Korea's emergency medical response to disasters needs improvement

Medical workers provide first aid to victims of the crowd crush in Itaewon, Seoul, Oct. 30. Yonhap

By Lee Hyo-jin

More lives could have been saved in the Itaewon crowd crush, had the country's emergency medical resources been mobilized more effectively, according to medical experts. They called for improvements to the medical response system in the wake of the tragic accident on Oct. 29, which killed at least 156 people and injured nearly 200.

In particular, they pointed out the absence of a "control tower" to take charge and delegate tasks during emergencies, along with poor communication between related authorities such as the fire agency, medical personnel and law enforcers.

Such problems were on display in screenshots of a group chat between the disaster-related authorities, which were disclosed by Rep. Shin Hyun-young of the Democratic Party of Korea (DPK), Wednesday.

Around 1:39 a.m. on Oct. 30, an official of the fire department wrote, "We will transfer some 30 dead patients to Soon Chun Hyang University Hospital. Please check on the hospital's capacity." Soon Chun Hyang University Hospital was the nearest general hospital from the scene, located a kilometer from the accident site.

But an official at the National Medical Center (NMC), which oversees hospital bed capacity and deployment of medical personnel, said, "Don't do that. Do not transfer the dead patients now. We are going to take some 40 patients who are still alive to the hospital first, including those who are critically injured."

At around 1:45 a.m., fire agency officials once again checked on hospital capacity to transfer the dead, but the medical official responded, "We are not doing that. Please send the patients who are alive to the hospitals first."

The messages also revealed that some medical workers were blocked from entering the scene of the disaster by police.

"Our doctors cannot enter the scene due to police control. We can't deploy our medical team in this situation," according to a message from an NMC official sent at 11:41 p.m.

Lee Hyung-min, head of the Korean Society of Emergency Medicine, pointed out that more lives might have been saved if the injured patients had been transported swiftly to nearby hospitals.

"It is regretful that too many resources were put into performing on-site CPR. Technically, patients suffering from cardiac arrest are not the top priority at disaster sites," said the ER doctor at Hallym University Sacred Heart Hospital, explaining that injured patients who have a higher chance of survival should have been taken to the nearest hospital immediately.

According to health ministry data, over 80 patients, most of whom were pronounced dead or were suffering cardiac arrest, were taken to Soon Chun Hyang University Hospital. Dozens of patients suffering breathing difficulties and severe injuries were transported to more distant hospitals, with the farthest one being 27 kilometers away, possibly causing a delay in receiving due medical attention.

"I think the biggest problem was that there was virtually no one in charge," Lee said.

Under the current protocols, the head of the district's public health center oversees medical responses to disasters. But Choi Jae-won, head of Yongsan District's public health center, arrived at the Itaewon alley around 11:30 p.m., more than an hour after the crowd crush had begun at around 10:15 p.m.

Why did it take so long for DMAT to arrive?

Ambulances transfer victims of the Itaewon crowd crush to hospitals, Oct. 29. Yonhap

The first team of medical personnel to arrive on the site was the disaster medical assistance team (DMAT) from Seoul National University Hospital, at 11:20 p.m., more than an hour after the first 119 call reporting that people were dying in the crowd crush was made at 10:15 p.m.

A total of 15 medical teams from hospitals around Seoul and Gyeonggi Province were deployed, with the last one arriving at 1:51 a.m.

DMAT refers to a team of four to five healthcare workers including doctors, nurses and ER professionals. They are assigned to arrive promptly at the scene of a disaster and perform patient triage ― classifying patients according to clinical priority ― and provide first aid to urgent patients.

The DMAT system was adopted in Korea in 2015 following a series of disasters the previous year, including the February 2014 collapse of a resort building in Gyeongju, North Gyeongsang Province, which killed 10 people and the Sewol ferry sinking in April resulting in the deaths of 304 people.

According to the protocols, the health ministry orders the deployment of the DMAT through the NMC at the request of the fire agency or the Ministry of the Interior and Safety.

However, the state-run NMC received the first call from the fire agency at 10:38 p.m., 23 minutes after the agency acknowledged the emergency. At 10:48 p.m., the fire agency issued a level 3 warning, the highest in its three-tier system, but the NMC failed to realize the seriousness of the disaster and did not issue a Code Red, its highest warning level, until some 45 minutes later.

"There were serious delays in the medical response due to a lack of communication about the severity of the disaster with the authorities at the site. The hospitals weren't notified swiftly about the estimated number of fatalities and casualties," an ER doctor at a general hospital in Seoul said on condition of anonymity. "Some hospitals didn't receive requests to deploy DMATs until after midnight."