Fort Carson, Colo. - U.S. Army Capt. William Clark, a physician's assistant (PA) with the 4th Combat Aviation Brigade, 4th Infantry Division, took a deep breath as he stepped onto the floor for his first day of training with Cooper University Hospital, April 7, 2025, in Camden, New Jersey.
The air in the trauma bay was heavy with the metallic tang of blood and antiseptic.
As the "trauma alert" siren echoed through the hospital's loudspeakers, the energy in the bay transformed instantly. The trauma team quickly donned their lead vests, gowns, masks, gloves, and eye protection, preparing to receive the next critically injured patient.
More than 30 trauma alerts and transfer cases came through the doors that day—everything from stabbings and gunshot wounds to elderly patients falling and fracturing their hips and motor vehicle collisions.
EMS would wheel in the victims, and the team immediately began the primary survey: assessing airway, breathing, and circulation—rapid interventions to identify and manage life-threatening conditions.
“One of my first cases involved a patient with a stab wound,” said Clark. “I was allowed to examine the patient using an ultrasound probe to check for internal bleeding in the abdomen, pelvis, around the heart, and within the chest cavity. The patient was stable, so we packed the wound and transferred him to the CT scanner to rule out any deeper injuries. Fortunately, the knife had not penetrated the chest cavity, and no vital structures were harmed, and we were able to close the wound and stabilize the patient.”
Nothing could have prepared Clark for the most traumatic case of the day—a young man involved in a severe motor vehicle accident who arrived unresponsive and with his blood pressure dropping.
A LUCAS device, a machine used during transport to advance lifesaving therapies, was performing chest compressions as EMS wheeled him in. Recognizing the severity of his condition, the trauma attending called for an emergency thoracotomy.
Trauma residents opened his chest, exposing the heart and great vessels. The surgeons clamped the aorta, and Clark stepped in to perform internal cardiac massage, manually compressing the heart to circulate blood. The team worked for ten minutes, but despite their best efforts, the young man did not survive.
The day was a whirlwind of adrenaline, action, and emotion. It left Clark exhausted—but also more committed than ever to learning, to supporting his team, and to serving every patient with skill and compassion in their most vulnerable moments.
“After talking to numerous trauma attendings, they were surprised that Army PAs were expected to deal with battlefield trauma without real-world training or experience,” said Clark. “The Cooper experience was the best training I’ve received thus far in regard to battlefield trauma.”
Starting in July 2023, the Medical Specialist Corps began assigning two Army PAs to a Military Civilian Partnership under the Army Military-Civilian Trauma Training Team Program (AMCT3). The 12-month fellowship program allows military medical personnel to train in high-volume, high-acuity trauma centers to minimize the initial fatality rate for future conflicts.
The AMCT3 program enhances PAs trauma skills through civilian hospital immersion, which supports the Army’s modernization efforts by providing commanders with a data-driven framework of information for rapid decision-making and improved battlefield conditions during Large Scale Combat Operations (LSCO).
The 4ID sent six PAs from April 2025 through June 2025 as part of a two-week pilot program at Cooper University Hospital.
A key requirement for Army PA training is the Army’s standardized Individual Critical Task List (ICTL). There is a total of 26 tasks that PAs are evaluated on, each one is required to be completed annually.
On average, the 4ID PAs completed over 100 trauma-related tasks from the ICTL during their two-week rotations, all while providing care to real patients versus simulated conditions.
Lt. Col. Joe Costello, senior division PA and emergency medical PA, said the only dedicated trauma training the Army provides for PAs is Tactical Combat Medical Care, a 5-day course that works well as a refresher but does not build proficiency in inexperienced providers.
Costello recommends increasing trauma training for PAs based on capability gaps identified during the division’s internal self-assessment of trauma competency. This recommendation supports the evolving requirements of the Army Health System under LSCO and proposes continued pilot implementation through the AMCT3 program and Cooper University Hospital as well as establishing a career life cycle training plan to ensure trauma readiness.
“The rotation at Cooper was massively beneficial because all residents and attendings were eager and willing to let us get hands-on experience and procedures,” said Clark. “I think the Cooper experience was the best training I’ve received thus far in regard to battlefield trauma.”
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