Emergency medical services system

Essential constituents for the construction of EMSS

The constituents of an EMSS might be added or deducted in accordance with changes in the medical environment, and certain constituents can be supplemented or emphasized through evaluation and analysis of the management. In modern times, the demand for high quality professionalized emergency medical services has increased. It is now in a phase where it has moved beyond EMSS construction and is evaluating and reinforcing the weak points for each constituent.

Constituents of EMSS

  • 01. Education and training
  • 02. Telecommunications
  • 03. Out-of-hospital transport agencies
  • 04. Inter-facility transport agencies
  • 05. Receiving facilities
  • 06. Specialty care units
  • 07. Report registration and response, dispatch
  • 08. Public information and education
  • 09. Audit and quality improvement
  • 10. Disaster management plan
  • 11. Mutual aid
  • 12. Protocols
  • 13. Financing
  • 14. Physician medical oversight
1. Manpower
Constituents of EMS Provider
Constituents of EMS Provider
Classification Main tasks
Pre-hospital phase  
Initial responder Practices the first emergency treatment until emergency medical personnel arrives
Emergency medical technician First-level emergency medical technician Report registration, call consultation, on-site treatment, transport tasks
Second-level emergency medical technician
In-hospital phase Judge the level of severity (triage), hospital transfer or public institutions
Emergency nurse practitioner Preparing documents, lecturer on emergency-related education, computer work regarding emergencies
Emergency medicine specialist Treating patients, medical oversight, education, research, evaluation, management, etc.
Emergency Medical Center medical team Emergency examination, treatment assistance
Comparison of level and education term or total time for emergency medical technicians by country
Comparison of level and education term or total time for emergency medical technicians by country
Level Education course
Korea Paramedic Completion of 2-week fire station first aid education
second-level emergency medical technician 330 hours
first-level emergency medical technician Completion of 3- or 4-year-course college program
USA EMT-A(Basic) 81-140 hours
EMT-I 110-1,000 hours
EMT-P At least 1,000 hours
Japan Paramedic Paramedic course II 115 hours
Paramedics course I 135 hours
First aid rescuer 1,135 hours

Manpower in the EMSS field is classified into first responder and emergency medical technician (EMT) in the pre-hospital phase, and emergency medical specialist, emergency nurse practitioner, and medical staff in the in-hospital phase.

Among civilians (lay persons or lay rescuers), police officers, and public service workers, those who have completed a first aid course provided by the government or emergency medical service institutions can be a first responder.
EMTs are the main manpower in the practice of emergency medical treatment in the pre-hospital phase, and the classification of levels or the terms might differ in each country. The education course or performance tasks differ in accordance with the levels, and the levels can be further subdivided.
Since there is no limit in the workplace of EMS personnel in each field, emergency medical specialists or emergency nurse practitioners can practice in the pre-hospital phase and emergency medical technicians can also work at emergency medical service centers.

2. Report registration and response (dispatch)

The response to a report is a medical oversight task to order the dispatch of paramedics, find a hospital, consult about emergency medical treatment, or guide the code of behavior until paramedics arrive at the scene.
An EMSS can be accessed by phone with different numbers in each country (911 in the USA, 999 in the UK, 02 in Russia, 114 in Italy, 119 in Japan, etc.).
The access method for using an EMSS is a report which is registered by phone. In Korea, paramedics can be accessed by dialing 119 and the police can be accessed with 112.

3. Education and training

People that usually first encounter patients are their families. A range of education is required for various types of jobs, from CPR (basic CPR and wound resuscitation) for civilians (lay persons), education courses and supplementary education for civil servants (police officers, people working in emergency medical service information centers and health service fields) and people working in the EMS field to mock training by setting up virtual situations. So the development of education programs appropriate for the level of each type of occupation and securing lecturers is important for efficient education.
As a huge amount of the national budget would be needed to employee human resources equipped with certificates after completing the education courses needed for each field of the EMSS, it is more appropriate to develop manpower through the self-education system of the EMSS utilizing professional academic bodies related to it.
The appropriateness of the implemented education will be evaluated frequently and the results will be analyzed to give feedback for matters to be improved and to meet the expected value.

