BAMC must stop medical training on pigs

Fresh out of medical school and newly commissioned in November 2000, I was at Fort Sam Houston, staring at an unconscious goat and being told to perform medical procedures as if it were a soldier. It was clearly not a soldier.

The goat’s thin legs, awkwardly pointed toward the ceiling, were nothing like those of a human — a potentially deadly difference when learning to apply a tourniquet. The rib cage was much narrower and deeper. Goats have one more pair of ribs than humans, which means inserting a chest tube — a lifesaving procedure to treat a collapsed lung — is performed in a different location. I had already placed several chest tubes on human patients, and this was nothing like that.

We all knew we couldn’t “save” the goat; the animals would be killed at the end of class.

The uselessness of that exercise made a strong impression on me. That’s why, two years later, when it was my turn to train Army medics, I replaced goats with SimMan, a computerized “simulator” that replicates human anatomy and physiology.

The training I oversaw proved crucial. In August 2003, those medics responded to a massive explosion outside the Embassy of Jordan in Baghdad. They saved a lot of lives, and

I’m confident that a big reason was because they didn’t have to waste vital seconds translating goat anatomy to the human casualties bleeding before them.

More than 20 years later, the same flawed logic of using anatomical surrogates still permeates certain areas of military medical training.

At Brooke Army Medical Center, physicians completing their emergency medicine residency perform dozens of invasive procedures on live pigs. Meanwhile, across the U.S. and Canada, a whopping 97 percent of similar programs — including at hospitals affiliated with the Army and Air Force — have replaced animals or never used them in the first place. Naval Medical Center San Diego ended its “pig lab” almost a decade ago, in 2014.

The case for replacing animals is even stronger now than it was when I was training. That’s in part due to Hollywood special effects artists, who created the “Cut Suit,” a device worn by an actor that includes anatomically correct internal organs, breakable bones and flowing “blood.” The actor wearing the Cut Suit can writhe and scream, providing a far more realistic training experience than an unconscious pig.

The U.S. military knows how valuable the Cut Suit and other simulators are because it has studied them. They know the devices modeled on human anatomy are as good or better than animals for teaching lifesaving skills, building selfconfidence and preparing for the stress of the battlefield. The authors of a 2018 U.S. Army study involving more than 200 medics concluded: “Synthetic models can produce a stress response equivalent to that of live tissue…”

Simulators are less expensive, too. One U.S. Army study found simulators “cost substantially less per trainee than live tissue training.”

Why is BAMC still using pigs to train doctors? In an attempt to get an answer, 14 other former military physicians and nurses and I sent a letter to BAMC officials. We also partnered with the Physicians Committee for Responsible Medicine, a nonprofit that advocates for human-relevant medical training. We paid for billboards, which recently went up around San Antonio, that feature a pig in a combat helmet declaring, “Pigs Make Lousy Soldiers. Stop Using Animals to Train Army Doctors.”

For the sake of soldiers, I hope BAMC gets our message.

Dr. Robert DeMuth grew up in San Antonio and Dallas. He served as an Army combat engineer during the first Gulf War, as a flight surgeon and as the brigade surgeon at Fort Hood (now called Fort Cavazos). He left the Army in 2007. He practices internal medicine in Iowa.