Emergency medical technicians such as 119 paramedics, smart medical instruction pilot business
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.
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.
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
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)
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
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
- Improvement proposal
- Business plan
- Finalization of business regions
- Education for new human resources
- Implementation of continuous project
- 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.
Roles and organizations
Contents of execution for each step