The first group of non-residency trained ER physicians was created in 1961 in California.
The first description of CPR was in a 1966 edition of JAMA, along with an article entitled The Emergency Department Problem where it was quoted, “For many years, the emergency service has been the most neglected and often the weakest department in the hospital.”
The American College of Emergency Physicians (ACEP) was established in 1968 and a year later the first EM resident, Bruce Janiak, was trained.
Fifty years ago, in 1970, the first EM residency was created right here at the University of Cincinnati!
Back in the day of physical charts, there were individual boxes for surgery and medicine patients; “combining of the boxes” was the first step to expanding the scope of practice of EM physicians.
Emergency Medicine was initially a joint board certification in 1979 with ACGME approved residencies in 1982 and primary board certification by 1989. (For reference, the first specialty to be board certified was ophthalmology in 1917.)
We are the safety net. We must always be more than Triage.

How can we be better professionals, better leaders? Professionalism is a belief system in which its members are trustworthy and respectful, not just about ethics but also about scientific and technical competency.
Examples of unprofessional behavior:
- Persistently incomplete medical records
- Being late, missing deadlines
- Poor interpersonal communication/conflict, bad attitude
- Poor ability to accept performance feedback
Being on time and appropriate sign-out (i.e. procedures, new patients) is dependent on group culture. Decide amongst your team what is acceptable and stick to it.
Patterns of behavior are more telling than one-offs; we’re all human.
Most unprofessional behavior comes from misunderstanding another's perspective; seek first to understand. When a mistake is made, own it and strive to be better the next time.
In summary, ask yourself, “Am I doing the right thing?”

We are the masters of undifferentiated disease. We neither want to send sick patients home nor admit patients that are not sick; both extremes are undesirable.
Initial approach is just like oral boards - “What do I see when I walk in the room?” This first look frames the rest of the encounter.
You won’t find what you don’t look for. Get your patients undressed. Touch your patients’ skin. Call families & nursing homes to get collateral. Every piece of data is important to justify the gut feeling generated of “sick or not sick”. .
Vitals are vital. Fear diaphoresis. Never ignore an acidosis. Know your equipment. Be careful talking yourself out of doing a test. If you think about it more than 15 seconds, it probably deserves to be done.
Know your limits. Mistakes are inevitable. Never be too big to ask for help.

“I shall not today attempt further to define… but I know it when I see it” - Potter Stewart

Taming the SRU

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