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Emergency medical technicians such as 119 paramedics, smart medical instruction pilot business

Promotion Background

Provision of prompt and appropriate medical treatment to emergency patients is a prerequisite for the recovery of patients
  • Expansion of the range of duty of emergency medical technicians can be considered for 119 paramedics, such as use of medication, etc., but in this case, measures to guarantee the medical security are needed.
  • The current '119 Paramedics On-site First Aid Standard Guidelines' prescribe that paramedics must transport patients after practicing CPR for at least 5 minutes, excluding the time of report.
    • In actuality, paramedics practice CPR at the scene for approximately 6 minutes, which results from the fact that paramedics are expected to quickly transport patients to a medical institution as opposed to carrying out actions on site.
  • According to the current Medical Act/Emergency Medical Service Act, emergency medical technicians are medical personnel, and they can only practice first aid within a limited range of duties with doctors' orders.
    • This is based on the intent that places emergency medical technicians somewhere between ordinary people and medical personnel and only lets them conduct treatments required for life support (airway maintenance, CPR, etc.) when it is difficult for a doctor to directly and comprehensively diagnose a patient’s condition due to geographical and physical limitations, so that using medication and other invasive measures that need professional judgment can be conducted after the patient arrives at a medical institution and medical personnel check the patient's condition.
    • However, advanced countries put efforts into promptly providing professional medical treatment in case of emergency by letting emergency medical technicians of a certain qualification inject medication or conduct advanced cardiovascular life support (ACLS) under medical direction (U.S.A.) or by having a doctor in the ambulance upon dispatch (France, Germany).
The following elements should be improved in Korea for professional emergency treatment to be provided from the very first step at the scene:
  • A change in the existing role of emergency medical technicians (paramedics) that aim for fast arrival and fast transport,
  • Enhancement of the ability of emergency medical technicians (paramedics) to conduct emergency treatment for main diseases at the scene,
  • Enhancement of the guidance, role, and competency of professional medical personnel regarding medical treatment, and
  • Establishment of feedback and an appropriate evaluation system for results afterwards.

Business contents

Establishment of a “base hospital-type medical oversight system” focused on local and regional EMS centers and enforcement of pilot business to vitalize direct medical oversight combined with smart devices

After establishing a hotline between ER doctors at medical oversight base hospitals and emergency medical services, paramedics conduct medical treatment under the guidance of a doctor via video in case of emergency (expanded medical treatment and simple treatment will follow protocol and base hospitals will thoroughly conduct training and education in advance)


Treat patients by sending a patient’s condition via images using wearable smartphones.

Guidance doctor

Guide paramedics from hospitals using hotline smartphone with high-definition video call app.
* Using exclusive application that has better image quality compared to general video calls and better phone connection

Target hospital

Conducts public offering to local and regional EMS centers as base hospitals
Proceed by affiliating with fire stations in the corresponding region (at least one station)

구급대원과 지도의사 간의 스마트 기기를 활용한 환자상태 정보 공유
거점병원을 중심으로 여러 협력병원과 소방서 구급대간의 연계 형태
According to Article 44 of the Framework Act on Health and Medical Services (pilot projects of health and medical services), a pilot project for health and medical services will be conducted from 2015 that will introduce the following elements targeting patients with cardiac arrest: let the emergency medical technicians carry out emergency treatment, such as ACLS, within the expanded range of duties of emergency medical technicians during the pilot project period.
  • A team-system method (or multiple dispatch system) will be implemented upon the dispatch of emergency medical technicians (paramedics) to the scene.
  • Establishment of a hotline between competent guidance doctors and team leaders of emergency medical technicians
  • Expansion of the range of utilization of paramedics’ bodies by distributing wearable video calling devices
  • Guidance doctors directly check the scene and provide guidance with smart devices
  • Emergency medical technicians (paramedics) conduct ACLS under the direction of a doctor

Business goal

To contribute to the improvement of the survival rate of emergency patients by providing active emergency treatments at the scene.

Business promotion plan

2015 pilot projects (trial operation targeting regions with institutions that applied for participation) → Evaluation (current status of business promotion, solving problems) → Expansion of business regions in 2016 → Evaluation (examination of nationwide expansion, etc.) project through the analysis of business achievements → This pilot project has prolonged for another year

  • Prior preparation
  • Selection of participating institutions
  • Selection of operating company
  • Human resources education
  • Operation of committee
  • Distribution of equipment
  • Establishment of system
  • Establishment of committee
  • Development of education program
  • Work agreement
  • Implementation of original project
  • Evaluation
  • Improvement proposal
    • Expansion of regions
  • Business plan
    • Finalization of business regions
  • Education for new human resources
  • Implementation of continuous project
  • Evaluation
  • Examination of phased expansion

Business promotion policy

  • To concentrate on the construction of a system to improve the survival of emergency patients by providing active emergency treatment at the scene.
  • The Ministry of Health and Welfare establishes a project plan and handles everything that has to do with the business. The National Medical Center handles everything that has to do with performing business including planning, education, administration, and data management.
  • Receive letters of intent for business from local and regional emergency medical centers. After reviewing and discussing their business plans, the Ministry of Health and Welfare integrates the target candidates and finalizes the business method.
  • Ensures the internal stability of the business by providing administrative and financial support to the institutions participating in the pilot project.
  • To deliver the situation of the scene in real time with a smartphone, etc. to overcome geographical and physical limitations upon the occurrence of patients with cardiac arrest and conduct active and professional treatment of patients at the scene in accordance with a doctor’s professional judgment.
  • To develop and distribute a business management system so that regional data management and evaluation can be realized.

