Em. Med. Annual Report 2011 - Hennepin County Medical Center

A Thumbnail History of
Emergency Medicine in the U.S. and
Hennepin County Medical Center
The Start
The National Scene Post WWII by Ernest Ruiz, MD, FACEP
Access to emergency room (ER) care across the
U.S. in the fifties and sixties did not keep up with
the needs of the growing post-war population. The
numbers of practicing physicians had not kept
pace with the growth. Many people began to use
the ER as their primary source of medical care.
Under-staffed, under-funded, and under-equipped,
ERs were serious problems for most hospitals.
Practicing physicians who staffed community
hospitals were pressured by demands for their
time. They were on-call to the ER during their
non-clinic hours. Hospitals and their affected
physician staff became open to ideas that might
ease the situation.
In 1961, an over-burdened practicing physician,
James D. Mills in Alexandria, Va., decided to limit
his practice to ER coverage. He pulled together a
group of like-minded physicians to cover their
community hospital ER around-the-clock. They
would make a modest living at it. They became
"specialists" in emergency care. James Mills
(1920-1989), a respected general practitioner and
proper gentleman, is credited as being the "father
of emergency medicine." The "Alexandria Plan's"
success encouraged physicians elsewhere to get
organized as well. General practitioners John G.
Wiegenstein in Lansing, Mich., Ralston R. Hannas
in Sentinal, Oak., and Harris B. Graves in Omaha,
Neb. joined or formed similar groups and
vigorously carried the message onto the national
stage. They envisioned that emergency care could
be improved across the U.S. if physicians who
4 | Department of Emergency Medicine Activities Report | 2009-2010
chose emergency medicine as their livelihood had
their own national organization. Wiegenstein
(1930-2004) and seven others boldly formed a
society called the American College of Emergency
Physicians (ACEP) in 1968. ACEP met in
Colorado the next year and 128 physicians
attended. Hannas (1918-2005) and Harris
(1928-1995) had joined in. ACEP is now widely
accepted as the most effective sounding board for
the practice of emergency medicine while strongly
encouraging scientific progress. It has over 26,000
members. The vision of these few men and
women lives on. They looked forward to the
establishment of residency training for emergency
physicians and the attainment of primary board
status for emergency medicine.
Academia Stumbles Forward
Meanwhile, academic institutions responsible for
the big-city teaching hospitals assigned
responsibility for their ERs to the departments of
Surgery and Medicine. Although their residency
training programs provided some medical
manpower, the need for clinical experience in their
specialties did not justify staffing the ER solely with
their residents. The ER was as serious a problem
in the "city hospitals" as it was in community
hospitals. Unfortunately, the inter-departmental
competition for scarce resources common to
teaching hospitals at that time made the common
sense approach used by James Mills impossible.
The obvious solution was to create a residency
program for emergency medicine. This was not an
option because it would have encroached on the