[비즈한국] Amidst the difficulties in emergency medical services caused by the exodus of emergency room staff, it has been revealed that 'emergency medical directors,' who are responsible for supervising, evaluating, and providing medical guidance for ambulance operations, are also facing operational disruptions due to staffing shortages. According to data from the National Fire Agency, monthly visits by emergency medical directors were suspended at over 20 fire stations nationwide from March to August, the period following the mass resignation of resident doctors. This has sparked calls to increase the service allowance, which has been frozen for 11 years, and to redistribute responsibilities with receiving hospitals.
Number of Fire Stations With Suspended Services More Than Double Compared to Pre-Crisis Levels
Under the Act on 119 Rescue and Emergency Services, emergency medical directors perform education and training for paramedics, as well as guidance and evaluation of emergency activities. These roles are primarily filled by emergency medicine specialists, and each fire agency is required to appoint or commission at least one emergency medical director. These directors also perform 'direct medical guidance,' where they provide instructions on patient treatment to paramedics via voice or video calls from city and provincial fire headquarters' emergency situation management centers. Previously, '1339' provided medical guidance, but following criticisms that the dual numbers could cause public confusion, the function was transferred to '119' and integrated into the emergency situation management centers in June 2012.
However, the emergency medical directors, consisting of emergency medicine specialists, are also suffering from a recent labor shortage. According to data on 'Appointment and Work Status of Emergency Medical Directors' received by Representative Yong Hye-in of the Basic Income Party (a member of the National Assembly's Public Administration and Security Committee) from the National Fire Agency on the 2nd, monthly visits by these directors were suspended at over 20 fire stations under the Gangwon, Chungnam, Jeonnam, Gyeongbuk, and Jeju Fire Headquarters from March to August. By month, the number of stations with zero visit days was 27 in March, 36 in April, 28 in May, 26 in June, 26 in July, and 27 in August. This is more than double the figures from January (11) and February (11), the period just before the medical crisis.
According to the National Fire Agency, the reasons for these absences were cited as 'absence due to collective action by doctors' and 'medical staff shortages.' In Gangwon-do, it was confirmed that three out of 14 emergency medical directors resigned this year alone. While emergency situation management centers, which operate in 12-hour shifts, have two directors each in high-demand areas like Seoul, Gyeonggi, and Incheon, other regions are struggling with only one, despite having to cover populations numbering in the millions.
Opinions Divided on Solutions: 'Increase Allowances' vs. 'Change Work Methods'
Frontline medical staff rely heavily on the assistance provided by emergency medical directors. Professor A, an emergency medicine specialist at a hospital in the capital region, explained, "Since paramedics are not medical doctors, they tend to rely on and trust the emergency medical directors. When these dedicated personnel provide consultation, it makes it easier for specialists at receiving hospitals to grasp the patient's condition, and they don't have to shoulder all the responsibility themselves. It also reduces waiting times for medical institutions." He added, "Due to staff shortages, it is difficult for receiving hospital specialists to take phone calls while treating patients. I believe it is more helpful to the field for emergency medical directors, who are not currently occupied with patient care, to take charge of medical guidance."
Low compensation is cited as a reason for the exodus of emergency medical directors. These directors receive 400,000 won for a daytime 12-hour shift and 500,000 won for a nighttime shift. The allowance has been frozen since 2013. With the recent sharp increase in workload, many emergency medicine specialists are choosing to focus on emergency room shifts rather than these roles. Some argue that money is not the only issue. Specialist B in the Gyeongsang region pointed out that the work method needs improvement rather than just the allowance, stating, "It seems like there is a lot of work right now because it's a special period, but before this, there was no shortage of people willing to take the role just to answer a few phone calls for 500,000 won."
Under current law, emergency medical directors must submit evaluation results of their fire agency's paramedic activities to the fire station chief every month. These evaluations are usually based on logs written by paramedics, which makes it difficult to determine if appropriate emergency care was actually provided. Emergency medicine specialist B stated, "It is impossible for doctors at receiving hospitals or emergency medical directors to assess the quality (of emergency care) just from written papers. Some even bring six months' worth of logs long after the fact, asking for an evaluation. There is no way to know if they wrote something contrary to the facts." He added, "It would be more desirable for medical staff at the receiving hospital to provide the consultation directly."