At the scene of the deadly stampede in Itaewon over the weekend, initial responses were dismally insufficient, failing to provide proper first aid to severely injured people, an emergency medicine expert said.

“In a disastrous situation, the role of the nearest hospital and that of the next-phase hospital should be different," said Lee Hyung-min, head of the Korea Emergency Medical Association, in answer to reporters’ question asking about the appropriateness of the responses to the accident while attending an academic conference on Sunday.

It may be important to make disaster-responding manuals and conduct training. However, more importantly, emergency medical and disaster response systems must be substantially improved to enable appropriate response in the field, Lee, a professor at Hallym University Sacred Heart Hospital, said.

“Safety takes money, and the same disaster does not happen twice. A system that most accurately identifies and commands disaster situations is needed. If the situation requires medical responses, our society should consider a system in which at least the Ministry of Health and Welfare or medical professionals can lead it,” Lee said.

According to the Ministry of Public Administration and Security, at least 154 people were killed and 149 injured as of 10 a.m., Monday, amid the tragic crowd crush accident in Itaewon, Seoul, on Saturday night. Among the dead were 26 foreigners.

Question: Do you think the initial responses to this accident were properly made?

Answer: I think the time it took the Central Emergency Medical Center disaster response team to recognize the situation and arrive at the scene was appropriate. After the disaster response team arrived, they arranged the scene relatively well. This is the result of an annual drill in preparation for a disaster. The scene was in the middle of Seoul, but the team rapidly distributed patients throughout Seoul, which also went one step further from the past.

Q: In contrast, what were the disappointing things?

A: In fact, they should not perform CPR at disaster sites. They should give priority to severely injured people. People who still breathe and are likely to survive if they receive emergency aid should be the first targets. The Soon Chun Hyang University Seoul Hospital, closest to the scene, should have been assigned such patients first. However, on Saturday, cardiac arrest patients were transferred to the hospital. For this reason, it became difficult for the hospital to play its role in treating critically ill patients. It was also regrettable that they could not transfer critical patients due to the lack of traffic control.

Q: Why did the initial response fail?

A: The site was not properly controlled. It was necessary to prepare a passage for the patient to be transferred, exclude the general public from the scene, and rescue the critically ill patient first. Officials should not have made a situation in which citizens performed CPR and carried patients on their backs. That is not a proper disaster response. The media reported that about 20 people received CPR until 2-3 a.m. That means the site went out of control. The control rate should be at least 60 to 70 percent, but this time, 80 out of 100 casualties were transferred amid improper on-site control.

Q: Why was the site not properly controlled?

A: In a disaster situation, someone has to control the scene. However, no one knew who was in charge of directing and permitting what to do on the spot.

Q: Does it mean there was a medical system, but the administrative system to control it was insufficient?

A: A correct description seems to be the lack of practice and preparation to respond to disasters. No matter how much you educate workers, the actual scene does not move accordingly. Now, we have to teach and train practical things. Korea’s disaster manual may be the best in the world. However, the manual is not being followed in the field.

Q: Explain what the problems are in greater detail.

A: A hospital is paralyzed when the fatalities from the disaster are transferred to it. It was the same during the previous Sampoong Department Store disaster. When the dead were transferred to nearby Gangnam Sacred Heart Hospital, it paralyzed the hospital. In disaster situations, the roles of the nearest and next-stage hospitals are different. However, medical responses will be confused if the field commander fails to control them. Therefore, dead people should be managed separately.

When a 100-car collision occurred in Incheon a few years ago, about 10 emergency medical specialists from Inha University Hospital went to the scene. However, the doctor had nothing to do because all the patients had already been transferred arbitrarily. If the site is not controlled, hospitals are thrown into disarray by the influx of patients, and the medical personnel doesn’t know what to do.

Q: On Saturday, many citizens volunteered to try CPR at the scene. What should the public do in a disaster like this?

A: The public should not be doing CPR there. Of course, I understand the feelings of the volunteers. However, CPR or relief activities should be left to field personnel. It would be of help if the remaining citizens turned around and built walls to prevent the site’s exposure and keep other people from approaching, And they should leave the site as soon as possible and refrain from visiting it.

Q: Unfortunately, the entire disaster scene was exposed to the broadcast.

A: What broadcasters need to do is not to show the situation without filtering but to inform people to leave the area and don’t visit the disaster site. On Saturday, the broadcasting of the three terrestrial broadcasters and cable news channels was no different from YouTubers.

Q: As one of the countermeasures, the government announced that it would conduct safety checks on local festivals. Do you think the local emergency medical systems are ready to deal with disasters like this accident?

A: I tell children not to go to places or events where more than 50,000 people gather. Suppose 60,000 people gather at Sangam World Cup Stadium in Seoul. There are usually 20 emergency medical situations per 10,000 people. However, when there are more than 60 to 70 emergency patients, from mild to severe, are we prepared to deal with them? No.

The hospital where I work (Hallim University Sacred Heart Hospital) is located in Gyeonggi Province, and I am also a member of the hospital's disaster management team. I will visit the site if such a situation happens in Gyeonggi Province. There is no separate workforce to respond to disasters. For now, a doctor on duty in the emergency room the previous day should be in charge of the disaster the next day. Even if the guidelines exist, the actual function cannot follow them.

Q: What should the government keep in mind to improve the disaster response system in the future?

A: Safety costs money, and the same disaster does not happen twice. It is time to stop making demonstrative guidelines and practicing. It's time for practical practice and preparation. There should also be a system to identify best and control disaster situations. The firefighting authorities are now in charge of disaster responses. However, if the situation mainly requires a medical response, we should consider a system to give control to the Ministry of Health and Welfare or medical professionals.