Recently, the Korean Medical Association Organization asked the media to use terms such as "emergency room nonadmission" and "difficulty admitting" instead of the expression "emergency room ping-pong," which refers to situations in which emergency patients and 119 paramedics cannot find a hospital for treatment and go from one medical institution to another.
The main reason the medical association moved to improve the terminology is that the expression emergency room ping-pong does not sufficiently reflect the structure of the medical field and could be mistaken as the responsibility of individual medical staff.
On the 22nd, the Korean Medical Association Organization said in a press reference that "although the expression emergency room ping-pong intuitively shows what the public feels, it does not sufficiently reflect the structural reality of the emergency medical system," and proposed expressions such as "emergency room nonadmission," "difficulty admitting emergency patients," and "admission restrictions due to inability to provide backup care."
Recently, the regional, essential, and public health subcommittee under the Ministry of Health and Welfare's medical innovation committee decided after meetings to standardize the term as "emergency room nonadmission" instead of "emergency room ping-pong."
Hospital workers say in unison about the problem of being unable to admit emergency patients, "It is not a simple refusal," and "Whether to admit an emergency patient cannot be decided by the will of a single physician."
They note it is the result of a complex interplay of the patient's condition, whether the medical institution can provide treatment or surgery, the availability of intensive care unit beds, whether on-call specialists in backup departments can respond, and the status of ongoing care for existing critical patients.
Within the medical community, there have been continued concerns that the expression "emergency room ping-pong" could make individual medical staff be seen as potential criminals.
They also point out that this expression could obscure the real causes, such as shortages of essential medical personnel, the collapse of backup care infrastructure, and excessive legal risk.
A trauma surgeon who has worked at a regional trauma center said, "Medical staff on the ground are deeply hurt by the expression ping-pong," adding, "This phrase sounds as if it contains the meaning that medical staff deliberately pass patients around."
The surgeon explained, "The current medical field faces structural problems that prevent us from admitting patients even when we want to," and "In the past, even without a subspecialist, an on-call resident often admitted patients first and treated them within the scope possible in an emergency."
Frontline medical staff noted that the burden of "medical disputes" is making decisions on whether to admit emergency patients more conservative. This is also cited as a reason medical students avoid so-called essential-care departments.
One specialist said, "As lawsuits increase and court criteria become more detailed, it has become difficult for medical staff to treat patients proactively," adding, "For example, precedents have accumulated in which the judiciary assigns post hoc liability for reasons such as an adult surgeon operating on a pediatric patient, and this has led to a pronounced chilling effect in the medical field."
Ultimately, the crux of the debate is not the expression used to describe the phenomenon, but how to build a medical system in which emergency patients can receive timely treatment.
The government is also looking for measures.
Recently, the Ministry of Health and Welfare released the results of a pilot project to improve the emergency patient transport system and said it will expand it nationwide starting in Sep. The pilot operated by having a regional emergency medical control room intervene to designate a receiving hospital when paramedics had difficulty selecting one.
According to the ministry, in the pilot conducted from Mar. to May in Gwangju, North Jeolla, and South Jeolla, there were no cases in which emergency patients in ambulances could not find a hospital, the so-called "emergency room ping-pong" or "emergency room nonadmission." There were 123 transport requests during the pilot period.
The on-scene time until paramedics departed for a hospital was shortened in some areas.
In Gwangju, the average on-scene time for critical patients was 16 minutes 6 seconds, down 1 minute 24 seconds from a year earlier, and in North Jeolla it was 12 minutes 54 seconds, down 24 seconds. South Jeolla saw a slight increase but maintained a shorter level compared with areas under similar conditions.
However, some in the medical community expressed "opposition" to expanding the pilot, saying there are problems with how the results are interpreted.
The Korean Society of Emergency Medicine physicians said, "Over three months, the total number of critical patient transports in the region is estimated at 8,000 to 10,000, but the 123 cases the government analyzed are a tiny fraction," adding, "It is unreasonable to judge the performance of the entire emergency medical system based on this."
It added, "The essence of the emergency medical problem is a shortage of backup care personnel and structural issues in the delivery system, and emphasizing only certain figures without fixing these is an illusion," and is calling for prior improvements to substantive infrastructure, disclosure of the pilot's raw data, and a reevaluation with participation by the medical community.