[Emergency Medicine on the Brink][Exclusive] 1. Pilot program underpinning the "Emergency Room Ping-Pong Prevention Act" found to be riddled with gaps

Hospital selection continues until a hospital is found, making non-acceptances impossible to count
Pilot program "results" cited to justify amending the law
Repeat-transfer statistics not tracked since 2024

Editor's NoteAn amendment to the Emergency Medical Service Act, dubbed the "Emergency Room Ping-Pong Prevention Act," will strengthen designated hospitals' obligation to accept critically ill emergency patients. It passed a Cabinet meeting and will take effect next April. The government says it used results from a three-month pilot program as the basis for the amendment. However, the pilot program had shortcomings in its design and evaluation criteria, and it did little to address the underlying problems. As a result, concerns among emergency medical professionals have not subsided. This series examines what the amendment overlooks and what issues require deeper consideration before it takes effect.

1. Pilot program underpinning the "Emergency Room Ping-Pong Prevention Act" found to be riddled with gaps

2. Hospitals are obligated to accept patients, but there are neither willing providers nor tools to assess the situation

3. Doctors turning their backs on the front lines: "One misstep and you can be dragged through years of litigation, even through the first trial"

4. "The law should not require hospitals to accept patients unconditionally; it should create a system that enables them to do so"

Structural flaws have been found in the figures the government cites as evidence of the success of the pilot program underpinning the "Emergency Room Ping-Pong Prevention Act" (an amendment to the Emergency Medical Service Act). Some statistical systems needed to assess the program's results do not exist at all. Despite concerns and opposition from the medical and hospital sectors, the amendment passed a Cabinet meeting based on an evaluation of the pilot program and is set to take effect. As controversy and criticism in the emergency medical field show little sign of abating, voices questioning the amendment's validity are expected to grow louder.

An analysis of materials that the office of Rep. Lee Sohee of the People Power Party obtained from the Ministry of Health and Welfare, together with this newspaper's reporting on the ministry, found that the ministry's "Emergency Patient Transport System Innovation Pilot Program," conducted from March to May in Gwangju, Jeonbuk and Jeonnam, was evaluated without adequate criteria or statistics for measuring its results. It was also found that figures the ministry presented as key achievements of the pilot program were the product of a structure that made a positive conclusion inevitable, regardless of what actually happened on the ground.

One example cited as a key achievement was that there were "zero cases" of emergency patients being turned away during the pilot program. Under the system, when a 119 ambulance crew cannot find a hospital, the regional situation room designated by the government names a "priority-acceptance hospital" and has the patient remain there in the meantime. This meant that, no matter how many times hospitals refused a patient, how long it took to find a hospital or how long the patient had to wait, the case could never be counted as a refusal. This highlights the extent to which the figures diverged from what was actually happening.

There were reportedly multiple cases during the pilot program in which critically ill emergency patients remained at the scene for more than an hour. The only change was that the regional situation room, rather than the ambulance crew, asked hospitals whether they could accept patients. When a hospital refused, the crew still had to search for another hospital, leaving the "ping-pong" situation unchanged. This suggests that simply changing the system to compel hospitals to accept emergency patients or impose stricter obligations on them may not be enough to solve the problem of patients being shuttled between emergency rooms.

An official from the Ministry of Health and Welfare acknowledged that these criticisms had merit, saying, "Because the regional situation room continues the selection process until it confirms a medical institution that can accept the patient, the system is structured so that separate cases of non-acceptance do not arise." The official added, "There were no media reports of patients being turned away, and frontline staff said the burden of selecting a hospital had eased. That is why we described the results as indicating a reduction in transport delays."

The planned evaluation indicators were also not properly implemented. In its project plan, the Ministry of Health and Welfare and the National Fire Agency announced four proposed evaluation indicators: changes in transport times, repeat transport rates, final treatment outcomes and patient satisfaction surveys. They also said they planned to analyze the reasons for repeat transports by severity level, as repeat transport rates were a key indicator. The repeat transport rate shows whether patients were promptly taken to a hospital capable of providing definitive treatment. Without knowing whether repeat transports decreased, it is impossible to determine whether the pilot program helped patients reach the appropriate hospital in time. Yet it emerged that no statistics had been available in the first place to calculate the repeat transport rate.

This is because the National Fire Agency has not tracked since 2024 the number of "repeat transports," in which an ambulance takes a patient to another hospital after the first hospital it approached was unable to accept them. When Rep. Lee's office requested data comparing repeat transports in the pilot program areas from March to May of last year and this year, the National Fire Agency replied, "We tracked figures related to repeat transports through the 119 Emergency Services Statistical Yearbook through 2023, but have not separately compiled or managed them since then. The requested data therefore do not exist." An official from the Ministry of Health and Welfare said only that "we will create and manage separate indicators as the pilot program is expanded nationwide in the future," offering no meaningful explanation for why the ministry had sought to analyze results using statistics that could not be compiled in the first place.

The amendment passed a Cabinet meeting last month and is scheduled to take effect next April. The full-scale program, which applies the pilot model nationwide, began in September in all 16 provinces and major cities and is now underway. When the Ministry of Health and Welfare announced the pilot program plan in February, it said it would analyze and refine the results after the program ended in Gwangju, Jeonbuk and Jeonnam, then expand it nationwide in the second half of this year. But before the pilot program in those regions had even ended, the ministry specified that it would expand the program nationwide "during the third quarter," citing potentially controversial results such as "zero cases" of non-acceptance, and proceeded with the rollout.

Even then, the evidence the ministry presented consisted only of interim indicators from the two months of March and April. An official from the ministry explained, "Our interim review confirmed that some issues and concerns could be addressed. We also expedited the expansion in light of the growing sense of urgency, as cases of pregnant women being turned away had occurred one after another in places such as Daegu and Cheongju."

A medical-sector official said, "The problems facing emergency medical care are rooted in complex circumstances that absolutely cannot be resolved by the 'Emergency Room Ping-Pong Prevention Act' alone, and the government must know that." The official added, "I can understand that the government is in a position where it is difficult to ignore complaints from the front lines, but I am concerned that hasty changes to the system could lead to unintended consequences."

This content was produced with the assistance of AI translation services.