Finding an ER in Korea is a matter of life and death

A man in his 70s who was in a car accident in Yongin one late night in May was rushed from one hospital to another in an ambulance, as all hospitals in the vicinity told the ambulance operators their emergency rooms (ER) were booked solid...

Medical staff members attend to a patient at the emergency ward of Ewha Womans University Seoul Hospital in western Seoul on June 10. [KIM JONG-HO]

A man in his 70s who was in a car accident in Yongin one late night in May was rushed from one hospital to another in an ambulance, as all hospitals in the vicinity told the ambulance operators their emergency rooms (ER) were booked solid.

After two hours of searching and rejections from 11 hospitals, the man died in the ambulance.

Just two months earlier, a 17-year-old student who fell from a four-story building was also rushed from one hospital to another in an ambulance, where the operators heard the same answers to all the hospitals they called — they were fully booked. The girl also died in the ambulance.

These repeated incidents have led to questions on whether the emergency healthcare system in Korea is saturated beyond capacity.

On the contrary, the office of Democratic Party Rep. Choi Hye-young found that nearly 50 percent of the patients treated in emergency rooms in Korea last year had minor illnesses that did not require the attention of the ER staff members.

“Many of the patients we accept at the ER daily actually come with minor conditions,” said a medical professional working at an ER of a major hospital near Seoul on June 7. “They line up at the ER, even though they have minor illnesses because this way they can get treatment faster than through a regular reservation system for outpatient care.”

As the doctor was speaking, a man in his 70s walked into the ER with a tick bite.

At another emergency ward at a major hospital in Seoul on June 10, a total of 107 patients were treated from midnight to 9 p.m. that day, of whom only five had critical conditions requiring ER attention.

Part of the problem lies with the accessibility and affordability of ER services for patients receiving medical insurance support as part of their low-income subsidies. Certain patients with critical illnesses or some homeless people who receive this support can use ER services at a subsidized price.

A case in point would be a patient in his 70s who has been bedridden since he had a stroke 10 years ago.

He was admitted to the ER at a hospital near Seoul on Sunday for a wrist injury. He was to be discharged after three hours, but his son threatened to sue the hospital for refusing his father further treatment. In this same manner, the son had his father hospitalized at another ER for a total of 320 days last year.

“Because the patient is a recipient of medical benefits, the cost of using the ER is not too burdensome for the family,” said a hospital staff member. “It seems that the son kept his father at the ER in this manner to avoid taking care of him at home.”

Medical staff members attend to patients at the emergency ward of Ewha Womans University Seoul Hospital in western Seoul on June 10. [KIM JONG-HO]

Part of the problem also lies with the practice of ambulance operators calling hospitals to find out empty ERs, a practice from the Covid-19 days, according to some medical experts.

The practice of ambulance operators calling hospitals in the vicinity to find out whether they had ER availability was not part of the ambulance protocol until the pandemic.

With the onset of the pandemic triggered by the highly infectious Covid-19 virus, the ambulance operators had to start calling hospitals to explain the patient’s fever level and conditions as well as ensure that the ER was ready to take in a Covid patient.

“Even after the pandemic was over, this practice stuck, becoming an unspoken code of conduct,” said a nurse in her 30s with nearly a decade of experience in emergency operations.

According to the national fire department, the number of cases where the ambulance took over an hour to find an ER with capacity increased 3.9 times in 2022 compared to 2019, totaling 16,939 in 2022. The number of cases where the patient was in the ambulance for over three hours grew from 22 in 2019 to 414 in 2022.

Ambulance operators moving an incoming patient to the emergency room of Ewha Womans University Seoul Hospital in western Seoul on June 10.

Some medical experts argue that it is time to scrap the practice.

“Of course, all the ERs will say they’re packed, the way forward is to ignore them and bring in the patients anyway,” said the head of an ER department of a university hospital in Korea. “Once the patient arrives at the ER, they can make space somehow.”

But this brings up the question of the liability of hospitals and medical staff members. If an ER patient dies while waiting for treatment at a ward, the responsibility for the death falls to the medical staff members, said Lee Hyung-min, president of the Korea Emergency Medical Association.

“Say a hospital is packed, but still takes in the patient for emergency treatment at the ER,” Lee said. “After the emergency treatment, if the patient still needs further complex treatments, such as surgery, the head of ER will have to make calls to other hospitals that can take in the patient. If the patient dies during this process, the responsibility is on the head of ER.”

According to other experts, a transparent system through which hospitals in Korea could share their ER capacity could be a solution.

“If each hospital could have a 24-hour coordinator who can update their ER status and share this via a common network between hospitals, and with all ambulance workers, the problem can be easily solved,” said Kim Ki-un, an ER director of Soon Chun Hyang University Hospital’s Bucheon branch.

Jung Jae-hun, a Gachon University infectious diseases professor, suggested a policy change to ensure that patients with minor illnesses visiting the ER are charged extra.

“If the policy so far has been about increasing accessibility of medical services to patients, we need to start thinking about limiting such wide accessibility to ensure those requiring critical medical attention are not overlooked,” Jung said.

BY SHIN SUNG-SIK, LEE ESTHER, ESTHER CHUNG [chung.juhee@joongang.co.kr]