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Updated 5:00 PM October 25, 2005

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Emergency medicine aided by motley revolutionaries

By Mary Beth Reilly

Medical School Communications

If it weren't for some quirky, largely Midwestern physicians, U.S. emergency rooms
(ERs) still might be stuck in the 1950s model, according to a U-M physician who has
researched more than 60 years of ER medicine.

At that time, most ER patients were seen by surgeons—

if they could be spared from the operating room—
private practice physicians or those with questionable
credentials, while some ERs were staffed by
unsupervised residents and medical students. So notes
Dr. Brian Zink, author of "Anyone, Anything, Anytime, A
history of emergency medicine," the first book on the
post-World War II history of emergency medicine.

Zink, a practicing ER physician, associate dean for

medical student career development and associate
professor of emergency medicine in the Medical School,
was moved to chronicle this historical shift when he
realized the window of time to hear the story of Zink (Photo by Martin Vloet,
emergency medicine directly from its founders was U-M Photo Services)
closing. He interviewed dozens of early revolutionaries
and found them to be interesting characters.

"They were more likely to have grown up in the Midwest, they were less likely to be Ivy
League-educated, and they were not plugged into the medical elite in this country," Zink
recalls. "They were starting something new on a grassroots basis."

One of the people featured in the book

is John Wiegenstein, a 1960 Medical
School graduate, who most often is
mentioned as the father of modern
emergency medicine. Born in a
Missouri cabin, an ex-seminarian who
tried automotive engineering and flight
school, he finally settled down to learn
and practice medicine. Although he
began as a general practitioner in
Lansing, Wiegenstein found he most
enjoyed being awakened in the night to
come to the ER to treat his patients.
While there, he saw that many of the
physicians either were misfits or not
trained to make lifesaving decisions.

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Emergency medicine aided by motley revolutionaries
The uniforms look a little different and the
procedures have become more advanced, but
emergency medicine still is about treating
patients with the smallest injuries or biggest
traumas. Above: Robert Wolfensperger,
emergency medical resident and program
director (left), and Dr. Allen Klippel (white coat)
assess the condition of a patient in the St. Louis
University Hospital in 1973. (Photo by Medical
World News) Below: Dr. John Erickson, an
orthopedic surgeon at the U-M Health System,
treats field hockey player Sara Wilhite in the
University Hospital emergency room (ER) for an
injury. Dr. Brian Zink, a U-M ER surgeon, has
written the first book about the post-World War
II history of emergency medicine. (Photo by
Scott Galvin,
U-M Photo Services)
"Krome was up for the battle to get
emergency medicine into the legitimate house of medicine."
Karl Mangold represents the entrepreneurial side of emergency medicine. He took a
systems approach to anything he did, be it caddying, delivering newspapers or
delivering lifesaving medical care, Zink says
Mangold saw that many hospitals needed to staff their emergency departments but
didn't have locally qualified physicians. In 1966, he co-founded Fischer Mangold, a
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Página 2 de 4
In 1968 Wiegenstein gathered several
other like-minded physicians and
founded the American College of
Emergency Physicians (ACEP), the
premier professional association in the
field. His goal for the ACEP was to
create national awareness of the need
for qualified emergency care and
training; to promote research in
emergency medicine; and to develop
emergency medicine as its own, board-
certified specialty.
"Wiegenstein was surprisingly modest,"
Zink says. "Very much driven by
values, he kept pursuing in a very
determined way what he saw needed
to be done, which was to form a strong
organization in order to propel good
emergency care to our patients."
Ronald Krome was another
revolutionary. He served as a crucial
link between early emergency medicine
practitioners and the academic world.
Fresh from his surgical residency in
1969, Krome was put in charge of the
emergency department at what used to
be called Detroit Receiving Hospital.
One of his first decisions was to
designate one—and only one—entrance
to the ER.
Zink recalls Krome as being funny,
gruff and irreverent, but with a good
sense of humor, chain-smoking
cigarettes throughout the interview.
"Pretty much everything that happened
that was important in emergency
medicine in the 1970s and 1980s, he
was a part of it. He was a tough
negotiator, but knew how to cajole, so
he was effective in working with the
medical establishment," Zink says.
"They didn't quite know what to make
of emergency medicine, and their initial
reaction was to shut it out.
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Emergency medicine aided by motley revolutionaries Página 3 de 4

company that supplied qualified emergency physicians to hospitals by contract.

"Mangold's goal was to deliver better emergency care to populations than they had
gotten previously," Zink says." Other similar corporations became exploitative in that
they were not hiring the best qualified emergency doctors, and that's an ugly side of
emergency medicine that is still being played out today."

Emergency medicine also had its critics. Oscar Hampton, chair of the Committee on
Trauma of the American College of Surgeons in the 1960s and 1970s, was so outspoken
that he served as the perfect foil in the struggle to make emergency medicine a
recognized specialty, Zink says.

"It was paradoxical that Hampton, like many other surgeons, would want better trauma
care for emergency patients, but he viewed it as only a surgical domain, and not
something to be shared with other physicians," Zink says.

"Hampton reacted vigorously against an organized emergency medicine specialty,

although in later years some people said Hampton knew he wasn't going to win that
battle, but he had so much fun engaging in it that he was almost a caricature."

Having a nonconformist background both helped and hurt these revolutionaries. It

helped them to understand what medicine needed at the time, but it hurt them because
they didn't fit into the academic world, Zink says. But they were aided by the social and
political changes of the 1960s and 1970s, so in the end emergency medicine became a
valid, recognized and valuable medical service.

Today, the ACEP has more than 20,000 members.

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