TRANSPORT AND EMERGENCY MEDICAL RESPONSE SYSTEMSEXAMINATION OF THE EMERGENCY MEDICALRESPONSE SYSTEM IN KOREA AND SUGGESTIONSFOR IMPROVEMENTS RELATING TO TRANSPORT
Sei-Chang OH, Ph.D.
Associate Professor
Division of Environmental, Civil and Transportation Engineering
Ajou University, Suwon, Korea(Received May 31, 2004)
Emergency medical response system in Korea was launched in 1982 for the improvement of national welfare. Emergency medical response
system is made up of accident scene phase, transport phase, hospital phase, and communication system. The accident scene and transportation
phase are mainly conducted by the 119 Rescue team and the hospital phase takes place at emergency medical centers. The communication system
is managed by emergency medical information center.
This research focuses on the examination of current emergency medical response system related to the transport of emergency vehicles andsuggests some transport-related ideas to improve the system in Korea. The study aimed to investigate the present emergency medical response system
and identify problems, questionnaire survey and literature review were carried. The ideas include the improvement of emergency information flow andthe development of preferential treatment methods for emergency vehicles. To improve the emergency information flow, this research studied thebridge between emergency medical information center and traffic information center and proposed the efficient utilization of traffic information for the
better treatment of an emergency. When it comes to the movement of emergency vehicles, various preferential treatment methods were suggested.
Key Words: Emergency medical response system, Emergency information, Transport of emergency vehicle, Preferential treatment, Emergency rescue

1. INTRODUCTION
According to the research of the Korea Health Industry Development Institute, the preventable rate ofdeath from trauma is 40.5% and the problem in pre-hospital phase is rated as 57.1% among causes1. The main
problems in the pre-hospital phase include an inefficient
emergency medical response system (EMRS) and transport system.
The Road Traffic Safety Authority reported in 2002
that the number of accidents on highways among thenumber of accidents in total was 2.82%, but the numberof deaths from highway accidents among the number ofdeaths from all traffic accidents was rated as 7.78%2,
showing that the death rate from highway accidents washigher than non-highway accidents. The higher death ratefrom highway accidents reveals that the degree of risk on
a highway is much higher than that in general and moreover the EMRS for highway accidents is not operated systemically.
For the improvement of EMRS, the Ministry of
Health and Welfare has planned to expand financial resources to establish infrastructure for the rapid transportof emergency patients, and to introduce advanced emer-

32 • IATSS RESEARCH Vol.28 No.2, 2004

gency medical centers. In addition, the Ministry of Construction and Transportation and the National Police
Agency have tried to redesign locations where traffic accidents frequently occur to secure safe traffic facilities,
and to operate a traffic safety inspection system. However, intimate collaboration between medical-related authorities and transport-related authorities has still to be
sufficiently established. Accident information collectedby transport-related authorities is not delivered to medical-related authorities instantly. Medical-related authorities take full charge of emergency transport and receive
little help from the transport-related authorities., hence
close cooperation between two authorities is essential toadvance EMRS.
This research focuses on the review of present
EMRS related to the transport of emergency vehicles andbrings some transport related ideas to improve the system in Korea. To investigate the present EMRS and identify problems, a questionnaire survey and literature review
were carried out.
This paper is organized as follows. In the next section, we examine the EMRS in Korea. We then identify
transport-related problems in EMRS in Korea, and finally,suggestions on transport-related ideas to advance the
EMRS are made, followed by the conclusion.

