While special knowledge and ability in treating emergency conditions dates to antiquity, emergency medicine (EM) as a specialty is only 50 years old. Use of ambulances to transport battlefield casualties to a centralized care area was initiated in the 1790s. Staffing an ED 24/7 occurred first in the U.S. in 1961. Until the advent of specialty training in the 1970s, EDs were generally staffed by hospital physicians on a rotating basis. Ambulance services where often run by funeral directors, because they had vehicles that could transport people horizontally. In the Anglo-American model, emergency medicine has evolved into a specialty with its own training and board certification. However, EM does not exist as a specialty in many nations, and unfortunately, that approach remains detrimental to the patient with a time-sensitive emergency, as they may not receive appropriate initial care and can remain undifferentiated while being directed to the appropriate service.
In the 1980s, emergency medicine became one of the fastest growing specialties and emergency departments, especially in urban settings, began to be overcrowded with indigent patients. The annual number of emergency department visits in this country has increased virtually without interruption since the 1950s.
It is estimated that there are approximately 5,000 emergency departments in the U.S., and 42,000 physicians practicing within them, providing care for 136 million annual ED visits. Currently, there are over 170 approved EM residencies in the US matriculating over 1,800 physicians per year. Emergency medicine has been and remains one of the most competitive specialties for medical student applicants for more than a decade.