergency treatment and has the potential to become serious." This may affect work or daily life or cause significant discomfort. Vital signs are typically normal or at the upper or lower limits of normal. Level 4 refers to "a condition that can be treated or re-evaluated within one to two hours, considering the patient's age, level of discomfort, and potential for deterioration." Level 5 represents "a condition that is acute but not urgent and may be part of a chronic problem that has worsened or remains stab le." These minor symptoms do not pose an immediate risk to the patient, so testing and treatment may be delayed, and their use in medicine may be limited.[16]

3.3 Hospital Selection and Patient Transfer

The decision regarding hospital transfer is based on the paramedic's judgment of whether the hospital can provide the treatment the patient is likely to need (e.g., brain surgery, cardiac examination, and procedure). The patient's Pre-KTAS information must be provided to the situation room to determine the most appropriate transfer institution.[17] The patient should be transferred to the most suitable emergency room, unless there are separate instructions. However, since the emergency room may not be able to accommodate the patient at the time, the situation of the hospital must be confirmed before transfer to ensure the patient's safety. The following guidelines should be considered when determining transfer by Pre-KTAS.[18]

Level 1 - Most appropriate receiving facility

Level 2 - Closest and most appropriate receiving facility based on communication between the paramedic, situation room, and the emergency room

Level 3, 4, 5 - Most appropriate emergency room based on communication between the situation room and the emergency room. If there are existing regional patient transfer guidelines, the transfer hospital can be selected accordingly. Low-level emergency patients should consider their preferred hospital.

According to the 2024 National Fire Agency's pre-hospital emergency patient classification and transfer system operation plan, for Pre-KTAS evaluation results: For Level 1 and Level 2, transfer is primarily recommended to regional emergency medical centers/local emergency medical centers.

For Level 3, transfer is primarily recommended to emergency medical institutions.

For Level 4, transfer is primarily recommended to emergency medical facilities.

For Level 5, transfer is recommended to general hospitals and clinics.[19]

4. Discussion and Conclusion

According to statistics from the National Fire Agency, the number of patients transported due to traffic accidents in 2023 was 168,846, including 44,210 drivers and 29,594 passengers. This represents 8.4% of all patients transported by paramedics, and the number of traffic accident patients has been increasing annually.

When a traffic accident occurs, firefighters follow a series of steps: dispatch, safety measures at the scene, rescue, and patient transport. These steps are interconnected, not individual elements. A failure in any part of this process can hinder the ability to secure the life of a person in need of rescue. This study examined the traffic accident handling procedure, which has been academically insufficient, in the order of dispatch, scene arrival, rescue, and emergency treatment. Additionally, the Korean-style pre-hospital emergency patient classification system, implemented by the National Fire Agency in 2024, was introduced in detail within this series of processes. Pre-KTAS, the Korean pre-hospital emergency patient classification system, categorizes patients into five stages: resuscitation, emergency, urgent, semi-emergency, and non-emergency. It is recognized as a classification system suitab le for the realities of Korean emergency medical care and is expected to significantly contribute to the rescue and emergency treatment of patients at traffic accident sites in the future. Looking ahead, we hope to further enhance the Korean pre-hospital emergency patient classification system and introduce a severity classification system using a QR code reader, enabling it to provide useful data at traffic accident sites for firefighters.[5]

Lastly, the study of traffic accident patient handling procedures using the Korean pre-hospital emergency patient classification tool did not present specific traffic accident cases. Future follow-up studies should integrate the ‘Disaster Site Standard Operating Procedure (SOP)’ and ‘Site Safety Management Standard Guidelines (SSG)’ with the Korean pre-hospital emergency patient classification tool, leading to more practical research.