보건복지부 영문홈페이지

Guarantee Nationwide Coverage All the Way Until Final Treatment by Reforming the Emergency Medical Service

 

- Announcement of the Fourth Basic Plan

on Emergency Medical Service (2023-2027) -

 

□ On Tuesday, March 21, the Ministry of Health and Welfare (Minister Cho, KyooHong) announced the Fourth Basic Plan on Emergency Medical Service (2023-2027), aimed at achieving "nationwide emergency medical service all the way until final treatment."

 

○ The Basic Plan, compounded of suggestions on how the new government should develop Korea's emergency medical service policy over the next 5 years, was extensively discussed by experts and scholars in the relevant fields and confirmed following review and a vote by public hearing and by the Central Emergency Medical Service Committee* (Chairperson: Minister of Health and Welfare).

 

* A body which reviews the Basic Plans on Emergency Medical Service and yearly execution plans, emergency medical service fund operations, mid- to long-term development of emergency medical service, and other matters in accordance with the Emergency Medical Service Act.

 

○ As emergency medical service is a component of essential health care directly linked to preservation of lives, the Fourth Basic Plan on Emergency Medical Service serves as a component plan for fulfilling the "severe" and "emergency" categories of the Essential Healthcare Support Measures announced in January.

 

□ The government has implemented the three Basic Plans on Emergency Medical Service so far to continuously develop the response capabilities in all areas of emergency medical service through measures such as the establishment of an emergency medical service provider classification system, improvement of transport infrastructure (air ambulance etc.), and expansion of regional trauma centers.

 

□ However, many people still endure difficulty in receiving appropriate emergency medical care. The recent shortage of essential healthcare resource has led to hospital admission rejections* and frequent hospital transfers resulting in missing the golden time, thus increasing the death rates**, in what is being recognized as a problematic decline in the availability and quality of severe and emergency medical service.

 

* 2021 Statistical Yearbook of Emergency Service indicate "not enough space in emergency rooms" accounts for 16.2% of the reasons for redirection of emergency patients by paramedics.

** The rate at which severe and emergency patients died after admission increased from 5.7% in 2018 to 6.2% in 2022.

 

□ An emergency medical service policy change is necessary and the Fourth Basic Plan envisions "nationwide emergency medical service all the way until final treatment", and comprises 17 key tasks in four areas for achieving the national target of "regionally complete essential and public medical service."

 

1. Emergency Scene Management and Transportation

 

○ To give the public easier access to emergency medical service, an information system which helps users identify conditions by symptom and shows availability of space for nearby emergency rooms, among other features, will be established, with campaigns to be executed to educate the public on first using the 119 emergency consulting service in instances where an emergency is not certain.

 

- To reduce visits to emergency rooms of large hospitals by non-emergency patients, protocols will be established to guide them to use the appropriate medical service provider for a given severeness of condition*, and campaigns for improved observance of the principle of "prioritizing severe & emergency patients" will be executed.

 

* Example: Directing non-emergency patients who visit an Emergency Room to other proper health facility, putting in place a procedure to obtain informed consent on comparatively higher out-of-pocket payment for non-emergency patient

 

○ Mandatory CPR training will be provided to a wider range of members of the public to increase the public's interest in CPR and capacity to perform CPR. Accessibility of Automated External Defibrillator (AEDs) will be improved by having their locations indicated on map apps.

 

○ Air ambulance service will be expanded in vulnerable regions to ensure fast emergency medical transport to and from isolated areas. Air ambulance operating standards will be improved to prioritize the use of air ambulances for transport of severe/ emergency patients and those in isolated areas.

 

○ A standardized Triage and Acuity Scale will be used at the scene and in hospitals for improved speed and efficiency of emergency transport. Paramedics will be improved in their capability to select destination hospitals, and the range of duties performed by paramedics will be expanded to provide all required medical treatments during emergency transport.