EXAMINATION OF THE EMERGENCY MEDICAL RESPONSE SYSTEM IN KOREA AND SUGGESTIONS FOR IMPROVEMENTS RELATING TO TRANSPORT

2. EXAMINATION OF EMERGENCY MEDICALRESPONSE SYSTEM
2.1

Outline of EMRSEMRS means a systematic organization that provides rapid and efficient medical treatment to patients
who need the emergency service3. It includes not only
treatments in a hospital but also an extended medical service to regional communities. EMRS was begun in order to overcome the distance between emergency sites
and medical centers.
The response process from the EMRS can be described as the following 3 phases:• Accident scene phase: The immediate response of
emergency vehicles and persons upon receiving an accident report and on-site treatment of the injured;• Transport phase: Transportation of injured persons
from the accident injury site to a hospital;• Hospital phase: Prompt and professional treatment in
hospital.
A communication system is also needed to interconnect the above mentioned 3 phases effectively.
2.2

EMRS in Korea
EMRS in Korea commenced in Seoul from 1982
through the foundation of the 119 Rescue team from morethan 10 fire stations.
Emergency Medical Information Center (EMIC)
In Korea, EMIC was established in 1991. The goalof EMIC is to provide the necessary information to users ubiquitously, and can be reached by the telephone
number, 1339. There are 12 EMIC’s that it provide a consultation about emergency medical care and guidance toa suitable emergency medical institute. Table 1 shows the
manpower in 12 EMIC branches.
Major functions of EMIC are based on Articles 27
and 28 of ‘Emergency Medical Treatment Law’. The
functions are as follows:• Providing information about emergency medical treatment and a suitable hospital for an emergency vehicle;

S.-C. OH

• Management of sickbed information of a hospital;• Collecting evaluation data of hospital and ambulance
managers;• Coping immediately when there are many patients;• Observation of infectious disease and new types of disease by analyzing patients’ symptoms in emergency
medical institutes;• Other tasks arranged by ‘Order of Ministry of Healthand Welfare’.
119 Rescue team5
EMRS has to be a prompt, professional and wellorganized system that meets the requirements of emergency patients. Among the elements of EMRS, the 119
Rescue team plays an important role such as quick transport of emergency patients. The 119 Rescue team generates high productivity with a relatively low cost because
it can utilize existing equipment such as ambulances, fireengines, staff and communications apparatus that belong
to the fire department.
Table 2 shows the number of ambulances and emergency rescuers in the 119 Rescue team by region in 2002.
According to the statistics of 2002 shown in Table
3, the 119 Rescue team transported 944,775 times with
1,107 ambulances. The total number of transported patients was 982,697 persons, meaningly an average of
2,692 patients were transported per day6.
According to Suh’s report7, reaction time of emergency vehicles is influenced by social factors and environmental factors. Social factors include demand oftransport, method of call, degree of traffic congestion, hospital location, population, etc. Environmental factors include road condition, topography, weather condition, etc.
The average dispatching distance for emergency vehicles
is 2.3km in Seoul, 4.1km in 5 metropolitan areas, and7.1km in provinces. Average reaction time of emergency
vehicles is 4.2 minutes in Seoul, 5.2 minutes in 5 metropolitan areas, and 7.6 minutes in provinces. It reveals that
dispatching distances and reaction times of cities are usually shorter than those of provinces.
As of Jan. 2003, 119 Rescue teams possessed 22 helicopters. Information on operation of 119 Rescue team’s
helicopters is shown in Table 4. In general, a helicopter

Table 1 Manpower of EMIC4
Role

Head

Section
Chief

HealthSectionBusiness
SectionCommunication
SectionPublic Health
DoctorNumber of persons

12

12

70

24

24

48

IATSS RESEARCH Vol.28 No.2, 2004 •33

TRANSPORT AND EMERGENCY MEDICAL RESPONSE SYSTEMS

Table 2 State of 119 Rescue team
RegionAmbulance
Total

Total

SpecialEmergency rescuer
General

Total

Nurse

EMT
First
degreeSeconddegreePractical
Training center
nurse
CertifiedProfessional Others
EMT

