Questions/Answers

❍ Emergency Medical Consultation Service (EMCS) The EMCS initiative provides counseling and guidance to Korean citizens abroad who are in an emergency medical situation, but have difficulty accessing medical services due to the unfamiliar environment, language barrier, high medical costs, etc. The scope of services includes diagnosis of illness and its severity, emergency treatment guidance, recommendation of medication and dosage, and support in locating hospitals and communicating with local medical teams and ambulance EMTs. ❍ National duty to protect Korean citizens abroad Korea’s constitution specifies that it is the duty of the State to protect its citizens abroad, and the “Consular Assistance Law” also protects overseas Korean nationals. For this purpose, Korea dispatches consular representatives to foreign nations to protect its citizens abroad, but in the field of emergency medicine, it is the EMCS initiative that provides 24-hour borderless service. 「CONSTITUTION OF THE REPUBLIC OF KOREA」 Article 2 (2) It shall be the duty of the State to protect citizens residing abroad as prescribed by law. 「CONSULAR ASSISTANCE LAW FOR PROTECTION OF CITIZENS ABROAD」 Article 3 (1) The State shall strive to protect the life, body, and property of citizens abroad from incidents and accidents, and shall establish and implement policies for protecting citizens abroad. (Enforcement Date Jan. 16, 2021) ❍ Need for EMCS due to increase in the number of citizens abroad According to the Ministry of Foreign Affairs (MOFA) and the Tourism Knowledge & Information System, the number of citizens abroad has increased approximately 8%, from 2,472,746 in 2015 to 2,672,202 in 2017, and the number of overseas departures has increased 78%, from 16,080,684 in 2014 to 28,695,983 in 2018. In fact, the number of cases using EMCS is also increasing annually due to the increased number of citizens abroad.

❍ Identical EMCS for citizens inside & outside the country EMCS has been available to citizens in the country for 30 years, but it was implemented only recently for citizens abroad, with EMS doctors and consultants providing 24-hour services. ❍ Equal service provided to foreign workers Most Korean ocean vessels hire a large number of foreign crew, who should be provided with the same medical service as the Korean crew. Most recent data shows that 603 foreigners used the service between July 1, 2018 and June 30, 2019, accounting for 48.4% of all maritime consultation cases.

❍ Quality EMCS for everyone offered free of charge through multiple channels EMCS is in line with the UN SDG 3.8. The recipients of the service pay no fees, and medical experts (emergency doctors, nurses, and paramedics) provide real-time quality medical consultation and guidance. We have diversified the channels through which the service can be accessed: Phone, email, and online. All three channels maintain a system that can receive the request without delay and provide the service immediately. ❍ Building EMCS infrastructure In order to maintain and develop this service reliably, we have signed an MOU with the Korean Society of Emergency Medicine, and have recruited four emergency doctors for the EMS Center of the National Fire Agency through the personnel exchange and employment program with the Seoul National University Hospital, which is the most prestigious medical institution in Korea. On average, they have 8.5 years of clinical experience in emergency rooms, and the 12 EMS consultants are experts with field experience as ambulance crew. We are utilizing the “WHO Maritime Emergency Medical Service Guide Book,” which has officially been approved by WHO, to provide efficient services for ships under an extremely restricted medical environment.

❍ Guaranteeing social and economic sustainability The Korean Fire Service is responsible for fire- and rescue-related pre-hospital EMS. The NFA is not only in charge of legislation and policy-making, but also provides the same service to the public as the regional fire services, as the law stipulates. NFA is also in charge of the Emergency Medical Consultation for Citizens Abroad (EMCCA) program because it is an international effort. Financially, it is one of the national EMS fund initiatives. The 2020 budget bill allocates 657,000,000 KRW for employing additional emergency medicine specialist doctors, and we have plans to continually increase this budget.

❍ Public service fills the gaps in Consulate Call Center services The recipients of this initiative are citizens abroad, including crew and passengers of deep-sea vessels. What they have in common are the unfamiliar environment, language barrier, and the burden of medical costs, and thus they find themselves in highly vulnerable medical environments. Previously, MOFA provided a service, which helped deal with emergency situations by accepting calls 24 hours a day via the Consulate regarding incidents and accidents abroad, and then contacting the concerned public institutions. However, existing staff of the Consulate Call Center could not provide professional medical consultation services, and it was difficult to find institutions or doctors that could offer any medical help. Therefore, NFA’s regional fire headquarters began providing Emergency Medical Consultation Services (EMCS) for crew and passengers of deep-sea vessels in 2012. In 2018, National Fire Agency(NFA) signed an agreement with Ministry of the Interior and Safety(MOFA), and has been sending out EMCS information via SMS, and providing 24-hour EMCS to all citizens abroad.

