Ronald D. Stewart

Ronald Daniel Stewart, Officer of the Order of Canada, Member of the Order of Nova Scotia, Member of the Executive Council of Nova Scotia (hon), former Minister of Health for the Province of Nova Scotia and member of the provincial parliament, was born in North Sydney, on the island of Cape Breton, Nova Scotia, and was raised in the neighbouring town of Sydney Mines. The son of a community-minded homemaking mother and a coal-miner father who entered the mines at the age of 14, his early education was obtained in local schools in which he was steeped in the classics and from an early age was expected to excel in his studies. He led his 18-member class at graduation and was awarded several scholarships to university.1 He was the first of his family to graduate from high school and the only member of his graduating class to enter university.

Choosing to attend Acadia University in the Annapolis Valley of the province, his decision to leave home at the age of 17 was influenced by his desire for residential life at a school with a sense of community. During his time at Acadia he was active in student affairs, heading up several student clubs and organisations as well as being elected President of the Students' Union. During his time at Acadia he received a scholarship for overseas study focused on emerging post-colonial nations, first in France at the University of Paris and later in Algeria.2,3 His choice of a small liberal-arts university was influenced by a sense of community instilled at an early age in the island culture of Cape Breton.

His work as President of his university’s Students’ Union provided a taste of political action and his first overseas experience planted the seed of examining the challenges of global health issues, which surfaced later in his academic medical career.

During that summer of 1964 in Algeria his field of study was public health and the structure of a developing health system. The Algerian study was interrupted when a major explosion, attributed to militant dissidents, occurred in the port of Annaba (formerly “Bône”), resulting in thousands of dead and injured.4,5 After participating in relief and rescue efforts for several days with almost no sleep, he was arrested by Algerian authorities who were detaining many foreign citizens, interrogated for several days in a holding cell and then ordered deported to France; fortunately his passport was returned. He completed his study tour in France and returned to Canada later that year. He had credited that experience with his increasing interest in global health and in acute care medicine.

Following graduation from Acadia he took up medical studies at Dalhousie University, during which time he was elected President of the Medical Students' and Interns' Society, a tenure marked again by bold initiatives and innovative programs.6 Under his leadership the desire of many idealistic medical students for community and charitable giving was channelled by this student-president into a Medical Auction6 to raise funds for the “Foster Parents’ Plan” as well as an annual variety show, EUPHORIA!, both of which have become fixtures in the medical school calendar and which continue to raise thousands of dollars annually for community and international charities. In recognition for his work on behalf of students and the community he was awarded the “Gold ‘D’ by his fellow students as well as a study grant for a research health project in the Canadian Arctic examining the health status of First-nations’ children and adults.7 This latter award was to further influence his choice of a rural general practice.

After receiving his medical degree Dr. Stewart began practice in a northern coastal fishing village on his home island of Cape Breton. In one of the most isolated rural practices in the province he found himself not only a solo-practice family physician, but also serving as “dentist” (“tooth-hauler” in the parlance of patients), county coroner, vet, “physician to sick mariners” and church organist.

During those years he focused on improving physicians’ home visits in collaboration with the local Public Health Nurse. Determined as well to improve the transport and care of patients referred to regional and provincial hospitals from the relatively remote fishing communities in the north highlands, as an interim measure he outfitted his jeep as an ambulance until a proper vehicle was available. To supplement his focus on emergency care, first-aid/CPR courses were offered to residents of the area, and swimming classes were organised after the young physician, with a growing appreciation of preventive medicine, learned that almost all adults and many of the children could not swim, despite their almost daily and intimate relationship with the sea. Having attended, as “county coroner,” five drownings in this first several months of practice,8,9 he felt that this was a major public health problem and instituted a community-based “learn-to-swim” program the following summer.

