Sharing Memories

of Emergency Medicine

in the Detroit Medical Center &

Wayne State University’s

School of Medicine

Dr. Blaine White

Emeritus ES Thomas Professor of Emergency Medicine

Emeritus member National Academies of Science, Engineering, and Medicine

May 4, 2024

Detroit Receiving Hospital was built in 1915 to be a public hospital

providing care regardless of ability to pay. It became Wayne-SOM

primary teaching hospital in 1917 and was later renamed Detroit

General Hospital.

In 1974 DGH had 12-bed inpatient wards & only one 6-bed SICU.

Post-resuscitation Medical patients often went on these wards with

a pressure-cycled Vent and no cardiac monitor.

This was the Property Window facing many yellow-plastic chairs

in the DGH lobby. Patients were searched on arrival in the ED &

could pick up their property after discharge.

DGH Ambulance Dock ~1970

Our defibrillators looked like this – NO MONITOR. There

were 3 in the ED sitting on corner tables in Room 4 Trauma,

Room 6 Male Medical, and Room 7 Female Medical.

Our black

AMBU bags

hung on the wall

& were cleaned

& reused.

Our Pressure-cycled Byrd Ventilator

Developed by Byrd, a WWII hi-altitude pilot. Settings: FIO2, Flow rate,

Peak pressure, & Expiratory Time. PEEP by placing exhale line end

under water. Only 2 volume vents in Hospital were never used in ED.

Our Monitor: 1970 Burdick EKG machine with paper strip

Cardiac Resuscitation produced yards of paper strip on the floor.

We had to unplug EKG leads before defibrillation.

Patients in Room 6. NO RESUSC BAY. Standing where this picture

was taken, the AMBU bag on the wall, defibrillator, drug cart, & a

gurney for resuscitation were in the corner to the left.

No Computers - Charts typed in write-up. H&P & Orders

hand written.

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No EKG Techs – We ran all EKGs ourselves. It was a good

way to learn about posterior, right-side, & Lewis leads.

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No Clerks – We filled out all lab and X-ray requests by hand.

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No Floor Drains – Housekeeping cleaned up large blood

messes with cherry-scented sawdust, shovel, & a mop.

​

We started all IVs and drew all blood samples. A city

nurses union contract did not allow them to do this.

Filling out the environment for

our Residents 1976-1980

DGH was a leading hospital providing care in the 1967

Detroit Riot, & Dr. Ron Krome was part of that as a

Surgery resident. Upon graduating In 1969, he was

appointed the first Chief of the DGH ED.

In 1969 DGH also had amazing Interns for $6K !!

First EM Resident – 1970

Dr. Bruce Janiak @ University of Cincinnati

​

University Association for EM (UAEM) forms – 1970 – required

a faculty appointment - later became SAEM

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First Academic Department of Emergency Medicine –1971

U Southern California: Chair – Dr. Gail Anderson

​

Journal of the American College of Emergency Physicians -1972

later became Annals of Emergency Medicine

Dr. Ron Krome was Chief Editor for 14 years

​

National Early 1970s Emergency Medicine Firsts

Mid-1970s Personal Journeys

In 1973 Dr. Brooks Bock leaves

Urology residency for the ED &

works with Ron for a DGH-WSU

Emergency Medicine Residency.

He is 1976 1st Residency Director.

​

Dr. Judy Tintinalli graduates

U-Michigan Medicine residency,

returns to DGH ED, and becomes

Residency Director in 1977. She

then brings the first Study Guide

into being by 1980.

​

In 1974 I came from a Providence

Medicine residency to ED & began

lab work on shock & brain damage

by ischemia & reperfusion.

In 1977 Ron forms UES-PC, makes

Brooks, Judy, & I full partners, and

assigns us to write the Emergency

Medicine Practice Plan for WSU -

SOM. Brooks took on financial

leadership because our billing was

netting < $1.00 per ED chart.

More Important Developments 1968- 1980

1968 – Dr. John Wiegenstein (Lansing) leads founding of ACEP

​

1972 – Detroit EMS established

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1975 – AMA approves Emergency Medicine Section

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1976 – ABEM incorporates and uses MSU-OMRAD to plan exam,

but in 1977 ABMS rejects ABEM as a Primary Board

​

1979 - Drs. John Wiegenstein, David Wagner (Philadelphia), &

Ron Krome lead ABMS negotiation that approves ABEM

9-21-1979 An Incident in GOP campaign for 1980:

Who Is Your President?

1980 - Mt. Carmel Hospital begins development toward

Its EM residency that will become another major part

of WSU Academic EM

1980 – We move into new Detroit Receiving Hospital

Brooks & Ron worked hard on ED design, and we get 3-bed Resusc,

real monitor-defibrillators, volume ventilators, arterial pressure monitors,

Pacemakers, CT scanner, adjacent stat-lab, a large OCU, large Crisis

Center, EMS radios with EKG for first Detroit ALS paramedics, and

decent office space in the ED.

A Lighter Moment: GIFT from 1981 DRH-EM Class

In WSU-SOM Emergency Medicine was a Division of the Dept.

of Surgery. By 1977 Ron, Brooks, Judy, & I all held paid WSU

tenure-stream academic appointments, & we had good records

for productivity in Education, Research, & National Service. In

1981 we hoped for a clear path to our own Academic Dept.

