A bill titled "Amendment to the Emergency Medical Services Act," aimed at stopping the "emergency room shuttle," passed the National Assembly's Health and Welfare Committee on the 17th. However, it appears unable to escape criticism as merely "pouring water into a leaky bucket (the emergency room)."
The core of this amendment is to quickly designate an emergency medical institution capable of accepting emergency patients for transport. If no such medical institution can be promptly designated, the Central Emergency Medical Situation Room and the 119th Ambulance Situation Center will assign an accepting institution, and the designated medical institution must accept the patient.
This effectively prevents hospitals from refusing emergency patients brought to their emergency rooms. However, within the medical community, concerns are raised that this amounts to a "mandatory acceptance system for emergency patients," forcing hospitals without capacity to inevitably accept transferred patients. This is because the amendment lacks any procedure to verify a hospital's acceptance capacity before transport. At the same time, it retains the obligation for hospitals to maintain dedicated phone lines and staff to receive calls. In effect, it removes obligations from those making calls while leaving only obligations on those receiving them.
Another core element of this amendment is that field paramedics will make the initial assessment of whether a patient's condition is mild or severe. However, even for doctors, judging a patient's severity by eye without accurate testing is not easy. In actual emergency scenes, patients who have not lost consciousness may appear to be in mild condition but could actually be suffering from severe brain hemorrhage—a scenario that is not rare. Consequently, physicians who have worked in emergency rooms are sharpening their criticism: "Paramedics make the (severity) assessment, yet the emergency room accepting the patient bears responsibility for any incorrect outcomes."
Whether an emergency room can immediately accept a patient varies moment by moment depending on its facilities, staffing, and the circumstances of its affiliated departments. For example, even if a patient requiring urgent ophthalmic surgery is brought to the emergency room, it becomes meaningless to accept them there if no ophthalmologist from the affiliated department is available. However, under the amendment, it remains unclear who will coordinate when the Central Emergency Medical Situation Room and the 119th Ambulance Situation Center issue conflicting judgments or overlapping designations, or who will be responsible for follow-up actions when the designated hospital cannot provide necessary treatment.
The "emergency room shuttle" occurs when a severely ill emergency patient is transferred to an emergency room unable to accept them. Ultimately, to stop this shuttle, a system must be established to quickly transfer patients to medical institutions capable of accepting them. Whether an emergency room can accept severe emergency patients should be determined by assessing remaining beds, availability of surgery or procedures, professional staffing, and the capacity of affiliated departments for follow-up care. It is not too late yet. The National Assembly and the government must listen to the urgent appeals from emergency room frontlines during the remaining legislative review and the drafting of subordinate regulations, and re-examine the amendment once more.
in OPINION
