Transcript Emergency Medicine: A Brief History & Specialty Definition

Emergency Medicine:
A Brief History & Specialty Definition
Prepared by:
Paul M. Been, DO
Akron General Medical Center
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
Napoleonic Era Ambulance
Post WWII Boom
• Population growing exponentially
• 400% increase of emergency room visits
from 1940-1955 (NEJM Article - Shortliffe)
• Need for emergency room facilities
1961: Full-time Emergency
Physicians Emerge
• James Mills Jr., M.D. - Alexandria Plan
• Michigan 30 physicians - Pontiac Plan
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
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
EMRA is Born
• Founded in 1974
• Remains the only independent resident
specialty organization
• More than 9000 current members
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
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
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
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
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
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.