Commentary Military ‘live tissue trauma training’ using animals in the U.S. – its purpose, importance and commentary on military medical research and the debate on use of animals in military training G. Martinic, MSc(Hons), DipAppSci, DipAnTech, MAIBiol Introduction There has been a significant change in the types of injuries sustained on the modern battlefield due to the use of improvised explosive devices (IEDs) which are designed to cause severe penetrating injuries to limbs and torso, often resulting in massive haemorrhage in injured soldiers. Massive haemorrhage is the most common preventable cause of death for soldiers wounded in combat1. Hence life saving training techniques and practices are being used by US military medical personnel in an effort to reduce this incidence. ‘Live tissue trauma training’ (LTTT), or ‘combat medic training’2, as it is referred Sourced from: ‘Medic Training’ by Alexander Hunter to in the US, involves the use of animals (mostly for the Washington Times (2010). B1_nu_helmet_base_ goats and pigs) for the purposes of direct surgical s640x413.jpg /washingtontimes.com intervention in which physicians and paramedical personnel (military and civilian) obtain surgical He also highlights opinions and recent examples of skills by treating severe traumatic injuries. Once the animal research/training debate from both the animals are deeply anaesthetized, wounds of the pro- and anti- points of view and provides examples type army paramedics and doctors are likely to see of alternative types of LTTT tuition. He hopes that in combat situations are inflicted. Such wounds are this article will encourage wider discussion within then appropriately treated in order to gain valuable respective scientific, defence and animal welfare ‘trauma care’ experience not likely to be offered in circles, leading to further refinements in the welfare any other form. Upon completion of LTTT, animals and protection of animals used for these important, are humanely euthanased without ever regaining although often controversial, purposes. consciousness. Despite the understandable highly emotive and sensitive nature of LTTT, by pr oviding Why LTTT needs to continue new combat medics with methods in how to manage Jim Hanson2, a former member of a US Special critically-injured soldiers within the first few hours Forces unit, writes in the Washington Times (‘Save post-event, and where there is no local access to people, not pets’), that in his view animal use should doctors or medical facilities, military personnel assert continue for LTTT because ‘banning medic training that such realistic training programs are necessary using live animals could kill US troops’. Interestingly, and have facilitated the saving of countless lives of this publication was intentionally timely and was in soldiers who have sustained life-threatening injuries direct response to a bill before the US Senate at the 2,7,8,9 on the battlefield. In this ‘opinion’ article the time. This bill, known as the ‘Battlefield Excellence author explains how and why animals are used for Through Superior Training Practices Act’3, sought LTTT and in some areas of military medical research to amend the US Defense Appropriations Act which (MMR), as well as why he feels that the continued aimed to phase in human-based training methods use of animals for LTTT is justified at this time. Page 4 Journal of Military and Veterans’ Health Commentary and replace the current use of live animals for LTTT. rapidly apply surgical airways. Hence, ‘the spectrum If passed, this bill will require the US Department of care they are expected to provide at any given of Defense, no later than 1st October 2014, ‘to use moment exceeds what an entire civilian trauma only human-based methods for training members of centre might encounter in a week or month’.7 the Armed Forces in the treatment of severe combat While most LTTT tuition involves the infliction of and chemical and biological injuries’. It will also wounds using surgical instruments, some select US prohibit the use of animals in such training.3 One of special operations units8,9,10 have conducted LTTT the main groups that are seeking this change is the using various ‘projectile’ methods such as gunshot U.S. Physicians Committee for Responsible Medicine wounds, (bayonet) stab wounds, (napalm) burns, (PCRM), who strongly oppose the use of animals for and amputations. Such courses, known as ‘Combat research and training in any arena. Many believe Trauma Management’, are ‘designed to test and that this bill (known as the ‘BEST Practices Act’) will reinforce the application of knowledge with regard likely end up costing the lives of US troops in order to patient stabilization and treatment on an injured to save the lives of some animals simply because US animal-patient. The use of ballistic wounding in these military medics will no longer have access to vital courses is used to create a variation of wounds and and realistic LTTT. environments to complicate patient management and The PCRM, and other groups that