1,107

664

443

4,559

196

517

1,686

15

26

1,546

Center

1

1

0

8

1

0

3

0

0

0

573
4

Seoul

109

48

61

654

24

116

304

4

5

192

9

Pusan

51

23

28

229

20

1

104

4

4

83

13

Daegu

45

32

13

182

9

6

109

0

0

37

21

Incheon

41

16

25

176

4

56

59

0

1

50

6

Gwangju

22

22

0

99

5

11

41

2

0

40

0

Daejeon

26

20

6

122

11

12

62

0

0

37

0

Ulsan

20

12

8

87

7

9

25

1

0

0

45

Gyeonggi

158

87

71

631

13

108

228

0

6

124

152

Gangwon

100

60

40

381

1

0

198

0

0

43

139

Chungbuk

76

59

17

208

0

37

38

0

2

114

17

Chungnam

91

82

9

283

9

51

80

0

2

113

28

Jeonbuk

72

34

38

287

21

8

104

2

4

146

2

Jeonnam

79

51

28

290

23

37

80

1

1

130

18

Gyeongbuk

98

65

33

390

20

25

120

0

0

209

16

Gyeongnam

97

37

60

370

13

22

110

0

1

121

103

Jeju

21

15

6

162

15

18

21

1

0

107

0

Table 3 Accomplishment of 119 Rescue
Year

Numberof ambulance

Numberof transport

Number oftransported patients

Average transported
patients per day

Transported patients
per ambulance

2002
2001

1,107
1,095

944,775
944,435

982,697
985,618

2,692
2,700

888
900

Increase(%)

1.1

0.0

-0.3

-0.3

-1.3

Table 4 Operation of 119 Rescue team’s helicopters (in 2002)
RegionNumber of
Helicopter (EA)

Manpower(person)Number ofOperation (times)

Operation Hour
(Hour)

Number of Transported
Emergency Patient (person)

Center
Seoul
Pusan
Daegu
IncheonGwangju
Ulsan
Gyeounggi
Gangwon
Chungnam
Jeonbuk
JeonnamGyeonbuk

2
4
2
2
1
1
1
3
2
1
1
1
1

20
25
14
17
10
8
7
23
17
8
11
8
8

194
528
141
211
74
123
62
445
261
57
108
193
92

420
323
161
259
69
161
86
555
309
73
147
121
73

0
0
1
0
18
14
1
4
12
6
11
107
7

Total

22

176

2,489

2,758

181

34 • IATSS RESEARCH Vol.28 No.2, 2004

EXAMINATION OF THE EMERGENCY MEDICAL RESPONSE SYSTEM IN KOREA AND SUGGESTIONS FOR IMPROVEMENTS RELATING TO TRANSPORT

is operated by two pilots. In case of an emergency rescue operation, one helper can be added. Two copies ofthe emergency rescue report should be prepared. One
must be submitted to a doctor and the other is kept in the
119 Rescue team for three years.

3. PROBLEMS OF EMERGENCY MEDICALRESPONSE SYSTEM
A questionnaire survey was given between April 2
to May 16 in 2004 to check the present EMRS and identify any problems. The targets of the questionnaire survey were 30 domestic general hospitals and emergency
medical centers. The contents of the questionnaire weredivided into two parts; equipment and facilities related
to emergency medical treatment and operation of EMRS.
Detailed questions are as follows:• Equipment and facilities related to emergency medical treatment;• Number of emergency vehicles owned;• Function of extra emergency call centers;• Other equipment and facilities related to emergency
medical treatment;• Operation of EMRS;• Scenario to respond to an emergency• Assignment of staff to cope with an emergency andtheir roles;• Communication with related organizations;• Any difficulties to operate EMRS.
Problems identified from the questionnaire survey
and literature review are as follows.
3.1

Problems in transport phase
EMIC, 119 Rescue team, and hospitals take chargeof EMRS in Korea. EMIC plays an important role in collecting information on emergency medical services ineach hospital, receiving emergency calls, requesting the
dispatch of an emergency vehicle and connecting communication between ambulance and center. The 119 Rescue team is responsible for the pre-hospital care at thesite and the transport of patients. Usually, emergency rescuers who conduct emergency medical treatment at thesite or on the way to hospital instead of doctors play therole as EMT. Existing emergency rescuers usually complete the training course in emergency medical service
and rescue to acquire emergency rescuer’s certification.
However, emergency rescuers act passively because theyS.-C. OH

