CHAOTIC. THIS word encapsulates the everyday scene in anemergency room. Those who have visited the facility will recall the overwhelming confusion as people frantically come and go, with different levels of pain and anxiety etched out on their faces. It is the job of the emergency department personnel—doctors, nurses and paramedics—to give acute commands to locate and resolve the patients’ source of discomfort, and provide medical care to the suffering individuals as quickly as possible. Unfortunately, due to a lack of capital and the problem of understaffing, most users of the emergency room must wait in a long line for an unknowable number of hours, which often leads to their frustration and even violent outbursts. In recent events, some of these patients have resorted to directing their aggression towards the emergency personnel, who end up suffering irreversible physical and psychological injury.
Recent cases of assault
On May 1, a 48-year old female paramedic who worked at the Iksan Fire Station, Kang Yeon-hee, died from cerebral hemorrhage. A month earlier, she had been a target of assault when on duty: while transporting an intoxicated man to a nearby emergency room, he punched her several times on the head and continuously insulted her with abusive and obscene language. After the incident, the paramedic was reported to have experienced symptoms of trauma, such as constant nausea, dizziness, and insomnia. She was later diagnosed with a damaged automatic nervous system, a condition that is known to have been caused by the attack and ensuing stress. Soon after, the paramedic collapsed at home, and although she was immediately transported to a hospital, she passed away one week later.
Unfortunately, this event was not the first time that paramedics have had to struggle with violence. The supervisor of the aforementioned victim at the Iksan Fire Station revealed in an interview with The Joong-ang News Korea that paramedics usually choose not to report any assaults since the juridical process hardly produces any significant results. He also added that over the course of the past three years, the number of cases involving violence towards paramedics has reached 564. This, however, is only a sum of the cases that were officially reported—the rest remain buried under the surface.
A similar situation awaits in the emergency room. Once the patients are transported by the paramedics, doctors and nurses become possible victims of assault. On August 4, one patient caused a commotion in an emergency room and was arrested by the police, only to be released upon arrival at the police station. After his release, he returned to the same hospital on that night to threaten the medical staff with a piece of broken glass. Such incidents are only the tip of the iceberg. Reports by the Ministry of Health and Welfare show that the number of cases involving violence in emergency rooms—ones that were officially registered—reached over 800 in 2017. The numbers shockingly displayed an upward trend, having peaked over 500 in just the first half of 2018.
The costs of violence in the emergency room
This type of open aggression against the medical staff in the emergency room has an even larger societal impact than it may seem. One major consequence is the decrease in the number of emergency medical workforce. The demand for workforce in this field is already innately high: not many consider this career as their first choice due to the rigorous qualifications and difficult working conditions. The issue of violence, therefore, only worsens the already-challenging situation.
It is no secret that South Korean students who aspire to become doctors avoid majoring in emergency medicine. In 2014, only 0.01% of the 76,328 members at the Korean Medical Association had majored in emergency medicine. This number was around two to three times smaller than the number of doctors majoring in the more popular areas such as otolaryngology. Yonhap News explained that this is no surprise as a typical emergency medical doctor spends more than 100 hours at work in a week. Along with the demanding workload, these medical students must now consider the possibility of becoming victims of assault in their workplace. This predicament is even more detrimental to paramedics. Because of the nature of their occupation, paramedics must often dedicate much of their time to lengthy and difficult shifts. Being subjected to violence provides more strain on their stringent working schedule. If violence becomes rooted as an inevitable aspect of the job, South Korea may have to face the severe consequences of the lack of human resources in one of their most and crucial life-saving industries.
The other patients of the emergency room also unavoidably experience repercussions of the attacks. According to the Ministry of Health and Welfare, any given emergency room receives up to 200 patients daily. If the staff members at an already understaffed facility are being assaulted or are distracted, the 200 patients who require immediate treatment are at risk of having their turns delayed. This can be fatal in a life-or-death situation where every second matters. Even if the patients’ conditions are not as severe, they would have to wait in pain, which increases the risk of worsening their conditions beyond repair. The problems caused by violence in the emergency room is not limited to just the staff who are on duty. This issue is a cause of concern for all members of society.
Protocols against emergency room violence
A survey published by the Journal of the Korean Society of Emergency Medicine collected data from six different emergency rooms to reveal that 84.8% of its respondents felt the police did not immediately intervene in conflict situations. 92.8% of these respondents stated that they felt this way because the police didd not fully engaged in stopping the offenders from committing the violence. In many cases, the it appears that officers overlooked the situation as bystanders.
