Editorial: Gone to the Dogs? Medical Training Finds a Better Way
In emergencies, physicians need to react quickly. An accident victim who is bleeding internally or is unable to breathe cannot wait while a caregiver reads an instruction manual. To train for urgent situations like these, surgeons and emergency physicians take a course called Advanced Trauma Life Support, or ATLS. They learn key emergency procedures and repeat the course periodically to keep their skills fresh.
But whom do they practice on? Until fairly recently, the answer was dogs, or sometimes pigs. During a class, anesthetized animals underwent one procedure after another. At the end of the session they were euthanized.
Needless to say, many trainees were not happy with using animals. Some instructors were not satisfied either. They knew that emergency caregivers need to understand human anatomical landmarks, not those of dogs or other animals.
At the University of Maryland, instructors pioneered the use of human cadavers in medical training. People who donated their bodies for use after their deaths allowed the university to establish what was arguably the best ATLS course in the nation. Trainees studied each procedure with a perfect “model” of human anatomy and none of the distractions of using animals.
Unfortunately, other locales found it hard to follow Maryland’s lead. Due to differences in local regulations, course sponsors found it hard to access human cadavers from their state-run anatomical pathology systems. It was easier to order animals from a dealer. For years, PCRM sought ways to help medical centers obtain human cadavers, but most found the process cumbersome and unworkable.
Enter TraumaMan. This remarkably life-like model of a human torso has all of the anatomical landmarks trainees look for, with a human-like feel. Produced by Simulab Corporation in Seattle, TraumaMan uses an elastomeric composition designed specifically for surgical dissection. This manikin proved its worth in trauma training. A trainee can incise the skin, which actually bleeds. Passing a finger through the chest wall incision, the trainee feels the ribs and lung, and practices inserting a chest tube. TraumaMan is also used for cricothyroidotomy, pericardiocentesis, diagnostic peritoneal lavage, and intravenous cutdown—all procedures used in ATLS courses.
The American College of Surgeons approved TraumaMan for use in ATLS courses, and medical centers began buying them faster than Simulab could produce them. Simulab also makes simulators for other medical procedures, such as central line and femoral line placement, and custom-builds simulators for medical centers with unusual needs. Other companies produce pediatric simulators. Intubation manikins, for example, are used to teach caregivers how to establish an airway, a skill sometimes taught using live cats.
Aside from anatomical perfection, these simulators give trainees a chance to repeat procedures over and over, something not possible with animals, all of whom are discarded at the end of a session.
Still, some medical centers continue to use animals for trauma training, a practice of increasingly dubious legality. Federal law mandates that medical personnel using animals affirm that they have considered available alternatives and found them inadequate. With more than 90 percent of ATLS classes using nonanimal methods, alternatives are clearly available, and none would argue that animals provide superior training. After all, how encouraging would it be for a physician to tell an injured person, “Don’t worry, I once tried this on a pig”?
Twenty years ago, animal laboratories were routine in medical schools, trauma training, intubation classes, and, of course, high school and college biology classes. Biological supply houses profited enormously from the grisly trade in animals, and training was typically substandard. All of that is changing as growing consideration for animals, the need for better training methods, and dramatically improved technology mandate a shift to new and better educational methods.
Neal D. Barnard, M.D.
President of PCRM