3 months into doctors strike, finding an emergency room in Korea is harder than ever

Posted on : 2024-05-21 17:04 KST Modified on : 2024-05-21 17:04 KST
At an EMS situation room in Seoul, staff said that a patient was lucky to have only needed 10 calls to hospitals to find a place that would treat them
Inside an emergency medical care situation room in Seoul’s National Medical Center on May 10, 2024. The situation room oversees transfers of patients between emergency rooms. (Lim Jae-hee/The Hankyoreh)
Inside an emergency medical care situation room in Seoul’s National Medical Center on May 10, 2024. The situation room oversees transfers of patients between emergency rooms. (Lim Jae-hee/The Hankyoreh)


Editor’s note: As of Monday, May 20, Korean interns and residents have been on strike for three months. To mark this, the Hankyoreh paid a visit to the front lines of the ongoing crisis: an EMS situation room in the greater Seoul area that consults and directs patient transfers across the nation. There’s been a sharp rise in calls seeking beds in emergency rooms, and patients outside the capital area are not being provided treatment in a timely manner. These are just a few of the reasons that Korea must normalize its health care delivery system, and soon.

“We suspect this to be a case of drug intoxication, but the patient needs testing since they’re not regaining consciousness.”
At 4:30 pm on May 10, an urgent phone call reached the Seoul metropolitan area’s EMS situation room, located in the National Emergency Medicine Center in Seoul’s Jung District. Medics from a regional emergency medicine center in Gangwon Province were desperate, as they had already been rejected from five hospitals in the area.
For the unconscious 40-year-old to receive treatment, they needed to be examined and diagnosed at a major hospital. Left with no other options, the medics were forced to call the greater Seoul area’s EMS situation room. The staff in the room jumped into action. Finally, a call placed to a major hospital in Gangwon gave them the response they needed: “Send the patient over.”
It took 23 minutes and 10 phone calls to find a spot for the patient, from the moment the EMS sitaution room received the initial phone call to the time they were OK’d to send the patient.

“This time we were lucky,” one of the situation room’s staff members said after the fact. “It usually takes around an hour since we normally need to call more than 10 places.”
The government has been relying on a provisional medical care service system to monitor the nationwide disruption in health care caused by the en masse resignations of medical interns and residents. EMS situation rooms like the one the Hankyoreh visited, which coordinates the transfers of patients between emergency rooms, are part of the interim system. 

The original plan was to set up such EMS situation rooms in the Seoul metro, Chungcheong, Jeolla and Gyeongsang regions in April and May, but plans were moved up by a few months in response to the walkouts by hospital house staff.

These situation rooms essentially act as triage centers, assessing which hospitals to send patients to based on the severity of the patient’s condition and a given hospital’s capacity for treatment. According to the National Medical Center, 1 in 10 people who visit emergency rooms in Korea are transferred to a different emergency room to receive appropriate treatment. As of 2022, the total number of patients transferred was 485,844, or 9.6% of all patients who sought out the emergency room (5,067,164).
Speed is crucial when it comes to these types of transfers. Patients suffering heart attacks, the most common ailment among those seeking emergency care, must be treated no later than two hours after they report chest pain. The EMS situation rooms work around the clock with two to four response team members and one emergency physician. One of the response team members assesses the patient’s condition, and the emergency physician determines the appropriate medical facility for the patient. The other response team member then calls various emergency rooms to enable the transfer.
The protracted health care crisis has made this service even more invaluable. Ministry of Health and Welfare statistics show that the number of cases handled by the four regional EMS situation rooms was 433 in March and 693 in April. As of May 16, the situation rooms had already handled 419 cases this month.
The problem lies in the fact that, despite the increase in workload, the walkout by junior physicians has led to a lack of manpower. Of dire need are doctors who can consult on calls into the EMS situation rooms. In order to assess the severity of a patient’s condition, these physicians must have specialties in emergency medicine, internal medicine, and surgery.
At least 30 doctors are needed per situation room for normal operations, yet all but the EMS situation room in Seoul are short staffed. The disparity between regions is starkly evident, with the Jeolla center having only five emergency physicians on staff, Gyeongsang having 12, and Chungcheong having 13. The mass resignation of medical interns and residents has left emergency rooms understaffed and hard-pressed to find anyone to fill the empty positions.

The Ministry of Health and Welfare deployed 12 public health doctors to these EMS dispatch centers, but because some of the physicians specialize in family medicine and pediatrics, the move has been criticized as a “makeshift” measure.
To make matters worse, the turnaround for emergency room transfers is getting longer. The vacuum in patient care has, as of May 16, left 18 out of 43 trauma centers — hospitals that specialize in caring for urgent patients — turning away patients. 
The situation is going downhill even at emergency rooms at secondary care facilities, which do not rely so heavily on medical residents and interns.
“Even through March, secondary hospitals were accepting a lot of patients. But rising fatigue among secondary hospital staff has led to secondary care facilities requesting that urgent patients be transferred elsewhere,” said Kim Jung-eon, head of policies for medical disasters at the National Emergency Medical Center. Kim was serving as the emergency physician on call when the Hankyoreh visited the situation room.  
The ongoing absence of interns and residents at the nation’s hospitals has shined an unflattering light on South Korea’s fragile emergency medical care system. Starting in May, the government has allowed the EMS situation rooms to assist in the transfer of patients in the most critical of conditions in ambulances.
However, emergency rooms, which are increasingly overstretched with the absence of residents and interns, are finding it increasingly difficult to answer all of the requests from the dispatchers.
“Even if patients are brought in, we have no choice but to turn them away because the medical departments that need to operate on them do not have the time to see them,” said Lee Hyung-min, the chairperson of the Korean Emergency Medical Association. “Secondary hospitals have almost exhausted their capacity to see patients. I’m worried this will only mean less care for more patients.”
“Since medical interns and residents who were in charge of the ICUs have left their stations, emergency rooms no longer have places to send patients when they’re done seeing them but need further care, meaning that emergency rooms are filling up and having to turn away patients,” says Jeong Hyung-jun, the head of policy for the Korean Federation Medical Activist Groups for Health Rights.

“The best case scenario would be interns and residents returning to their stations; but if that is not possible, the government should immediately take practical measures to help hospitals hire more specialists or focus on critical care,” he added. 

By Lim Jae-hee, staff reporter

Please direct questions or comments to [english@hani.co.kr]

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