4. Telecommunications system
우리나라 응급의료정보ㆍ통신체계 모식도

In order to provide high-quality EMS, each constituent and administrators of the EMSS needs to be made one complete organism. The telecommunications network is in charge of that task. The constituents of a communications system for EMS are:

1. Access

2. Report registration and call consultation (dispatch)

3. Medical oversight

Both landline and wireless are possible, but landline is mainly used
As the use of cellular phones has become widespread these days, they can be useful in an emergency situation. Not only does the construction of an information system using a computer communications network enable the expansion of the range of duties possible with communications, it also serves as a momentum for enhancing the quality of EMS. Since the information collected for each constituent of EMS through a computer communications network can be used in research, evaluation materials, medical oversight, etc., the construction of a stable telecommunications network is essential for leaping toward an advanced EMSS.
The EMS telecommunications network in Korea is being constructed in connection with the 119 emergency rescue of fire stations and EMS institutions centering on emergency medical service information centers. The NEMC is in charge of guidance and supervision regarding the construction and management of the emergency medical service telecommunications network.

5. Transport issues

The transport of emergency patients can be divided into out-of-hospital and inter-facility transport. The patient transport system is composed of transport means, boarding crew, emergency medical service institution, and telecommunications.
Examples of transport means would be land transport (ambulance), air transport (aircraft, helicopter), and marine transport (rescue boat). Air transport is used for mountain or island regions where transport to an EMS institution takes a long time or transport via a land route is difficult. In nations or regions composed of neighboring islands, marine transport is used a lot.
In Korea, general and special ambulances are in operation in accordance with the level of severity of the patient. In the case of the USA, three types of standardized ambulances are in operation.
Air transport in Korea mainly uses the fire-fighting helicopters of fire defense teams and rarely military helicopters from nearby military bases.
The 119 emergency rescue is in charge of transporting patients in the pre-hospital phase, and hospital ambulances or pay ambulances operated by private transport companies are mainly used for inter-facility transport. In principle, the closest EMS institution appropriate for emergency medical treatment will be chosen as the receiving hospital in accordance with the severity of the patient.
When professional treatment such as emergency surgery or cardiac/cerebral angiography is required, the patient should be instantly transported to an EMS institution that can provide such treatment. The information regarding medical oversight for providing treatment during transport or information regarding the receiving hospital should be acquirable through the telecommunications network between the ambulance and EMS institution.

6. Emergency medical service institution (receiving facilities)

The ERs in EMS institutions must be equipped with the manpower, facilities, and equipment to provide 24-hour medical treatment for emergency patients.
They should also have telecommunication devices with which ambulances and EMS information centers can share information and ambulances needed for transport.
The ER is a part of in-hospital phase in the EMSS and should be designed in a structure appropriate for practicing emergency medical treatment such as disease on the basis of severity rooms and recovery rooms.
The EMS institutions are normally classified in accordance with the possibility of using available resources or specialty care. The government evaluates the ERs in each medical institution in accordance with regulations, designates competent ones as EMS institutions, and assigns them with proper tasks considering the local population and balance with neighboring regions.
In order to continuously improve the level of EMS institutions, a standardized evaluation guide that can evaluate the appropriateness of EMS should be developed and the evaluation of each EMS institutions and budget support should also be provided.
Currently, the Korean government has established a medium- and long-term plan for the completion of an emergency medical specialist treatment system, improvement of the standard of ER staff, and advancement of facilities and equipment to evaluate EMS institutions every year and provide budget support accordingly.

