‘Covid-19 reveals urgent need to reform ER operation’

Song Soo-youn  Published 2020.05.25  17:01  Updated 2020.05.25 17:01


Since the outbreak of Covid-19, the number of patient visits to the emergency room (ER) has gone down apparently because of fears of viral infections. As patients with mild symptoms shun ER visits, local ER centers have been finally relieved from overcrowding, some said.

However, others raised concerns about the ER's fundamental problem, pointing out that the number of patients who died at ER or death-on-arrival (DOA) cases has increased since Covid-19.

Healthcare experts exchange views at a YouTube show by K-Healthlog on Friday, a channel operated by The Korea Doctors’ Weekly. From left are Lee Wang-jun, chairman of Myongji Hospital, Professor Wang Soon-joo of Hallym University Dongtan Sacred Heart Hospital, Professor Heo Tag of Chonnam National University Hospital, and Professor Kim In-byung of Myongji Hospital.

Emergency medicine specialists said the local emergency medical system needs an overhaul to respond well to infectious diseases, in light of the Covid-19 outbreak.

On Friday, the Korean Society of Emergency Medicine (KSEM) and The Korean Doctors’ Weekly held an online panel discussion at a YouTube show “Corona Fighters Live” by K-Healthlog, a channel operated by The Korean Doctors’ Weekly.

At the show, experts said Korea needed to overcome the weakness of the emergency medical system, revealed by Covid-19.

According to KSEM, patient visits to ER at hospitals in Gyeonggi Province in February and March marked only 57-73 percent of those recorded during the same period last year. However, the number of patients who died at an ER or pronounced dead before the ER arrival went up during the same period.

It analyzed patients at 10 regional emergency medical centers and severe emergency medical centers in Gyeonggi Province.

The number of patients transferred by an ambulance in February and March declined 12 percent to 9,554, from 10,833 a year earlier. During the same period, patients who walked themselves into an ER plunged 34 percent.

On the contrary, patients who died after an ER arrival or who arrived at the ER after death jumped 27 percent to 378 in March from 298 a year earlier. The data needed some adjustments, but the numbers were meaningful, the KSEM said.

“The numbers reflect patients’ psychological state that they feared to go to the hospital. We experienced this during the MERS (Middle East Respiratory Syndrome) outbreak,” said Wang Soon-joo, head of the KSEM’s Emergency Medicine Future Research Institute (Hallym University Dongtan Sacred Heart Hospital).

KESM needed to analyze further whether the cause of the increase in ER deaths was Covid-19 or others, Wang noted.

However, it was true that it was difficult for an ambulance driver to find a hospital for a patient with respiratory symptoms. KESM had other data showing that the time of patient transfer increased longer than a year earlier.

“We could assume that such a prolonged situation could affect the survival rate of emergency patients or the occurrence of complications,” Wang said.

He emphasized that the current emergency medicine system was vulnerable to infectious diseases.

If a disease similar to Covid-19 spreads, it would overwhelm the system, he warned.

“The nation upgraded the emergency medicine system during the MERS outbreak, but we need to re-distribute manpower and re-organize structure,” Wang said. “As ER staff has to move around various spaces, including isolated space within an ER and isolated testing facilities, we need to make sure that they are free from possible infections.”

After the MERS outbreak in 2015, the Ministry of Health and Welfare supported hospitals to install negative pressure rooms within ER centers, according to Wang.

Hallym University Dongtan Sacred Heart Hospital received over 100 million won ($80,378) government support to establish three negative pressure rooms at its ER. Still, the hospital also had to spend an additional 400 million won, he said. Due to such high cost, most hospitals are using general quarantine rooms within the ER, not the air-tight negative pressure rooms, he added.

KESM Chairman Heo Tag (Chonnam National University Hospital) criticized the health authorities for excluding emergency medicine when responding to infectious diseases.

Korea has made various efforts since the MERS outbreak, but the government’s measures were centered on experts in infectious disease and preventive medicine only, he said.

“When you get suddenly ill, ER is the first place you visit. If emergency medicine collapses, the local medical system could collapse. Emergency medicine should not be excluded from policy responses to infectious diseases,” Heo emphasized.

Another expert pointed out that the government needed to streamline the reimbursement system so emergency medicine departments could respond to infectious diseases.

Lee Wang-jun, chairman of Myongji Hospital and the leader of the Working Group of the Korean Hospital Association's Covid-19 Emergency Response Headquarters, said it was difficult to completely separate negative pressure rooms from other space, or rooms for caring patients with an infectious disease from others, within an ER.

Thus, when a Covid-19 suspected patient needs urgent surgery, medical staff should wear protective gear and perform surgery in a negative pressure room, he said.

“The cost of an operation on a Covid-19 suspected patient and the cost under a normal circumstance are different. It doesn’t make sense that the hospital gets the same reimbursement for the surgery,” Lee said.

In case of an outbreak of infectious disease, the government should provide additional “disaster reimbursement” so that hospitals can put infections under control, he added.

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