The evolution of emergency medicine.

In this manuscript, I will outline three specific evolutionary achievements in the delivery of emergency and trauma care, followed by caveats on what prevents an emergency and trauma system from achieving optimal goals and maintaining them. First, I will review the emergence of the specialty of emergency medicine under the guidance of Dr. James Mills, and outline the steps he took to establish the specialty in acute care hospitals. Second, I will discuss the heroic career of Dr. R Adams Cowley, a cardiothoracic surgeon who took some of the principles of cardiac resuscitation and surgery and rapid military evacuation of the wounded from the battlefield, and applied them to the resuscitation and transport of the severely injured trauma patient to a fully prepared and equipped trauma center, and also created an organized approach to trauma care in Maryland. Third, I will provide an overview of the subsequent development of a comprehensive emergency medical system in the Commonwealth of Virginia. Finally, I will emphasize what prevents good public health policy regarding emergency medical and trauma care, and some of the changes that must be made to ensure that the Commonwealth of Virginia and other states provide optimal care for their citizens through their emergency medical care and trauma systems.