Number and functions of EMS institutions in Korea (20 March 2018)
Number and functions of EMS institutions in Korea (20 March 2018)
Number of EMS institutions Functions
NEMC (1 place)
  • 1. Evaluation of emergency medical institutions, etc. and support for activities that improve the service quality
  • 2. Education and training for emergency medical personnel
  • 3. Coordination among regional emergency medical centers under Article 26, and support therefor
  • 4. Research related to emergency medical services
  • 5. Coordination and support for duties related to emergency medical services during a disaster, etc. in Korea or overseas
  • 6. Management and operation of the emergency medical services telecommunications network
  • 7. Other duties related to emergency medical services prescribed by the Minister of Health and Welfare
Regional EMC (36 places)
  • 1. Treatment of emergency patients
  • 2. Support of emergency medical services during a large disaster
  • 3. Education and training for emergency medical service workers within the region prescribed by the Minister of Health and Welfare
  • 4. Other duties related to regional emergency medical services
Professional EMC (4 places)
  • 1. The Minister of Health and Welfare may designate professional emergency medical service centers for each field among general hospitals for emergency medical treatment for patients with wounds, burns, poisoning, etc. after consulting with mayors and governors.
Local EMC (117 places)
  • 1. The mayor or governor designates regional emergency medical centers among general hospitals and operates them in order to provide appropriate emergency medical services to the local residents.
Local EMS institution (258 places)
  • 1. The mayor, governor, or head of a district designates regional emergency medical centers among general hospitals and doctor’s offices and hospitals according to Article 3 (2)-1 of the Medical Service Act to provide appropriate emergency medical services to the local residents.
7. Professional emergency medical facilities (specialty care)

If there is no professional emergency medical service institution for patients with special diseases or damage that require special facilities, space, and medical specialists in the EMSS field, trouble might occur in the selection of a receiving hospital or transfer between hospitals and appropriate emergency medical treatment is not possible.
In addition, it might affect the establishment and development of an EMS plan in the future as it is difficult to collect information on the frequency or prognosis of the occurrence of patients. Professional EMS institutions should be established in regions with a high repetition rate and have great accessibility by conducting examinations of the repetition rate and mortality of patients in advance. A standardized site or transport transfer protocol should also be developed in order to efficiently manage EMS institutions.
There are currently two professional emergency medical service centers in Korea and the number is expected to increase.

8. Public information and education

Information for the public is composed of a proper approach to the use of EMS, first aid methods, and how to prevent injuries and disease. Such education is a significant element in an EMSS in that it reduces the use of unnecessary EMS and maximizes the efficiency of the EMSS. It would be appropriate for the government to revitalize the public emergency medical education (first aid, CPR, etc.) about the EMSS and promote prevention methods (fastening safety belt, wearing safety hat, etc.) and emergency medical service-related information (seasonal spread of flu and infectious diseases, awareness of food poisoning, etc.) regarding preventable injuries and diseases through media (television, radio, newspapers, etc.).

9. Audit and quality improvement

In order to improve the EMSS, the administration should constantly and regularly conduct quality evaluation and quality improvement activities regarding medical accountability and appropriateness, and the cost effectiveness of every constituent of the EMSS. To realize that, a standardized evaluation standard for report registration and consultation (dispatches), responses, field assessment and emergency treatment, and hospital outcome should be developed.
Not only does the construction of a computer information network make such work easier, it also helps improve the EMSS. The evaluation should define the managerial problems in the EMSS and provide improvement measures and be used in providing feedback, as opposed to pointing out individual mistakes.

10. Protocols

The protocols for EMS are used to set a standard that must be practiced in certain situations. The protocols are developed not only for the medical field but also for managers or administrative personnel in the EMSS. The protocols for EMS are mainly about the standards for triage, treatment, transport, and transfer. An emergency medical service manual can be divided into protocols that can be applied to both direct and indirect medical oversight and standing orders developed for indirect field medical oversight, but standing orders are more of a subset of protocols. In other words, with protocols, one may need the permission of a guidance doctor before conducting emergency treatment for one item, but with the standing orders, one can conduct phased emergency treatments without previous permission from a guidance doctor.
However, if the emergency medical service provider’s communication with a guidance doctor is blocked at the scene, the provider should conduct phased medical treatment on his or her own in accordance with the protocols of standing orders, and such authority should be guaranteed by law.

