Frequently Asked Questions: Implementing Nonanimal Training Methods in U.S. Military Medical Courses

Q: What does this medical training entail?

A: In U.S. military combat trauma training courses, pigs and goats are subjected to severe injuries, including stab wounds, gunshot wounds, burns, and amputations, before being killed. The U.S. Army Medical Research Institute of Chemical Defense gives a toxic dose of the drug physostigmine to vervet monkeys, inducing seizures, difficulty breathing, and potentially death. This animal use takes place during combat casualty care exercises designed to prepare medical personnel for the treatment of biological and chemical weapon casualties.

Q: Who receives this training?

A: Much of the U.S. military’s combat trauma training is for medics and corpsmen, with a significant amount of training also for physicians, physician assistants, other military medical personnel, and infantry. Chemical casualty care training courses are taken by physicians, physician assistants, nurses, medics, firefighters, and emergency medical technicians.

Q: Where does this training take place?

A: Combat trauma training courses using animals occur on at least 15 U.S. military facilities, including Fort Bragg and Fort Sam Houston, as well as facilities run by private contractors Assessment and Training Solutions, Deployment Medicine International, and Tier 1 Group. The chemical casualty care training courses take place at Aberdeen Proving Ground in Maryland.

Q: Don’t military medical personnel need to train with living tissue in order to best prepare for battlefield injuries?

A: The use of goats and pigs for combat trauma training is suboptimal due to, among other issues, the animals’ anatomical and physiological differences from humans. Compared with humans, goats and pigs have smaller torsos and limbs, thicker skin, and important differences in anatomy of the head and neck, internal organs, rib cage, blood vessels, and airway. Likewise, vervet monkeys lack a white sclera (the outer coat that covers much of the eyeball), the texture of the skin on their faces and hands is significantly different from humans, and they are unable to communicate common findings such as nausea, abdominal distress, and neurological symptoms. These differences make it particularly difficult to observe some of the hallmark symptoms of a chemical agent.

Q: What training methods should replace the current use of animals?

A: The most important elements of combat trauma training are realism, human-specific injuries and treatments, volume of trauma exposure, and team building. The ideal training paradigm combines medical simulators, immersive simulated combat environments, and military or civilian trauma center training. As for chemical casualty care training courses, researchers with the Israel Defense Forces Medical Corps and Israel’s Carmel Medical Center have developed a nonanimal training curriculum for the medical management of patients exposed to nuclear, biological, and chemical weapons. The course includes didactic teaching, simulation training, and the use of moulage, in which actors with makeup mimic the signs and symptoms of chemical warfare casualties.

Q: Aren’t medical simulators expensive?

A: From a financial standpoint it makes sense to replace live animal use with training methods such as medical simulators. While many military spending figures are not available to PCRM, an existing Army protocol for 68W medics states that 350 students are trained each year using live goats at an estimated annual cost of $153,300. However, the very same procedures could be taught using the American College of Surgeons-approved TraumaMan System simulator for approximately $40,250 per year. Thus, using simulators for this course could save the Army and taxpayers as much as $113,000 per year.

Q: Is there enough room in civilian trauma centers for military medical personnel?

A: A 2006 report found that 57 percent of Level I trauma centers and 74 percent of Level II trauma centers report a problem with inadequate numbers of on-call physicians. Civilian trauma centers are also threatened by a shortage of supporting medical personnel. Embedding military physicians, physician assistants, and medics and corpsmen in civilian trauma centers yields benefits both to fallen troops and to civilians whose local trauma centers face staff shortages or closure.

Q: How many animals are used each year for this type of training?

A: The U.S. military’s combat trauma training courses use approximately 9,000 goats and pigs each year. In the chemical casualty care training courses about 20 vervet monkeys are used annually, and each monkey is exposed to physostigmine up to six times per year.

Q: Aren’t the animals fully anesthetized during these procedures?

A: While animals are given anesthesia, pigs are known to develop hyperthermia and a variety of abnormal physiological responses when given anesthesia, and also are susceptible to fatal ventricular fibrillation. In the chemical casualty care training courses, monkeys are given only the dissociative anesthetic ketamine. According to veterinarian Henry Melvyn Richardson, D.V.M.: “In my early career, veterinarians used ketamine as a lone anesthetic, but most of us realized the limitations and risks of doing so. Ketamine alone provides poor muscle relaxation, increased salivation, laryngeal spasms . . . Given the known effects of physostigmine, I am deeply concerned that the combination of the agent with ketamine poses an unacceptable risk of respiratory collapse.” In addition, animals are subjected to the trauma of continued confinement, shipping, preparation, and experimentation.

Q: Aren’t there animal welfare regulations in place?

A: Yes, but unfortunately the Department of Defense and its components are in violation of the Joint Regulation on animal welfare. The regulation prohibits the use of nonhuman primates for “[i]nflicting wounds with any type of weapon(s) to conduct training in surgical or other medical treatment procedures.” The Joint Regulation also requires that “[a]lternative methods to the use of animals must be considered and used if such alternatives produce scientifically valid or equivalent results to attain the research, education, training, and testing objectives.”

Q: Hasn’t the use of live animals for this training reduced battlefield fatalities?

A: While there are competing viewpoints among military experts as to whether the battlefield fatality rate has declined in recent years, no conclusive evidence has been presented to support a direct link between the use of animals in combat trauma training courses and improvements in survival. In fact, in a March 29, 2009, Baltimore Sun article, Ronald F. Bellamy, M.D., one of the Army’s leading authorities on combat casualty statistics, claimed that the overall death rate for wounded soldiers has not improved over historical measures. More wounded are surviving to reach hospitals (attributed to the use of body armor, not field medical care as claimed by the military). But a higher percentage are dying after reaching hospitals (attributed to the severity of injuries). Dr. Bellamy states that combat casualty statistics reveal “almost nothing about the quality of medical care,” and further states that “[t]he notion of a quantum improvement in medically related survival is a myth.”