History

In 1981 the Army initiated training in emergency medicine for physician assistants (PAs). The training was in response to an Army-wide emergency medicine physician shortage. PAs were trained to augment physician staff in the perpetually busy emergency departments. Most assignments were to understaffed military hospitals located throughout the United States.

Selected PAs were enrolled in a training program at Darnall Army Community Hospital, Fort Hood Texas, which already had an existing emergency medicine physician residency. The program of study was twelve months in duration and paralleled the second post-graduate year of training for emergency physicians. However, suffering a severe PA shortage in line units and with PA retention dropping, the Army reduced or ceased most post-graduate training for PAs in 1986. A total of twelve emergency medicine PAs (EMPAs) were trained during those initial five years.

In 1989 the American College of Emergency Physicians published a position paper in the Annals of Emergency Medicine on the utilization of PAs in military emergency medicine.¹ While there was some division among physicians as to the practicality of utilizing PAs in emergency medicine, the authors made the important point that the training of PAs in this field prepared them for the type of trauma that could be anticipated in combat.² The authors stress that PAs should be used as physician extenders and not as a physician substitute. The article maintained that EMPAs could be an asset to a military emergency department. The college advocated that all EMPAs should receive a formal course of training in either a fellowship or residency program for at least twelve months and that the training should be conducted at an ACGME approved emergency medicine physician residency program. In 1991, the Army Surgeon General approved a plan for a revised program. The first formal EMPA residency program began at Brooke Army Medical Center, Ft. Sam Houston, Texas on 1 July 1991. In 1992, a second program was established at Madigan Army Medical Center, Ft. Lewis, Washington and in 1995 the EMPA program at Darnall Army Community Hospital, Ft. Hood Texas was re-opened. All three training sites have active emergency medicine physician residencies. Upon successful completion and graduation from EMPA training, the graduates are awarded the M2 identifier (65DM2).

In 2007, the U.S. Army and Baylor University partnered to develop an eighteen-month emergency medicine residency to generate post-graduate-level EMPAs and clinical scientists to better serve Military Health System service members and their beneficiaries. The graduates were awarded a Doctor of Science degree after completing rigorous clinical rotations, examinations and oral boards, and original research. In 2008, the program expanded to a fourth site at William Beaumont Army Medical Center, Ft. Bliss, Texas. In 2011, the U.S. Army - Baylor University Residency Program expanded to partner with the United States Air Force to also train U.S. Air Force DSc EMPAs to support global missions and beneficiaries. In 2022 the program expanded again, welcoming its first U.S. Navy resident. Finally, in 2023 the program matriculated its first-ever Coast Guard resident.

¹American College of Emergency Physicians. Task Force on Military Emergency Medicine. Military emergency medicine systems. Ann Emerge Med. 1989;18:2 16
²The US Army Emergency Medicine Physician Assistant Program, MM Peter A. Forsberg, PA-C, MSC, Fed. Prac;03, 1996