❍ Preventing gender obstacles in consultation EMCS is for men, women, and all gender minorities alike. In the recent consultation cases (July 1, 2018-June 30, 2019), 83.5% were men, 15.8% woman, and 0.7% others. The most notable gender-related case was one where a caller complained of a lump in the testicle along with abdominal pain. The consulting doctor prescribed medication taking into account the patient’s potential unsafe sexual behavior. We have two male and two female doctors, and an even number of male and female EMS consultants to handle gender sensitive cases related to reproductive organs.

❍ (Crew and passengers at sea) Providing proper treatment with limited resources NFA has translated WHO’s “International Medical Guide for ships, 3rd edition” with WHO’s approval, and has been distributing the materials free of charge for use on board ships. NFA also helps the Korea Maritime Institute use them in training. In addition, NFA suggests a list of prescription-based medicine and equipment for medical officers on board ships to enable them to provide proper emergency treatment with EMCS. ❍ (Citizens abroad) Meeting the demands of citizens in emergency medical situations in foreign countries It is difficult to know what to do when one falls sick or sustains an injury in unfamiliar foreign countries, because of the language barrier, high medical costs, and difficulty in accessing medical facilities. According to most recent EMCS data (July 1, 2018–June 30, 2019), 602 medical consultations, 569 emergency treatment recommendations, and 284 medication directions were provided, and the demand is rising.

❍ Expanding the service to all Korean citizens abroad NFA’s Busan headquarters had been providing EMCS for maritime crew and passengers since 2012. Subsequently, NFA built a better organized system by signing an MOU with the Korea Maritime Institute, which trains maritime emergency medical officers. In 2017, the NFA EMS Center was installed with 16 personnel, including four emergency medicine specialist doctors, and then expanded to cover not just maritime crew and passengers but all Korean citizens abroad. ❍ MOU for specialization of the service For the specialization and development of EMCS, NFA signed an MOU with the Korean Society of Emergency Medicine, which covers education, training, medical consultation guidance, emergency medical policy, and development of emergency services. In 2018, NFA signed an agreement on personnel exchange, EMS research, and cooperation in education with the SNUH, the most prestigious medical institution in Korea. ❍ Efforts to improve the service We have created a standard form for recording the consultations. We record every case in detail, and report on the analysis of the records semi-annually. Apart from the semi-annual reports, we evaluate the results of the consultations on completion. We classify the patient’s conditions into the categories of “improved without hospital treatment” / “improved after hospital treatment” / “improved with hospitalization and surgery” / “deceased,” and track the changes in the patient’s condition. Moreover, we analyze the data by condition, country, and period, and strive to provide better emergency medical services.

❍ Successful recruitment of hard-to-hire doctors NFA had previously failed to hire doctors five times, due to differences in wages. We concluded that it would be impossible to recruit doctors through general recruitment, and devised a three-pronged approach to hiring. First, we contacted doctors with interest in public medical care through social networks, and recruited two doctors. Second, we signed an agreement with SNUH and recruited two additional doctors through exchange of personnel. Lastly, in order to motivate the doctors to continue to work with us, we appropriated their wages at the maximum level of their position.

❍ The first institutional personnel exchange in Korea and innovations in communication The Korean government carried out its first institutional personnel exchange in history between the National Fire Agency and Seoul National University Hospital to hire emergency medicine specialist doctors who could not be employed through general recruitment. We have diversified the modes of accessing the service into email, phone, and web site, which are available 24 hours a day. We are also sending out SMS to mobile phones of travelers with information about this service and more.

❍ Expanding domestic EMCS to all citizens abroad Domestic EMCS, which we have been providing for 30 years, has proven its effectiveness in pre-hospital emergency medical situations. It increased the rate of return of spontaneous circulation(ROSC) in recipients from 4.5% in 2013 to 10.6% in 2018 by providing instructions on emergency treatments to be performed by the caller on site before the arrival of the ambulance in a total of 1,393,467 cases of medical consultation. We were confident that if the service was expanded to citizens abroad, it would be of tremendous help in inadequate medical environments.

No similar service from other countries served as a model or reference for EMCCA. National Fire Agency(NFA) has never looked into whether a similar service exists in other countries.

❍ Plans to assist Vietnam adopt the service as a Korea International Cooperation Agency’s Official Development Assistance (KOICA ODA) initiative The Korean government conducts the “International Development Cooperation Initiative” with developing countries every year, and NFA suggested helping developing countries adopt the EMCS (including for citizens abroad). Vietnam showed considerable interest and agreed to adopt the service. This is a two-year initiative set to begin in 2021. In the first year, we will share information on the general understanding of EMCCA, construction of the system, and law revisions. We will be training government policy managers in the field of Vietnamese pre-hospital emergency medical service. In the second year, we will be training the staff who will be directly involved in operation of the system. Through practice-based training, they will gain skills and knowledge in making the service manuals, evaluating the service, and more. Vietnam is in need of EMCCA, due to its large number of overseas travelers and workers. We believe that operating the EMCS service via a system built in a department of a central government institution would contribute to the medical care-related satisfaction of citizens abroad.

