Journal of Yeungnam Medical Science

Original articles

Emergency and Critical Care Medicine
Comparing emergency medical system governance in Japan and South Korea: lessons for high-income countries from a multisource comparative health systems analysis: Kentaro Kajino, Jung Ho Kim, Jeong Ho Park, Kyoung-Jun Song, Mohamud R. Daya, Yasuyuki Kuwagata; J Yeungnam Med Sci. 2026;43:3. Published online December 18, 2025; DOI: https://doi.org/10.12701/jyms.2026.43.3

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Abstract PDF Supplementary Material: Background
Japan and South Korea, two advanced East Asian nations with universal health coverage and similar demographic challenges, have developed markedly different emergency medical services (EMS) systems. Despite growing interest in international benchmarking, structured, comparative studies that yield policy-relevant insights remain limited.
Methods
We conducted a multisource comparative health-systems analysis using statutory laws, government publications, academic society reports, peer-reviewed literature, and national statistics. Key domains included EMS governance, workforce, prehospital organization, hospital-based emergency care, legal obligations for EMS patient transport and hospital acceptance, and governance and quality assurance mechanisms. Data were synthesized in comparative tables and narrative summaries to highlight structural and operational differences.
Results
Japan’s EMS system operates under decentralized municipal control through 722 fire departments, serving 4,100 designated emergency institutions with 6,139 board-certified emergency physicians. In 2023, over 6.64 million ambulance dispatches occurred, and 8.6% were classified as critical cases (1.3% death and 7.3% severe). Korea’s EMS system is centrally governed with 412 designated facilities in a tiered system and 2,464 specialists. Annual ambulance activations exceeded 3.5 million, with severe cases accounting for approximately 5% to 10%. Japan employs a multilayered legal–institutional structure, primarily involving the Fire Service Act and the Medical Practitioners Act, allowing clinical discretion, whereas Korea enforces unified regulations with stricter obligations and criminal penalties for hospital refusal of emergency patients.
Conclusion
The contrasting systems suggest that hybrid governance that combines centralized standard settings with local operational flexibility may optimize EMS performance. These findings provide lessons for EMS reform, cross-border collaboration, and disaster preparedness in high-income nations facing similar demographic and healthcare challenges.

Emergency and Critical Care Medicine
Clinical investigation on acute pyelonephritis without pyuria: a retrospective observational study: Hyung Keun Song, Dong Hyuk Shin, Ji Ung Na, Sang Kuk Han, Pil Cho Choi, Jang Hee Lee; J Yeungnam Med Sci. 2022;39(1):39-45. Published online August 11, 2021; DOI: https://doi.org/10.12701/yujm.2021.01207

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Background
The current guidelines for the diagnosis of acute pyelonephritis (APN) recommend that APN be diagnosed based on the clinical features and the presence of pyuria. However, we observed that some of the patients who are diagnosed with APN do not have characteristic clinical features or pyuria at the initial examination. We performed this study to investigate the characteristics of APN without pyuria.
Methods
A retrospective, cross-sectional study was conducted on 391 patients diagnosed with APN based on clinical and radiologic findings, between 2015 and 2019. The clinical features, laboratory results, and computed tomography (CT) findings were compared between patients with normal white blood cell (WBC) counts and those with abnormal WBC counts (WBC of 0–5/high power field [HPF] vs. >5/HPF) in urine.
Results
More than 50% of patients with APN had no typical urinary tract symptoms and one-third of them had no costovertebral angle (CVA) tenderness. Eighty-eight patients (22.5%) had normal WBC counts (0–5/HPF) on urine microscopy. There was a negative correlation between pyuria (WBC of >5/HPF) and previous antibiotic use (odds ratio, 0.249; 95% confidence interval, 0.140–0.441; p<0.001), and the probability of pyuria was reduced by 75.1% in patients who took antibiotics before visiting the emergency room.
Conclusion
The diagnosis of APN should not be overlooked even if there are no typical clinical features, or urine microscopic examination is normal. If a patient has already taken antibiotics at the time of diagnosis, imaging studies such as CT should be performed more actively, regardless of the urinalysis results.

