OpEd published in the Michigan Daily by Mark J. Lowell, M.D., medical director of Survival Flight, 1/19/2011
Update: Starting in the summer of 2011, U-M developed a new program for intubation training which no longer requires us to rely on cats and which will use simulators instead. No cats have been used in training since July 2011 and there are no plans to use them in the future.
The University of Michigan Survival Flight’s first obligation has been, and always will be, to provide the best possible care to the critically ill patients we are called upon to transport. Much has been said about the training methods used to ensure Survival Flight nurses can meet this obligation.
To adequately prepare for their jobs, new Survival Flight nurses undergo a four-month orientation during which time they use simulators almost exclusively. Survival Flight held four animal training labs in FY 2009-2010, using four cats (three of which were adopted) and 16 pigs.*
One might ask, “Why can't we completely eliminate the need for practice on animals?”
Survival Flight transports some of the sickest patients in the country, who frequently require interventions the referring hospital is incapable of performing — that’s why they're being transported to the University Hospital. On the way to the University, potentially life-threatening complications can occur that require immediate, sometimes surgical, intervention.
To save a patient’s life during transport, our nurses may need to insert a chest tube to drain blood, fluid or air from the chest cavity to allow the patient’s lungs to fully expand. They may have to perform an incision to administer life-saving medications or to establish an alternate airway when inserting a breathing tube isn’t possible or the patient's airway is crushed. Nurses may even have to perform an invasive procedure called pericardiocentesis to remove a dangerous build-up of fluid pooling around a patient’s heart. All these procedures require the skilled use of a surgical scalpel.
Survival Flight nurses are trained above and beyond the level of most all other flight teams because they're required to perform these emergency life-saving procedures, which most nurses never will. And, because they're not trained as surgeons, they rarely have the surgical experience before joining Survival Flight that they’ll need to perform those procedures.
There's no rubber-coated mechanical simulator on Earth capable of replicating the experience of performing these incisions on a living being.
The first time one of our nurses is called upon to perform one of these procedures will be for a critically ill patient, and any hesitation or mistake made during the performance of the procedure may result in the patient’s death — nurses must be 100 percent prepared to act promptly and correctly.
There's no credible research that supports the complete elimination of animals for Survival Flight nurse training. Simulators haven't evolved to the point where they're superior to training on an animal model for certain surgical procedures.
We're working toward complete elimination of animal labs in our Survival Flight training program, but until new models are available, our commitment to patient care requires us to stay the course.
When animals must be used, the labs are conducted humanely. All animals are fully anesthetized so that they feel no pain or suffering. The training procedures used have been reviewed and approved by the University Committee for the Use and Care of Animals at the University, whose membership includes veterinarians.
Earlier this year, in response to an outside complaint, Survival Flight’s laboratory protocols were reviewed by the United States Department of Agriculture, and no violations were identified.
Other flight programs across the nation still use animal models but may not state so publicly. We know from conversations with Michael Frakes, president of the Air & Surface Transport Nurses Association, which is an organization routinely referenced in claims made against the use of animals in flight nurse training, that organizations that host their Transport Nurse Advanced Trauma Course select the type of lab skills they find preferable and cost effective — not the ASTNA.
Anonymous surveys of our flight nurses who have had training using simulators and animals overwhelmingly agree that while simulators are beneficial for learning when to perform certain procedures, they're no substitute for scalpel-to-skin contact that only animal labs can provide.
More than 35,000 patients have been transported by Survival Flight — a testament to the training and expertise of our nurses. Survival Flight has won national and international patient care competitions four times in the past four years.
Though we look forward to the day when we can phase out animal use completely, simulations for nurses haven’t all reached that level yet. When they have, be assured that we will be using them.
Until then, we must continue to do what is necessary to ensure the safety of the patients that entrust their care to us.
* These numbers have been updated from the original article. The cats used in Survival Flight training are adopted out whenever possible; sometimes pre-existing medical conditions, such as carrying feline leukemia virus, or behavioral issues prevent adoption. From 2002 through July 2011, 16 of 23 the cats used in training were adopted into new homes.