1. 1966: Landmark report outlines deficiencies in the Emergency Care System

    Report Calls for Increased Emphasis on Emergency Care
    Trauma surgeons played a special role in emergency medicine; the American College of Surgeons established a Committee on Trauma in 1922. In 1955 Robert H. Kennedy, M.D. — "the king of trauma" — called emergency room care "the weakest link in the chain of hospital care in most hospitals in this country …

  2. 1968: ACEP founded by group of physicians on August 16

    Board of DirectorsACEP is Born
    In 1967 Dr. John Wiegenstein and Dr. Eugene Nakfoor teamed up to provide emergency room coverage for St. Lawrence Hospital in Lansing, Michigan. Dr. Wiegenstein wanted to know more about "what do we do the first hour". With no formal training available, he sought it in unconventional places …

  3. 1968: ACEP Gets Its First National Members

    Going National
    On November 16 of 1968, 29 emergency physicians answered the call of Dr. Reinald Leidelmeyer to convene and discuss the formation of a nationwide organization. Dr. Leidelmeyer practiced emergency medicine in Fairfax, Virginia and had occasional contact with Dr. James Mills’ pioneering group in Alexandria, Virginia …

  4. 1968: The Origin Story of the ACEP Logo

    ACEP Logo SymbolThe ACEP Logo: What it Really Means
    Emergency medicine was rapidly growing and its practitioners were feeling the need to organize. In Michigan Dr. John G. Wiegenstein had pulled together a few emergency physicians and started ACEP, but it was a national organization in ambition only. Then Dr. Wiegenstein heard of a meeting planned to organize …

  5. 1969: ACEP’s first Scientific Assembly held in Denver with 128 physicians attending

    Scientific Assembly CoverA Scientific Premiere
    "Bring your wife along with you," declared the program for ACEP’s First Scientific Assembly at the Denver Hilton November 19-21, 1970. "And don’t forget your skis." More might have attended except the material took 5 weeks to arrive via penurious Third Class Mail. But 14 faculty and 128 physicians physicians – about a fifth of ACEP’s membership …

  6. 1969: First ACEP chapters established in Massachusetts and Michigan

  7. 1970: First emergency medicine residency program established in Cincinnati

    Cincinnati GeneralThe First EM Residency
    The same general circumstances that forged ACEP also led, independently, to the first emergency medicine residency program. The University of Cincinnati Medical School worked with a large city-run hospital, Cincinnati General. The General abutted a large and under-served neighborhood accounting for many of the …

  8. 1972: First issue of the Journal of the American College of Emergency Physicians (JACEP)

    Journals CoverThe Precursor of Annals Debuts
    As ACEP grew, it needed a respectable journal. The editor of "Emergency Medicine" had offered 2 to 4 pages a month for ACEP news. Future ACEP president Dr. George Podgorny, who had academic surgical training, objected to being ‘captive’ and led the fight to reject the offer. Staid title and all, the Journal of the American College of Emergency Physicians began …

  9. 1972: Emergency care hits mainstream with television premiers of Emergency! and M*A*S*H

    Emergency!Before ER, There’s EMERGENCY! When the medical drama Emergency! debuted on January 15, 1972, viewers’ first glimpse at an emergency physician at work is of Dr. Joe Early, holding a young boy upside down to shake out a quarter. Then an electrocuted lineman is rushed in, but Dr. Kelly Brackett and Nurse Dixie McCall lose him …

  10. 1973: Congress enacts Emergency Medical Services Systems forming 911 emergency services

    Congress Steps Up
    EMS development nationwide made limited progress after the 1966 report on accidental death and disability. That year’s Highway Safety Act had funded some regional ambulance growth and tied state transportation funding to EMS elaboration, but this carrot/stick approach was only marginally successful. John McDade – an original Alexandria practitioner …

  11. 1979: Emergency Medicine named 23rd medical specialty by the American Board of Medical Specialties

  12. 1980: First emergency medicine physicians certified by ABEM

  13. 1983: ACEP headquarters moves to Irving, TX

  14. 1985: Congress enacts EMTALA mandating emergency care for all Americans

  15. 1993: ACEP celebrates 25th anniversary

  16. 1994: “ER” television series premiers September 19

  17. 1997: ACEP passes historical resolution requiring members to have board certification in emergency medicine or have completed an emergency medicine residency program

