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Introduction The 'golden hour' is a key concept in trauma care [1], as time plays a crucial role in saving the lives of severe trauma patients. Any delay in definitive [...], Purpose Early operative control of hemorrhage is the key to saving the lives of severe trauma patients. We investigated whether emergency room (ER) stay time [time from the ER to the operating room (OR)] is associated with trauma severity and unexpected trauma death [Trauma and Injury Severity Score (TRISS) method-based probability of survival (Ps) [greater than or equal to]0.5 but died] of injured patients needing emergency trauma surgery. Methods We performed a retrospective review of all trauma patients requiring emergency surgery and all patients with pelvic fractures requiring transcatheter arterial embolization at our hospital from January 2002 to December 2012. We analyzed the relationships among injury severity on ER admission [Injury Severity Score (ISS); Revised Trauma Score (RTS); Ps; Shock Index (SI); American Society of Anesthesiologists Physical Status (ASA-PS)]; mortality rate; unexpected trauma death rate; and ER stay time. Results ER stay times were significantly shorter for patients with life-threatening conditions [RTS Conclusions Our results suggest that all medical staff should work together effectively on high-risk patients in the ER, bringing them immediately to the OR according to their level of risk. If injured patients need emergency trauma surgery, ER stay times should be kept as short as possible to reduce unexpected trauma death. Keywords Delaying factor * Emergency surgery * Preoperative period * Trauma * Unexpected trauma death

Introduction The keys to saving the life of a severe trauma patient are definitive airway management, proper oxygenation, and stabilizing circulation by early restoration of homeostasis. In the operating room [...], Purpose Airway management of trauma patients during emergency surgeries can be very difficult and presents a challenge for anesthesiologists. Difficult airways are associated with emergency surgical airways (ESA), but little is known about ESA in the operating room. We conducted this study to clarify the present use of ESA for trauma patients in emergency surgery settings. Methods We performed a retrospective review of all trauma patients requiring emergency surgery under general anesthesia at our hospital from January 2002 to December 2012, focusing on ESA. Results During the study period, 15,654 trauma patients were treated at our hospital, of whom 554 (3.5%) required emergency surgery. Four of these patients (0.72%) received ESA as definitive airway management. Two patients with severe facial injury and distorted upper airways and 1 patient with penetrating neck trauma received open standard tracheostomy (OST). These three patients received OST as the initial approach to intubation. A fourth OST was performed after several unsuccessful attempts at endotracheal intubation. No cases were classified as 'cannot ventilate, cannot intubate' (CVCI), and there were no complications associated with ESA. All cases had good outcomes. Statistical analysis revealed that patients with severe facial trauma (Abbreviated Injury Scale >3) received ESA at a significantly higher rate than others (p = 0.015, odds ratio 14.1). Conclusion One of the most important functions of anesthesiologists is risk management. We should recognize risks that can cause CVCI situations, and make proper clinical decisions, including providing ESA, to assure patient safety. Keywords Emergency surgery * Difficult airway * Trauma * Tracheostomy