oppose vivisection increase training realism’.7 It should be stressed that (surgery used for experimental purposes on during such procedures, animals are always deeply living organisms4) such as People for the Ethical anaesthetised (at a surgical plane of anaesthesia) for Treatment of Animals (PETA) seek an expanded the entire period, given appropriate analgesia, and use of simulators and other training aids so as to humanely euthanased post-training. completely replace LTTT, despite the fact that such The production of extensive injuries in animals simulators and training aids cannot adequately used for LTTT is important so that medics, when mimic bodily functions or recreate the reality of faced with a real combat situation are unlikely to a wounded living being. In contrast, it is widely ‘freeze’ due to emotional shock and they are able to accepted in US defence circles that, were it not for quickly identify what they need to do, and apply it training programs such as LTTT, most medics would immediately and confidently. Such is the reality of be sent into combat situations never having had the LTTT that even hardened military personnel, when experience of treating a real traumatic injury. The observing a gunshot wound for the first time, cannot viewpoint of most medics is that the visceral reaction remain unaffected by the experience. LTTT training that a living animal can invoke, being similar to also provides clinical and psychological ‘conditioning that which each medic must face when a (human) for the horrors and chaos of war.’ Indeed there are life is in danger, is something that no simulator or many medics belonging to Special Forces (elite) units training aid can provide. According to the PCRM, who would gladly provide testimonials in support the US Department of Defense currently uses of the fact that such training, albeit graphic, has approximately 9,000 pigs and goats, and 20 vervet saved the lives of their colleagues who had sustained monkeys annually to teach Army medics, Navy severe wounds in actual combat.2,8,9,10 Despite corpsmen and Air Force personnel to respond to numerous advances in modern military technology, the most common causes of preventable battlefield such as personal body armour and armour-plating fatalities.1 Others claim that these figures are more of vehicles, it cannot be disputed that a confident than fifty-fold higher5, though these claims appear and well-trained combat medic is probably the most unsupported by any firm evidence. This is put into likely ‘instrument’ to save a wounded soldier on the perspective when one considers that in just one week battlefield. Furthermore, a military spokesman for in the month of February 2009 in the U.S., 2,236,000 the US Army in Europe recently announced that hogs were slaughtered for meat consumption.6 In effective combat trauma training, such as LTTT, LTTT sessions, military trainees practice procedures had contributed to the lowest ‘killed-in-action rate including tourniquet application, emergency in military history’.11 Thus, as LTTT actually saves management of haemorrhage, blocked airway lives, military personnel believe that this vindicates emergency techniques (such as cricothyroidotomy) their position, and that LTTT should continue. The and chest tube placement. This is because combat author, who also believes that priority should be medics are ‘trained and prepared to save life, and given to human life over that of animals, concurs to keep the casualty alive in austere high-threat with this view. Indeed, it would seem that others are conditions for hours on end’. Faces are often also of this view. David Hull, in his review of ‘Animal destroyed due to blast and burns injuries caused Liberation’,12 wrote that “if a choice has to be made by IEDs used by insurgents, and there is a need to between saving a human being and saving a pig, Volume 20 Number 4; November 2012 Page 5 Commentary we would be morally obligated to save the human requirements at the cellular level regardless of the being because human beings are capable of greater state of consciousness. If successful, this area of sentience (possession of feelings such as pain and MMR is likely to have applications within the civilian emotional states such as fear) than pigs. One must world as well, for example in assisting victims of be careful when drawing such conclusions however motor transport accidents. as the degree of pain experienced by an organism Another significant part of MMR is the issue of cannot be assumed to be proportionate to its level of chemical weapons defense research (CWDR; as sentience.13 opposed to chemical weapons offence research - banned in US for decades). This is another area where Military Medical Research animals are used for military purposes.1,2,4,5 In order In the area of MMR numerous devices (for example, to find cures for soldiers exposed to deadly chemical tourniquets), procedures (damage control surgery) attacks on the battlefield, vervet monkeys are used and clinical practice guidelines (use of balanced as a model for CWDR.