History of Emergency Medicine: Then and Now

By Nicole Ehnle, Business Development Associate

With commentary from Sanford Glantz, MD, Chief Medical Officer

Emergency medicine is a young field, ever growing and until recently, always struggling to find its place as a legitimate and respected specialty in the bigger world of medicine. Thanks to our own Dr. Sanford Glantz, I was able to gain some insight on just how much this specialty has changed over the years.

To give some history of emergency medicine, the American College of Emergency Physicians (ACEP) was established in 1968, but Emergency Medicine didn’t officially become a specialty until 1979. Until this era, hospitals were usually staffed by rotating family physicians, surgeons and other specialists.

From Triage Doctors to Diagnosticians

Thirty plus years ago, when Emergency Medicine became an official specialty, it still wasn’t considered a legitimate field by many. As the saying goes, those who “could” had a private practice; those who “couldn’t” worked in the ED. Emergency physicians were simply “triage doctors, deciding which specialist to call,” says Dr. Glantz. Today, “we’re the diagnosticians of the hospital.” Emergency physicians now are more appreciated and respected than ever in the history of emergency medicine.

The Battle is Won

“We are now the expert in the first hour of care, and other specialists depend on our expertise to manage patients emergently,” Dr. Glantz elaborates. “We are one of the leading specialties in research and evidence based medicine. We are the key to trauma, stroke and MI care, and we are the experts on emergent airway management.

“We used to have to fight with other specialties to order CT’s and sonograms, use RSI medication and even disposition patients (admissions and transfers). This still goes on occasionally, but for the most part we have won these battles.”

Since the emergency department is the front door of the hospital for the majority of patients, EM doctors have teamed up with hospital administration to study patient flow, delays in treatment and admission, and the appropriateness of transfers in and out of the hospital. We went from not being considered a real member of the medical staff, to one of the key members. Some EM doctors have become so good at this that they are now CEOs of hospitals.

A Long Way to Go

While in the history of emergency medicine we may have won many of those battles, other challenges arise in the ever-changing (and hopefully ever-improving) healthcare scene. Today, “there are still a large number of non-boarded EM doctors working in emergency departments throughout the country,” Dr. Glantz explains. “The federal government capped the number of residency positions and the number of graduates are barely keeping up with the attrition rate. Most of the non-boarded EM doctors do a great job, but it would be ideal to have all boarded doctors in emergency departments.”

It seems like we are headed that way. “Some of the career EM doctors who are not boarded have taken the American Association of Medical Specialties (AAPS), says Dr. Glantz. “This board is not recognized by the American Board of Medical specialties (ABMS), but the test is similar to the American Board of Emergency Medicine (ABEM). While not officially recognized, it shows a commitment to learning and maintaining the education and skills needed to work in any emergency department in the country.”

In addition, “emergency medicine and EMS have teamed up and most of the improvements in prehospital care have come out of emergency medicine,” Dr. Glantz continues. “Some of the highlights are AED’s on ambulances that did not have them and medications, including narcotics and anti-seizure medications used by medics. Mass casualty protocols and trauma system protocols have all been driven by emergency medicine. And this is an ongoing process; as new evidence comes out, EM doctors are changing the protocols and adding new skills to the medics’ and EMTs’ skillsets.”

Perceptions about the ED have also changed. These days, we deal less with how physicians are perceived than with how the patients are perceived. “The perception is that a lot of ED visits are unnecessary, but studies show that only ten percent of ED visits are not emergencies,” Dr. Glantz explains. Patients presenting in the ED have to be taken seriously. No matter how trivial their complaint may seem, most people wouldn’t be there if it wasn’t an emergency to them.

We still have a long way to go to perfecting the processes involved in emergency medicine and medicine in general. Still, it helps sometimes to take a step back and look at the history of emergency medicine to see how far we’ve come.