A tripling of emergency room visits nationwide occurred between the 1940s and the 1960s. The decade of the 1960s represents a confluence of policy and social changes that lit the match for the creation of emergency medicine and the transformation of the emergency room into the emergency department. By 1961, the first groups of physicians dedicated to providing care in the emergency department started.

Several major events in the 1960s converged to change social thinking and the health care landscape. In 1966, the National Academy of Sciences and National Research Council published the landmark report, “Accidental Death and Disability: The Neglected Disease of Modern Society,” which highlighted the magnitude of the injury problem in America and the poor state of ambulance and emergency services.² Motor vehicle injuries, during a time in which automobiles and highways were also booming, were a matter of particular concern. The report noted that soldiers injured in the Korean War on the front lines were systematically moved to emergency care better and faster than Americans at home injured in motor vehicle crashes. This white paper had a huge impact on EMS and emergency services in hospitals.

Emergency medicine can look back at 50 years of change and recognize that our growth and advancement is underscored by the profession’s commitment to the needs of patients and communities.

Health Care Goes National

In 1965, health care became a national issue. About half of Americans age 65 or older (called “the aged”) lived in poverty and had no insurance. In response to growing public concerns, Medicare and Medicaid were enacted to provide insurance for the aged and money to the states to provide Medicaid to the poor. This was overseen by the Bureau of Health Insurance, which became the Health Care Financing Administration, and then became the Centers for Medicare and Medicaid Services. Hill-Burton–financed hospitals were obligated to accept these new insurances.

The resulting expansion of patients with insurance caused greater demand for care that existing doctors’ offices and clinics could not meet, so people turned to the emergency department for care, often sicker than if they had had routine care.

In 1966, President Lyndon Johnson, responding to a March report from the President’s Committee for Traffic Safety, made it a priority in his State of the Union address. He championed legislation, the Highway Safety Act, that included driver education, law enforcement, crash prevention, engineering standards, and medical care and transportation of the injured. The Department of Transportation was formed, and within it, the National Highway Traffic Safety Bureau was formed, later becoming the National Highway Traffic Safety Administration (NHTSA). EMS was expanded federally due to the death toll from motor vehicle crashes, which is why NHTSA has always played a large role in EMS and still does today. In 1971, NHTSA’s Office of EMS published the first guidelines for training emergency medical technicians.