‘ER shuttling’ cannot be stopped without separating first aid from final treatment: experts

To prevent the repeated transfer of patients between emergency rooms, experts suggested that responsibilities for emergency care and final treatment should be separated.

Currently, if a patient does not receive final treatment after initial emergency care, medical institutions may face civil or criminal lawsuits, making them reluctant to admit emergency patients.

During a policy forum at the National Assembly on Tuesday, Lee Hyung-min, president of the Korean Emergency Medical Association (KEMA), noted that only two or three emergency medical institutions nationwide have pediatric emergency medicine specialists on-site.

“Ultimately, the possibility of final treatment depends not on the emergency room itself, but on the availability of pediatricians,” Lee said.

Despite such reality, there have been cases in recent years where emergency medicine specialists have been penalized when patients' conditions worsened after final treatment, Lee pointed out. “Due to the lack of final treatment infrastructure and legal risks, passive acceptance is leading to emergency room tours.”

He also said a lack of understanding of the emergency medical care system, which consists of regional and specialized emergency medical centers for patients with severe emergencies, regional emergency medical centers for patients with moderate emergencies, and local emergency medical institutions for patients with minor emergencies, is fueling misunderstandings about emergency room shuttling.

“What the public wants is final treatment, meaning that if someone goes to the emergency room with eye pain, they should be treated by an ophthalmologist, and if someone’s face is severely lacerated, they should be treated by a plastic surgeon,” Lee said. “However, in reality, such final treatment is impossible at regional emergency medical institutions.”

“Without separating emergency treatment from final treatment, discussions on reviving the emergency medical system are impossible. In a situation with significant legal risks, this issue must be resolved to address emergency room tours. Emergency care and final treatment must be separated, and legal risks must be reduced,” Lee emphasized.

He also stressed the need for legislation similar to the U.S. Emergency Medical Treatment and Labor Act (EMTALA).

EMTALA is a U.S. law that prohibits refusing or transferring unstable emergency patients without providing appropriate treatment. Emergency medical personnel are exempt from civil and criminal liability if they provide emergency care in accordance with the procedures and standards established by law.

“In the United States, EMTALA was enacted to establish immunity standards through social consensus. The claim for immunity is based on the provision of proper emergency treatment,” Lee said. “Medical personnel who have done their best in emergency care should not be prosecuted and should be granted immunity.”

Government acknowledges need to ease legal burden, moving to improve law

The government also expressed its intention to pursue policies to ease the legal burden on emergency medicine professionals.

It also noted that the participation of tertiary general hospitals is necessary for regional emergency medical centers treating critically ill emergency patients. Currently, among the 44 medical institutions designated as regional emergency medical centers, 29 are tertiary general hospitals, while the remaining are general hospitals.

“We are reviewing the pre-hospital transfer stage to resolve the issue of emergency patients not being admitted. However, among the regional emergency medical centers that must treat critically ill emergency patients, only about 29 are tertiary general hospitals,” said Song Young-jo, director of the Emergency Medical Care Division at the Ministry of Health and Welfare. “Hospitals are desperate to become tertiary hospitals, but they are reluctant to be designated as regional emergency medical centers.”

“It seems that they feel that being designated as a regional emergency medical center increases their responsibility for treating critically ill patients and responding to disasters, but the support measures, such as the number of patients they can treat, are insufficient,” Song said. “We are considering ways to adequately compensate regional emergency medical centers for treating critically ill emergency patients.”

He continued, “One of the concerns that emergency medicine specialists feel most acutely is exposure to lawsuits. While discussing measures to alleviate legal burdens as part of medical reform, we are separately discussing revisions to the Emergency Medical Care Act for the emergency medicine field and recognize the necessity of such revisions. Although reaching a social consensus will take time, we consider this an important issue and will prioritize its implementation.”