are unable to obtain legal protection against their medical treatment. According to Kim’s report8, 46.1% of total responders were satisfied with the on-site treatmentof the 119 Rescue team, and 48.3% of those said that the
119 Rescue team is only concerned with the transport ofpatients rather than medical treatment. It showed thatmost users are not fully satisfied with the 119 Rescue
team’s treatment.
The non-cooperative attitude of road users presents
another problem in the transport phase. Usually, otherdrivers on the road hardly give way to emergency vehicles. Even though they concede their right of way toan emergency vehicle, their behavior is so irregular that
it is very difficult for emergency vehicles to get precedence. It was determined that a systematic education ofdrivers on how to respond to emergency vehicles is lacking. The absence of any kind of preferential treatment for
emergency vehicles was pointed out as another crucial
problem to be solved.
3.2

Problems in emergency information flow among
related organizations
EMIC opened and operated since July, 2000 is not
rapidly connected to the moving out of emergency vehicles. It has a trouble to acquire accurate emergency information of the site. The 119 Rescue team belongs to
the Ministry of Government Administration and Home
Affairs. However, EMIC belongs to the Ministry of
Health and Welfare. Therefore, their tasks are separated.
According to a survey9 given to EMIC’s employees, only
5% answered that the emergency communication network
is very well utilized and 65% of all responders said that
it is not used properly. The Employee think that EMIC
has a low rate of usage. The absence of cooperation
among EMIC, emergency medical service institutes, andthe 119 Rescue team is the main reason. The 119 Rescue team and emergency medical service institutes tend
not to share information with EMIC.

4. SUGGESTIONS FOR IMPROVEMENTS
RELATING TO TRANSPORT
4.1

Treatment of traffic flow at an accident site
When a traffic accident occurs, traffic congestion
accumulates until the accident has been cleared, because
an accident happens unexpectedly, delay is inevitable.
Delay causes a waste in time and energy. In addition, it
disturbs the rapid clearance from the accident and patient
IATSS RESEARCH Vol.28 No.2, 2004 •35

TRANSPORT AND EMERGENCY MEDICAL RESPONSE SYSTEMS

transport. Therefore, it is very important to clear delayed
traffic within a short time. On highways or primary roads,
delivering accident information to drivers via variable
message signs could be considered as a good way to reduce delays. Accident and detour information have to beconveyed to drivers so as to discourage them from getting into the accident site, and help to control traffic flow
and to reduce delays. It could be also worthwhile to disseminate transportation information related to accident,
delay, and detour routes via radio broadcasts.
4.2

Application of preferential treatment method toemergency vehicles
The patient transport phase is mostly conducted onroads except in some special cases. For fast and effective transport, a preferential treatment method for emergency vehicles could be applied. Preferential treatment
method for emergency vehicles is one of the subjects thattransportation engineering could investigate. For thetransport phase on a highway, a preferential treatment
method at a toll gate can be considered. Electronic Toll
Collection System (ETCS) is installed at several spots(Chunggye, Sungnam, Pangyo) along the outer beltway
of Seoul. Vehicles with an OBU(On-Board Unit) can passthrough a toll gate without stopping for ticketing or payment. Therefore, if an OBU is placed in emergency vehicles, they do not become involved in delays and queues
at toll gates. However, at the most toll plazas in Korea,
toll collection is managed manually. Hence delays andqueues are prone to exist. An exclusive toll gates or lane
for emergency vehicles could be the answer to save a precious time at toll gates.
In case of local arterial streets, an intersection is themost troublesome location during the transport of emergency vehicles. Especially in a metropolitan city, emergency vehicles experience long delays at intersections
during the peak hours. For the continuous movement ofemergency vehicles, the preferential treatment by signal
control at intersections could be considered. However,most signals can be controlled by a local controller located on site. Signal control by relevant staff for eachtransport of an emergency vehicle is impossible. Therefore, a traffic information center that can manage all traffic signals in the region is needed to provide thepreferential treatment. Lately, many local governments
are establishing traffic information centers as a part of Intelligent Transport Systems (ITS). If these traffic information centers are able to control all of the local signal
controllers, preferential treatment for emergency vehicles
would be enabled.