  18. 1998: 19,774 total ACEP members

  19. 2000: 108 million patient visits to US emergency departments

  20. 2005: ACEP Rally at the US Capitol brings 4,000 emergency physicians and nurses to Washington DC

  21. 2006: ACEP releases first report card on the State of Emergency Medicine

  22. 2008: ACEP celebrates 40th anniversary

  23. 2010: Affordable Care Act includes emergency care as an essential health care benefit and the prudent layperson standard

  24. 2016: 8,866 professionals attended Scientific Assembly in Las Vegas

  25. 2017: 141.4 million patient visit to US emergency departments

  26. 2017: 38,385 total ACEP members

  27. 2018: ACEP celebrates 50th anniversary

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1966: Landmark report outlines deficiencies in the Emergency Care System

Report Calls for Increased Emphasis on Emergency Care

Trauma surgeons played a special role in emergency medicine; the American College of Surgeons established a Committee on Trauma in 1922. In 1955 Robert H. Kennedy, M.D. — "the king of trauma" — called emergency room care "the weakest link in the chain of hospital care in most hospitals in this country...." His pithy diagnosis helped focus the rapid development of EDs in the coming years.

In 1966 the National Academy of Sciences released Accidental Death and Disability: The Neglected Disease of Modern Society, which noted that in 1965 accidental injuries killed 107,000. "The general public is insensitive to the magnitude of the problem," the report claimed, and its recommendations included "development of a mechanism for inspection, categorization, and accreditation of emergency rooms on a continuing basis."

Meanwhile Kennedy was studying ambulance services and collaborating on several important booklets for public safety professionals: Standards for Emergency Ambulance Services and the 128-page pocket manual Emergency Care of the Sick and Injured. In 1969, at the age of 82, he addressed an organizational meeting of ACEP, passing the torch for emergency care to a new generation.

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1968: ACEP founded by group of physicians on August 16

Board of Directors

ACEP is Born

In 1967 Dr. John Wiegenstein and Dr. Eugene Nakfoor teamed up to provide emergency room coverage for St. Lawrence Hospital in Lansing, Michigan. Dr. Wiegenstein wanted to know more about "what do we do the first hour". With no formal training available, he sought it in unconventional places: a cruise that featured an emergency orthopedics program, EMT training in Ohio. Intrigued to find a doctor in his class, the EMT instructor invited Dr. Wiegenstein to dinner along with a representative from the Division of Accident Prevention of the U.S. Public Health Service. Dr. Wiegenstein talked about the need for a national organization for training emergency physicians, and his dinner partners encouraged him.

Dr. Wiegenstein found other physicians through the company that handled his billing. On August 16, 1968, eight physicians met in a Lansing Holiday Inn: Dr. Wiegenstein; Dr. Nakfoor; John Rupke, MD; John Rogers, MD; Robert Rathburn, MD; Richard Lingenfelter, MD; Robert Leichtman, MD; and George Fink, MD.

Hot on the agenda: "college" versus "academy." Dr. Wiegenstein at first favored an academy, having used the American Academy of General Practice as an organizational model. Dr. Rogers argued that a "college" might carry more heft. Membership was limited to those who "voluntarily devote a significant portion of their medical practice to emergency medicine and surgery." The inclusion of osteopaths led to the first organizational rift; Dr. Lingenfelter never returned.

One doctor brought a lawyer to facilitate incorporation, and by day’s end Dr. Wiegenstein was chairman of the American College of Emergency Physicians, whose goal was getting practitioners together to determine the best ways to run and maintain a viable emergency department. His original intent of furthering the education of emergency physicians wasn’t included, but would be addressed soon enough.

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1968: ACEP Gets Its First National Members

Going National

On November 16 of 1968, 29 emergency physicians answered the call of Dr. Reinald Leidelmeyer to convene and discuss the formation of a nationwide organization.

Dr. Leidelmeyer practiced emergency medicine in Fairfax, Virginia and had occasional contact with Dr. James Mills’ pioneering group in Alexandria, Virginia. In 1966, he defined the basic elements of specialty status for emergency medicine in the Virginia Medical Monthly. The Arlington meeting grew out of a 1968 article in Medical World News quoting Dr. Leidelmeyer on the benefits of a national organization of emergency specialists.

