No criteria for 'non-acceptance' despite pilot program claims

Hospital selection took up to 1 hour, 48 minutes in some cases

Lawmaker Lee So-hee: 'We need to verify whether results were properly assessed'

An emergency medical center. [Yonhap]
An emergency medical center. [Yonhap]

South Korea's health authorities have been touting "zero emergency room rejections" as a key achievement of a pilot program designed to reduce the phenomenon of ambulances being turned away from hospital after hospital — but it turns out they never established a definition for what counts as a rejection in the first place.

According to the office of People Power Party lawmaker Lee So-hee, the Ministry of Health and Welfare told Lee in a written response that it was "difficult to provide a separate definition due to the absence of criteria for emergency room non-acceptance," when asked about the status of ER rejections during emergency patient transport nationwide.

Emergency room non-acceptance refers to the situation in which an ambulance cannot secure a receiving hospital for a critically ill patient, forcing the vehicle to drive from facility to facility in search of one willing to take the patient.

In the same response, the ministry said it was "difficult to confirm a causal relationship between transport delays and patient deaths based on fragmentary facts alone." It added that determining whether a delay occurred requires a complex assessment of the patient's condition and severity, the region, and the situation at individual hospitals at the time.

Yet the ministry had previously cited "zero non-acceptances" as a headline result of the pilot program. In a press release in June, it described the "Emergency Patient Transport System Innovation Pilot Program" as a "successful conclusion," announcing that "not a single case of emergency room non-acceptance occurred over three months."

The Ministry of Health and Welfare and the National Fire Agency jointly ran the program to reduce transport delays by making more efficient use of limited emergency medical resources. It ran from March through May this year, covering Gwangju, North Jeolla Province and South Jeolla Province.

"The ministry promoted 'zero non-acceptances,' but there were no criteria for what non-acceptance even means," Lee said. "It wasn't that non-acceptances numbered zero — it was that the standards for counting them numbered zero."

Questions have also been raised about whether the "zero non-acceptances" figure is meaningful given how hospital selection works under the program. According to the ministry, the regional emergency medical coordination center continues the hospital-selection process until a facility willing to accept the patient is found — a structure that, by design, produces no recorded non-acceptances. Even if finding a hospital takes a very long time, the case would not be counted as a non-acceptance as long as a facility is eventually secured.

Successful hospital placement through the pilot program accounted for only about one-third of all cases, raising further questions about whether the program's results have been properly assessed.

Of 123 total cases registered during the pilot, the regional emergency medical coordination center successfully placed patients at a medical institution in only 43 cases, or 35 percent. By contrast, 64 cases — more than half the total — ended in withdrawal of the request.

Even among successful placements, the time required varied widely. Some cases were resolved in as little as around 10 minutes, while one took as long as 1 hour and 48 minutes. Among withdrawn cases, the process took up to 1 hour and 26 minutes in at least one instance.

"With successful hospital placement at only 35 percent, I intend to demand at this national audit that the ministry first establish criteria for non-acceptance and answer for whether the pilot program's results were properly verified," Lee said.

Meanwhile, the National Assembly passed an amendment to the Emergency Medical Services Act on Thursday that overhauls the emergency medical transport system. The revised law allows the Central Emergency Medical Coordination Center and the 119 Emergency Medical Dispatch Center to designate a receiving facility when an appropriate hospital for a critically ill patient cannot be quickly identified.

People Power Party lawmaker Lee So-hee speaks during an interview at the National Assembly in Yeouido, Seoul. [Lim Se-jun]
People Power Party lawmaker Lee So-hee speaks during an interview at the National Assembly in Yeouido, Seoul. [Lim Se-jun]

mp1256@heraldcorp.com