Although emergency medicine and aerospace medicine may, at first glance, seem like two fields worlds apart, both share a common goal: managing critical, life-threatening situations where quick thinking, expertise, and collaboration are essential. Emergency physicians are known for their ability to make rapid decisions in high stress environments, often with limited resources and information.

The ability to adapt and integrate into a team is essential. These skills translate well to the field of aerospace medicine, where medical personnel aboard aircraft or in space, as well as ground-based consultants, are limited by the medical equipment at hand and the possibility of delayed communication with specialists. They must act efficiently with the resources available and have a comprehensive understanding of not just medicine, but also the specific hazards associated with flight.

Both disciplines also focus on prevention, aiming to minimize health risks and ensure safety. In aerospace medicine, this involves monitoring the health of astronauts and pilots before, during, and after missions. In emergency medicine, it involves responding rapidly to prevent further harm and stabilize patients. 

At the forefront of human exploration, highly skilled professionals in the field of aerospace medicine have dedicated themselves to ensuring human safety and performance in extreme environments. The field has existed for as long as humans have sought to explore the skies; in the United States, this dates to the early 1900s, with much of its initial development focusing on military aviation.

In October 1929, the first meeting of the Aerospace Medical Association took place, and in 1953, the American Medical Association recognized aviation medicine as a distinct subspecialty under the American Board of Preventive Medicine.¹ In contrast, it wasn’t until 1976 that the American Board of Emergency Medicine was established; emergency medicine was approved as a specialty in 1979.² Despite aerospace medicine being an older subspecialty of preventive medicine, it remains less well-known to the public than emergency medicine, possibly because of its niche nature and limited training opportunities.

The authors at work. (Click to enlarge.)

The combined emergency medicine and aerospace medicine residency program at the University of Texas Medical Branch (UTMB) accelerates what would traditionally take five to six years of training—three to four years of emergency medicine, followed by two years of aerospace medicine residency or fellowship—into a combined four-year curriculum, emphasizing the overlap between these two specialties.

The first two years focus on building a strong foundation in emergency medicine. During this time, residents work shifts in the emergency department and participate in rotations typical of traditional emergency medicine training, including intensive care, trauma surgery, orthopedics, anesthesia, ultrasound, and obstetrics. 

In the third year, residents pursue a master’s degree in aerospace medicine, with courses focused on aerospace physiology, preventive medicine, occupational medicine, and public health. Outside of class, residents continue to work shifts in the emergency department.

The fourth year allows residents to apply the knowledge gained in the previous years while rotating at NASA’s Johnson Space Center, private space companies like Axiom and Virgin Galactic, the Federal Aviation Administration, and practicing polar/wilderness medicine in Antarctica. Additionally, throughout the program, residents participate in various research projects and present at the annual Aerospace Medical Association Conference. 

 A Universe of Opportunities

A career in aerospace medicine might look slightly different for each physician. Graduating residents can apply their unique training in many different capacities. 

Graduates  can become operational flight surgeons, working as crew physicians for civilian or government-sponsored astronaut missions. In this role they could  find themselves screening pilots or astronaut candidates in flight medicine clinics, working in mission control at Johnson Space Center, or providing telehealth support to astronauts on the International Space Station.

They may even be among the first to greet astronauts upon their return to Earth and assist in their rehabilitation and transition back to a terrestrial environment. 

There is still much to learn about how flight and the space environment affect the human body, so the opportunities for research are vast, and many trained in aerospace medicine dedicate their lives to research.   

The flexibility of emergency department scheduling also allows for work in both fields, caring for critically ill or medically underserved populations in the emergency department while simultaneously supporting some of the healthiest individuals on (and off the) Earth in the aerospace sector. 

As NASA and the commercial aerospace industry continue to expand, the demand for board-certified aerospace medicine physicians will grow. UTMB has been at the forefront of training these professionals. 

A Shared Mission 

Although emergency and aerospace medicine are be practiced in different settings, both share a commitment to saving lives through rapid, effective care in high-pressure situations. The broad scope of practice in the emergency department provides a solid foundation of medical knowledge and the chance to hone the ability to think critically and make the most of limited resources, essential skills in the world of aerospace medicine. The new combined program at UTMB offers an accelerated track to becoming board certified in emergency medicine and aerospace medicine so the future of aviation and spaceflight can continue to be supported. 

Dr. McNerlin is one of two inaugural emergency medicine/aerospace medicine combined residents at the University of Texas Medical Branch. She studied human biology at the University of California, San Diego, before completing medical school at Georgetown University School of Medicine in Washington, D.C. She currently holds her private pilot license, and when she isn’t working, she is probably spending time outside hiking or backpacking.  

Dr. Kaganov is one of two inaugural emergency medicine/aerospace medicine combined residents at the University of Texas Medical Branch. Dr. Kaganov studied chemistry at Johns Hopkins University before completing medical school at Wake Forest School of Medicine in Winston-Salem, N.C. As a native Russian speaker with growing proficiency in Spanish, he hopes to bridge the gap between Slavic, Hispanic, and English-speaking aerospace organizations to foster greater international collaboration. When he isn’t working, he is probably training in calisthenics or making coffee. 

References 

1. Campbell M. Aerospace medicine milestones. Aerospace Medical Association. https://www.asma.org/about-asma/history/aerospace-medicine-milestones. Accessed April 7, 2025.
2. Huecker MR, Shreffler J, Platt M, et al. Emergency medicine history and expansion into the future: a narrative review. West J Emerg Med. 2022;23(3):418-423.