nnel primarily consisted of junior physicians in training, or "moonlighting" physicians (Mills, 1987, p. 81). Diagnosis and treatment often merely involved a call to the appropriate resident. Furthermore, when a patient had multiple injuries and a representative from each relevant surgical subspecialty was needed, the mix of personalities easily resulted in confusion (Mills, 1987, p. 81).
However, because of the huge responsibilities assumed by emergency departments, it soon became evident that they merited far more attention than they had been receiving (Mills, 1987, p. 81). During the 1950s and 1960s, a number of factors created the need for reform. Some of these included increasing specialization, declining numbers of general practitioners, increasing medical technology based within the hospital, greater expectations by the public, and increasing third party insurance support for emergency care (Mustalish, 1986, p. 418). The two decades saw an enormous increase in the number of visits to emergency departments from 18 million to more than 49 million during the period from 1958 to 1970 (Mustalish, 1986, p. 418).
The first to recognize the need for change was the American College of Surgeons (ACS) (Mills, 1987, p. 81). However, while the ACS performed numerous surveys and made recommendations, it was largely ignored ("Medical News", 1986, p. 415).
Then, in 1966 the National Academy of Sciences (NAS) issued a landmark study, "Accidental Death and Disability: The Neglected Disease of Modern Society." The study stressed the difference that competent initial emergency medical care, efficient transportation, and active treatment could make in survival rates among the critically injured (Rockwood et al., 1976, p. 300). It served to catalyze civilian concern over emergency health care ("Medical News", 1988, p. 1017).
One priority which was identified included the import
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