Pioneering contributions of Peter Safar to intensive care and the founding of the Society of Critical Care Medicine.

During the Crimean War, Florence Nightingale, the parent of professional nursing, segregated the most severely injured soldiers and bedded them in close proximity to the nursing station. This perhaps represented the beginning of intensive care. During the poliomyelitis epidemics in Scandinavia of 1949 and 1952 and, subsequently, during the polio epidem! ic of 1948 and 1949 in Los Angeles, special respirato! ry units were organized for bag ventilation of patients with bulbar polio. Excepting postanesthesia recovery units first implemented by Dandy in 1923 at the Johns Hopkins Hospital, which evolved more fully during the Second World War, there were no inten! sive care units as we know them today until 1958 [1]. Almost concurrently, although with somewhat differing emphasis, Weil and Shubin at the University of Southern California School of Medicine and the Los Angeles County General Hospital and Safar at the Baltimore City Hospital developed the first physician!staffed medical and sur! gical units for management of patients with immedi! ately life!threatening conditions [2, 3]. The Los Angeles team was co!headed by two cardiologists, Weil and his life!long collaborator, the late Dr. Herbert Shubin, and Chief Surgeon Leonard Rosoff. It was initially named the Shock Ward because its initial emphasis was on acute circulatory failure. Peter Safar's unit was identified as an «intensive care» unit, with major emphasis on management of the airway and on breathing, following the tradition of Dandy [4]. Both in the Los Angeles and in the Baltimore units, there was 24!hr/day, 7!day/wk physician commitment to the care of the most seri! ously ill and injured by a multidisciplinary team rep! resenting both medical and surgical specialties. The goal of both units was fuller commitment to lifesav! ing care for the most seriously ill and injured, with primary emphasis on breathing, circulation, neuro! logic recovery, and control of infection. Both were committed to clinical and laboratory research, although the focus of the research of the Eastern and the Western centers was quite different. The Los Angeles team focused on an understanding of mecha! nisms of acute life!threatening illnesses and injuries [5—7]. Accordingly, it pioneered the development of monitoring and measuring devices. Equipment, including recorders, transducers, cuvettes, and ther! mocouples were taken from the physiology laborato! ry to the bedside. Central venous and arterial cath! eterization for pressure and cardiac output measurements by dye dilution techniques, measure! ments of central and peripheral body temperatures, detection and quantitation of life!threatening cardiac arrhythmias based on electrocardiographic heart rate and pulse rate, and respiratory frequency were imple! mented. The University of Southern California unit was a joint project of the departments of medicine and surgery and included isotopic methods for mea! surements of plasma and red cell volumes, especially for detection of hypovolemic shock. The «STAT Laboratory» concept was born in Los Angeles for rapid, «point of care» measurements of blood gases, electrolytes, and arterial blood lactate [8]. As early as 1960, the University of Southern California unit began to implement, primitive, digital computer methods for data management and bedside display [9]. Peter Safar's unit maintained early emphasis on the airway and ventilation, in part an extension of the Safar!initiated priorities in 1957 of the A and В of cardiopulmonary resuscitation, including Peter's sin! gular commitment to that of saving lives by demon! strating options for better management of the airway and breathing and for pharmacologic interventions [10, 11]. Peter was an early proponent of titrated therapy. He and his associates maintained early emphasis on ventilation, cardiopulmonary resuscita! tion, and neurologic outcomes in addition to the other priorities of the modern anesthesiologist. The University of Southern California group emphasized circulation, including acute myocardial infarction, sepsis, and drug overdoses. In the years that followed, however, interest in circulation gained momentum in Pittsburgh and ventilation in Los Angeles. In 1961, both units began the first fellowship programs in what emerged as critical care medicine. The initial leaders of the field came from these pro! grams, and our graduates literally populated new cen! ters all over the globe and constitute a new genera! tion of critical care leaders.