Jesse M. Pines

Fifty Years of Transformation of Acute and Emergency Care

In his landmark 1979 piece which defined a specialty, Peter Rosen, MD, called emergency medicine “an unaccountably late development in modern medicine.” Rosen strongly argued for a specialty defined not by an organ system or a particular patient population, but by “initial care . . . of life threat[s].” This fundamental notion is now reflected in the American College of Emergency Physicians’ (ACEP) definition of emergency medicine as “the medical specialty dedicated to the diagnosis and treatment of unforeseen illness or injury, including the initial evaluation, diagnosis, treatment, coordination of care among multiple providers, and disposition of any patient requiring expeditious medical, surgical, or psychiatric care.” Though the framing of a physician’s expertise in terms of a phase of care was without precedent 50 years ago, today we understand it implicitly.