The Origins of Emergency Medicine in the U.S.

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Broken arm, rapid blood loss, trouble breathing, or even a dangerously sick child, any or all of these patients could cross the threshold of an Emergency Room at any moment. Open 24 hours, seven days a week, 365 days of the year, Emergency room staff are there when we need them most.

Medical care as a specialty dates back to the early 1800s, however, emergency medicine only dates back 50 years, making it the youngest recognized specialty in the medical field.

So what happened before there was Emergency Medicine (EM)?

Early History ~ 1800s

  • Dominique Jean Larrey, Napoleon’s chief surgeon, noticed the lack of immediate care to soldiers on the field. He is credited with the concept of triage, developing a horse drawn ‘ambulance’ to gather the injured and transport them to a nearby treatment tent.
  • General Practice (GP) physicians were among the most common specialties available. As a result, GPs were often in charge of ‘emergency care’ in the form of house calls to patients round the clock.

Early 1900s

  • After World War II, doctors learned trauma procedures for patients on the field leading to a new specialty. As more specialized medical roles developed, it became apparent that treatment within a large hospital network was more beneficial than a private office. This lead to the creation of the emergency departments for patient admission.
  • Early emergency departments were run in one room. The department could be run by anyone, from interns in their first year, to a physician on call for the day such as a psychiatrist or dermatologist. On-call physicians were good at handling cases in their specialty, but not as strong with assisting other patients sometimes leading to delays in patient care or misdiagnoses.

Modern Day Advancement ~ 1960s

  • 1961: Recognizing the need for Emergency Medicine specialization, Dr. James D. Mills convinced three of his coworkers to leave their medical practice to develop an Emergency Department in Alexandria, VA. Just north of their efforts, a larger group of 23 physicians were doing the same in Pontiac, MI. This became known as the Alexandria-Pontiac plan. The Alexandria emergency department (ED) became the first organized group of physicians providing medical care in an ED setting.
  • 1966: Helping move the evolution of EM forward, a report documenting the lack of care available in the ED was published by National Academy of Sciences. During this time, medics on the field in the Vietnam War realized medical trauma care for soldiers in the field was more advanced than the care back home in the ED.
  • 1968: In Lansing, MI, eight physicians organized the first group focused on educating physicians on EM care named American College of Emergency Physicians (ACEP). This group was created with the belief that emergency medicine should qualify as a specialty for physicians.

1970s

  • 1970: Bruce Janiak enrolled at the University of Cincinnati becoming the first emergency resident trainee.
  • 1971: Three students enrolled at the University of Southern California in Los Angeles. This is now the oldest running program.
  • 1972: The American Medical Association (AMA) officially recognized EM as a specialty. This was no easy accomplishment. Some physicians opposed the new specialty saying a lack of focus made it unnecessary.
  • 1973: Just one year after officially inducting EM into the medical world, the federal Emergency Medical Services Systems was passed funding regional and local EMS services.
  • 1974: To unite the residents in training, Emergency Medicine Residents Association (EMRA) was formed.
  • 1976: The ACEP established the American Board of Emergency Medicine (ABEM) which was approved and became the twenty-third recognized medical specialty in the US just three years later.

1980s and 1990s

  • 1989: The ABEM was granted primary specialty which meant emergency medicine was no longer under any other focus, allowing it to develop subspecialties. Sub-specialties of emergency medicine in the U.S. include toxicology, pediatric emergency medicine, emergencies and disasters, critical care, hyperbaric medicine, administration/practice management and research.
  • 1990s: Emergency Medicine became more publicized through media with shows like ER.

The Current State of Emergency Medicine

According to an interview with Dr. Don Stader by WFAE, 20 percent of the US population will visit the Emergency Room at least once a year. Since the development of EM, the specialty continues to grow in education and treatments. Data collected in 2009 by the CDC show demand for emergency service increased by 35 percent from 1996, and the need continues to rise.

The demand of EM does not only come from patients, but from medical trainees as well. EM has become one of the most competitive specialties in the medical world, producing over 2,000 graduates every year.

The emergency room is no longer a small room, but instead an entire department complete with a staff of nurses and physicians specialized to treat in emergency situation. Visitors to the department   do not always have a life-threatening emergency, but patients use the ER as an after-hours clinic. The ER is also a place for patients with no insurance or limited health care.

As a physician, what role do you think Emergency Medicine will play in America’s future? What do you think are the biggest issues facing ERs today? If you work in this field, we would love to hear from you.

We will be discussing this and more inside Sermo, our physician community. If you’re an M.D. or D.O., please join us.

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