​

But, except for Ron, we weren’t surgeons. The early ’80s recession

led to large cuts in WSU-SOM general funds from the University, &

our tenure-stream faculty positions were eliminated from the Dept.

of Surgery.

​

Brooks moved to Austin, Texas. Ron and Judy moved to Beaumont

Hospital, and in fall 1982 I left for 4 years tenured faculty research

under Dr. Wiegenstein at MSU and ED practice at Mt. Carmel. Judy

went on to become Chair of EM at U North Carolina @ Chapel Hill.

By 1984 I had six-figure federal research grants at MSU.

Then Things Went to Hell

Emergency Medicine Resuscitated in mid-1980s

At DRH & WSU-SOM

In 1986 Brooks recruited me to return as a tenured Associate

Professor to establish a strong research base.

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By 1988 we have our first 3-year NIH-RO1 grant for $588,980.

​

We get our own laboratory, & Dr. Gary Krause joins our faculty

& receives many NIH grants. Dr. Brian O’Neil becomes our first

research fellow. He gets a NIH-K08 grant for $412,973.

Dr. Brian Tiffany & Dr. Bob Neumar are our 2^nd & 3^ed research

fellows & both earn a Ph.D. in Physiology; Neumar also gets a

NIH-K08. By my 2006 paid faculty retirement, our lab

had received over $6-million in research grants.

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Both Dr. O’Neil and Dr. Neumar are now EM Academic Chairs.

WSU-SOM wanted Emergency Medicine Research

In 1990 Emergency Medicine became a

WSU-SOM full Academic Department

We’ve had 3 outstanding Chairs of our Department -

All Tenured Full Professors

The WSU Department of Emergency Medicine

and the MCES medical practice

continued to grow

In 1991 DMC bought Mt. Carmel Hospital and closed both old Grace

and Sinai Hospitals. The new Sinai-Grace Hospital was housed

in what had been Mt. Carmel.

This 334-bed general hospital

provides the full range of medical

care. Its MCES physicians & 36

EM residents care for ~90,000

patients yearly in the 75 bed ED.

​

This outstanding WSU EM

program is a major part of our

Academic Department.

1995 - EM Residency @ St. John Hospital Affiliates

with WSU-SOM Department of Emergency Medicine

Dr. Don Benson was a Navy medic

during the Vietnam war, then served

as an ED nurse at old DGH, and then

graduated med school and became a

DRH EM resident in 1980. He went

on to found the St. John EM

Residency.

In 1995 the St. John EM Residency formally affiliated with the

WSU-SOM Department of Emergency Medicine. This outstanding

program sees ~100,000 patients yearly in a 73-bed ED.

No other WSU Department has this record, and there will be more.

Since 1990 we’ve become an

Outstanding WSU-SOM Clinical Department

& Practice Group

• Maintain Practice Independence – MCES Owns our own Ship.
• This work’s too fundamental for gouging or national corporations.
• Collaborate, Cooperate, Lead – but Stay in our cockpit’s Left Seat.
• Independent Strong Residencies – potential Life Rafts
• Academic Excellence brings great Value to Practice negotiations.
• Practice Independence brings great Strength to Academics.
• Practice Independence & Academic Excellence produce great care.
• Take care of each other.

The Importance of the Endowed Chair & Professorships

In the WSU Department of Emergency Medicine

While he was WSU EM Academic Chair and MCES President,

Dr. Bock remembered our EM faculty positions being cut in the

early ‘80s. That doesn’t happen with endowed appointments

because the University has a major fiduciary responsibility to take

care of the endowments. Thus Steven Hawking held the 1663

Cambridge University Lucasian Chair also held by Isaac Newton.

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By collaboration of MCES & the Academic Department,

The Dayanandan Endowed Chair was established in 1994,

The ES Thomas Endowed Professorship in 1997, and

The BF Bock Endowed Professorship in 2005

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We should work toward more of these. They motivate, attract, &

hold people with outstanding talents, and that has major long-term

value for MCES Practice as well as for Teaching, Research, & Service.

I must bring this to a close, but

There are so many outstanding doctors and staff

I haven’t yet named in this history talk….

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Drs. Berk, Delcourt Dubey,

Dunne, Ehrman, Favot,

Freeman, Jones, Kaufman,

King, Kline, Kouyoumjian,

Lagina, Levy, Lewalski,

Messman, Paxton, Sherwin,

Smylie, Tabbey, Taylor,

Velilla, Wahl, Welch, ….

MANY YEARS here – No Burnout on a Mission

Together You Are

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ED Chiefs…,

Professors, an Associate Dean, & a WSU Vice President…,

Research Faculty & Staff for a Grant Portfolio 5^th Nationally…,

Residency Leaders and consistent teachers…,

Journal Editors…,

Book authors…,

ACEP, SAEM, & ABEM Leaders…,

Leaders of our med student teaching…,

ACLS & ATLS Directors and teachers…,

MCES Leaders…,

Doctors doing outstanding care & teaching 24/7/365…,

Outstanding ED Nurses who have taught us all…,

Coordinators & Secretaries that make it all work…,

You Are Amazing – and it’s been a great honor to be

one of you and count you as such dear friends.