The Ministry of Health and Welfare moved to revise lower-level regulations to refine staffing and facility standards for regional and local emergency medical centers and to require real-time disclosure and management of their capacity to accept emergency patients.
The ministry said on the 27th it will preannounce a partial amendment to the Enforcement Rule of the Emergency Medical Service Act through Apr. 8. The crux is to specify matters delegated by the Emergency Medical Service Act, which was amended twice last year, and to reorganize the emergency care delivery system to focus on severe and emergency patients.
◇ Mandatory capabilities for surgery and critical care of severe patients
The amendment spells out clinical functions "after the emergency room stage" in the designation standards for regional and local emergency medical centers. The aim is not simple treatment but assessing whether they can actually take full responsibility for severe patients through to the end.
For regional emergency medical centers, airway management such as endotracheal intubation and cricothyrotomy; mechanical ventilation and chest tube insertion; and circulatory interventions such as defibrillation, extracorporeal pacing, and central venous catheterization must be available 24 hours a day. Imaging such as CT, MRI, and focused sonography of the heart and abdomen, as well as interpretations, and clinical laboratory tests needed to diagnose severe emergency conditions must also be available at all times.
Furthermore, centers must have operative and procedural capabilities for cardiogenic shock and cardiovascular angiography; critical care for neurologic and respiratory patients; targeted temperature management; extracorporeal membrane oxygenation (ECMO); emergency brain and abdominal surgery and angiography; continuous renal replacement therapy (CRRT); and neonatal intensive care. They must also show records of accepting patients in severe emergency disease groups within three years before applying for designation.
Local emergency medical centers must also have capabilities for basic imaging such as CT and echocardiography, emergency brain and abdominal surgery, and critical care.
◇ "For regional centers, one specialist per 5,000 more patients"
Staffing standards were also tightened. Regional emergency medical centers must have at least five board-certified emergency physicians, add one more if emergency room visits in the previous year exceeded 30,000, and secure one additional specialist for every 5,000 visits thereafter. This strengthens the previous standard of "one per 10,000" to "one per 5,000."
Local emergency medical centers will also be required to add one specialist per 7,000 visits once they exceed 30,000.
However, to ease the burden, the number of specialties allowed to assign dedicated emergency room specialists was expanded from 10 to 12, adding obstetrics and gynecology and family medicine.
Dedicated emergency medical information management staff at regional centers will increase from two to four, with at least one present 24 hours a day, reflecting the intent to operate transfer and referral systems at all times. Security staff must also be present around the clock.
Facility standards were also revised. Regional centers must place the emergency room, intensive care unit, operating room, and laboratory as close together as possible, and secure at least two negative-pressure isolation beds and at least three general isolation beds. They must have at least 30 emergency-dedicated inpatient beds and at least 20 emergency-dedicated ICU beds.
Local centers are newly required to operate at least three emergency-dedicated inpatient beds and at least two emergency-dedicated intensive care beds.
Operating rooms will use general operating rooms but must run 24 hours a day and be given priority for emergency patients, which will be codified. When transferring a severe emergency patient to another hospital, the emergency medical officer in charge and the relevant specialist must decide on the same day and notify the National Emergency Medical Center.
In addition, regional centers must maintain at least three disaster medical assistance teams in preparation for mass-casualty incidents. Each team must include at least one physician, at least two nurses or emergency medical technicians, and at least one administrative staff member.
◇ Real-time notice of available beds and surgical capability
Newly delegated matters under the law were also established. Heads of emergency medical institutions must notify the National Emergency Medical Center of ▲ the number of available beds and the status of equipment ▲ staffing operations including on-call coverage ▲ whether they can accept emergency patients and reasons for nonacceptance ▲ current capabilities for surgery and procedures for severe emergency conditions. Any changes must be reported without delay.
Regional and local emergency medical centers must also open and operate a dedicated emergency medical line 24 hours a day. Caller ID must be available, and the line must not be used for purposes other than communication with transport personnel. They must record and retain the requester's affiliation and name, key patient information, and reasons for nonacceptance. Performance in operating the dedicated line will be reflected in evaluations of emergency medical institutions.
In addition, a provision for an emergency medical fact-finding survey (Article 5-2) was newly established to investigate and publish emergency care demand and utilization patterns, the status of facilities, equipment, and staffing at institutions, and records of 119 ambulance activities. When necessary, a separate task force may be formed or a research institute may be commissioned. The results will be disclosed on the Ministry of Health and Welfare website.
The enforcement rule will take effect upon promulgation, but the notice of operational status (Article 18-2) and the dedicated line provisions (Article 39-3) will apply from May 12. The ministry plans to finalize the amendment after collecting opinions through Apr. 8.