1954: EDs Called the ‘Weakest Link’

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Brian Zink’s Concise History of Emergency Medicine: 1954: EDs Called the ‘Weakest Link’

Sixty years ago, emergency medicine had not been invented, and no true emergency physicians were in practice. A heralded speech and its publication by Robert H. Kennedy, a concerned senior surgeon brought attention to problems in the emergency room, but at the same time created a label – “weakest link” – that would hang with emergency medicine for decades [1].

In 1954, Kennedy, who had served from 1939 to 1952 as chairman of the Committee on Trauma of the American College of Surgeons gave the “Oration on Trauma” at the American College of Surgeon’s Clinical Congress in Atlantic City, New Jersey. He discussed the clinical problems and deficiencies in trauma care and he challenged the audience with provocative questions. During part of his discussion, he questioned the quality of care being provided to trauma patients in the emergency departments:


“In the emergency room in your hospital who examines an injured patient first? May it be the most junior intern, who has never seen a traumatic case before, or an indifferently trained foreign physician with language difficulty? Have you prepared and posted a directive which will give these junior men an idea of what instances require the immediate notification of a surgical resident?…. Will the attending notified be at the most junior level or a senior man with experience? ….Do you know from personal inspection what goes on in your emergency room in the middle of the night or do you stay away due to a subconscious fear of what you might see?….There is little doubt in my mind that the weakest link in the chain of hospital care in most hospitals in this country is the emergency room attention to the injured” [2].

Kennedy’s use of the term “weakest link” to describe the ER was picked up and promoted in a paper by Shortliffe et al in the New England Journal of Medicine in 1958, and included in the title of a paper published by Shortliffe in Hospitals in 1960 [3]. Although Kennedy and others used the term to incite change in the ER, instead “weakest link” became a label associated with emergency care and those who practiced in ERs.

It would be another 15 years until the first emergency medicine residency was created and another decade until the first emergency physician specialists were certified in 1980 [1]. Today, emergency medicine and emergency physicians are still part of the chain, but can no longer be termed “the weakest link.” Emergency medicine has fought for its legitimate standing in the house of medicine and has developed over the past 60 years to now be the strongest and most vital link in the care of the acutely ill and injured.


1. Zink, BJ; Anyone, Anything, Anytime – A History of Emergency Medicine. Mosby Elsevier, Philadelphia, PA, 2006.
2. Shortliffe, E.C., Hamilton, T.S., and Noroian, E.H., The emergency room and changing pattern of care. New England Journal of Medicine. 1958. 258(1): p. 20-25.
3. Shortliffe, E.C., Emergency rooms…weakest link in hospital care? Hospitals, J.A.H.A., 1960. 34: p. 32-34, 107.


Brian J. Zink, MD is a Professor and Chair in the Department of Emergency Medicine at Alpert Medical School of Brown University. Dr. Zink is also the author of Anyone, Anything, Anytime- a History of Emergency Medicine (Mosby Elsevier, 2006)

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  1. patrick jean on

    i agree. as a practicing emergency physician i find the best physicians are now in the ed. the others may be very good in their area of expertise but only if we spoon feed them cases they can understand and are in their comfort realm.

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