Chest Pain and 119 Emergency Care: "Not Considered Emergency Medical Treatment?"

- The Health Insurance Review and Assessment Service (HIRA) concluded that if test results for emergency room patients suspected of having acute heart conditions do not confirm such conditions, the case will not be recognized as an "emergency medical case."

- The CAAC ruled that medical treatment provided to a patient brought to the emergency room via a 119 ambulance should be recognized as "emergency medical care," overturning HIRA’s decision to deny payment of emergency medical expenses.

(22, October. 2024, ACRC)

The Central Administrative Commission (CAAC) concluded that it is unlawful to deny recognition of medical interventions as "emergency medical treatment" in cases where patients presented symptoms that could pose significant health risks but were later found to be non-existent.

The Anti-Corruption and Civil Rights Commission (ACRC), led by Chairperson Ryu Chul Whan, announced that the CAAC overturned HIRA’s decision not to recognize medical care provided to a patient who complained of chest pain and arrived at the emergency room via 119 services as emergency medical treatment*.

* Under the Emergency Medical Services Act, medical care is deemed "emergency medical treatment" when it is urgently required to prevent life-threatening conditions or severe harm due to illness or injury. If the patient cannot pay the medical bills, the government covers the cost and later seeks reimbursement from the patient.

In this case, a 34-year-old man (Mr. A) living in a shelter collapsed at a subway station in August last year due to chest pain. Responding to a passerby’s report, the 119 emergency service transported him to a regional emergency medical center (Hospital B).

The medical team at Hospital B suspected acute heart disease based on his unstable vital signs and admitted him to the resuscitation room for tests, including ultrasound, CT scans, and an ECG. Fortunately, the results showed no signs of acute heart disease.

However, as Mr. A could not afford the medical expenses, he was discharged later that day, and Hospital B applied for government reimbursement of the treatment costs to HIRA. HIRA rejected the application, claiming that the absence of acute heart disease meant the treatment did not qualify as emergency medical treatment.

The CAAC ruled that not recognizing medical interventions as emergency medical treatment simply because the patient’s condition was later found to be non-emergent goes against the intent of the Emergency Medical Services Act.

The CAAC noted that Mr. A’s symptoms (chest pain and collapse at the subway) raised sufficient suspicion of a cardiovascular emergency, ing the 119 emergency team and medical staff to act accordingly. Therefore, the interventions should be classified as emergency medical treatment.

As such, the CAAC declared HIRA’s rejection of Hospital B’s claim for emergency medical reimbursement unlawful.

Park Jong-min, Chairperson of the CAAC, stated, "Emergency medical professionals must act decisively to save lives without hesitation. The CAAC will work to address shortcomings in the emergency medical system and its operations to ensure support for these vital decisions.