Evolution of Emergency Medicine: A Historical Overview

1. Emergency Medicine: A Brief History & Specialty Definition Prepared by: Paul M. Been, DO Akron General Medical Center

2. Emergency Medicine Roots • A French surgeon noticed during the Napoleonic era that injured soldiers on the battlefield died because of lack of immediate care • An ambulance corps was established, marking the development of the concept of triage

3. Napoleonic Era Ambulance

4. Post WWII Boom • Population growing exponentially • 400% increase of emergency room visits from 1940-1955 (NEJM Article - Shortliffe) • Need for emergency room facilities

5. 1961: Full-time Emergency Physicians Emerge • James Mills Jr., M.D. - Alexandria Plan • Michigan 30 physicians - Pontiac Plan

6. ACEP is Born • 1967 - Dr. John Wiegenstein - Lansing, MI • Recruited nationwide with the same objective • August 16, 1968 – 8 physicians met in Lansing • ACEP was born • Dr. Wiegenstein became the first chairman

7. Training History • University of Cincinnati Medical School recognized need for improving medical care • The AMA approved the hospital’s proposal for a residency with a focus in emegency care • In 1970, Bruce Janiak was the first resident

8. EMRA is Born • Founded in 1974 • Remains the only independent resident specialty organization • More than 9000 current members

9. A Specialist in Emergency Medicine Is… • Dedicated to the diagnosis and treatment of unforeseen illness or injury in any type of setting • Physician’s responsibilities include the initial evaluation, diagnosis, treatment and disposition of any patient requiring expeditious medical, surgical or psychiatric care • Moreover, the emergency physician is responsible for coordinating pre-hospital care, educating emergency department staff and coordinating care between numerous providers and healthcare facilities

10. Board Certification • Completion of an accredited emergency medicine residency program (at least 36 months) • ABEM certification examinations • Written qualification exam • Followed by an oral certification • Upon successful completion of these requirements, a physician is then considered to be an ABEM diplomat

11. Fellowship Status • 2 pathways • Applicants must be board certified plus three years ACEP membership and contribute service to the specialty • A second pathway to honor physicians who contributed to the specialty but were not board certified due to their entrance to the specialty prior to the availability of residence training programs

12. FACEP Controversy • Fellowship given to non-board certified physicians under second pathway • Limited window of 2 years • Honored our founders who created the specialty and could not train

13. Conclusions • Emergency medicine have come a long way • EMRA celebrated its 35th anniversary in 2009 • ACEP celebrated its 40th anniversary in 2008 • EMRA and ACEP will continue to work on behalf of the emergency medicine physician • Goal: Only route to board certification in emergency medicine is through an emergency medicine residency

14. References • Schlicher, Nathaniel R., ed. Emergency Medicine Advocacy Handbook. Irving, TX: EMRA, 2009. Print. • American College of Emergency Physicians. 2010. About Us: History of ACEP: EM Milestones. http://www.acep.org/aboutus.aspx?id=35148. Accessed January 27, 2010.