The government has drawn its sword to end the "emergency room ping-pong." It aims to change the scene of an ambulance carrying a cardiac arrest patient going from hospital to hospital asking whether they can take the case. For critical patients, the regional emergency medical situation room, not the 119 ambulance crew, will directly designate the receiving hospital.
The Ministry of Health and Welfare and the National Fire Agency said on the 25th that they will conduct a "pilot project to innovate the emergency patient transport system" to ensure the rapid transfer of emergency patients to appropriate emergency medical institutions within the golden hour and to operate an efficient emergency medical system. The pilot will run for three months from March to May in three jurisdictions: Gwangju, Jeonbuk State, and South Jeolla Province.
◇ Faster for critical cases, 119 focuses on treatment on scene… four major transport system overhauls
The blueprint for the pilot has four strands.
First, each city and province will refine its emergency patient transport guidelines in detail by severity and situation. Hospitals, ambulance crews, and local governments will sit at the same table to agree on guidelines that actually work.
Second, for areas where guideline revisions alone are not enough, the government will add its "transport system innovation plan." The core is a structure in which the regional emergency medical situation room supports the selection of the receiving hospital for critical emergency patients (pre-KTAS 1–2). In contrast, patients of moderate severity or lower (pre-KTAS 3–5) will be transported according to prearranged procedures under the revised guidelines.
Third, information sharing will be strengthened. The plan is to link ambulance patient data with hospitals' real-time bed, staffing, and equipment status to create a "visible resource map."
Fourth, a steering committee of emergency medical and ambulance experts will be formed to check progress and, after the pilot ends, to prepare improvement plans and decide whether to expand nationwide.
Through this, the government said it will guarantee critical patients a faster chance to receive care suited to their condition, and by organically linking the transport and inter-hospital transfer systems, it will enable 119 ambulance crews to focus more on on-scene treatment.
◇ 119 sends data, situation room assigns hospitals… priority intake if delayed
Here are the details. When a critical emergency patient occurs, the 119 ambulance crew simultaneously sends the patient's information to the regional situation room and the 119 ambulance situation management center.
Based on this information, the regional situation room screens appropriate hospitals, checks whether they can accept the patient, selects the receiving hospital, and notifies the scene. When urgency is especially high, the situation management center and the regional situation room will work together to decide on a hospital quickly.
If a receiving hospital is not selected within an appropriate time and there is a risk of transport delay, the regional situation room will designate a "priority intake hospital capable of stabilization" by referencing the status of medical resources. In short, take the patient first and treat. However, patients requiring immediate intervention, such as cardiac arrest, will be transported straight to the designated hospital under existing guidelines.
If a critical patient transported by 119 needs to be moved to another hospital for definitive treatment, 119 will support the inter-hospital transfer.
For patients of moderate severity or lower, the 119 ambulance crew will check the transport guidelines and the status of hospital resources and select a hospital immediately. Depending on the patient's condition, information will be shared with the medical institution in advance.
For low-frequency, high-difficulty conditions such as digit replantation surgery to reattach severed hands or feet, pediatric emergencies, and deliveries, the list of transport hospitals will be updated by situation and symptom, taking into account medical resources in nearby cities and provinces.
The key to this system is information. The government will revamp the patient information items that 119 ambulance crews must assess on scene and ensure swift delivery to hospitals and the regional situation room through the "119 ambulance smart system." This system is used for on-scene ambulance crews to send patient information to the situation management center, regional situation room, and hospitals, and to request and receive hospital intake decisions.
Hospitals' operating status for ICUs, operating rooms, and equipment such as MRI and CT will also be organized so intake capacity can be seen at a glance, and this will be maintained up to date on a regular basis.
◇ Nationwide expansion after pilot checks… expand centers and pair with staffing measures
A steering committee will also be set up to review the pilot. The Ministry of Health and Welfare, the National Fire Agency, the National Emergency Medical Center, city and provincial emergency medical departments, regional fire headquarters, and emergency medical support groups will participate. They will discuss detailed guidelines and case review plans, analyze results, and prepare a national expansion standard plan in the second half of this year.
The government will also revise transport guidelines for areas outside the pilot regions. It said it will hold regional roadshows to discuss supplementary measures suited to local medical conditions.
Saying it will fundamentally resolve the issue of emergency room non-admission, the government will also pursue institutional improvements. It will supplement the designation criteria for regional emergency medical centers and add more regional emergency medical centers. To secure essential and emergency medical personnel for regional hospitals, it will push to introduce a regional doctor system and establish a public medical school.
Minister Jung Eun-kyeong of the Ministry of Health and Welfare said, "To create solutions tailored to the characteristics of the community, the community must be the key actor in discussions," adding, "To resolve the emergency room non-admission problem, the community, the Ministry of Health and Welfare, and the National Fire Agency will all operate the pilot with a shared sense of responsibility."
Kim Seung-ryong, acting commissioner of the National Fire Agency, said, "Securing the golden hour is more important than anything else for critical emergency patients," adding, "This pilot is a process to find the best way to transfer patients quickly to the right hospital. The fire service will focus all capabilities on protecting lives so the public does not tremble with anxiety on the road."