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Busan Metropolitan City to End the Emergency Room “Runaround”: Tailored Response Strategy by Emergency Patient Type and Severity

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Busan Metropolitan City (Mayor Park Heong-joon) announced that, to resolve the “emergency room runaround” caused by refusals to accept patients and delays in transporting patients, it has established a tailored response strategy by emergency patient type and severity and plans to pursue multiple policy measures in parallel.

To strengthen rapid, specialized treatment capacity for severe trauma patients, the City will pursue the designation of two regional trauma hub hospitals. In addition, for acute drug intoxication patients—who have repeatedly experienced prolonged emergency room stays and refusals to accept patients—the City will introduce an “Acute Drug Intoxication Sequential Care System” as a new project this year.

With the shared policy goal of enabling emergency patients to be accepted promptly, the two initiatives focus on structurally reducing the likelihood of the “emergency room runaround.”

As the first response measure, the City will pursue the designation of two regional trauma hub hospitals and will hold a public call for selecting a subsidized project operator from today (the 22nd) through February 5.

Among medical institutions capable of providing 24-hour trauma emergency care, the City will select those equipped with core infrastructure and operational capacity, including trauma care personnel, facilities, and equipment, and will establish a “Busan-style trauma emergency medical system” so that, when severe trauma cases occur, timely and appropriate treatment can be provided.

Regional trauma hub hospitals will be responsible for initial treatment and stabilization for severe trauma patients and, when necessary, will ensure continuity of care through rapid linkage with the Busan Regional Trauma Center.

Through consultations with the Busan Regional Trauma Center, the City will establish role-sharing and a coordinated linkage system: regional trauma hub hospitals will handle initial response and stabilization for severe trauma patients, while the regional trauma center will provide definitive care, including highly complex surgery and intensive care.

Through these efforts, the City expects to reduce transport delays and refusals to accept severe trauma patients and to help alleviate overcrowding at the regional trauma center.

As the second strategy, the City has introduced a severity-based “sequential care system” for acute drug intoxication patients.

This patient group has wide variation in severity and often requires linkage to psychiatric care, making it a representative emergency condition group with frequent refusals to accept patients and repeated transfers.

Accordingly, the City established a sequential transport-and-treatment system by categorizing institutions into severe-care institutions and mild-care institutions based on patient severity.

This project is led overall by the City and the Busan Emergency Medical Support Center, with participation from the Busan Fire and Disaster Headquarters and nine local emergency medical institutions.

Transport will be carried out based on on-site severity triage by 119 EMS crews and hospital selection by the Emergency Medical Situation Control Center. After emergency treatment, follow-up management will also be supported, linked to the Mental Health Welfare Centers in the 16 districts and counties, depending on the patient’s condition.

Participating emergency medical institutions:

• ●(Severe-care institutions: 3) Inje University Haeundae Paik Hospital, Inje University Busan Paik Hospital, Pusan National University Hospital

• ●(Mild-care institutions: 6) Kosin University Gospel Hospital, Busan Medical Center, Daedong Hospital, Dongnae Bongsaeng Hospital, Busan St. Mary’s Hospital, Good GangAn Hospital

Through these two initiatives, the City expects practical effects in addressing the “emergency room runaround,” including reducing delays in patient transport and refusals to accept patients, strengthening functional role-sharing among medical institutions by emergency patient type, and increasing the concentration of treatment for severe patients.

In addition, during project operations, the City plans to systematically collect and analyze data related to transport, acceptance, and treatment and to use it as evidence for future policy improvements to the Busan-style emergency medical system.

Jo Gyu-yul, Director General of Citizen Health Bureau at Busan Metropolitan City, said, “The emergency room runaround is a structural challenge that is difficult to solve with a single project, and it requires a systematic response tailored to emergency patient type and severity,” adding, “Busan Metropolitan City will pursue customized policies in parallel to ease refusals to accept patients and delays in patient transport and will work to create an emergency medical environment where citizens can receive treatment quickly.”