Thanks to technological advances, it’s now possible for emergency room doctors to prepare for their life-saving work without the need to train on animals. The use of pigs, goats, and other animals in medicine should be limited to what is strictly necessary, should be reviewed regularly, and should be discontinued whenever and wherever possible. As all but a handful of medical programs have determined, one area where this is now clearly possible without any sacrifice in quality is in emergency-medicine training programs.
The Maine Medical Center, in Portland, recently stopped using live animals in its emergency program, leaving only 11 hospital programs in this country that still use live animals.
The one holdout in New England is run under the auspices of Brown University’s Warren Alpert Medical School, at Rhode Island Hospital, in Providence. Until very recently, it was thought that Dartmouth-Hitchcock Medical Center, in Lebanon, N.H., also used animals in its emergency medicine program. But when the Globe inquired, spokesman Rick Adams said, via e-mail, that that was no longer the case.
“With advances in teaching and training technology, we currently use only high-fidelity mannequins and simulation-based training in our Emergency Medicine program,” Adams said. In a follow-up e-mail, he said Dartmouth-Hitchcock had ended live animal use in 2017.
Speaking broadly, animals in such training programs are subjected to a variety of invasive procedures, such as cutting through the skin and flesh to relieve or establish an airway, find a vein, or insert a tube to drain blood or fluid.
The animals are anesthetized before the procedures, and euthanized afterward.
The Physicians Committee for Responsible Medicine, which promotes alternatives to animal use in training, has been persuasively making the case that equally good or better alternative are available. These are lifelike models of the human head, neck, and torso, with realistic replications of human anatomy, including skin, muscle, cartilage, and fat. These simulators even bleed when the skin is cut. The most popular model, TraumaMan, is used to train thousands of medical students each year. The committee’s work has provoked some annoyance among emergency-medicine program administrators — but also some serious rethinking of those programs.
The fact that New England institutions like Maine Medical Center, Dartmouth-Hitchcock, Bay State Medical Center (in Springfield), Yale-New Haven Hospital, and Beth Israel Deaconess Medical Center have all moved away from live-animal use in the last few years shows the direction of emergency medicine. According to the physicians committee, 95 percent of the 270 such programs nationally do not use animals.
Still, it’s a path not taken at Brown. In a forwarded statement from April, Brown University and Rhode Island Hospital said their program uses “fewer than 15 pigs” a year and maintained that viable alternatives to animal use do not exist in all instances.
“Brown EM trains resident physicians using synthetic models and high-fidelity mannequins for a variety of procedures,” the two institutions said. “Yet, equally effective synthetic model alternatives simply do not exist for every complex medical procedure that an emergency physician must be prepared to perform.” The statement cited only cricothyrotomy, a technique for establishing a patient airway in case of several facial trauma or regular-airway obstruction.
Here’s the problem for Brown: Other highly regarded institutions have arrived at the opposite conclusion — that sophisticated, programmable, interactive simulators work just as well. “Why would 96 percent of EM programs use simulation if it isn’t better?” says Dr. John Pippin, director of academic affairs at the physicians committee. “It seems to us that Brown-RIH can hardly claim to be right and 260 programs are wrong.”
Brown and Rhode Island Hospital noted that their program conducts an annual review “to consider any new technologies that may emerge as alternatives.”
In their next review, program administrators and instructors should visit their peers at similar institutions that have come to very different conclusions in the last few years. Or the many other programs that have been animal-free for some time.
There should be a sense of concern in being unique in New England on this matter. It’s time for a change at Brown.