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First-aid medical systems are out of whack

Posted March. 31, 2023 08:10,   

Updated March. 31, 2023 08:10


Even within one minute, which you may not even notice passing, emergency patients can stand at the crossroads of life and death. Undoubtedly, it must be one of the worst nightmares for their families who desperately pray for a miracle. It may feel as if the misery will last forever while they are overwhelmed by the fear of losing their beloved ones in the worst-case scenario.

The terrifying time of one minute occurred to Lee Jun-gyu, 13, and his mother, Yun-yeong, on Dec. 8 last year. Having no idea that a brain hemorrhage was killing her son’s brain cells, she had no option but to watch dispatchers calling eight ERs to ask to take in the bleeding boy.

On Oct. 25 last year, Park Jong-ryeol kept pleading for help. Even while he was suffering excruciating pain in his leg, as many as 23 medical centers rejected an operation to put the broken vessels together. The Dong-A Ilbo's Hero Content Team tracked down every minute of the 228 minutes and 378 minutes during which Jun-gyu and Jong-ryeol, respectively, were left untreated while something was going dreadfully awry among first-aid dispatchers, ERs, and operating rooms.

The team talked to 31 interviewees including dispatchers, which transported the two patients, and ER doctors and surgeons who treated them. To disclose what was unfolding while emergency patients, untreated, were left adrift, a thorough review was done of exclusive data, including the telephone call records provided by the 119 General Situation Room of the National Fire Agency and the disaster situation room of the National Emergency Medical Center.

The results were that the first-aid medical service system ridden with loopholes makes it inevitable for everyone involved to end up in a tragedy even after they all do their best. It turned out that the government-run situation dashboard for emergency cases did not serve the purpose of helping 119 dispatchers and ER doctors figure out where surgeons are available to perform an operation. The only way to report patients' health status was to call every single hospital. The double system of the 119 General Situation Room of the National Fire Agency and the disaster situation room of the National Emergency Medical Center, both short-staffed, failed at doing their jobs. What’s worse, there were a shockingly small number of surgeons on standby for surgery. Given the severity of the realities, it was lucky that Jun-gyu and Jong-ryeol could enter the operation room at the last minute.

Here is a comprehensive report that ferrets out all the facts that explain why South Korea’s social medical safety nets have ended up being crippled.

(Jun-gyu’s 228 minutes)

At 2:27 p.m. on Dec. 8 last year, Jun-gyu, a 13-year-old boy, was found unconscious at home in Dongtan New Town of Hwaseong, Gyeonggi Province. Looking at her son shaking the limbs and wetting his pants, Yun-yeong panicked too much to call first-aid dispatchers. She managed to recall the number 119 to ask for help.

No one noticed that the boy’s brain was filling with blood after swollen blood vessels burst in the skull. The symptom is observed only after a patient is tested in an ER. For this reason, he was supposed to meet two doctors – an ER doctor and a neurosurgeon. Two minutes after Yun-yeong’s call, Osan 119 Fire Station sent an ambulance to his place with Jo Yun-ji, a chief paramedic, behind the wheel. Previously, garages in fire stations were designed to be placed on a flank of the facilities. However, it is currently required that they should be located at the front side based on transportation experts’ deliberations to minimize emergency response time.

Despite such well-thought-out efforts, minutes saved are sometimes wasted in vain, as seen in Jun-gyu’s case. He was supposed to be cared for by doctors who could tackle an ongoing brain hemorrhage by opening up the skull, sucking out the blood, and suturing the broken brain blood vessels. Only one doctor was believed to be capable of handling his case in Ajou University Hospital, 17 minutes drive from his place.

Professor Lim Yong-cheol, a neurosurgeon, however, was in the middle of surgery around the time when Jun-gyu collapsed. The professor's operation could take up to three to four hours. At that point, only 27 minutes passed.

Thirteen minutes after the case was reported to the fire station, dispatchers knocked on the door, behind which Yun-yeong was wiping her son, wet, on the floor. Yun-ji parked the ambulance in front of the apartment building and rushed upstairs. If any other dispatch team, which was closer to Jun-gyu, had been sent, it would have taken five minutes. However, dispatchers at all five fire stations nearby were on the job.

Rubbing Jun-gyu’s ribs harshly, Yun-ji could hear him respond with a sharp “ow,” implying that he was an emergency patient who could respond to strong stimuli while unconscious. His systolic BP was around 110 mm Hg and heart rate was 97 beats per minute, both of which were within the normal range. However, he needed to be taken to the hospital to figure out why he fainted.

