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The Rise of Emergency Medicine in the Sixties: Paving a New Entrance to the House of Medicine Anne Merritt

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The Rise of Emergency Medicine in the Sixties: Paving a New Entrance to the House of Medicine Anne Merritt Yale University EliScholar – A Digital Platform for Scholarly Publishing at Yale Yale Medicine Thesis Digital Library School of Medicine 8-6-2009 The Rise of Emergency Medicine in the Sixties: Paving a New Entrance to the House of Medicine Anne Merritt Follow this and additional works at: http://elischolar.library.yale.edu/ymtdl Recommended Citation Merritt, Anne, "The Rise of Emergency Medicine in the Sixties: Paving a New Entrance to the House of Medicine" (2009). Yale Medicine Thesis Digital Library. 57. http://elischolar.library.yale.edu/ymtdl/57 This Open Access Thesis is brought to you for free and open access by the School of Medicine at EliScholar – A Digital Platform for Scholarly Publishing at Yale. It has been accepted for inclusion in Yale Medicine Thesis Digital Library by an authorized administrator of EliScholar – A Digital Platform for Scholarly Publishing at Yale. For more information, please contact [email protected]. The Rise of Emergency Medicine in the Sixties: Paving a New Entrance to the House of Medicine A Thesis Submitted to the Yale University School of Medicine in Partial Fulfillment of the Requirements for the Degree of Doctor of Medicine by Anne K. Merritt 2009 In memory of Mila, dear friend, for her inspiration Mila Rainof, M.D. Yale School of Medicine 2008 1980 – 2008 Contents Illustrations .......................................................................................................v Acknowledgements ..........................................................................................vi Abbreviations..................................................................................................vii Abstract .........................................................................................................viii Timeline of Events ...........................................................................................ix Chapter 1. Introduction.......................................................................................................1 2. Methods ............................................................................................................5 3. The Emergency Room Becomes a Community Medical Center.........................8 A Growing National Interest in Improving Emergency Services ..............................................9 The Changing Nature of the Physician-Patient Relationship...................................................19 The New Role of the Emergency Room ...................................................................................26 4. Advances in Military Medicine Revolutionize Emergency Medical Care ........30 Military Advancements in Pre-Hospital Care...........................................................................30 Military Advancements Are Applied to Civilian Medicine .....................................................35 A New Field: Emergency Medicine..........................................................................................43 5. Hospitals Restructure Emergency Services......................................................45 House Staff Resist Working in the Emergency Room .............................................................45 Physicians Resist Working in the Emergency Room ...............................................................47 A New Idea: Physician Groups Staff the Emergency Room....................................................49 The Beginning of a New Medical Specialty.............................................................................52 6. Emergency Medicine Begins in a Small Community Hospital.........................55 Alexandria Hospital ...................................................................................................................55 Long Journey Ahead for New Emergency Physicians .............................................................72 7. The Urban Teaching Hospital Resists Emergency Medicine as a Specialty......75 Hartford Hospital .......................................................................................................................75 Yale-New Haven Hospital.........................................................................................................89 8. Conclusion ....................................................................................................107 Urban Teaching Hospitals Develop Triage Systems and Ambulatory Care Facilities..........107 A Collaboration Between Community and Teaching Hospitals ............................................111 The Rise of Emergency Medicine...........................................................................................113 Appendix Illustrations ...................................................................................................117 Selected Bibliography ...................................................................................125 Illustrations Figures 1. Hospital internships in selected years from 1941-1963 ............................................117 2. Percentage of emergency visits to short-term, general, and other special hospitals that were classified as emergency visits, 1954-1966.......................................................117 3. Percentage increase of outpatient visits and inpatient admissions to short-term, general, and other special hospitals, 1954-1966.......................................................118 4. Annual percentage change in population of Alexandria, Virginia, 1800-1980..........118 5. Annual percentage change in population of Hartford, Connecticut, 1810-1980........119 6. Emergency service visits at Hartford and Yale-New Haven Hospitals, 1960-1975...119 7. Annual percentage change in population of New Haven, Connecticut, 1800-1980...120 8. Emergency service visits by month at Yale-New Haven Hospital in 1953, 1958, and 1963 .................................................................................................................120 9. Net percentage increase in population and emergency room visits at Hartford and Yale-New Haven hospitals, 1956-1970 ...................................................................121 Tables 1. Hospital Internships and Residencies ......................................................................122 2. Percentage of Emergency Visits to Short-Term, General, and Other Special Hospitals.. .................................................................................................................122 3. Historical Populations, 1800-1980...........................................................................123 4. Comparison of Population to Emergency Room Visits at Hartford and Yale-New Haven Hospitals......................................................................................................124 vi Acknowledgements I would first like to thank all of the nurses and physicians who generously shared their personal stories with me: Dr. David Crombie, Dr. Steven Goldfinger, Dr. Lenworth Jacobs, Dr. Richard Lee, Jane Pinson, Dr. David Podell, Dr. Peter Rosen, Dr. John Schriver, Dr. Richard Stahl, and Dr. Albert Weihl. John Harley Warner, my thesis advisor, has my gratitude for his thoughtful guidance during all the stages of research and writing. My appreciation to Dr. Brian Zink, author of Anyone, Anything, Anytime: A History of Emergency Medicine, for his encouragement and mentorship. I am obliged to the Section of the History of Medicine at Yale School of Medicine for its funding support. A special thank you to Steven Lytle at the Hartford Hospital Archives, Susan Dee at the Yale-New Haven Hospital Archives, and George Combs at the Alexandria Library for their gracious assistance in providing many resources for my research. I am grateful to Justin Barr and Eric Geary for their generous editing of this manuscript. My family has my deepest gratitude for their constant love, support, and inspiration. I cannot thank enough my mom, Nancy Merritt, who provided the impetus for this project; my dad, John Merritt, who tirelessly refined my ideas; and my sister Jennifer for her constant insight. vii Abbreviations ABEM American Board of Emergency Medicine ABMS American Board of Medical Specialties ACEP American College of Emergency Physicians ACS American College of Surgeons AHA American Hospital Association AMA American Medical Association ASA American Society of Anesthesiologists ATLS Advanced Trauma Life Support CCU Cardiac care unit CPR Cardiopulmonary resuscitation ED Emergency department EMS Emergency medical services EMT Emergency medical technician ER Emergency room ERC Emergency Room Committee GNP Gross National Product GP General practitioner HEW United States Department of Health, Education, and Welfare HMO Health Maintenance Organization MASH Mobile Army Surgical Hospital MRO Medical regulating officer MUST Medical Unit Self-Contained, Transportable SAEM The Society for Academic Emergency Medicine YNHH Yale-New Haven Hospital viii Abstract THE RISE OF EMERGENCY MEDICINE IN THE SIXTIES: PAVING A NEW ENTRANCE TO THE HOUSE OF MEDICINE. Anne K. Merritt (Sponsored by John H. Warner). Section of the History of Medicine, Yale University, School of Medicine, New Haven, CT. This thesis investigates how emergency medicine evolved in the United States in the 1960s. Three case studies, Alexandria Hospital, Hartford Hospital, and Yale-New Haven Hospital, demonstrate the changes in emergency medicine at a small community hospital, a mid-sized teaching hospital, and an urban academic institution, respectively. The government, the
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