A Brief History of Emergency Medicine from the 1950’s to Today

Perhaps the greatest irony of our species is that it is during the times we shed the most blood that we strive to save the most lives. In the rich and varied history of our world, it is emphatically times of war that encourage the greatest strides in medicine. The desperation necessitates rapid and conspicuous development.

The first American ambulance appeared in 1861 during the American Civil War, when Union physicians Joseph Barnes and Jonathan Letterman devised new means of transporting wounded soldiers. Four years later, the first hospital-based ambulance service came from Cincinnati, Ohio out of Commercial Hospital. Another former Union Army soldier was responsible for an on-call ambulance service that took off in 1869.

How far we have come. Where now an ambulance takes between 6.5 to 11 minutes to arrive and FNP programs in Texas can be studied anywhere in the world, history reminds us how far we have come in such a short amount of time. Today, this article examines the last seventy years as a reminder of our progress in the pursuit of saving lives.

1950 – 1960

The 1950s saw a surge in medical research and learning. The details behind Cardiopulmonary Resuscitation (CPR) started to become widely published for the first time, developing the skills of already-existing Emergency Medical Services (EMS) personnel in the US – enabling them to save lives on-site. Hospitals also began to gain more technological resources, of both better quality and efficiency.

During the Korean War, the H-13 Sioux Helicopter was used by the US Air Force to establish forward-operating medical units and to extract critically wounded soldiers.

1960 – 1970

This period contains possibly some of the most unbelievable occurrences of our nation’s Emergency Medicine (EM) history. At this point, emergency care was not the domain of any kind of governing authoritative body. Emergency departments were populated by physicians undergoing their residency but with no senior supervision. Staff shortages were accounted for by conscripting attending physicians, moonlighters, and medical students. 

There was also a huge class disparity. The wealthy received urgent, consistent care, while the poor were left to suffer long wait times, and substandard treatment – even for the time.

Also Read: 8 Medicines You Need to Have on Hand in Case of a Medical Emergency

In 1965, Medicare and Medicaid increased Americans’ access to health insurance, however, clinics were ill-prepared to deal with the sudden rash of patients. Indeed, the increase from 1965 to 1970 was from 29 million to 43 million patients per year.

1970 – 1980

The need for further action was recognized in the 1970s and Emergency Department specialty training was implemented. Furthermore, a staff rotation was utilized to provide higher standards of care, with fresher workers trained specifically for their role. This included the first board certifications that oversaw and approved this training and granted certification.

In 1976 the American Board of Emergency Medicine (ABEM) was founded, and in 1980, conducted its first certification exam.

Ambulance design also changed, with the high tops we associate with today’s ambulance vehicles becoming a standard innovation. However, the chassis on these vehicles could not withstand the increased load. It was eventually swapped out for a van chassis and outfitted with audio and visual warnings to increase the safety of driving these vehicles. 

Until this point, ambulances were co-opted hearses from local funeral parlors!

1980 – 1990

In many ways, the 1980s were the cause of many of medicine’s current concerns. In 1982, the documentary DPT: Vaccination Roulette lit the spark that would set the embers alight for the current anti-vaccine movement. The film made outlandish claims as to the side effects of vaccines and minimized their benefits to a harmful degree. 

In 1991, the book A Shot in the Dark did the same thing, leading to scared and angry people forming victim advocacy groups. Although similar stupidity happened worldwide, due to the United State’s vigorous checking of this issue, the impact was kept relatively minimal as opposed to the same movement in the UK.

1990 – 2000

During ABEM’s initial years, they offered what was called a “practice track”, a mode of study that allowed attending physicians and students to become certified if they spent a satisfactory amount of time during their residency completing practical work.

However, this mode of certification was closed, much to the chagrin of Gregory Daniel and other emergency medical residents. Daniel and his fellow plaintiffs were victims of the sudden closure of their chosen intake stream, and thus when the method of certification was no longer recognized, Daniel and his cohorts sued ABEM in 1990 and even established their own official body known as the Association of Disenfranchised Emergency Physicians (ADEP) – now just known as the Association of Emergency Physicians (AEP).

The lawsuit lasted for 15 years, and would eventually rule in favor of ABEM.

The Modern Era

Although there are still two decades of medical history to examine, we understand a lot of where emergency medicine is now. It’s the most effective it’s ever been, and as more research and testing is done, the more effective it will become. Enemies to healthcare today are the very people who rely on it to keep themselves healthy and alive. Anti-vaccine conspiracy theorists, the free-market owned-and-operated medical system, and a rapidly approaching medical staff shortage. Thankfully, our technology and scientific knowledge are doing wonders to keep us safe. We hope it will for many years to come.