Business promotion system

  • The National Medical Center (National Emergency Medical Center) is the main agent of business promotion and the Ministry of Health and Welfare and Ministry of Public Safety and Security provide administrative support.
  • For the smooth promotion of the business, a business promotion committee and advisory committee are established. The business promotion committee is subdivided into an operational committee, a working-level education committee, and a regional committee for each base.
  • Once the business promotion committee is established, a pilot project consignment contract will be signed targeting the base hospital to which the head of the committee belongs and parts of business operational issues such as a budget will be entrusted (including the issue regarding the operation of the working-level education committee).
    • Once the regional committees are established, pilot project consignment contracts will be signed targeting the regional base hospitals and parts of business operational issues such as budget will be entrusted.
119구급대원 등 응급구조사 스마트 의료지도 시범사업 관련 추진체계
Roles and organizations
Roles and organizations
Classification Roles & responsibilities
MHW (Division of Emergency Healthcare)
  • Establishing business plan and taking overall control of the business
  • Supporting budget, adjusting tasks, and consulting among departments
MPSS (119 Rescue and EMS Bureau)
  • Mediating tasks and cooperating among regional fire stations regarding paramedics training, etc.
  • Co-op regarding the execution of project on site
NME (NEMC) EMS Informatization Planning Team
  • Overall control in the execution of project
  • Planning, education, administrative support, data management, etc.
  • Ordering service business, selecting business operators and managing project execution
EMS Research and Planning Team
  • Supporting research statistics
Business Promotion Committee
(medical institutions participating in project, fire stations, etc.)
  • Working-level consultation such as project execution plan, operation, etc.
  • Operating regular meetings for participating institutions
  • Conducting research and developing manual and educational materials
  • Conducting education for medical oversight doctors and paramedics in each region
  • Drawing project result report
Advisory Committee (experts such as the Korean Society of Emergency Medicine, etc.)
  • Regular reviews of the status of the execution of the project
  • Consultation on other issues regarding execution of the project
Participating medical institutions (medical oversight doctors)
  • Medical oversight for paramedics’ on-site activities
  • Participating in the business cooperation agency
119 paramedics
  • Carrying out on-site rescue activities under the guidance of medical oversight doctors
  • Participating in the business co-op agency
Business executing companies
  • Establishing smart medical oversight Information system
  • Technical support for system operation
Contents of execution for each step
Contents of execution for each step
Step Measures Required competence
Prior preparation education and training
  • Establishment of business promotion committee (education and training focusing on the participating institutions, preparing for details in business operation, in charge of business)
  • Understands the intent of business and establishes and operates network
  • Selects a 119 emergency service with enough manpower and equipment
  • Checks the required manpower and will to participate (paramedics)
  • Prepares for site protocol and conducts education/training
  • Prepares for education and site business protocol (guidance doctor)
    (Takes lead in developing education protocol through the promotion committee)
Establishment of equipment and system
  • Introduces wearable equipment
  • Prepares measures for receiving and sending data and method for storing and managing data
  • Improves equipment
  • Data sending, receiving, and storing technology
Contents of execution for each step2
Reporting patient assumed to have cardiac arrest
  • Moves out to the scene in accordance with 119 paramedic’s order when the patient is assumed to have cardiac arrest.
  • Ability of 119 paramedics to judge cardiac arrest
  • Two ambulances (or two vehicles that can provide emergency service at a similar level) with at least four paramedics are dispatched at the same time.
  • Emergency service manpower needed for dispatch
Arriving on the scene
  • Injects oxygen and checks patient’s electrocardiogram rhythm
  • Oxygen injecting device and vital sign monitoring device
  • When it’s assumed to be cardiac arrest, conducts ACLS after reporting to medical oversight doctor
  • Ability to decide on conducting CPR
Conducting CPR
  • Conducts ACLS and reports patient’s condition in real time (using wearable devices and smartphone)
  • Ability of circumstantial judgment and medical delivery (paramedics)
  • Manpower that can always respond when requested (guidance doctor)
  • Use medicine/defibrillator when needed in accordance with protocol (injections in accordance with guidance doctor’s judgment and order)
  • Ability to practice ACLS (paramedics)
  • Appropriate circumstantial judgment and ability to provide guidelines (guidance doctor)
  • Completes on-site CPR and decides to transport
  • Ability to judge medical situation
  • Transports to hospital by conducting patient monitoring and needed treatment
  • Ability to provide treatment during transport
Contents of execution for each step3
Evaluation and repetitive education
  • Records images of the site situation and provides feedback on matters that need to be supplemented
  • Records and stores the site situation, feedback
  • Regular protocol repetitive education/training
  • Customized repetitive education program for each team