As the government began a pilot program to end the so-called "emergency room pinball," it said it is "not a complete solution, but at least a first step to reduce confusion without agreements."
The core is to clearly define transfer principles by region so that emergency patient transfers move according to an "agreed procedure," not a "random choice."
Structural tasks such as revising laws, expanding personnel, and easing legal risk remain. Still, the government repeatedly emphasized that "it is necessary to explicitly define the roles of emergency medical institutions, 119 emergency medical services, emergency dispatch centers, and regional situation rooms."
Minister Jung Eun-kyeong of the Ministry of Health and Welfare, Joo Young-guk, director of 119 Response at the National Fire Agency, and Lee Jung-gyu, director of public health policy at the ministry, explained the purpose of the "pilot project to innovate the emergency patient transfer system" at a briefing on the 25th.
-There are concerns about whether this project will solve emergency medical problems.
"Emergency medical problems are not simply about transfer and referral. They are resolved when strengthening final treatment capacity, protecting essential medical services, and reinforcing safety nets all work together. Such changes take time."
However, the government said "there are areas that can be addressed immediately."
"The problem of emergency patients not being transferred in time needed improvement, at least in the short term. So the pre-hospital stage (119) and the hospital stage will work organically to strengthen the transfer and referral system for critically ill emergency patients."
It also explained the background of the pilot.
"Regional emergency medical situation rooms were introduced in 2024. There was a need to verify in the field how to divide roles and cooperate among institutions."
-Hospitals already check whether they can accept patients. Will this actually save time?
"The key is not 'whether we check' but 'how we distribute.'"
The government said it already identifies, by region, hospitals that can accept severe cases such as cardiovascular, cerebrovascular, trauma, and delivery. The problem is when patients surge at the same time.
"If two patients go to one hospital at the same time, both may not receive proper treatment. We intend to operate a system that reviews resources in real time and distributes patients."
To do this, it said it will prepare internal detailed manuals, including the number of times to check accepting hospitals and procedures for switching when not accepted, and verify them for three months.
-What is the role of a priority-accepting hospital?
"A priority-accepting hospital is not the final treatment hospital. It is a hospital that can provide basic emergency care and then refer."
Geographic accessibility is an important criterion.
"For suspected cardiac arrest, the patient goes to the nearest regional emergency medical center. Other urgent patients are first considered for facilities that can be reached within the time window. If conditions are difficult, we will make an organic judgment including regional emergency medical institutions."
-What if all hospitals cannot accept patients? Isn't this effectively a forced designation?
"There is currently no legal obligation to accept."
However, it said there are hospitals that accept patients in emergencies even now.
"There is no explicit obligation, but frontline medical staff agree that someone has to provide stabilization care."
It also acknowledged the medical community's concerns about legal risk.
"We are reviewing ways to ease liability for medical accidents by revising the Emergency Medical Service Act and more. However, there are limits to applying this immediately to the pilot project."
Still, it said there is a clear reason to set guidelines first.
"These things are already happening in the field. Proceeding randomly without guidelines creates greater confusion. Even with limited resources, regions should set agreements and move forward."
If, after priority acceptance, the patient is referred to a final treatment hospital, 119 will handle the retransfer.
"What priority-accepting hospitals struggle with most is when referral after stabilization does not happen. In the pilot, we will take responsibility to a certain extent for transfer to the referral hospital."
-Are there enough personnel for retransfers?
"We are not doing this because we have slack. We will make maximum use of reserve ambulances."
-What is the number of severe patients in the pilot regions and the staffing plan?
"In the pilot regions, there are an average of 89 severe emergency cases per day."
The government has secured a budget to add 30 staff members to regional situation centers this year. However, it is difficult to fill all positions immediately, so it plans to operate with partial support from personnel in other regions.
"There will be a workload burden, but we will take steps to minimize problems."
-Some say this will make existing hospitals take more patients.
"The goal is not to make hospitals take more patients. It is to clearly define who will play what role when a patient appears. A situation that moves without agreements, as now, leads to wasted time and delayed treatment."
-What about the problem of emergency room resources being crowded by mild cases?
"We gave some guidance to the public during the conflict between doctors and the government, but there is no separate publicity plan in this pilot project."
However, it acknowledged that the influx of mild cases into emergency rooms burdens critical care.
"Many mild cases come directly to the emergency room by taxi. Then the ERs that should see critical patients become saturated. Public outreach needs to be considered separately."
-How will you respond to backlash from the medical community?
"The core concern is about legal risk. We fully understand that."
However, the government saw the disorderly situation in the field as a bigger problem.
"We need to solve these issues at the same time. There are differences by region, but we will keep persuading."
-What is the time standard for transfers to priority-accepting hospitals?
"It differs by region. It is not set in one- to two-hour units."
-What are the criteria for selecting pilot regions?
"We did not select them because there were many non-acceptance incidents. In particular, South Jeolla is a region with relatively few medical resources. We judged it appropriate to establish principles first where resources are limited."