Yun-ji decided to move Jun-gyu to the ambulance and call ERs. She knew most ERs would not take in patients under 15 if pediatricians were off duty. She first called medical centers with pediatricians on standby as she knew. She was ready to go anytime if she could successfully contact any available hospital.

Yun-ji called Hallym University Dongtan Sacred Heart Hospital at 2:49 p.m.

“The only doctor working at the hospital is off duty,” she heard.

A call was made to Catholic University of Korea, St. Vincent`s Hospital at 2:50 p.m.

“We have staff on duty, but no beds are left empty because we already have too many patients today,” she heard.

She called Ajou University Hospital at 2:50 p.m. “The surgeon in charge is away,” she heard.

The three medical centers have pediatricians ready at all times. However, all of them rejected Jun-gyu because they were not available.

A dashboard with the availability of hospital beds in nearby ERs on display is installed inside every ambulance. However, it does not help dispatchers find pediatricians who can handle children and teenagers because no such information is displayed on the screen.

Emergency pediatrician Cheon Eun-jae at Ajou University Hospital was briefed on Jun-gyu’s case. Convulsion in childhood can happen due to various causes. It can be handled simply by reducing it if it is merely due to a fever. However, if cerebritis or epilepsy is at play, their corresponding treatments follow.

This was a very bad coincidence where the only specialist in pediatric neurology in the hospital was in quarantine due to COVID-19. If Jun-gyu were infected with cerebritis or epilepsy, as described in the more drastic scenario, he would have to be transferred to another hospital. If so, any delay would cause a brain issue or death.

Eun-jae could not help but recommend that Yun-ji should go find another hospital.

Yun-ji contacted Seoul National University Bundang Hospital at 2:51 p.m. “If you insist, you could bring him but it will be a long wait,” she heard.

She phoned Cha University Bundang Medical Center at 2:56 p.m. “You can come with him, but he won’t possibly be hospitalized,” said a staff member on the phone. The hospital was too short-handed to take care of in-patient children. It was already full of too many young patients at that time. More than 100 patients visited and were treated in the ER. It might be only natural that too many young patients were headed to the hospital because other facilities rarely took them in. One year ago, a 30-month-old baby with a cardiac arrest due to convulsion was sent to the hospital, one hour’s drive away. Back then, the pediatric emergency room was busy treating the baby and had to reject other patients.

She talked to Hallym University Sacred Heart Hospital on the phone at 3:07 p.m.

“We have no more available beds,” said staff.

Yun-ji started off with no destination in her mind but headed northward anyway. She even called hospitals in Bundang-gu, Seongnam City, and Anyang City but to no avail.

If rejected repeatedly, she would probably end up in northern Gyeonggi Province. She needed help to find if there was any hospital available in these regions at that moment. She asked the 119 General Situation Room to find medical centers toward which she might rush.

It was a cold winter day, but she was busy on the phone to the extent of not feeling any cold in the ambulance with the heater system turned off to reduce Jun-gyu’s fever. Around 41 minutes after Jun-gyu’s case was first reported, at Yun-ji’s request, staff at the 119 General Situation Room at the Gyeonggi Disaster and Safety Headquarters started searching for a hospital where Jun-gyu could be transported. It was no different from how Yun-ji did. The staff had to call every hospital to brief them on the patient and ask if he could be taken in.

A 911 dispatcher calls Seoul National University Bundang Hospital at 3:08 p.m. “You can come if you don’t have any options nearby, but the patient should get a COVID-19 screening test first.”

Yun-ji calls Dongsuwon General Hospital at 3:10 p.m. “We don’t have any pediatrician.”

The dispatcher then calls Ajou University Hospital at 3:11 p.m. “If nowhere else takes him, we can provide first aid.”

At 3:12 p.m., Yun-ji calls Pyeongtaek Good Morning Hospital. “I recommend he goes to a bigger hospital.”

At 3:16 p.m., the dispatcher calls the Catholic University of Korea St. Vincent’s Hospital. “We can’t confirm‎ the availability here,” said the hospital staff, giving him another number.

At 3:18 p.m., The dispatcher calls the Catholic University of Korea St. Vincent’s Hospital again. “We already have three patients waiting in the ICU.”