House calls by physicians in the region were a basic staple of Family Practice in the north highlands, and were expected day and night, and without regard for the weather. Returning from a midnight house call during an April blizzard in his second year of his practice, the itinerant physician suffered a head injury following a probable encounter with a moose and was transported in a newly-acquired ambulance to the neurosurgical unit in the provincial capital of Halifax.10 He returned to practice after rehabilitation, although not completely recovered from a speech defect and right-sided paralysis.11

After several years based in the Neil's Harbour, he applied for, and was chosen over sixty other candidates, for the last available position in the first-ever academic (University of Southern California) department training specialists in emergency medicine at the Los Angeles County/University of Southern California (LAC/USC) Medical Centre.12 He set off from the north highlands of Nova Scotia in his Volvo station wagon packed with every scrap he owned and six days later was tentatively navigating US Interstate 10 into Los Angeles searching for the monolithic concrete building, the exterior of which was familiar to the millions of daytime soap-viewers of General Hospital, Los Angeles County/USC Medical Centre.

He was not long into his residency when he became fascinated with the medical assistants who were crucial to the operation of the mammoth Department of Emergency Medicine which at the time saw up to 1000 patients per day. Many of these “Physician Assistants”- PA’s as they were called- were former “medics” recently returned from Viet Nam and who received “on-the-job” training in the Department and who, as “non-physician clinicians,” performed many tasks usually undertaken by physicians. Within the Department of Emergency Medicine at LAC/USC these “PA’s” did much of the clinical work alongside the residents. Staff physicians were teachers and clinical supervisors.

A similar program extending beyond the walls of the hospital caught his attention; a newly-instituted initiative (1969) training firefighters to perform in the streets life-saving procedures such as CPR, defibrillation, the administration of medications, etc. as a pilot “paramedic” project.13 Thus began a major facet of his career in medicine which was to lead him well beyond the walls of LA County Hospital or freeways of California. It took him to every state in the USA, including Alaska and Hawaii, to every continent except Antarctica, and involved major consultations in the growing field of Emergency Health Services in his homeland of Canada, in Australia, New Zealand, the UK, Hong Kong, Germany, Africa, the Middle East and the Caribbean. Through this sub-specialty he assumed a leadership role in national and international organisations, serving in the United States as founding president of the National Association of EMS Physicians14, as well as being elected to the executive of the World Association for Disaster and Emergency Medicine (originally the Club of Mainz), serving for over 10 years.15

His focus on paramedic education and the definition of a curriculum for these “non-physician clinicians” resulted in the first “textbook” designed specifically for paramedics and which was composed largely after emergency department shifts and an informal stint at the fire department “Tower” – the training facility for firefighters, located not far from the hospital. Both the textbook and his classroom presentations to paramedics attempted to relate concepts and content of the “Tower” firefighters’ curriculum to the medical/clinical principles required of an emergency care provider.16,17 On completion of his residency at USC he was offered a position on staff of its Department as well as the newly-created position as medical director of paramedic training for the County of Los Angeles.

His tenure as Medical Director was characterized by a major increase in the number of paramedics being trained, more than tripling the number of classes, which required the opening of two major training sites and additional clinical facilities. Not content to remain in the hospital and classroom, Dr. Stewart was renowned, and later celebrated, for what seemed his constant presence in the streets of Los Angeles in his attempt to understand the challenges and issues facing the newly-minted healthcare providers, as well as the environments in which they worked.17 These personnel, as well as the environment, caught the attention of the public when Universal studios and NBC network had begun to air a six-year weekly television portrayal of the ups and downs of two Los Angeles paramedics in Emergency!,17 a show whose popularity in both syndication and the internet continues to the present.18 Because of his position as medical director in the Los Angeles EMS system, he was appointed medical advisor to this television show and its cast,19 as well as several others from Universal Studios and NBC.20,21

Dr. Stewart remained in his position as Medical Director of Paramedic Training for the Department of Emergency Services of the County and on the Faculty at USC until accepting an offer from the University of Pittsburgh to assume the role as Professor and Head of the fledgling emergency program at the University Hospital as well as the position of Medical Director of the Department of Public Safety of that city.22 Supported by the University and eight teaching hospitals in the city, and using his influence as Medical Director of the Emergency Medical (Paramedic) Services, he was successful in establishing an academic institute, The Center for Emergency Medicine, within 6 months of his assuming his position.23 The Center, now the largest of its kind in North America, gave rise to research programs in Emergency Medical Services as well as emergency medicine in general, an Office of Education out of which came the national curriculum for EMS personnel,24 the largest air and ground critical care transport system in the United States, as well as being a centre for international paramedic and physician training.23,25

His career in Pittsburgh was highlighted by two major awards: the first, the Rotary “Star of Courage” honoured his role as EMS Medical Director in the field amputation of a worker’s leg which was crushed atop one of the city’s bridges during its demolition,26 the second citation recognized his work to alleviate suffering during a major tornado disaster north of the city.27 The institute and residency program in emergency medicine he helped establish have become world leaders in research and education in the specialty24,25, and on his departure from the University he was granted an honorary professorship and was made a citizen of the City of Pittsburgh. He continues as an adjunct professor within the School of Medicine and the School of Health Sciences and Rehabilitation at the University of Pittsburgh.