Five of ACEP’s founding members made the trip from Michigan to the Marriott Twin Bridges in Arlington. Dr. Mills was covering his emergency department that morning, but attended in the afternoon.

Dr. Leidelmeyer began the meeting with a presentation on the local growth and evolution of ED’s, and with a call for better ambulance service. Then Dr. John Wiegenstein took the podium to explain ACEP’s formative months while his colleagues distributed a brochure, constitution, and bylaws. Dr. R.R. Hannas spoke next on the specialty recognition efforts of the American Academy of General Practice.

Finally a motion was made to recognize ACEP as a national group, retaining its officers until an election could provide a more national board. Six of the men in the room that day would end up ACEP presidents: Dr. Wiegenstein (1968-1971), Dr. Mills (1971-1973), Dr. Hannas (1973-1974), Dr. William Haeck (1974-1975), Dr. Harris Graves (1975-1976), and Dr. John McDade (1979-1980).

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1968: The Origin Story of the ACEP Logo

ACEP Logo Symbol Art Auer

Ronald Leidelmeyer

Art Auer

Art Auer and Cathy Sleicher

The ACEP Logo: What it Really Means

Emergency medicine was rapidly growing and its practitioners were feeling the need to organize. In Michigan Dr. John G. Wiegenstein had pulled together a few emergency physicians and started ACEP, but it was a national organization in ambition only. Then Dr. Wiegenstein heard of a meeting planned to organize the country’s emergency physicians. The organizer, Dr. Ronald Leidelmeyer of Maryland, was invited to Michigan for a parley but he was unimpressed with ACEP’s bivouac office—an overturned box and some card chairs in a basement storage room of the Michigan State Medical Society (MSMS).

Dr. Wiegenstein vowed to present a more professional front at the actual meeting, and enlisted the help of MSMS executive director Herbert Auer. They needed a logo for the printed material — something new and forward looking. "I don’t want any snakes," said Dr. Wiegenstein. Auer covertly enlisted his son Art, who had some design experience. Young Auer envisioned a square composed of 64 smaller squares. One square was missing—it became the dot in the ‘i’ in American — and represents the absence of emergency medicine from the framework of American organized medicine at that time.

From this secret assignment Art Auer would become ACEP’s executive director, overseeing a critical period in the history of emergency medicine in the United States. To help celebrate 4 decades of ACEP achievement, we’re going to trace the evolution of emergency medicine through the eyes of ACEP with weekly web notes.

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1969: ACEP’s first Scientific Assembly held in Denver with 128 physicians attending

Scientific Assembly Cover

A Scientific Premiere

"Bring your wife along with you," declared the program for ACEP’s First Scientific Assembly at the Denver Hilton November 19-21, 1970. "And don’t forget your skis." More might have attended except the material took 5 weeks to arrive via penurious Third Class Mail.

But 14 faculty and 128 physicians -- about a fifth of ACEP’s membership -- attended the first educational meeting designed by emergency physicians to meet the needs of their new style of medicine. Future president R.R. Hannas, MD, designed a curriculum ranging from tracheotomies and burn treatment to legal and financial issues for practitioners. "You could just feel the enthusiasm in the hallway," remembered then president John Wiegenstein, MD. "They were just vibrant."

Fiscal flashback: Registration cost $50 for members, $75 for non-members.

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1970: First emergency medicine residency program established in Cincinnati

Art Auer

Cincinnati General

Art Auer

Bruce Janiak

The First EM Residency

The same general circumstances that forged ACEP also led, independently, to the first emergency medicine residency program. The University of Cincinnati Medical School worked with a large city-run hospital, Cincinnati General. The General abutted a large and under-served neighborhood accounting for many of the 100,000 annual visits to its emergency department.

In 1967 a young internist and hematologist named Herbert Flessa began talking with the hospital chief of staff about improving emergency care through better education. Conversations with the AMA’s Council on Education led to Flessa penning a white paper on training the emergency physician. Suddenly a national expert, Flessa found himself in the winter of 1970 meeting the ACEP founders at AMA headquarters in Chicago.

