The government will revise the Enforcement Rule of the Emergency Medical Service Act. It refined the designation standards for regional and local emergency medical centers to codify the "final treatment provision capacity" for critical patients. If they fail to meet the standards, they will be eliminated from reassignment.
It also strengthened the standards for securing additional specialists. Until now, regional centers were required to have at least five emergency medicine specialists, add one more if emergency room visits exceeded 30,000 in the previous year, and secure one additional specialist for every subsequent increase of 10,000. Now, they must secure one additional specialist for every increase of 5,000.
However, it said this is not a plan to produce a large number of new specialists for hiring, but a structure to reassign existing personnel.
The Ministry of Health and Welfare gave advance notice on the 27th of a partial amendment to the enforcement rule containing these measures. It plans to finalize it after collecting opinions through Apr. 8.
Currently, 44 regional emergency medical centers and 137 local emergency medical centers operate nationwide. In 2024, emergency room use totaled 7,844,739 cases. Among them, by Korea Triage and Acuity Scale (KTAS) criteria, ▲level 1 1.8% ▲level 2 8% ▲level 3 52.0% ▲level 4 31.5% ▲level 5 5.7%.
The following is a Q&A with Song Young-jin, head of emergency medical services at the Ministry of Health and Welfare, Ko Eun-sil, director of emergency medical policy at the National Emergency Medical Center, and Jang Han-seok, head of the emergency medical policy research team.
- If regional or local centers fail to meet the designation standards.
"They will not be eligible for reassignment. Under current law, reassignment occurs every three years. If they fail to meet the standards after three years, existing institutions will also be eliminated."
However, they said incentives will be used in tandem rather than only penalties.
"We are considering giving extra points at designation if there are two or more specialists working in the emergency room."
- Local centers face poorer conditions than regional ones. Can they meet the standards?
"A nationwide review of local centers did not show that most would fail to meet the standards. For staffing, we raised the nurse standard but eased the burden by widening the range of recognized specialties for dedicated specialists."
- You strengthened the standard for securing additional specialists at regional centers. Which institutions are currently noncompliant?
"Considering the reorganization of the delivery system, we ran staffing numbers for about 80 candidate institutions. About two came out as noncompliant. However, we actually expect around 60 or so to be designated. We believe there will be no staffing shortfalls among institutions to be designated."
They said a large-scale increase in personnel is not necessary.
"Please understand this as a process of reallocating existing personnel according to function or reorganizing into a critical emergency medical center system."
- The obligation for regional centers to designate an "emergency-dedicated operating room" was eased.
"We reflected on-the-ground opinions. Cooperation between anesthesiology and surgery is key to operations. There was criticism that, given a general operating room system already in place, maintaining a dedicated operating room would actually be inefficient."
- If operating rooms run 24 hours, wouldn't that require staff on constant standby?
"Not so. The intent is to make the on-call system more efficient."
- You required priority assignment of operating rooms to emergency patients; what if that conflicts with scheduled surgeries?
"The government will not set detailed adjustment standards. Each medical institution has its own internal guidelines. It can vary depending on the situation."
- You created emergency-dedicated wards and ICUs at local centers.
"We analyzed National Emergency Department Information System (NEDIS) data from recent years. There were not a few cases transferred due to a lack of ICUs and wards. We estimated the minimum number of beds needed."
The judgment is that bed capacity at regional centers is already maxed out.
"This structure supplements the shortfall at local centers, which will take patients between critical and moderate severity. We consulted with academic societies and the hospital association."
- You required real-time notifications of reasons for inability to accept patients. What about the administrative burden?
"We are already entering the data through the National Emergency Medical Center's master dashboard. This does not add a new procedure."
- You increased information management staff at regional centers from two to four. What about the additional expense?
"Situations differ by hospital, so it is hard to say uniformly. The emergency medical fund will provide partial support."
This year's emergency medical fund budget is 495 billion won. Of that, 2.46 billion won will be used for related support.
- What about the expense of operating dedicated lines such as transfer and transport hotlines?
"They have already been in operation. We merely codified them this time. No additional expense is expected."
- What are the penalty provisions for medical institutions that repeatedly refuse to accept patients?
"We understand that the pending amendment to the Emergency Medical Service Act includes related provisions. This is separate from the enforcement rule."
- Without penalties, won't the front line remain unchanged?
"The principle is to accept patients if the capacity exists. However, immediate penalties that do not consider the circumstances of individual medical institutions can heighten confusion on the ground. We will make adjustments within the legal framework."
- What about support funds for regional and local centers?
"There is support through National Health Insurance reimbursement, and there are subsidies based on evaluation results. Subsidies are paid differentially by type and grade. This year, a regional center that receives an A grade will be supported with 600 million won."
This year's budget for evaluation subsidies for regional and local centers totals 39.5 billion won.