Returning in 1987 first to the University of Toronto and later to his home Province, Dr. Stewart took up duties in emergency medicine and anaesthesia at Dalhousie University and conducted research in the management of acute pain in trauma. He entered public life in 1991, received the nomination for the Liberal Party in the riding of Cape Breton North,28 and was successful in the general election of 1993.29 He served in the Cabinet as Minister of Health and Registrar General for the Province until 199630, remaining a member of the Legislature until September 1997.31 His tenure as Minister was noted particularly for his diplomacy and sensitive management of the major issues surrounding contamination of the Canadian blood system with HIV. At the time Dr. Stewart was chair of the Council of Health Ministers of Canada and as such was delegated to respond to the crisis, interfacing with patients, families, other governments and the media. A compensation program was devised and instituted during his term, as well as broad and fundamental changes in the blood system structure and governance. Perhaps his greatest achievement as Minister was the creation of a modern, efficient and clinically effective Emergency Health Services (EHS) province-wide system which included a curriculum for paramedics within a diploma-level training program, standards for ambulances and equipment, a central “medical 911” dispatch and pre-arrival instructions, an aeromedical (“Lifeflight”) service for rapid response to emergencies in the regionalized system, a modern specially-designed fleet of ambulances and the institution of EHS clinical protocols.32 He expanded the provincial homecare program to include all citizens, implemented regionalized hospital services, provided support for an emergency medicine residency at the Medical School, laid out a funding and governance plan for a Nova Scotia Health Research Foundation and amalgamated two large teaching hospitals into a major academic health sciences centre.33,34 Under his leadership a Tobacco Control Division was created within the Ministry and legislation was introduced which provided for a broad program aimed at the reduction of tobacco addiction in the province, particularly among youth.35 He gained a national and international reputation as a leader in tobacco control and the prevention of addiction, receiving awards and commendation for this work in this important aspect of Public Health.36,37

Dr. Stewart has received numerous awards and acknowledgements of his academic and life achievements. In 1978 he received the Rotary “Star of Courage,” a medal of valour awarded for his leadership in a spectacular rescue of an entrapped iron worker whose limb was crushed and subsequently amputated during the demolition of a bridge 150 feet above a river in Pittsburgh. That same year he was inducted into the University Hospital of Pittsburgh’s Hall of Fame for his participating in this daring rescue.38 He was recognised by the American College of Emergency Physicians with the Mills Award for teaching and research in 1986,39 and in that same year the National Association of Emergency Medical Services’ Physicians named their most prestigious award after him as founding president (The Ronald D. Stewart Award for Excellence).40 For his work with the County of Los Angeles and the University of Southern California’s Department of Emergency Medicine he was given The Red Blanket Award in recognition of his achievements while a resident and faculty member and his career in emergency medicine that followed. In 1989 the National Association of Emergency Medical Technicians in the United States conferred on Dr. Stewart the Farrington Award, given annually to the physician deemed to have made a major contribution to prehospital clinical care and education in the United States. This was the first time the award was given to a foreign physician.41 He was one of 19 Canadians who received the “Canadian Citizenship Award” in 1992 from the national government.42 For his contributions to medical research and science, he was granted the honorary degree of Doctor of Science by his undergraduate alma mater, Acadia University, in 1988.43 In 1993 he received the highest honour given by his country, when he was inducted as an Officer of the Order of Canada.44,45 His national leadership in advocacy for the control of tobacco addiction in Canada was recognised in 1994 with the Award of Excellence of the Canadian Council on Smoking and Health, the Non-Smokers’ Rights Association Award of Merit in 1997 and the Norman Delarue Award from Physicians for a Smoke-free Canada in that same year.46 In 1995 he received the Centennial Medallion of the City of San Francisco for his earlier work in that city in paramedic training and public health, as well as the 25th Anniversary Medal awarded by the Paramedic Program of Los Angeles County in honour of his contributions to the field of prehospital care.20 In 1995 Dr. Stewart was granted the Award of Excellence and an honourary life membership by the Canadian Association of Emergency Physicians.47 He was elected to the National Executive of the Canadian Council on Smoking and Health in 1996, and became its President in 1997, serving until 2001. In 1996 he was appointed honourary co-chair of an advisory committee on the future of emergency medical services, established by the Department of Transportation of the United States government.48 In 1999 the program in Emergency Medicine at the University of Pittsburgh established an award in honour of Dr. Stewart's work at that institution and in 2003 the Ministry of Health for Nova Scotia and the Division of EMS of the Dalhousie Faculty of Medicine established the "Ronald Stewart Emergency Health Services Research Award" for projects related to the education and training of paramedical personnel.49

