Some of the earliest references to emergency medicine can be found on the battlefields of the French Revolution in the late 1700s1. A young Dominique Jean Larrey served as a military surgeon, a position he held after he was told he needed more practical experience despite completing an 8-year apprenticeship. During his service, he noticed ambulances posted behind conflict lines, only picking up wounded soldiers after the finding ended. Some injured soldiers waited days before being evacuated, many ultimately dying before being helped. Keep in mind this was also half a century before Pasteur’s germ theory came to prominence in the 1850s.
Larrey noticed the French mobile artillery, consisting of horse-drawn cannons, were surprisingly nimble and proposed the creation of horse-drawn carriages to evacuate injured soldiers that came to be known as ambulance volantes, or “flying ambulances.” These flying ambulance units consisted of a driver and a medical provider with tools, much like EMS crews of today. Larrey would later help develop a triage system strictly dependent on severity of injuries, regardless of the soldier’s rank. He also made major contributions to several emergency techniques still used today, including pericardiocentesis and decompressive thorocostomies2. For his services, Larrey would later be promoted to be Surgeon-in Chief to Napoleon’s Imperial Guard.
Fast forward several centuries to the 1900s and despite advancements in the recognition and care of emergent conditions, there was still no “emergency medicine” specialty. Typical emergency rooms consisted of rotating residents from other specialties such as IM or surgery. A significant percentage of ambulances were run by funeral directors because they had vehicles that could transport people horizontally3.
In 1961, physicians in Virginia and Michigan focused on devoting their careers to emergency medicine specifically, and ACEP was created in 1968. In 1972, the first emergency medicine residency was created at the University of Cincinnati, followed by University of Chicago and Medical College of Pennsylvania soon afterwards. In 1976, ABEM was founded, and was formally recognized by the American Board of Medical Specialties on 9/21/1979. Back then, the EM specialty only required 2 years of training. Since then, there has been variance, including transitional or prelim intern years in medicine or surgery. Today, all EM residencies begin with a categorical intern year, with some 3-year program (like Maimo) and some 4-year programs.
References
1. Jackson J. Dominique Jean, Baron Larrey. Warfare History Network. Published October 2, 2023. Accessed December 19, 2023. https://warfarehistorynetwork.com/article/dominique-jean-baron-larrey/
2. Ramdhan RC, Rai R, Brooks KN, Iwanaga J, Loukas M, Tubbs RS. Dominique Jean Larrey (1766–1842) and His Contributions to Military Medicine and Early Neurosurgery. World Neurosurg. 2018;120:96-99. doi:10.1016/j.wneu.2018.08.159
3. Suter RE. Emergency medicine in the United States: a systemic review. World J Emerg Med. 2012;3(1):5-10. doi:10.5847/wjem.j.issn.1920-8642.2012.01.001
4. Young M. Ruth Bader Ginsburg’s Childhood Home in Brooklyn. Untapped New York. Published September 21, 2020. Accessed December 19, 2023. https://untappedcities.com/2020/09/21/ruth-bader-ginsburg-childhood-home-brooklyn/
5. About Us. Maimonides Medical Center. Accessed December 19, 2023. https://maimo.org/about-us/