Changes in emergency medical services transport time during the 2024 Korean healthcare system crisis

Abstract

Background: The 2024 Korean healthcare system crisis raised concerns regarding delays in emergency medical services (EMS) transport to emergency departments (EDs). We evaluated changes in total EMS transport time before and after the onset of the crisis. Methods: We performed a multicenter observational study using an interrupted time series (ITS) design. Adult patients transported by EMS to 13 EDs in Seoul between April 19, 2022, and December 31, 2024, were included. Changes in total EMS transport time were analyzed using ITS regression with hospital-week aggregation and covariate adjustment. In-hospital mortality was examined as a secondary outcome using multivariable logistic regression. Results: A total of 199,150 patients were included, with 153,320 in the pre-crisis period and 45,830 in the post-crisis period. During the post-crisis period, weekly EMS transport volume was lower, while patients had higher prehospital National Early Warning Scores and ED triage acuity. Before the crisis, total EMS transport time showed a declining trend of −0.07 min per week (95% confidence interval [CI], −0.10 to −0.04). At crisis onset, an immediate increase of 6.74 min was observed (95% CI, 4.71 to 8.77), followed by an increasing post-crisis trend of 0.15 min per week (95% CI, 0.11 to 0.19). After adjustment, post-crisis transport was associated with lower odds of in-hospital mortality (adjusted odds ratio, 0.83; 95% CI, 0.78 to 0.89). Conclusions: The 2024 Korean healthcare system crisis was associated with an immediate and sustained increase in EMS transport time.