Late in 1996 Dr. Stewart resigned from the Ministry of Health to become active in the world-wide campaign to combat the scourge of antipersonnel landmines (APM’S), a passion which carried him to the UN, the International Committee of the Red Cross in Geneva, London, Berlin and other world capitals, and remote areas of countries affected by APM’s. He personally wrote and then campaigned vigourously for a resolution in support of a total ban on APM’s submitted to the general assembly of the World Association for Disaster and Emergency Medicine (WADEM) as well as publishing and advocating for arms control.15,50 His untiring efforts were credited with two landmine resolutions being unanimously passed, supported even by the American and Russian delegations to two General Assemblies of the World Association (1997, 2005), despite the stance of their home governments. His background in emergency medicine and his experience in political and public life led to an invitation to attend both Ottawa conferences at which the international treaty was constructed and signed to ban these weapons. He was asked by the federal government of Canada to participate in and then chair groups discussing medical aspects of APM’s and recommending additional efforts outlined within the Ottawa Treaty.51,52

Following his work in government in 1998, he helped create a consortium of government, university and industry, Emergency Health Solutions International, as a corporate structure affiliated with Dalhousie University, carrying out business, humanitarian and educational projects overseas. In January of 2000 he was awarded a medal by the City of Halifax in recognition of his contribution to the city, his province and his country. In April of 2000 he was the special guest of the County of Los Angeles and keynote speaker at the 30th Anniversary celebrations of the paramedic program in California. As the first medical director of paramedic training, he was inducted during the conference as an honorary paramedic for the State of California.20 His early paramedic texts were donated, by invitation, to the Smithsonian Institution in Washington, DC for an exhibit honouring the pioneers of emergency medical services systems in the United States.53 In 2001 he was asked to give the Shanaburger Memorial Address of the National Association of Emergency Medical Services Physicians, an organisation he served as founding President in 1984. In 2004 he returned as an honoured guest to present the same memorial lecture and commemorate the 20th anniversary of the organisation.54 Most recently the Centre for Emergency Medicine at the University of Pittsburgh established The Ronald Stewart Humanitarian Award, conferred on the graduate who most exemplifies “compassion, a caring spirit, and respect for others.”

Dr. Stewart recently held the position of Professor and Director of Medical Humanities within the Faculty of Medicine of his alma mater Dalhousie University. He has held joint appointments as Professor in Dalhousie’s Departments of Emergency Medicine and Anaesthesia, was appointed Professor Emeritus in the Faculty of Health Professions and is, in addition, Adjunct Professor in the Faculty of Health and Rehabilitation Sciences and Adjunct Professor in the Medical School of the University of Pittsburgh. More recently he accepted an appointment as Adjunct Professor at Cape Breton University on his home island.