36 • IATSS RESEARCH Vol.28 No.2, 2004

To introduce Car Navigation System (CNS) basedon Global Positioning Systems (GPS) to emergency vehicles is another possible idea. EMIC can construct the
management server to monitor the location of each emergency vehicle quipped with GPS in real time. It is also
possible that a shortest path to the assigned hospital canbe conveyed to the emergency vehicle by using real timetraffic information. This can reduce a transport time andincrease safety by a suggested shortest path.
Transport via helicopter is efficient when patientsare in a critical condition or surface transport is impossible. In Korea, transport via helicopter in case of emergency rescue is not fully matured. As we can see in Table
4, the number of transported emergency patients is not
so large compared to the operation hours of a helicopter. In my opinion, it is because of the shortage of theabsolute quantity of the number of emergency rescue helicopters and the complicated procedure of requesting
an emergency rescue helicopter. Therefore, we need toincrease the number of emergency rescue helicopters in
the near future and to select the location of heliports
carefully and ideally. To select the location of a heliportfor emergency patients, a kind of technique such as asolution to the facility locations problem could be applied. To introduce a helicopter dispatching system,
major cities and regions have to prepare heliports at
proper locations and train staff to manage them. A helicopter dispatching system is useful in the following
cases; (1) Traffic congestion is so heavy that an emergency vehicle can not travel rapidly; (2) There is no way
to approach the site by road; (3) Patients’ condition is so
critical that an emergency vehicle can not reach a hospital in time.
4.3

Preparation of manual on how to respond to
emergency vehicles
It is a good way to educate drivers through a manualon how to respond to emergency vehicles to improve an
EMRS. Usually drivers hardly make a concession to
emergency vehicles. Even if they concede a right of way
to emergency vehicles, their behavior is so irregular that
it often makes it more difficult for the emergency vehicle
to travel. Therefore, it is desirable to make a manual thatguides drivers on how to respond to emergency vehicles,
to concede their right of way and to educate drivers withthe manual. Questions about the manual could be included in the driver’s license test.
The following Fig. 1, 2, 3 show the improved
EMRS after implementing the suggestions.

EXAMINATION OF THE EMERGENCY MEDICAL RESPONSE SYSTEM IN KOREA AND SUGGESTIONS FOR IMPROVEMENTS RELATING TO TRANSPORT

S.-C. OH

Emergency

BeforeReportan emergency

Instructan emergency
treatment
Requestdispatchingof ambulance

Reportan emergency

Reportan emergency

Requestdispatchingof emergency
vehicle1339
EMIC

Report patients’condition
during transport

Emergency
Medical Center

119 Rescue Team

Emergency

After

Reportan emergency

Instructan emergency
treatment

Requestdispatchingof ambulance

Reportan emergency
Reportan emergency
1339
EMIC

Conveythe most
suitable path
Emergency
Medical Center
Real-time monitoringof ambulance by GPS

Requestdispatchingof emergency
vehicleConveyreal-time traffic
information

Traffic
Information
Center

119 Rescue Team
Real-time monitoring of
emergency vehicle by GPS

Fig. 1 Diagram of emergency information flow

Fig.1 shows a diagram of emergency information
flow. As it appears, the more efficient management ispossible with a traffic information center conveying traffic information to an EMIC. First, an EMIC can monitor

the real-time position of emergency vehicles throughGPS. Secondly, an emergency vehicle can transport patients efficiently using the optimal path guidance from an
EMIC.
IATSS RESEARCH Vol.28 No.2, 2004 •37

TRANSPORT AND EMERGENCY MEDICAL RESPONSE SYSTEMS

BeforeEmergency
VehicleEmergency transportation
to the hospital

Dispatch to the Scene
Accident Scene

Instructan emergency
treatment
Informan emergency
situation

Emergency
Medical Center

Guide toa suitable
hospital
Informthe patients’condition

EMIC: transport: information

After

Emergency
VehicleDispatch to the Scene

Emergency transport
to the hospitalPreferential
treatment
at signalizedintersections
and toll gate