There are 245 dispatchers nationwide who handle emergency calls and give guidelines. Forty of them are contract workers. The dispatcher who helped Jun-gyu find a hospital that day left work two months after his contract ended. Even regular employees are transferred to different departments every two to three years, making it hard to build their expertise.

Eun-jae was a bit surprised when she got the second call from the Dispatch Center asking to accept Jun-gyu. ‘It’s noon on a weekday, and they still haven’t found a hospital.’ She was worried that the patient hasn’t still come around. “We can give him first aid. Come quickly.”

Fifty minutes after her first call to 911, Yun-ji quickly reviewed each hospital's status as informed by the dispatcher. She had to choose between Ajou University Hospital, where first aid was possible but detailed examination was difficult, and St. Vincent’s Hospital where the examination was possible. Still, there was a long wait for the ICU.

The situation was uncertain at both hospitals, but she had to decide quickly. Jun-gyu’s condition was getting worse and worse. She finally decided to head toward Ajou University Hospital.

Sixty-five minutes after the call, the ambulance carrying Jun-gyu finally arrived at the emergency room of Ajou University Hospital.

Seventy-seven minutes after the call, Eun-jae quickly finished her urgent medical appointment and went to where Jun-gyu was waiting. The emergency room is not organized by early arrivals, but by the severity of symptoms. There were many children who came first, but she saw Jun-gyu first.

Looking at Jun-gyu’s condition, it was strange that he couldn’t regain consciousness for a long time. His blood pressure was high. “He said his eyes hurt yesterday, and today he had a headache so bad that he couldn’t go to school,” said his mother. Eun-jae sent Jun-gyu to the examination room.

One hundred and fourteen minutes after the call, the brain examination revealed that he had a stroke. He was bleeding so much that the brain had been pushed to one side.

After Eun-jae’s call, a neurosurgeon rushed to the emergency room on the first floor. He checked Jun-gyu’s condition and called Yong-cheol.

Yong-cheol was seeing patients in the cerebrovascular operating room on the third floor. He briefly took a look at Jun-yu’s brain scan and ordered additional examinations. Yong-cheol said, “I’ll finish this up quickly and come down,” but he was anxious. He couldn’t just leave the patient in the middle of a procedure.

Two hundred and twenty-eight minutes after the call, Yong-cheol checked that the condition of the patient he just treated stabilized and began Jun-gyu’s surgery. It was 12 hours and 35 minutes after Yong-cheol’s arrival at the hospital at 5:40 a.m. He puts on protective gear for his head and neck.

He opened Jun-gyu’s head and drilled a hole in his skull. Blood gushed out at high pressure due to the bleeding. He needed to drain the blood to lower the pressure. Then he had to close the ruptured blood vessels. If he didn’t act quickly, Jun-gyu could become a vegetative patient or die. There was already too much blood loss. The mortality rate was over 40 percent.

‘In only Jun-gyu had come sooner…,’ Yong-cheol thought to himself. The five-hour and seven-minute surgery had now begun.

Yun-ji continued to think about Jun-gyu while going on seven more dispatches until 9 a.m. the next day. She didn’t even know that he had a brain hemorrhage and was at a critical point in his life. The patient's treatment results are not shared with the ambulance team, so Yun-ji has unanswered questions. ‘What should I do if I meet a child like Jun-gyu again?’

How many patients wander in a life-and-death moment, looking for a hospital to take them? There are no accurate statistics.

The National Fire Agency releases official data on ‘rejections,’ which is the number of cases where an ambulance picked up a patient and arrived at the emergency room but was not admitted. In 2021, there were 7,634 cases. However, this number is only a small part of the actual number of patients who wandered in an endless loop of ERs. This is because it only includes patients who actually showed up at the ER and were turned away. It doesn’t include cases like Jun-gyu’s, where the caller was turned away. This is because the paramedics don’t have a record of the rejected calls.

There are figures that give us a glimpse of the actual “drifting.” The Gyeonggi Provincial Fire and Disaster Headquarters was the only one in the country to report “refusal to accept calls last year. It transported 446,866 emergency patients. Of those, 85,099 called more than one hospital because they couldn’t find one at once, which is one in five transfers. Among the patients who were not accepted by the first hospital they called, 18,565 had serious suspicions of cardiac arrest, unconsciousness, chest pain, shortness of breath, or convulsions.

At this time, there is no way to exactly determine how many people across the country had this happen to them, or whether they received treatment in time to save their lives.