Emergency Care Examined

Emergency Medicine: The Origin Story

Robert Calandra

War was the impetus for the creation of emergency medicine care. Before World War II, when health insurance was unusual, seriously sick or injured people were commonly treated at home. But doctors returning home from the war knew that critically ill or injured patients had a better chance of survival if they were treated in a hospital.

Evidence that faster care saved lives became more evident during the Korean War. Surgeons with the Mobile Army Surgical Hospital—the MASH units that became famous because of the movie and television show—learned the value of trauma triage and transport.

But getting injured or acutely ill people to the hospital was a dicey proposition at best. Most American ambulance services were ill equipped. Half were run by morticians or funeral directors because “they had vehicles that could transport people horizontally,” according to Robert E. Suter, whose 2012 paper published in the World Journal of Emergency Medicine titled “Emergency Medicine in the U.S.: A Systematic Review,” is a history of emergency medicine in this country.

Patients lucky enough to make it to a hospital were still rolling the dice. Most hospitals required interns and attending physicians from pretty much every specialty to work in the emergency department as part of their training, or as a requirement to have staff privileges. On any given day trauma patients most likely would be first seen by an inexperienced intern and then handed over to whomever the attending physician on call was, be they a general practitioner, psychiatrist, or dermatologist.

In 1961, James D. Mills, MD, recognized the need for better emergency care. Mills must have been persuasive because he convinced three of his colleagues to abandon their private practices and join him in opening the first fully staffed, 24-hour emergency department in Alexandria Hospital in Alexandria, Va.

At about the same time, a group of 23 physicians at Pontiac General Hospital in Pontiac, Mich., northwest of Detroit, were also setting up an emergency department.

Groundbreaking report

Those early pioneers may have “lit the flame” of emergency medicine, as Suter says, but it was fanned into a bonfire by a September 1966 report from the National Academy of Sciences and National Research Center titled, “Accidental Death and Disability: The Neglected Disease of Modern Society.” The groundbreaking report chronicled the dreadful state of American emergency medicine and resulted in President Lyndon B. Johnson signing the National Traffic and Motor Vehicle Safety Act and the Highway Safety Act into law.

Realizing that medical schools did not offer specialized, academic training in emergency medicine, the Michigan doctors, along with six other colleagues, formed the American College of Emergency Physicians (ACEP). Back in Virginia, another group of doctors formed their own association. The two groups joined forces under the banner of the ACEP.

Another white paper

In 1972, Emergency, featuring L.A.’s paramedics and doctors, premiered on television. (Twenty-two years later, ER, set in Chicago, would become a huge hit.)

Emergency medicine was hot, at least with the general public. But another white paper from the National Academy of Sciences and National Research Council scolded the federal government for being all talk and very little action. In response, Congress threw its support behind the fledgling specialty by passing the Emergency Medical Services Systems Act in 1973. The law provided grants to expand and improve emergency medicine, as well as study, plan, and establish a nationwide EMS system.

In 1976, the American College of Emergency Physicians created the American Board of Emergency Medicine to become the country’s 23rd recognized medical specialty.

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