Karl Mangold -- A Pioneer Passes

November 2009

By Robert C. Solomon
ACEP NEWS Medical Editor in Chief

It's midnight. Ten minutes ago, you were healthy--but now you have chest pain and you're sweaty and you think you are about to die. Who is going to take care of you?

This question, wrote Dr. Karl Mangold, is the essence of why the specialty of emergency medicine was needed. On Sept. 21, 1979, as Dr. Mangold reached the end of his year as immediate past president of ACEP, the American Board of Medical Specialties granted the long-sought recognition toward which he had worked so tirelessly, and emergency medicine was officially established as the twenty-third specialty.

Dr. Karl Mangold died on June 3, 2009, and on Oct. 4, the ACEP Council adopted a memorial resolution honoring him. The whereases of that resolution used some of the very same phrases found in the obituary in the newspaper read by the residents of Karl's northern California community of Diablo. However, on July 11, when family and friends came together for a celebration of his life, only Dr. Herschel Fischer, Dr. Mangold's business partner in Fischer-Mangold, one of the earliest multistate emergency medicine staffing companies, had much to say about Karl's professional career.

If not for my own brief remarks expressing the appreciation of his colleagues and many millions of patients, one might have left the Diablo Country Club with little awareness of Dr. Mangold's role as a pioneer in our specialty. Yet those gathered spoke so warmly of him as a brother, father, husband, and friend that one could not have come away without an understanding that this was a man whose kindness and generosity touched so many so personally, just as in his profession his work touched the lives of so many emergency patients.

After training in internal medicine in Chicago, Dr. Mangold was assigned, during the Vietnam era, as a flight surgeon for the U.S. Coast Guard in the San Francisco Bay area. Immediately bored with taking care of trivial problems afflicting healthy young men, he approached a local hospital about working nights in its emergency room. That entrance to the hospital was locked at night, and he saw two patients in his first 12-hour shift. Over the next few years, however, the lock came off, the patient volume soared, and he found himself excited by the challenge of taking care of patients with undifferentiated and potentially life- or limb-threatening presentations.

In 1969, Dr. Karl Mangold spent 2 weeks of 15-hour days doing a "fellowship" in the emergency department at Massachusetts General Hospital. By then he was committed to the idea of the brand-new discipline for which a professional organization had been founded the year before in Lansing, Mich. In 1970, he attended his first ACEP meeting in New Orleans, and in 1971, he was elected to the Board of Directors.

In the early 1970s, Dr. Mangold and his business partner, Dr. Fischer, negotiated contracts with a couple of hospitals to staff their emergency departments. They carefully limited those endeavors at first, because at a time when the earliest EM residency programs were just getting started, the supply of capable physicians was very small. Eventually, Fischer-Mangold would have dozens of contracts across many states.

Dr. Fischer was always cautious and measured, Dr. Mangold enthusiastic and optimistic. At the memorial celebration, Dr. Fischer told of how convinced he was that Karl was insane, and that they would never be able to get emergency physicians to work in Alaska. Yet Karl thought the right marketing of the state's wilderness beauty would lure physicians who had been attracted to the rugged individualism of the specialty, and he was right.

Alaska, as America's "last frontier," still attracts those with pioneering spirit: that essential inner drive that Dr. Karl Mangold displayed in all he did to help in the founding of emergency medicine as a specialty.????????????????????????????????


Editor's note: Contributions in Dr. Karl Mangold's memory may be made to the Emergency Medicine Foundation (www.EMFoundation.org).

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