Paramedics sort out the ill from the well

The day started out slowly for Lee Yong, something that rarely happens as head of the emergency services team at the Sejongno branch of the Jongno Fire Department.
But it’s not because life-threatening situations are consuming the team’s time. In the nine years he has worked for the department, which covers the Jongno, Seodaemun and Jung districts in Seoul, Mr. Lee said those situations have been rare. It’s because when the control center dispatches his crew of three to places where someone has called the emergency number 119, it’s often a questionable ailment.
At night, calls come in asking emergency services personnel to help carry their drunken friend out of a bar. Some call claiming that a homeless person is dying on the street, but when the ambulance gets there, the “dying man” has wandered off. Others have called because their child has a simple fever. Others claim a mortal wound that turns out to be a small cut on their finger.
“We are thankful that life-threatening situations are not common,” Mr. Lee said.
That’s probably best because emergency services personnel are restricted in what treatment they can render to patients. Despite professional medical training, under the domestic health law, paramedics can only render minimal, life-saving care to patients unless they have consulted a medical doctor. The law only allows doctors to perform medical treatment; paramedics are caught in a gray area, although they have more leeway with a doctor’s OK.
For example, the law prohibits paramedics from administering medicine intravenously for conditions such as low blood pressure or using a defibrilator to deliver an electric shock to the heart of a person suffering from heart failure. Paramedics said they would use their hands for cardiopulmonary resuscitation rather than the device.
“I never had the chance to use many of the skills that I have learned in school to treat people,” said Choi Mi-gyeong, a graduate of a health college who has the highest of two levels of paramedic training and has worked for the fire department for five years. “We just feel lucky that we don’t see many life-and-death situations and that we usually reach the hospital before the patient starts complaining more about the pain.”
However, in practice, paramedics interviewed said they do not withhold treatment for those whose lives are in danger, and they ensure they do the best for the patient.
Ms. Choi said the scariest moment in her life was when her team was transporting an electrician who was electrocuted while on duty. He was in severe pain, and half of his body was burned, but there was no other way to help him except to yell at the driver to step on the accelerator, she said. Luckily, they delivered the man to a nearby emergency center in time, and he was saved.
But emergency medical personnel are hamstrung in other ways. There is only one ambulance in each of Seoul’s 109 small fire stations run by 21 main fire departments throughout the city. It averages out as one ambulance for every 100,000 people in Seoul. That ambulance is shared by two emergency services teams who take turns working 24-hour shifts every other day. So when one ambulance is on a call, the next caller has to wait for another one to come from a different branch, which is likely farther away.
In South Korea, there is one paramedic for every 9,562 people. In Japan, there is one paramedic for every 2,191 people, according to the National Emergency Management Agency.
In 2005, one Korean ambulance was sent out 1,230 times to save people, while each Japanese ambulance handled an average of 858 cases a year. However, National Emergency Management Agency officials say that 57 percent of Korean paramedics have qualification licenses specifically for emergency services, while only 23 percent have those qualifications in Japan.
“Just 10 years ago, most paramedics were nurses,” said Lee Eun-wa, an instructor at an emergency services training facility at the Seoul Fire Academy. “To reinforce the shortage in manpower, we trained firefighters to achieve qualification licenses to practice first aid and emergency care.”
However, the qualification ―called a level two license ― is limited to basic first-aid procedures such as opening an airway, performing the Heimlich maneuver and cardiopulmonary resuscitation.
A more complicated procedure, such as injecting a dose of glucose to a diabetes patient, is considered a “level-one” skill that can only be performed by those who pass a state-run exam after majoring in emergency care studies.
There are no statistics on the number of paramedics who have a level-one license, but fire department officials said the number is still very low. Fire departments started recruiting professional paramedics in 2003. Seoul city recommends that an emergency services team include at least one level-one paramedic as part of a three-person team.
“There is a huge difference between a ‘level-one’ and a ‘level-two’ licensor,” said Choi Hea-kyung, an Emergency Medical Services professor at Seoul Health University. “Students are trained to perform medical procedures that emergency room doctors perform.” Prof. Choi said emergency medical services majors take pathology, physiology and anatomy courses as part of their education.

Hotline helps patients connect with doctors

The Seoul Metropolitan Emergency Operations Center started a hotline for patients and paramedics about 18 months ago to talk to medical doctors and gain their approval for treatment while they are en route to a hospital.
According to Korean law, paramedics are only supposed to render minimal care without a doctor’s consent. Paramedics said they try in good faith to contact doctors but will treat patients. The law says medical care should only be given by doctors. They can be connected to the hotline by calling 119.
Suh Eui-soo is one of the three newly recruited doctors at the Emergency Medical Control and Guidance Team at the operations center who works with paramedics. He also helps ordinary people who call 119 seeking medical advice, even though the phone number is supposed to be only for people in an emergency.
“Even when people are not in urgent situations, people who know this service call asking for medical counseling,” said Dr. Suh.
“The idea is that everyone ― whether rich or poor ― should have access to medical care,” said Kim Jae-san, manager of Emergency Services Department at the National Emergency Management Agency.
The unemployed and senior citizens call 119 most frequently. In 2004, 73,086 people over 60 years old, or 33 percent, called119 ambulances, while people in their forties came in second, at 17 percent. The rest ranged in age from teens to the elderly.

Ambulance or taxi? Medics vexed by bogus patients

When people treat ambulances as their own private limousine to go to a hospital, it makes paramedic Lee Yong uncomfortable.
Mr. Lee, who heads the emergency services team at the Sejongno branch of the Jongno Fire Department, said he has responded to dozens of cases where people who are not having an emergency call 119 and request help.
“We do what the patients say because that’s our job as public servants,” Mr. Lee said. “But we are worried that while we are out dropping people off at the hospital, we will be neglecting someone who might really be in danger.”
Using the fire department’s 119 ambulance is free. Unless the patient is in a life-threatening condition, the emergency service workers are obliged to listen to what the patient or guardian wants first, and officials take pride in serving the public. Because of this, the National Emergency Management Agency is planning to start a “silver ambulance” service for non-emergency outpatients with chronic diseases. Paramedics welcome the news, saying it will help resolve the problem of ambulance shortages.
Kim Jae-san, manager of Emergency Services Department at the National Emergency Management Agency, said a person should be 65 years or older, be a non-emergency outpatient with trouble walking and currently receive government assistance to use the silver ambulance.
Meanwhile, as a reporter was interviewing Mr. Lee, an electronic bell sounded.
“That’s our call,” Mr. Lee said as he and and his colleague jumped up from their bunk beds.
The two ran down to a lot where the department’s vehicles were parked. Inside the ambulance, another paramedic was waiting in the driver’s seat. Mr. Lee spoke on a walkie-talkie with the control center operator, trying to determine the location of a 68-year-old heart attack victim.
Choi Mi-gyeong, a female paramedic on the team, sat in the back scribbling down what Mr. Lee said over the walkie-talkie. The car stopped just a few blocks away in Nakwon-dong, near Insadong. At the end of a corner, an old man was waving his hand at the ambulance.
“I knew it would be him again,” Ms. Choi said under her breath. She greeted him and helped the man climb in.
The man had to visit his doctor three times a week for renal dialysis. According to paramedics, he is one of many “regular customers” who call 119 for a free ride to a hospital.
After settling down on a stretcher, the man asked for “air,” and Ms. Choi stuck a rubber hose to his nose to supply him with oxygen.
Then he asked the driver to go to a hospital in Cheongnyangni, northeastern Seoul.
He also asked the driver to turn on the air conditioning It took a full hour for Mr. Lee’s team to return to the Jongno Department.

by Lee Min-a