A look at the history of the American College of Emergency Physicians - ACEP

Having been fortunate enough to attend this year’s RCEM Annual Scientific Meeting - which was held right on our doorstep here in Belfast - we decided to write a short blog on the history of the UK’s Royal College of Emergency Medicine.

But while Eolas Medical was founded by NHS doctors, our platform is now deployed across North America, Europe and Australasia. The United States in particular is a key region for Eolas Medical, with our customers including world-leading medical centres like Stanford, Vanderbilt, Northwestern and Mass General. So we decided it was high time we brushed up on the history of emergency medicine across the pond.

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The origins of ACEP

As it turns out, ACEP celebrated its 50th anniversary in 2018, so it’s a great time to gen up on its origins. Just like the UK’s College of Emergency Medicine, ACEP was a late bloomer compared to other US medical colleges. The American College of Physicians, for example, was founded back in 1915. If your mental arithmetic is up to speed, you’ll have already worked out that if ACEP celebrated its 50th anniversary in 2018 then it was born in 1968, a full 53 years after the ACP.

Mind you, as we noted in our history of RCEM, the UK’s Royal College of Physicians was founded a full 490 years before its Royal College of Emergency Medicine, so maybe ACEP isn’t doing so badly after all.

Another similarity between ACEP and RCEM is that they both arose from an early-20th-century realisation that accidental injury had become a major cause of morbidity and mortality and that it warranted a unique approach compared to other types of medical care. In the US, this was officially acknowledged when the American College of Surgeons established a Special Committee on Trauma in 1922. You might wonder why this didn’t happen half a century earlier in the aftermath of the Civil War, but there’s an easy answer to that: the American College of Surgeons itself wasn’t founded until 1913.

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The 'king of trauma'

The Special Committee on Trauma was a good start, but by no means a definitive solution to the growing problem of accident-driven harm. ACEP points to a physician named Robert H Kennedy as “the king of trauma”. In 1955, he pointed to the still nascent practice of emergency medicine as “the weakest link in the chain of hospital care in most hospitals in this country”. His opinion was borne out by the publication of a National Academy of Sciences report over a decade later, entitled Accidental Death and Disability: The Neglected Disease of Modern Society.

That report was apparently the rallying cry that the EM community needed. In 1968, John Wiegenstein drove the creation of ACEP, of which he was the first chair. The organisation started with just 29 members. Fifty years later, it was a hair shy of 50,000.

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Similarities between ACEP and RCEM

There are enough similarities between the history of ACEP and RCEM that people talk about the Anglo-American model of emergency care. But there are important differences too, arising largely from the fundamental differences between the UK and US healthcare systems.

Whereas RCEM is very much the final word on emergency medicine in the UK, things are a little more complicated stateside. In 1992, an emergency medicine doctor named James Keaney published a book called The Rape of Emergency Medicine. He actually wrote it under the pseudonym “The Phoenix”, but subsequently revealed himself as the author when he appeared on the US TV show 60 minutes. The book describes Keaney’s experiences of corporate influence in the field of emergency medicine, highlighting in particular the fact that some centres were employing non-specialist healthcare staff to run emergency services in order to maximise profits.

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This clearly resonated with many other EM practitioners and led to the establishment of the American Association of Emergency Medicine (AAEM) the following year. The AAEM is a lot smaller than ACEP with around 4000 members. One medical forum member described the situation in the following terms: “ACEP is the big dog which worries about lots of important things in EM. AAEM is the radical little dog which worries about a few important things in EM, specifically, our job security and fairness in the marketplace. By keeping AAEM around, we will be able to keep the big dog honest…”

And that’s a wrap for the brief history of ACEP! What’s really struck us as we’ve swotted up on the history of emergency medicine in the UK and US is how quickly EM has gone from being a surgical sideline to the beating heart of modern healthcare systems. Here in the UK, for example, the most widely used metric to track the performance of the whole NHS is A&E waiting times.

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