11. Medical oversight

Medical oversight is a duty conducted to improve the quality of EMS by being granted with certain authorities and responsibilities within the legal boundaries. In the EMSS, medical oversight ranges from guidance and education on the initial field emergency medical treatment to the management of the EMSS, performance assessment of EMS, and development of protocols.
Medical oversight is usually realized when doctors with lots of experience in emergency medical services, emergency medicine specialists, high-ranking emergency service technicians or nurses conduct emergency medical services under the supervision of a doctor, and the supervisor is legally responsible for the emergency medical treatment conducted by the field emergency medical service provider.
Medical oversight can be largely divided into direct and indirect M.O. Direct M.O. refers to when a medical guidance doctor (MO physician =EMS physician=medical director) is dispatched to the scene with paramedics and conducts emergency medical treatment or conducts medical orders via landline or wireless communications. Indirect M.O. is more comprehensive and refers to all medical oversight that is not direct M.O.

12. Financing
Establishment of an emergency medical services fund (Emergency Medical Service Act, revised on Aug. 24, 2011)
Establishment of an emergency medical services fund (Emergency Medical Service Act, revised on Aug. 24, 2011)
  • 1. An amount subsidized pursuant to the National Health Insurance Act from among the amounts collected from medical institutions as a penalty surcharge by the Minister of Health and Welfare in lieu of the suspension of their services under the National Health Insurance Act
  • 2. Contributions and donations by institutions and organizations related to emergency medical services
  • 3. Contributions by the Government
  • 4. Proceeds from the operation of the Fund
  • The Government shall appropriate the amount of its contributions under paragraph (1) 3 equivalent to 20/100 of the expected revenue for expenditures in the budget for each fiscal year under the following subparagraphs: <Amended by Act No. 9305, Dec. 31, 2008> ① Administrative fines under Article 160 (2) and (3) of the Road Traffic Act (limited to fines imposed and collected by the commissioners of provincial police agencies pursuant to Article 161 (1) 1 of the same Act)
    ② Penalties under Article 162 (3) of the Road Traffic Act

In order to improve and develop the EMSS, various businesses must be promoted and available funds must exist. The guarantee of funds is usually based on a tax system, collection of service fees for EMS, and raising donations. One specific method for securing financing would be that the government contributes parts of a tax system (alcohol tax, tobacco tax, etc.), additional license registration money, and various penalties as donations.
The establishment and management of funds are usually defined by law. In Korea, financing is secured under Article 20 of the Emergency Medical Service Act and is being used in paying back uncollected amounts, supporting EMS institutions, and promoting various businesses for the development of EMS.

13. Mutual aid

A mutual aid system (plan) must be well established, through which human and material resources can be supported from neighboring regions when a disaster or big accident that cannot be resolved with local emergency medical resources occurs or there exists no special equipment needed for emergency rescue in that region.
In general, mutual aid is composed of orders from the government or a memorandum of understanding for cooperation among neighboring regions which are followed by financial support from the government.

14. Disaster planning
Essential items and contents of disaster planning
Essential items and contents of disaster planning
Essential items Contents
1. Activity Standard for selecting regions that will conduct EMS, organization of departments and personnel, protocols
2. Education Disaster summary, prevention, and individual protocols for each department in case of disaster
3. Regular drill Conducted at least twice a year in regional units considering the characteristics of each region
4. Response Registration of disaster report, notification, dispatch

Since most disasters or big accidents are accompanied by lots of casualties, it is essential to establish a lifesaving plan in disaster planning. This plan is established by local disaster-related agencies (public agencies, EMS institutions, voluntary groups, etc.) considering regional characteristics based on the existing EMSS of that region. When the lifesaving plan is submitted, the administration department reviews and consults it and affiliates it with disaster planning in other fields to provide comprehensive disaster planning for the nation or region. Each EMS institution is to establish an emergency plan in preparation for internal disasters and conduct regional joint or self-emergency preparedness training. In addition, a plan to store supplies, especially medicine and medical equipment, in preparation for disasters should be established and prepared with the support and management of the government.