❍ Building and operating the NFA EMS Center We secured the EMCS infrastructure by building the NFA EMS Center with a budget of 2,500,000,000 KRW, while a maintenance budget of 280,000,000 KRW is allocated annually. ❍ Securing doctors through personnel exchange with SNUH and direct recruitment The personnel exchange program between an administrative institution (NFA) and a public institution (SNUH) was the first of its kind in Korea, and serves as a reliable hiring source. We have recruited additional doctors by contacting them individually. The consultant personnel were selected from among persons with abundant field experience.

❍ Strengthening the legal basis Although there are related articles in the “Act on 119 Rescue and Emergency Medical Services,” in order to make the legal basis for EMCCA more clear, we have plans to revise this Act and issue regulations related to tasks assigned to NFA. ❍ Securing Emergency Medical Fund Budget for year 2020 Aside from the budget for the wages of doctors and EMS consultants, the maintenance of the EMS Center, and other general accounts, we have allocated an additional 657,000,000 KRW to employ two extra part-time emergency doctors.

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❍ Awarded Grand Prize in 2018 Korean Government Innovation Practice The Korean government awards the “Best Korean Government Innovation Practice Grand Prize” each year for the introduction and spread of best innovative government practices. EMCCA and its recruitment process (personnel exchange) was selected as the Best Practice for 2018 and awarded the Presidential Grand Prize.

❍ Innovativeness and public benefit The “Best Korean Government Innovation Practice Grand Prize” winner was selected based on a three-step evaluation process: 1) document review by experts(33 selected from 420), 2) evaluation of public approval on the web(16 cases selected), and 3) expert and audience evaluation of presentations(final rankings determined). The main focus in the process was on the innovativeness and the amount of public benefit.

❍ Increased awareness in Korea Media reports on NFA being awarded the “Best Korean Government Innovation Practice Grand Prize” became an opportunity to raise awareness about the service in Korea, while also helping secure the budget. There have been no complaints against the service, which was provided proactively without any pre-existing demand from the public or the academic community of emergency medicine. However, two improvements were needed after a self-evaluation by the service providers. The first was the need for more information on the medical system in every nation. The second was the need for an SNS channel (such as Facebook), in addition to the existing modes of access: phone, email, and web site.

❍ Cooperation with NFA Operations Center For 20 years, NFA has operated an internet site for reporting fire, rescue, and medical emergencies. On this site, the menu for “Emergency Medical Consultation Service for Citizens Abroad” has been added, and it is currently supporting emergency medical consultations through the internet. ❍ Cooperation from regional fire agencies Aside from medical consultations, there may be other types of requests such as confirmation of the safety of family members in Korea, in which case the call is transferred to the concerned regional fire agency, which confirms the status of the family members and notifies the caller of the results. In the past one year, there have been seven requests of this kind. For example: “I cannot get hold of ... in Korea, he talked about committing suicide, please check if he is safe.” Also, if a doctor at the NFA EMS Center cannot offer a consultation due to his involvement in another case, the request is transferred to other fire agencies such as Seoul Metropolitan Fire & Disasters Headquarters EMS Center as we have cooperative relationships with regional fire agencies, thus ensuring that the consultation takes place smoothly.

❍ Sending SMS to overseas travelers and connecting Consulate Call Center (MOFA) Previously, MOFA used to send SMS text messages on emergency situations to overseas travelers, but now sends out SMS messages on EMCCA to citizens abroad. In case callers need assistance with something other than medical aid, such as translation, they are assisted via three-way or four-way phone calls. - Three-way call: Caller + Consular Call Center + Doctor - Four-way call: Participants of three-way call + local medical personnel, EMT, or consular representative ❍ Participation of various stakeholders Travel companies, ship-owner associations, crew training institutes, and companies and institutions that dispatch employees overseas are all engaged as the users and promoters of this service.

❍ Improved credibility of the government The government actively provides the service to protect citizens and ensure that they do not face medical isolation or inaccessibility in foreign countries, thereby improving its credibility. The service also covers foreign nationals working with Koreans, contributing to the co-prosperity of humankind. ❍ Development of a global emergency medical system and network Countries have different emergency medical systems. They differ in terms of their scope and quality, and medical supplies purchasable by the general public are limited. Therefore, we must gather more information on the emergency medical system in each country. We also recognize the need for developing networks with foreign fire agencies and emergency medical institutions to ensure cooperation in times of need. To address these matters, we plan to propose that the Korean government take this up as a new type of overseas training for government employees. ❍ Including SNS as a new consultation channel The need for including SNS as a new consultation channel was recognized, as the use of SNS is growing in popularity. If SNS were utilized, it would not only provide real-time chatting facilities, but also permit video communication, facilitating more accurate diagnosis.