During the French Revolution, after seeing the speed with which the carriages of the French
flying artillery maneuvered across the battlefields, French military surgeon Dominique Jean
Larrey applied the idea of ambulances, or "flying carriages", for rapid transport of wounded
soldiers to a central place where medical care was more accessible and practical. Larrey
operated ambulances with trained crews of drivers, corpsmen and litter-bearers and had them
bring the wounded to centralized field hospitals, effectively creating a forerunner of the modern MASH units. Dominique Jean Larrey is sometimes called the Father of Emergency Medicine for his strategies during the French wars.
Emergency medicine as an independent medical specialty is relatively young. Before the
1960s and 1970s, hospital emergency departments (EDs) were generally staffed by physicians
on staff at the hospital on a rotating basis, among them family physicians, general surgeons,
internists, and a variety of other specialists. In many smaller emergency departments, nurses
would triage patients, and physicians would be called in based on the type of injury or illness.
Family physicians were often on call for the emergency department and recognized the need
for dedicated emergency department coverage. Many of the pioneers of emergency medicine
were family physicians and other specialists who saw a need for additional training in
During this period, physicians began to emerge who had left their respective practices to
devote their work entirely to the ED. In the UK in 1952, Maurice Ellis was appointed as the first
"casualty consultant" at Leeds General Infirmary. In 1967, the Casualty Surgeons Association
was co-established with Maurice Ellis as its first president. In the US, the first of such
groups managed by Dr James DeWitt Mills in 1961, along with four associate physicians; Dr
Chalmers A. Loughridge, Dr William Weaver, Dr John McDade, and Dr Steven Bednar, at
Alexandria Hospital in Alexandria, Virginia, established 24/7 year-round emergency care, which became known as the "Alexandria Plan".
Maurice Ellis Blue Plaque Unveiling
It was not until Dr. John Wiegenstein founded the American College of Emergency Physicians
the recognition of emergency medicine training programs by the AMA and the AOA, and in
1979 a historic vote by the American Board of Medical Specialties that emergency medicine
became a recognized medical specialty in the US. The first emergency medicine residency
program in the world began in 1970 at the University of Cincinnati. Furthermore, the first
department of emergency medicine at a US medical school occurred in 1971 at the University
of Southern California. The second residency program in the United States soon followed
at what was then called Hennepin County General Hospital in Minneapolis, with two residents
entering the program in 1971.
1961: James Mills Jr MD started full time ED practice in Alexandria VA. At this time there are
only hundreds of ED physicians in the country.
1966: Trauma surgeon report calling ed "the weakest link in the chain of hospital care". THe
National Academy of Sciences released Accidental death and disability:the neglected disease
of modern society which noted injuries killed 107,000 yearly.
1968: Dr. John Wiegenstein and Dr. Eugene Nakfoor (lansing MI) founded ACEP
1969: ACEP's first scientific assembly with 128 physicians attending
1970: FIrst ER residency (Cincinatti General). First resident was Bruce Janiak. Dr. Herbert
Flessa was a young hematologist that wanted to improve emergency care. Initially approved
under family medicine. 2 year certificate program.
1972: University of Louisville, University of Chicago (Rosen)
1975: 31 Residencies
1979: ER named 23rd medical specialty by American Board of Medical Specialties
1980: First board certified ED physicians
The ER began after the second world war. Fewer home visits, office hours, urban sprawl made it harder to deliver quality care. Hospital based medicine increased. Usually a small room with a single nurse.
Currently there are 48,835 active emergency physicians. Median age is 50.
Emergency Medicine Documentary:
AKA Dr. Provolone