Emergency Rooms

The Emergency Department: A Historical Review

Prior to the 1960s, the nation's emergency rooms were in a general state of "neglect." However, as different factors placed an increasing demand for emergency care on hospitals, reforms were initiated. The result included improvements such as new systems, new personnel, and a new medical specialty. These changes have undoubtedly save many lives.

The typical emergency department today is a actually part of an entire emergency care system. This system consists of a community or regional network of services that provide for detection and reporting of medical emergencies, initial care at the scene, transportation and care enroute to a medical facility, and care of the patient until his is discharged, referred, or admitted for definitive medical care (AHA, 1972, p.viii).

Over the last 50 years, emergency health care has evolved considerably. Back in the 1940s, for example, the emergency room was often just an outoftheway hospital area somewhere between the boiler room and the laundry (Mills, 1987, p. 81).

These early emergency departments tended to produce little revenue for the hospital. In fact, they were thought of as a necessary evil, existing only because of medicine's obligation to serve the unfortunate and the unscheduled. Shoddy financial support often meant that emergency room instruments and furnishings were castoffs from the operating rooms (Mills, 1987, p. 81). In addition, ambulance attendants received

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auma unit was established at Cook County Hospital in Chicago and a national civilian trauma care network was initiated (Montgomery, 1980, 1019). Moreover, in 1970 a new residency program in emergency medicine was started at the University of Cincinnati in 1970 (Mills, 1987, p. 85). The example set by Cincinnati was soon followed elsewhere. Graduate programs were also established at the Univ. of Southern California, Los Angeles, and at the Medical College of Pennsylvania, Philadelphia. With residency programs in place, the American College of Emergency Physicians (ACEP) began looking toward the day when a certifying board for emergency medicine would be approved (Mills, 1987, p. 85). Activities which the ACEP undertook to define their new specialty included creating a core of knowledge and skills for emergency medicine, establishing a specialty journal (Annals of Emergency Medicine), formulating a pro tem approval mechanism for residency review (Liaison Residency Endorsement Committee), publishing Emergency Medicine: A Comprehensive Study Guide, conducting of postgraduate symposiums, and finally, developing a certifying examination (Mills, 1987, p. 85). Meanwhile, on January 20, 1972, in his State of the Union Message, Pre

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