 

- Emergency transport guidelines will be established to reflect the resources available in specific regions, including health facilities and their locations, so as to establish a regionally effective system of emergency transport. "Emergency patient acceptance protocol" will be established to better hold health facilities accountable for in-transit emergency patients.

 

 

2. In Hospitals

 

○ The standards of classification of facilities, personnel, equipment, and other resources by healthy facility type, thus far centered on diagnosis and emergency treatment inside emergency rooms, will be improved in stages to apply also to procedures that follow emergency room procedures, including admission and operations*.

 

* The classification standards will address provision of practical treatments for conditions of varying degrees of emergency and severeness (treatment accountability).

 

○ In addition to said improvement of classification standards, the function of diagnosis and treatment to be performed by health facilities at each level will be clearly defined to gradually upgrade the transfer system which enables limited medical resources to be effectively utilized based on the severeness of the patients.

 

- Since the roles of "local emergency medical centers," "regional emergency medical centers" and "regional emergency health facilities" lack clear distinction, the function of emergency medical service providers will be clarified and categorized into "severe," "moderate," and "mild” status. Emergency medical service providers will be renamed to allow their roles to be understood intuitively.

 

- The diagnostic function, classification standards, compensation structure, name, and other particulars of the said upgraded transfer system will be established collectively by stakeholders and experts and through research. The upgrade will take place in stages and through trials to allow for collecting feedback from those involved in the field.

 

○ Regarding treatment for severe and emergency conditions which individual health facilities cannot respond 24/7, health facilities will be networked to create regionally complete response systems.

 

- Municipalities’ emergency medical service resources will be surveyed to operate a system for the health facilities in a given region to take turns assigned to round-the-clock watch (duty assignment based on the day of the week*). Support will be provided to facilitate transfers between health facilities in instances where such transfers are required for adequate treatment**.

 

* (Before improvement) The difficulty of having all the health facilities in a region on round-the-clock watch for severe/ emergency patients leads to the problem of unavailable doctors capable of final treatment being on duty in the hospitals of a region on certain days of the week.

(After improvement) Hospital A will be on final treatment watch for severe & emergency patients on Mondays, followed by Hospital B on Tuesdays, and so on. Hospitals will be free to provide final treatment to severe & emergency patients on non-assigned days also.

 

** Improved health insurance compensations in cooperation for transfers between health facilities, improvement of the IT system for emergency health facility transfer cooperation in functions such as inter-personnel messaging, synchronized electronic records, media data, and other measures.

 

- To induce cooperation, the range of assessment and compensation of individual emergency medical service providers will be expanded to include cooperation between emergency medical service providers.

 

○ Severe and emergency medical service centers will be expanded to provide all severe and emergency patients a diagnosis within one hour from anywhere in Korea. Policy upgrade* will take place to make the treatment facilities of health facilities, including severe patient rooms and operation rooms, available first to emergency patients.

 

* To see funding for management & operation of inpatient rooms & severe patient rooms for emergency patients only.

 

- To see a greater inflow of competent personnel into the area of emergency medical service, special pay for personnel on watch for final treatment for severe and emergency patients, distribution of profit from emergency medical service among medical personnel, work-life balance of emergency medical service workers, and other measures will be subject to review.

 

○ Emergency medical service models will be developed to benefit the regions with medical personnel shortages. A pilot program will be undertaken to post city medical personnel in at-risk regions on a cyclic or dispatch schedule to address personnel shortages.

 

○ In line with the Essential Healthcare Support Measures and other policies, schemes for strengthening personnel and facilities will continue to be discovered and implemented.

 

○ To create an environment where patients are guaranteed emergency diagnosis, full-time help desk staff will be posted and an “emergency room patient experience assessment’ system will be introduced.

 

- Laws will be revised to prevent and handle abusive and violent acts against emergency room personnel. Improved response to abusive and violent acts will be achieved by implementing security personnel guidelines and manuals.

 

- Number of isolation beds will be increased for improved response in emergency rooms in the event of an outbreak of infectious disease. Systemic improvements will be made to enable flexible assignment of facilities and resources*.

