Documenting an Emergency (R)Evolution

To say that emergency medicine has changed a lot over the last 60 years would be an understatement. Frankly it was built from the ground up in that time. The documentary 24/7/365: The Evolution Of Emergency Medicine, narrated by Anthony Edwards of the old ER TV show, tells the story of the emergence of emergency medicine as a specialized study and highlights a number of the doctors responsible for establishing the systems of emergency care common today.

The documentary is split into multiple sections with titles such as “The Bad Old Days” and “The First Residents” to help lay out the chronology of emergency medicine in the wake of World War II. During and after the war, many Americans moved to city centers and away from their family doctors, but most city hospitals were not equipped for much beyond a simple suture. Emergency rooms, as we know them now, were usually just disused basement rooms without proper staffing.

Different plans were implemented by different hospitals and had varying degrees of success such as The Pontiac Plan in Pontiac, Mich, which arranged to have doctors who worked in the hospital take shifts in the emergency department while other doctors, such as Dr. Mills of Alexandria, Va, gave up his regular and successful practice to concentrate on working in his local emergency department. These measures were a step in the right direction, but doctors knew they needed proper training for emergency medicine and that it had to be a board certified specialty. The medical establishment fought this notion. 24/7/365: The Evolution Of Emergency Medicine takes us from those shaky beginnings to the post-Vietnam establishment of trained paramedics to more recent laws preventing hospitals from turning people away without at least giving them required basic care.

Two of the films’ contributors, writer and producer Dr. Mark Brady and interviewee and consultant Dr. Brian Zink, provided insight into this project. Dr. Zink said, “I wrote a book called Anyone, Anything, Anytime – a History of Emergency Medicine that was published in 2006. I interviewed many of the founders of the field of emergency medicine and spent three years researching the early history of the specialty. Mark Brady and others read the book and Mark got the idea to make a documentary using the basic story I put together and re-interviewing many of the key people with video.”

This is one of the more informative documentaries I have seen recently, and I was curious about the film’s intentions. Brady explained, “People don’t know that a generation ago there was no 911, there were no trained ambulance services, that firemen did not do anything medical, and that ERs were really no more than a room with probably the least trained doc to care for the sickest patients. That was just a generation ago. I wanted to show the origin of it all because that’s why I went into the specialty. The whole EMS/ 911/ ER system arose out of demand from a changing America. We are there because that’s what people wanted. I like that I never have to worry about a patient’s insurance. I can just do whatever I can for what they need.  I also am a huge dork and wanted to meet and talk with all these badasses who changed the American healthcare system for all the right reasons.”

Dr. Zink added, “I hope that the film, like the book, will cause people to consider the interplay between social, political and healthcare factors that led to the development of emergency medicine, and how far we have come in 40 years in providing high-quality, always available emergency care in the US.”

24/7/365: The Evolution Of Emergency Medicine skillfully takes viewers through the establishment of emergency medicine as the modern backbone of the hospital industry, told from the point of view of those who fought those battles. When asked what challenges lay ahead for the still young specialty of emergency medicine Dr. Zink replied, “There are lots of exciting areas and developments in healthcare where emergency medicine is a big part of the picture. We will figure out the proper role for emergency departments in increasing access to care, lowering costs, improving communication with other providers, handling complex care, medical homes, end of life care, an aging populace and generally learning how to function more like a system. We have been the safety net for all people, regardless of their ability to pay, when they have medical or psychiatric crises. We will still be that, but hopefully engaged in many new ways to deliver higher quality, lower cost care to the right patients at the right time.”

24/7/365: The Evolution Of Emergency Medicine has aired numerous times on PBS and information about screening the film or purchasing DVDs is available at 247365doc.com

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