Emergency Medicine Is A Relatively Recent Development In Medical History

History of Emergency Medicine

When exploring the history of of Emergency Medicine Residency Training, one word comes to mind – explosive! It’s almost unfathomable how far EM training has come in so little time – 65 years to be exact – and though it’s been a circumstantially fast-tracked journey, it’s had its fair share of bumps along the way.

EM training was first interwoven with the push for specialty status in Emergency Medicine in the late 1960’s and 1970’s. The modernization of hospitals shifted the focus of practitioners, with the number of American specialist physicians rapidly increasing, and the number of general practitioners declining. With technological advancements, demographic and social forces at work, people simply grew more reliant upon hospital emergency care.

It was apparent almost immediately that Emergency Medicine was going to require a different caliber of expertise and training, in which the ability to provide quality care is directly related to the EM environment, a unique type of clinical setting which can’t be accurately portrayed in institutional text alone, or by school administered learning. Thus, a new specialty emerged.

In 1961, James Mills, Jr., MD, and three of his colleagues began a full-time Emergency Medicine practice in Alexandria, Virginia. By the late 1960’s, hundreds of “Emergency Physicians” were in practice across the U.S..arly EM leaders left their practices to fully dedicate themselves strictly to Emergency Departments, as they recognized the huge need for Emergency Medicine training.

By 1968, John Wiegenstein, MD, and other founders organized these physicians to form the American College of Emergency Physicians (ACEP). ACEP has continued to serve as the driving force behind moving the field forward. E

What started as month-long courses administered at academic medical centers – the only apparent way to effectively train Emergency Physicians – not only sketched out the blueprint for CME courses, but became later known as the first formal residency program, with the first acting institution being the University of Cincinnati.

By this time, with EDs shifting to top of the preferred care choice of patients seeking emergency services, ED patient volumes were averaging admittance of more than 100,000 patients annually. A change was sorely needed and a young internist by the name of Herbert Flessa, MD revolutionized the EM training forever.

Flessa applied to the AMA to start a two year residency in Emergency Medicine (after a rotating internship), which was surprisingly approved under family practice – with a certificate of special training in Emergency Medicine – was promoted as an Emergency Medicine residency, thus the first Emergency Medicine residency was born in 1970.

Shortly thereafter, EM residencies sprang up across the nation, including Pennsylvania, Louisville, and Southern California, implementing what is now known as the standard for EM training, establishing organizations to further the push to for Emergency Medicine to be recognized as a specialty.

By 1979, the American Board of Emergency Medicine was approved by the American Board of Medical Specialties.

“We were different than everybody else. We were the soldiers of fortune that were trying to battle our way within this big medical center. Nobody understood who we were, what we were doing. So we had an enormous bond.” recalls Phillip Buttaravoli, MD, an early Emergency Medicine resident at the University of Cincinnati.

Joseph Bryant
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