Citations

Citations to this article as recorded by

Clinical Characteristics, Microbiological Spectrum, Biomarkers, and Imaging Insights in Acute Pyelonephritis and Its Complicated Forms—A Systematic Review
Marius-Costin Chițu, Teodor Salmen, Paula-Roxana Răducanu, Carmen-Marina Pălimariu, Bianca-Margareta Salmen, Anca Pantea Stoian, Viorel Jinga, Dan Liviu Dorel Mischianu
Medicina.2026; 62(1): 222. CrossRef

Emergency and Critical Care Medicine
Impact of an emergency department resident strike during the coronavirus disease 2019 (COVID-19) pandemic in Daegu, South Korea: a retrospective cross-sectional study: Yo Han Cho, Jae Wan Cho, Hyun Wook Ryoo, Sungbae Moon, Jung Ho Kim, Sang-Hun Lee, Tae Chang Jang, Dong Eun Lee; J Yeungnam Med Sci. 2022;39(1):31-38. Published online August 10, 2021; DOI: https://doi.org/10.12701/yujm.2021.01130

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Abstract PDF

Background
To prepare for future work stoppages in the medical industry, this study aimed to identify the effects of healthcare worker strikes on the mortality rate of patients visiting the emergency department (ED) at six training hospitals in Daegu, Korea.
Methods
We used a retrospective, cross-sectional, multicenter design to analyze the medical records of patients who visited six training hospitals in Daegu (August 21–September 8, 2020). For comparison, control period 1 was set as the same period in the previous year (August 21–September 8, 2019) and control period 2 was set as July 1–19, 2020. Patient characteristics including age, sex, and time of ED visit were investigated along with mode of arrival, length of ED stay, and in-hospital mortality. The experimental and control groups were compared using t-tests, and Mann-Whitney U-test, chi-square test, and Fisher exact tests, as appropriate. Univariate logistic regression was performed to identify significant factors, followed by multivariate logistic regression analysis.
Results
During the study period, 31,357 patients visited the ED, of which 7,749 belonged to the experimental group. Control periods 1 and 2 included 13,100 and 10,243 patients, respectively. No significant in-hospital mortality differences were found between study periods; however, the results showed statistically significant differences in the length of ED stay.
Conclusion
The ED resident strike did not influence the mortality rate of patients who visited the EDs of six training hospitals in Daegu. Furthermore, the number of patients admitted and the length of ED stay decreased during the strike period.

Citations

Citations to this article as recorded by

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Arum Choi, Beom Joon Kim, Jooyoung Lee, Sukil Kim, Woori Bae
BMC Emergency Medicine.2025;[Epub] CrossRef
Impact of Medical Residency Programs on Emergency Department Efficiency
Myeong Namgung, Sung Jin Bae, Ho Sub Chung, Kwang Yul Jung, Yun Hyung Choi, Chan Woong Kim, Ye Lim Gong, Ji Yun Lee, Dong-Hoon Lee
Medicina.2025; 61(6): 999. CrossRef
A deliberative framework to assess the justifiability of strike action in healthcare
Ryan Essex
Nursing Ethics.2024; 31(2-3): 148. CrossRef
Impact of junior doctor strikes on patient flow in the emergency department: a cross-sectional analysis
Svenja Ravioli, Raeesa Jina, Omar Risk, Fleur Cantle
European Journal of Emergency Medicine.2024; 31(1): 53. CrossRef
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Debra Malina, Lisa Rosenbaum
New England Journal of Medicine.2024; 390(3): 279. CrossRef
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Eun Kyung Choi, Sanghee Yeo
Korean Journal of Medical Education.2024; 36(2): 157. CrossRef
Impacts of industrial actions, protests, strikes and lockouts by health and care workers during COVID-19 and other pandemic contexts: a systematic review
Isabel Craveiro, Pradeep Kumar Choudhury, Ana Paula Cavalcante de OLiveira, Alessandra Pereira, Inês Fronteira, Raphael Chança, Giorgio Cometto, Mario Roberto Dal Poz, Paulo Ferrinho
Human Resources for Health.2024;[Epub] CrossRef
Why Did All the Residents Resign? Key Takeaways From the Junior Physicians’ Mass Walkout in South Korea
Jinwook Park, Chang Ho Shin, Joo-Young Lee
Journal of Graduate Medical Education.2024; 16(4): 402. CrossRef
Comparison of the postoperative complications for gastric cancer surgery before and during the medical crisis in South Korea: a retrospective observational study
Kyoungdong Lee, Ba Ool Seong, Moon-Won Yoo
Annals of Surgical Treatment and Research.2024; 107(6): 354. CrossRef
Experience of operating a medical humanities course at one medical school during the COVID-19: a retrospective study
Yu Ra Kim, Hye-won Shin, Young Hwan Lee, Seong-Yong Kim
Journal of Yeungnam Medical Science.2023; 40(2): 179. CrossRef
Study on the Learning Environment of Medical Students in the COVID-19
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Keimyung Medical Journal.2023; 42(2): 80. CrossRef

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