 

* Use of companion waiting rooms, parking lots, & other suitable facilities as cohort isolation zones, availability of backup personnel to fill in for emergency room personnel who become infected, etc.

 

 

3. Specialized Response

 

○ (Severe trauma) Local trauma centers will operate on a standard operations model which defines patient populations by area, availability of resources, and other factors. The quality of service provided at trauma centers will be improved through graduated support based on operating standards and treatment achievements.

 

○ (Cardiovascular) Local cardiovascular disease centers will be re-assessed and re-designated to improve their capacity for specialized treatment. Networking with local paramedics and health facilities will be induced to shorten the time it takes for cardiovascular patients to receive final treatment.

 

- A pilot health insurance project for networks (teams) of regional medical specialists to get paid as a group will take place.

 

○ (Pediatric emergency) Pediatric medical treatment performance will be included as a criteria in the assessment of emergency medical institution in order to make sure a general pediatric medical treatment available at every emergency room, and pediatric emergency medical service centers will be increased to 12 from eight.

 

- The number of children's hospitals providing outpatient treatment after hours and on weekends and public holidays will be increased, and 24-hour pediatric medical service consulting centers will be operated on a trial basis in an effort to make minor pediatric medical service available outside of emergency rooms after hours.

 

○ (Psychiatric Emergency) Local emergency mental health centers will be increased to 14 from 8, and a central emergency mental health response council will be established for strengthened infrastructure for response to emergency mental health patients.

 

○ (Disaster response) The medical service system for response to disasters will be improved by incorporating the proposals in the aftermath of the “Itaewon crowd crush incident”.

 

- Establishment of regional disaster medical service councils to prevent disasters, improved information sharing and communication between the relevant authorities for the fastest first response possible, joint training of disaster medical assistance teams (DMAT), firefighters, and health center staff, improved operating conditions for DMATs, and other measures for faster response to disasters will be implemented.

 

 

4. Emergency Medical Service Infrastructure

 

○ A "regional emergency medical service system assessment" will be introduced to improve the entire process of emergency medical service, from call-in to transport, diagnosis, treatment, and transfer through cooperation among entities such as paramedic teams and health facilities in the region.

 

- The result of the regional emergency medical service system assessment will be reflected to the amount of the grants such as those from the Emergency Medical Service Fund provided to municipalities, forming an incentive structure

 

- Si/Do emergency medical service committees and regional emergency medical service plans will be operated so that the central government forms emergency medical service policies. Si/Do emergency medical service support groups will be formed and operated.

 

○ The Emergency Medical Service Resource Information System will be transformed into a platform providing emergency medical service information customized to the needs of users such as patients, paramedics, and health facility personnel. A mobile app version will also be made available.

 

- To increase efficiency of information gathering system, each medical department will be directed to update the availability of its services by emergency medical conditions in real time, and information accountability will be ensured by assessing and overhauling the accuracy.

 

- The National Emergency Department Information System (NEDIS) will be legally permitted to collect and share personal information. The NEDIS will then be linked with paramedic logs and health insurance records to achieve a system of seamless emergency medical service data which verifies emergency patients from transport to ER diagnosis and discharge.

 

○ Infrastructure will be strengthened in diverse aspects to allow the central government to implement effective policies.

 

- Policy effectiveness will be increased with improved legal backing of the National Emergency Medical Center's activities and recognition of its operating autonomy as well as through a potential split-off of the central emergency medical service situation room into regional emergency medical service situation rooms for inter-hospital transfer control, and a potential expansion of financial resources (discovery of new financial resources) for emergency medical service.

 

□ Minister Cho KyooHong stressed that "Emergency medical service is of high urgency and importance policy-wise because missing the golden time for treatments endangers precious lives."

 

○ He said, "By diligently executing the planned tasks over the next five years, we will do its best to create the infrastructure that will administer medical attention to emergency patients in any part of Korea within the golden time."

 

○ He also added, "Further measures will be implemented in the necessary areas to keep improving the foundation of essential healthcare."