💡 This article is written from the perspective of an emergency medicine physician with direct experience in South Korea’s emergency medical system. Every country’s healthcare system is different — but some problems have a way of looking familiar no matter where you are.

If you follow Korean news, you’ve probably come across the term ambulance diversion — when emergency crews are turned away from one hospital after another, unable to find a bed. It’s a phenomenon where a 119 crew (Korea’s equivalent of 911) spends precious time calling hospital after hospital, unable to find one willing to accept their patient.

The phrase conjures an image of an ambulance frantically circling the city. The reality is less dramatic but no less troubling: in most cases, the crew stays put — parked at the scene or somewhere nearby — while the phones keep ringing and the clock keeps ticking.

As an emergency physician, and as someone whose own family has been through this, I want to explain why this keeps happening. Not with statistics or policy jargon, but honestly.

Why Does This Happen?

There are two root causes — and they compound each other.

Not Every Hospital Has Specialists on Call Around the Clock

When a 119 crew brings a patient to the ER, some cases can be handled entirely by the emergency physician on duty. But many patients need a specialist from another department — a neurosurgeon, a cardiologist, a vascular surgeon. And here’s the problem: in most Korean hospitals, that specialist simply isn’t there at night or on weekends.

Only hospitals of a certain size — large general hospitals or university-affiliated medical centers — can even attempt to staff after-hours specialists. And even then, putting together a schedule with one doctor per department per shift is genuinely difficult. If the specialist on duty is already with another patient, the next emergency case either waits or gets redirected elsewhere.

This naturally leads to a question: Does Korea just not have enough doctors?

Not exactly. Walk through any busy commercial district in Korea and you’ll see clinics packed between the coffee shops — there is no shortage of physicians. The shortage is far more specific: there aren’t enough doctors willing to cover nights, weekends, and true emergencies.

Two systemic forces are driving this.

The first is reimbursement. Korea’s national health insurance fee schedule pays so poorly for emergency and after-hours care that hospitals genuinely cannot afford to staff these shifts. We’re not just talking about physician salaries — even covering support staff for overnight shifts is a financial stretch under the current structure.

The second is legal exposure. Treating an emergency patient means taking on someone who is already in serious condition, doing your best, and accepting that outcomes aren’t guaranteed. But in Korea’s current legal climate, even when there’s no criminal wrongdoing, civil liability has been found — and it has become a powerful deterrent. When a physician can be held responsible for a bad outcome that began before they ever met the patient, the rational response is to avoid those situations altogether. And many do.

Medical Resources Are Finite

The first problem was about people. This one is about infrastructure.

The number of ambulances, paramedics, emergency beds, and critical care equipment in any given region is fixed. And fixed resources — no matter how well distributed on average — will always have moments of scarcity.

I know this firsthand. My father-in-law fell down a flight of stairs and hit his head hard. He had a laceration over 10 centimeters long with arterial bleeding, and he couldn’t get up on his own afterward. With clear neurological signs, I had to rule out intracranial hemorrhage. I called 119 immediately.

The response? “All units are currently deployed. Please wait for one to return.”

Twenty minutes passed. A unit finally became available. Fortunately, it was the middle of the day, and a nearby university hospital agreed to accept him. We were lucky on two counts. At night, or if another emergency had come in ahead of us, the story could have been different.

Dispatch centers do their best to allocate resources based on regional data and historical demand. But emergencies don’t follow schedules. Temporary gaps are inevitable in any system — what matters is how small and infrequent you can make them.

The bed shortage tells a similar story. Patients and families naturally gravitate toward large university hospitals because they trust them to have the specialists needed for complex cases. This is a rational choice. But it creates chronic overcrowding in the places best equipped to handle serious illness. During my residency, even at a large institution, we regularly ran out of beds — patients waiting in family seating areas, sometimes in the hallway.

So What’s the Fix?

Honestly? A complete solution doesn’t exist. What we can do is make the problem smaller, less frequent, and less deadly.

The Definition of a “True Emergency” Needs to Shrink

Korea’s Emergency Medical Services Act defines eligible emergency conditions so broadly that the system is overloaded before a single ambulance moves. Conditions that rarely lead to true emergencies are listed alongside ones that kill in minutes.

In my view, a genuine emergency — the kind where the system must drop everything — falls into three categories:

• Neurological: altered consciousness, paralysis, seizure, sudden severe headache
• Cardiopulmonary: chest pain, difficulty breathing
• Hemorrhage: significant internal or external bleeding

What these have in common is that their underlying causes often involve a golden hour — the critical window where early intervention makes all the difference. The symptom itself doesn’t have a timer, but the diseases behind these symptoms often do. Stroke, myocardial infarction, aortic dissection, intracranial hemorrhage — these are conditions where every minute of delay accelerates irreversible damage.

Could the same symptom turn out to be something less serious? Absolutely. But no bystander, no family member, no one standing in that moment can reliably make that call. That’s exactly why the default should always be: assume the worst and move.

The other conditions currently listed in the law? Many of them warrant a hospital visit — but not necessarily an emergency system pushed to its limit to deliver them there.

On-Call Specialties Need to Be Distributed Across Hospitals by Region

Korea already has a system called the rotating on-call system for critical emergency conditions, where hospitals take turns covering specific critical illnesses. The concept is right. The execution falls short.

Participation is voluntary. The scope is narrow. And perhaps most importantly, having a specialist on call doesn’t always mean having the right specialist. A cardiothoracic surgeon who specializes in lung surgery can’t necessarily perform aortic repair. A neurosurgeon whose focus is the spine isn’t always the right person for a brain bleed.

In the Seoul metropolitan area, there are hospitals with dedicated aortic surgery teams available around the clock. Outside of that region, maintaining that level of specialized staffing and surgical infrastructure every single day is simply not realistic.

The solution, then, is to stop trying to make every hospital capable of everything — and instead guarantee that certain hospitals can handle specific critical emergencies reliably. That means funding, staffing, and protecting those centers from the administrative and legal pressures that currently push physicians away from the hardest cases.

Legal protection for good-faith emergency care. Reimbursement structures that don’t penalize hospitals for taking the sickest patients. These aren’t radical ideas — they’re prerequisites.

Final Thoughts

None of this gets fixed overnight. Building a functional emergency medical system requires movement across government, legislature, judiciary, and public culture simultaneously. That’s a slow process, and I have no illusions about how slow.

But as someone who works in emergency medicine — and as someone who will, one day, be on the other end of a 119 call — I believe it’s worth pushing for.

It’s not just Korea. Wherever you are in the world — I sincerely hope the day comes when emergency care works just a little better than it does today. As one emergency physician, that is my deepest wish.

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Dr. Edge keeps writing — as a doctor, and as a human being navigating life one story at a time.