The AMA officially approved Flessa’s proposal for a general practice residency with an emphasis in emergency medicine. In July of 1970 Bruce Janiak began residency training in emergency medicine. Most of his rotations were officially off-ward, but he gave them an emergency focus. For example, while doing orthopedics he spent most of his time in the emergency department pinning knees and putting hip fractures in traction.

Despite its bootstrap origins and early organizational turmoil, Cincinnati remains an elite emergency medicine program.

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1972: First issue of the Journal of the American College of Emergency Physicians (JACEP)

Journals Cover Journals Cover

The Precursor of Annals Debuts

As ACEP grew, it needed a respectable journal. The editor of "Emergency Medicine" had offered 2 to 4 pages a month for ACEP news. Future ACEP president Dr. George Podgorny, who had academic surgical training, objected to being ‘captive’ and led the fight to reject the offer.

Staid title and all, the Journal of the American College of Emergency Physicians began bi-monthly publication in January of 1972. "JACEP’s editorial content will include only that information which is of specific interest and value to the emergency physician and his co-workers" promised editor John van de Leuv, MD.

The first issue included an ACEP stump speech from James Mills, MD, as well as general articles on treating drug abuse, dental procedures in the emergency department, antibiotic use, acute eye problems, and arrhythmia in myocardial infarctions.

And just in case somebody didn’t grasp the talking points of the emergency medicine movement, there was also an article by Merlin K. Duval, Assistant Secretary for Health and Scientific Affairs at the Department of Health, Education and Welfare. JACEP’s 10-second summary: "Delivery of emergency medical care following an accident or injury may be likened to a ‘chain’ of events. To improve the quality and strength of this chain, it is necessary to improve the quality of every link. The time is now."

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1972: Emergency care hits mainstream with television premiers of Emergency! and M*A*S*H

Emergency! M*A*S*H

Before ER, There’s EMERGENCY!

When the medical drama Emergency! debuted on January 15, 1972, viewers’ first glimpse at an emergency physician at work is of Dr. Joe Early, holding a young boy upside down to shake out a quarter.

Then an electrocuted lineman is rushed in, but Dr. Kelly Brackett and Nurse Dixie McCall lose him. Brackett is upset, and McCall presses her point: "Kel, if somebody with the right equipment and trained to use it had gotten to this man in time, he’d be alive now." The scene sets up the pilot plot: Los Angeles is training its first paramedics, but by law they can’t work.

Brackett has his doubts but agrees to help with paramedic training. Not until young Johnny Gage and Roy DeSoto disobey orders to save Dixie does he relent. Finally he testifies before the California Assembly that paramedics would be "the most important advance in emergency medicine in the last 50 years."

Emergency! ran for 133 episodes and is credited with helping spur the growth of emergency medical services in the U.S. The credits listed Brackett and Early as F.A.C.S., but an important early script consultant was Ronald Stewart, MD, an early graduate of the Los Angeles County/UCS emergency medicine program who was developing L.A.’s landmark paramedic training program. In 1986 ACEP awarded Stewart the James D. Mills Outstanding Contribution to Emergency Medicine Award.

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1973: Congress enacts Emergency Medical Services Systems forming 911 emergency services

Congress Steps Up

EMS development nationwide made limited progress after the 1966 report on accidental death and disability. That year’s Highway Safety Act had funded some regional ambulance growth and tied state transportation funding to EMS elaboration, but this carrot/stick approach was only marginally successful.

John McDade -- an original Alexandria practitioner -- had a brother in the House of Representatives and helped arrange for the ACEP corps to meet Congressman Paul Rogers, chair of the House Subcommittee on Health and the Environment. Rogers and Senator Alan Cranston became the primary sponsors for EMS Systems Act of 1973, which provided major funding and federal support for local and regional EMS, research on EMS, and training.

The country was primed: The week before hearings on the bill President Johnson died; CPR was tried but failed. Senator John Stennis of Mississippi was shot the night before hearings, and nearly died. The role of emergency services in both incidents was dissected during debate. President Nixon vetoed it the first time around, narrowly avoiding an override. The bill passed after an unrelated provision on rural hospitals was removed.