His return to his alma mater, Dalhousie’s Faculty of Medicine in Halifax, Nova Scotia, was marked by his deep commitment to advocacy for students and attention to the content and methods current in medical education. In 1998 he was delegated by the Dean and Professor of Medical Humanities to begin an innovative program in the Medical Humanities called “Music-in-Medicine.” The performance groups within this unique initiative permit medical students, alumni, professors and staff to enjoy music as part of their educational and life experience within the contexts of the medical school and healthy lifestyles.55,56,57 The success of this program and its growing acceptance in other medical schools in North America were reasons cited for his being awarded the “Gold-headed Cane Award” by the students and professors of the Dalhousie Faculty of Medicine in 2002. This first-ever award of its kind at Dalhousie is given to the physician “who best demonstrates commitment to the ethical principles of the practice of the art of medicine.”58 He was selected by the Dean and Faculty of Albany Medical College in New York to deliver the 2002 Keys Memorial Lecture in the Medical Humanities at that institution. In the years since his return to Dalhousie, Dr. Stewart has developed, helped fund, and supervised over 25 international projects and student electives in Iceland, West Africa, Trinidad and Tobago, St. Kitts-Nevis, and Cuba. In 2005 the Office of Global Health of his alma mater, Dalhousie University, announced the creation of the Ronald D. Stewart Award for International Service to be presented annually to a student or student group in recognition of humanitarian overseas service.59 He continues his involvement in early medical education and has been elected by students to the “High-Five Club”, honouring his exemplary dedication to students and his close involvement with many in the tutorial sessions of the early curriculum. In 2008 the students of Dalhousie’s Faculty of Medicine conferred on him The Pine Cone Award for “…significant and lasting contributions made to undergraduate medical education.”

In September 2006 the Province of Nova Scotia announced that Dr. Stewart had been awarded the prestigious Order of Nova Scotia for his work in establishing emergency health services around the world, his work in landmines and with HIV issues and the blood system, and his dedication to the Humanities in medical education.60 In the same week, at a gala dinner in Pittsburgh celebrating the 25th anniversary of the residency in emergency medicine, it was announced that the University of Pittsburgh had established a two-million-dollar Ronald D. Stewart Research Chair in Emergency Medicine as a tribute to Dr. Stewart’s work in Pittsburgh, the United States, and around the world.61 In 2008 he was elected a “Hero of Emergency Medicine” by the Board of Governors of the American College of Emergency Physicians, honouring emergency specialists who have “made significant contributions to emergency medicine, their communities, their patients, or others.”62 This was followed in 2010 by his being given the inaugural ‘Paul Pepe Eagle Award’ by the University of Texas and Office of Homeland Security of the United States government, for “Service to Emergency Medical Services and to the American people and government.” In that same year the lifetime honorary position as “Member of the Executive Council (Cabinet) of Nova Scotia” was conferred on Dr. Stewart by the Queen’s representative in the province, Her Honour the Lieutenant-Governor, receiving the designation “Honorable” and the post-nominal letters “ECNS” for life. His academic career and his contributions as a clinician, clinical scientist and innovator were honoured in 2010 when he was granted the degree of Doctor of Laws (honoris causa) by Cape Breton University on his beloved island home.63 In April 2013, the Canadian Health Association named Dr. Stewart as recipient of their Award for Distinguished Service, recognizing his achievements in the fields of public health policy, medical education, overseas relief and the medical humanities.64 In addition, the annual James O. Page Award of Excellence, given to “individuals or agencies who have exhibited the drive and tenacious effort necessary to develop improved Emergency Medical Services systems, resolve important EMS issues and bring about positive EMS system changes” was presented to Dr. Stewart at the annual “EMS Today/Journal of EMS” 2015 conference held in Baltimore. He was the first foreign physician to receive this honour.65

Dr. Stewart continues in his role as a national advocate of Canada’s publicly-funded health system and of health renewal in Canada and the Province of Nova Scotia. He continues to add to his 200 publications in the art and science of medicine, and to pursue projects in the field of international health, particularly the health and political aspects of antipersonnel landmines, firearms control66, and the medical humanities. He most recently decided to return to the ‘other side of the lectern’ by pursuing a Master’s degree in the history of medicine, the tentative title of his thesis being, The influence of television on the creation of a new medical specialty (Emergency Medicine) 1974-1979. His research will be largely based on his experience during his time in Los Angeles as a technical advisor to several medically-based television programs including Marcus Welby, MD, and Emergency!

His recent major project is in expanding the medical school’s undergraduate curriculum to communities within the province of Nova Scotia in the form of a revised clinical clerkship (year 3 and 4) in partnership with Cape Breton University and the Eastern Management Zone of the Nova Scotia Health Authority.