Preferential
treatment
at signalizedintersections
and toll gate

Accident Scene

Instructan emergency
treatment
Informan emergency
situation

Guide toInforma suitable + the most
hospitalsuitable
path

EMIC

Emergency
Medical Center

Informthe patients’condition

Convey real-time traffic informationand the most suitable path

Real-time
monitoring by GPS

Traffic Information
CenterReal-time
monitoring by GPS

Fig. 2 Diagram of transport phaseFig. 2 shows the transport phase when adopting
preferential treatments. An emergency vehicle can obtaina right of way at signalized intersections and toll gates

38 • IATSS RESEARCH Vol.28 No.2, 2004

by the preferential treatment. It makes the transport phasefaster and more efficient.

EXAMINATION OF THE EMERGENCY MEDICAL RESPONSE SYSTEM IN KOREA AND SUGGESTIONS FOR IMPROVEMENTS RELATING TO TRANSPORT

S.-C. OH

Traffic accident occurs

Pre-hospital
Care

Pre-hospital
Treatment

Making a plan
for a treatment of traffic flowby related transport authority

Convey the nformation
to EMRS

Announce the emergency
information to drivers via
VMS and radio broadcasting

Dispatch the nearest
ambulance from 119 Rescue
or emergency medical center

Arrival of an ambulance to the scene

Monitoring
the positionof ambulance
by GPS

Convey the patient’s condition to EMIC

EMIC assigns the ambulance
to an appropriate hospital

Transport patientto the hospital

Assigned hospital prepares
emergency treatment
suitable to the patient

Transport
Rapid transport by preferential treatment<priority treatment at Toll gate and signalized intersections>

Hospital
Care

Arrive to the assigned hospitalFig. 3 Application of the transport-related improvement to EMRS

Fig. 3 shows an EMRS that is improved by thetransport-related treatment. Improvements are shown ineach phase.

5. CONCLUSION
The purpose of this research was to review the current EMRS related to transport emergency vehicles and
IATSS RESEARCH Vol.28 No.2, 2004 •39

TRANSPORT AND EMERGENCY MEDICAL RESPONSE SYSTEMS

to suggest some transport-related ideas as a solution toexisting problems. Although the EMRS in Korea has been
greatly improved since 1982, it does not provide full satisfaction to users. In this paper, problems were detectedin the transport phase and in the emergency information
flow among related organizations. To solve those problems, several transport-related improvements were suggested. These improvements included the treatment oftraffic flow at the accident site, application of preferential treatment methods to emergency vehicles, and preparation of amanual on how to respond to emergency
vehicles. To apply these suggestions, further detailed
studies such as a concrete introduction plan of these improvements, cost-benefit analysis of these suggestions,agreements on each role among medical-related organizations are essential.

REFERENCES
1. Health and Medical Treatment Statistics. Korea Health Industry Development Institute. (2003).
2. Traffic Safety Statistics. The Road Traffic Safety Authority. (2003).
3. Han-Seung Yang. Research of Emergency Medical System in Korea.
Gangnam University. (2000).
4. Art.7 of the Law about Arrangement and Management of Rescuer.
Ministry of Government Administration and Home Affairs. (2000).
5. Gyeong-Mo Lee. Study of Advanced Pre-hospital Phase in Emergency
Medical Response System. 15th Fire Administration Congress. (2003).
6. Administrative Data and Statistics of Fire Institute. Ministry of Government Administration and Home Affairs. (2002).
7. Gil-Joon Suh. Pre-hospital Trauma Care System in Seoul by 119
Rescue Services. “The Journal of The Korea Society of Emergency
Medicine” 12(2). (2001).
8. Meung-Ryong Kim. Perception of Satisfaction with Future of 119
Rescue in the View of the User. “The Journal of The Korea Society ofEmergency Medicine” 14(4). (2003).
9. Soon-Joo Wang. Analysis of Operational Result of the 1339 Emergency Medical Information Center. “The Journal of The Korea Societyof Emergency Medicine” 13(4).(2002).

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