[Emergency Care on the Brink] 2. Hospitals Face a Duty to Accept Patients, but Have Neither Doctors to Treat Them nor Means to Assess the Situation

44% of Center-Level Emergency Medical Institutions Cannot Provide Emergency Surgery 24/7
No Real-Time Link Between Hospital and 119 Information Systems
Front-Line Professionals: "Ambulance Ping-Pong Will Just Turn into Waiting Inside the ER"

Editor's NoteAn amendment to the Emergency Medical Service Act, known as the "ER Runaround Prevention Act," which strengthens designated hospitals' obligation to accept critically ill emergency patients, has passed a Cabinet meeting and will take effect next April. The government says the amendment is based on results from a three-month pilot program. However, concerns among emergency medical professionals have not subsided: the pilot program had shortcomings in its structure and evaluation criteria, and the amendment does little to address the system's fundamental injustices. This article examines what the amendment overlooks and what issues require deeper consideration before it takes effect.

1) Pilot program cited as basis for "ER Runaround Prevention Act" found to be riddled with gaps

2) Hospitals obligated to accept patients, but lack doctors willing to treat them and tools to assess the situation

3) Doctors turn away from emergency care: "One mistake can leave you tied up for years, through the first trial"

4) "The law should not force hospitals to accept every patient; it should create a system that makes acceptance possible"

When the "ER Runaround Prevention Act" (an amendment to the Emergency Medical Service Act), which passed a Cabinet meeting on October 13, takes effect next April, hospitals designated by the National Emergency Medical Center's Situation Room or a 119 emergency call management center will be required to accept critically ill emergency patients. The problem is that many emergency departments do not have doctors available to perform surgery after accepting a patient, and there is no reliable way to report such circumstances in real time. Medical staff worry that if a patient is assigned to a hospital that cannot treat them, the "ambulance runaround" on the roads will simply become a "waiting line in front of the emergency room."

A hospital's ability to accept a patient depends not on the number of vacant beds but on whether it has the medical departments and staff needed to provide surgery or inpatient care after emergency treatment—in other words, whether it has the capacity to provide follow-up care. When an emergency medical institution has difficulty providing care in a particular department, it posts a "service restriction message" on the emergency medical information network. According to data submitted by the National Medical Center to the office of So Byung-hoon of the Democratic Party of Korea, there were 24,256 such messages in the first half of this year, and 76.9% of them (18,664) cited staff shortages. Neurosurgery, which performs operations for conditions such as brain hemorrhages, cited staff shortages in 1,213 of 1,438 messages, while neurology, which treats strokes, did so in 1,221 of 1,360 messages.

Follow-up care capacity can change without warning, and hospitals still rely on individual messages from each department to the emergency room to keep track of it. Choi Seokjae, a professor of emergency medicine at Yeouido St. Mary's Hospital, said on November 10, "At our hospital, 27 departments regularly notify us of the times when they are unable to provide care. When a 119 emergency call comes in, an emergency medicine doctor has to check each case individually and decide whether we can accept the patient. There was even a case where the only professor in a department had a death in the family that day, making it difficult for the department to provide care for two to three days." He added, "Once emergency surgery begins, that department cannot treat other patients for several hours. Whether a department can provide care can change several times a day depending on circumstances like these, and there is no way to know in advance."

Only around half of hospitals maintain 24-hour follow-up care. According to the "Recommendations to the Government on Timely Transfer and Treatment in Emergency Care," issued by the Medical Innovation Committee on October 1, 101 of the 181 center-level emergency medical institutions nationwide (55.8%) were able to perform emergency surgery around the clock. In 24 of the country's 70 mid-level medical service areas, not a single institution could provide emergency surgery 24 hours a day. Regional emergency medical centers, which provide definitive treatment for critically ill emergency patients, face a similar situation. According to data submitted by the Ministry of Health and Welfare to the office of Lee So-hee of the People Power Party, only 17 of the 44 regional centers this year (38.6%) could perform surgery around the clock for thoracic aortic disease. Eleven of these were in the Seoul metropolitan area.

Medical professionals on the front lines continue to complain that the shortage of resident doctors has made it even harder to provide follow-up care at night and on weekends. Professor Choi said, "Most hospitals currently lack residents in essential medical specialties, so care is often unavailable at night and on weekends. If a patient with a suspected related condition is accepted when consultation with the relevant department is not possible, it could actually cause them to miss the golden hour for treatment."

The amendment requires hospitals to promptly notify the National Emergency Medical Center's Situation Room when they are unable to accept a patient and to assign dedicated staff to handle such notifications. But measures to bridge the gap between the amendment's intent and reality remain inadequate, including a requirement for the government to fund the necessary personnel and costs. In a survey by the Korean Emergency Medicine Association, 96% of emergency medicine specialists said it was impossible to report their capacity to accept patients in real time. Wang Sun-joo, a professor of emergency medicine at Hallym University Dongtan Sacred Heart Hospital, said, "Even in the emergency room, we often don't know whether doctors in other departments are operating or performing cardiopulmonary resuscitation. We can count the vacant beds, but we can't determine whether care is available."

The medical community has criticized the amendment for imposing an obligation on hospitals to accept patients without first establishing a system for follow-up care. The amendment stipulates that if a hospital cannot be promptly selected for a transfer, the situation room or 119 will designate one, and the designated hospital must accept the critically ill emergency patient. But the situation room faces the same difficulty in finding a hospital willing to take the patient. From January through July this year, the Metropolitan Emergency Medical Situation Room helped select hospitals in 409 cases, but a hospital was actually found in only 138 cases (34%).

Professor Wang said, "If a hospital without a doctor available to perform surgery is designated, it can only tell the patient, 'We can't treat you' or 'You'll have to wait a long time,' even if it accepts them. The ambulance runaround will simply turn into waiting inside the emergency room." Transferring an accepted patient to another hospital also creates a burden. "Sending a patient to another hospital takes as much time and effort as treating one, and other patients in the emergency room go without care in the meantime. The risks facing patients who are transferred before their treatment is complete remain as well," he said. Professor Choi said, "Any emergency medicine doctor wants to take in a critically ill patient. But when the follow-up care systems at university hospitals, which should provide the definitive treatment, have already collapsed, forcibly assigning patients alone cannot solve the problem."

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