Despite the demand for protection of the emergency personnel, the current security protocols have proven to be insufficient. The current law states that violence committed against an emergency medical worker will result in imprisonment of up to five years, or a fine of up to \50 million. However, recent cases have demonstrated that the law does not necessarily prevent the offenders from committing the crimes. Legal action is rarely taken; in most cases, the offenders who are intoxicated are easily released for being under the influence of alcohol.
This is because the assaults are judicially processed under one of the founding pillars of the South Korean criminal law: the principle of culpability. This principle states that if the offender is not able to be held accountable for the crime, the crime is not able to be processed. Accordingly, the criminal sentence is decided upon the level of culpability. Article ten of the criminal law states that the offender’s sentence can be reduced if he or she proves to have exhibited signs of physical or psychological weakness during the crime. In many cases of assault, inebriation is considered “a state of weakness.” That is, because the offender was unable to differentiate between right and wrong due to alcohol consumption, he or she cannot be held responsible based on the principle of culpability. On July 31, an intoxicated man who was arrested for injuring a staff member in an emergency room in Gumi-si was let go without any strict legal charges due to his lack of sobriety.
In light of these recent incidents, the Korean Medical Association has demanded the National Police Agency to urgently devise better methods of prevention and countermeasures against emergency room violence. They proposed a zero-tolerance policy and additional punishment in the form of longer sentences and heavier fines. The National Police Agency responded by claiming they would take stronger action and promised that, in case of an assault, police officers would be immediately dispatched to the scene to protect the victim from the offender. If there were continued attempts of attack, the police officers would be required to use weapons, such as tasers, to immobilize and apprehend the offender, and take him or her into custody for investigation. The National Police Agency also agreed to the zero-tolerance policy and promised to provide police force to emergency rooms that request a special patrol.
The challenges in the future of emergency rooms
Constructing an adequate solution to the enforcement of safety in all emergency rooms is a demanding task, as there are many factors and implications that must be taken into consideration. First is the level of violence being committed. Violence can take on various forms. An example of a more severe case is the infliction of physical wounds on the victim, while cases such as light pushing or verbal abuse are more difficult to solve due to their openness to interpretation. So much as a slight shove can be perceived as a serious threat by the staff under the zero-tolerance policy, resulting in a more severe punishment than the offender deserves. Without delineating the boundaries of violence, any room for vagueness can lead to inefficiency—over-penalizing for the small cases and not giving enough punishment for the serious ones.
Inebriation further complicates the issue in emergency rooms. A study conducted by Seoul National University’s emergency medical department revealed that 17% of the patients who visited emergency rooms were under the influence of alcohol. Such statistics sheds light on the issue, as half of the cases of violence were committed by intoxicated patients. Professor Shin Sang-do of Seoul National University, one of the researchers in the aforementioned study, stated in an interview with Yonhap News that the detrimental presence of a drunk patient in an emergency room has been underestimated, and that proper countermeasures targeting this specific group of people must be taken to prevent further problems.
However, as shown by the ineffectiveness of similar declarations made by the police force in 2013, there is a possibility that the National Police Agency may be unable to follow up on their promise due to their own lack of workforce. They had promised the medical associations to release an official statement with the implemented changes to the policy. Their promise has not yet been fulfilled, despite the continuation of violence. There have also been ongoing exchanges between various medical associations and regional police departments, but their reports are neither conclusive nor effective as of yet. Regardless of the prevalence of emergency room violence and the immediate danger that it presents to the society, it seems that there has been no significant action taken bylaw enforcement agencies to ensure the smooth operation in emergency rooms. It is the job of the National Police Agency to secure the safety of the emergency medical personnel, and increasing only the severity of the punishment will not be a direct preemptive measure against the problem. Longer sentences and higher fines do not help reduce the crime. Along with the escalation of procedures after the arrest, it will be crucial to establish security measures to prevent the crimes from occurring in the first place.
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Since we do not often weigh in the possibility of having to visit the emergency room one day, we often feel far removed from its problems. Even in the unfortunate case of an accident, we expect that there will always be professionals who are ready to give us necessary treatments. However, without sufficient protection of the medical staff, there might come a day when no one is available to come to our rescue in times of grave need.
Every new case of attack opens a new opportunity to shed some light on the problem from a different angle. Whatever the root of this issue may be, the dialogue must continue, and until a feasible solution is found, it is important for us to assume our social responsibility. Even the smallest steps, such as recognizing that emergency room violence is a societal issue, is another step towards change for the safety of ourselves and those around us. Adequate measures must be implemented, both by the public and the society, to eliminate violence in a place where our lives may be at stake.