Merritt Anne K
Department of Emergency Medicine, Yale University School of Medicine, 464 Congress Ave., Suite 260, New Haven, Conn. 06519.
J Hist Med Allied Sci. 2014 Apr;69(2):251-93. doi: 10.1093/jhmas/jrs054. Epub 2012 Sep 10.
Emergency medicine evolved into a medical specialty in the 1960s under the leadership of physicians in small communities across the country. This paper uses three case studies to investigate the political, societal, and local factors that propelled emergency medicine along this path. The case studies-Alexandria Hospital, Hartford Hospital, and Yale-New Haven Hospital-demonstrate that the changes in emergency medicine began at small community hospitals and later spread to urban teaching hospitals. These changes were primarily a response to public demand. The government, the American public, and the medical community brought emergency medical care to the forefront of national attention in the sixties. Simultaneously, patients' relationships with their general practitioners dissolved. As patients started to use the emergency room for non-urgent health problems, emergency visits increased astronomically. In response to rising patient loads and mounting criticism, hospital administrators devised strategies to improve emergency care. Drawing on hospital archives, oral histories, and statistical data, I will argue that small community hospitals' hiring of full-time emergency physicians sparked the development of a new specialty. Urban teaching hospitals, which established triage systems and ambulatory care facilities, resisted the idea of emergency medicine and ultimately delayed its development.
20世纪60年代，在全国各地小社区医生的领导下，急诊医学发展成为一门医学专科。本文通过三个案例研究，探讨推动急诊医学走上这条道路的政治、社会和地方因素。案例研究——亚历山大医院、哈特福德医院和耶鲁-纽黑文医院——表明，急诊医学的变革始于小型社区医院，后来蔓延到城市教学医院。这些变革主要是对公众需求的回应。20世纪60年代，政府、美国公众和医学界将急诊医疗推到了全国关注的前沿。与此同时，患者与他们的全科医生的关系瓦解了。随着患者开始因非紧急健康问题使用急诊室，急诊就诊人数急剧增加。为应对不断增加的患者数量和越来越多的批评，医院管理人员制定了改善急诊护理的策略。借助医院档案、口述历史和统计数据，我将论证小型社区医院雇佣全职急诊医生引发了一个新专科的发展。建立了分诊系统和门诊护理设施的城市教学医院抵制急诊医学的理念，最终延缓了其发展。
