Anti-Military Congressmen Undermine Medical Training

Then-PV2 Ron Westervelt, 12th SFG(A), in team live tissue training, March 1967.

The Washington word for “galactically stupid idea” is bipartisan, and before us we have a bipartisan bill to undermine military medical training. This is because these two partisans who are apparently bi (NTTAWWT… oh, who are we kidding, everything is wrong with that, it’s just not any of our business) … anyway, these two bi partisans value the opinions of their friends in PETA (the overt wing of the ALF terrorist group) more than they value the lives of soldiers. Which is not surprising, because they’re Congressmen, not a caste one normally associates with concern for les races oprimées. Such as, say, grunts.

Live Tissue Training, with which we have firsthand experience, is irreplaceable and necessary — as long as DC bums like these two soldier-haters keep sending our people into harm’s way. Want an example? Special Forces medics last year drew on skills learned in LTT in a heroic effort to save two SF troopers gravely wounded by a Jordanian Air Force gate guard. Despite what autopsy determined later to be the irrecoverably mortal nature of the wounds, they kept one man alive for the hours it took to fixed-wing evacuate him to King Hussein hospital, where he unfortunately expired. Elsewhere, that skill saves real, precious lives. We’ve seen it, live in full five-sense surround. (The smells stay with you).

Back to our “let-em-OJT-that-med-$#!+” Congressmen:

Rep. Hank Johnson, D-Ga., and Rep. Tom Marino, R-Pa., introduced a bill on Tuesday that would require the military to use only “human-based methods” to train service members to treat injuries sustained on the battlefield and end the use of “live tissue training,” in which troops stab or shoot pigs and goats to simulate the treatment of combat trauma, by Oct. 1, 2020.

Representative Hank Johnson’s military service was… uh, he doesn’t appear to have had any. He’s a lawyer, and a second (at least) generation payroll patriot; his father was a high-ranking bureaucrat and he grew up in DC. Representative Tom Marino? Another lawyer with no military service. He was in the chronological sweet spot for the Vietnam Era draft (H.S. grad, 1970), but somehow didn’t manage to wriggle into a uniform — he wriggled out of service, instead.

Johnson told the Washington Examiner he intends to raise the issue during debate on the fiscal 2018 National Defense Authorization Act and hopes to use the must-pass bill as a vehicle to ban live-tissue training. He said simulators offer better combat training than live animals, are more humane and are ultimately more cost-effective.

“It may cost more for a simulator than for a live animal in terms of initial outlay, but you can only use that animal once, you can use the simulator repeatedly. So over the course of time, it’s better,” he said.

Before you give too much credence to what Johnson says, bear in mind he’s the brain-dead moron who didn’t want to add any more Marines in Guam, because too many Leathernecks might make the island capsize and sink. (And yeah, he’s a lawyer. We bet you’re glad this dimbulb isn’t your lawyer. Or maybe he was, and that’s why your ex got sole custody of the kids and dog, or you’re reading this in the Halfway House library after completing all your hard time).

The military already has transitioned many of its medical training courses to use human-based simulators, which advocates say are realistic and better prepare troops to handle combat injuries since the simulators have the same anatomy as a human.

“Advocates” — nameless “advocates,” like nameless “experts,” are a technique used by a dishonest journalist to inject his or her opinion into the story. The only “advocates” who say that are the tofu-burning weirdos and cat hoarders of PETA, and the snake-oil salesmen who sell these simulators.

You can write this down: if you ever have to do a cutdown on a bleeder for real, or even just treat for tension pneumothorax, you’d rather it wasn’t your first time doing it except on a computer screen.

But for some training, the military continues to use live goats and pigs that are anesthetized, injured, treated and then euthanized.

The Defense Department is not onboard with completely ending its use of animals in combat trauma medical training – at least not yet. Lt. Col. Roger Cabiness, a department spokesman, said the military is “actively working to refine, reduce, and, when appropriate, replace the use of live animals in medical education and training.”

This reporter, Jacqueline Klimas, like Johnson and Marino, literally values the animals expended in LTT — 8,500 pigs and goats per annum — more than a similar number of human souls. At least when the souls are those of soldiers.

What a despicable, dysfunctional, amoral human being!

Perhaps she could find some way to mortally wound herself, so that her local EMS can practice on her, and spare the live of one endangered caprine.

Or maybe we can replace goat lab with something that doesn’t take a precious life, like, say, journalist lab.

After all, if it saves just one goat, it’s worth it, right?

via The military kills 8,500 pigs and goats every year for medical training. A new bill would end that | Washington Examiner.

42 thoughts on “Anti-Military Congressmen Undermine Medical Training

  1. LFMayor

    We still have plenty of convicts after we run out of legislators? Hey, then count me green on this.

    1. Boat Guy

      The only consideration would be the necessity to double-glove when working on “journalists”; we want our guys to have effective barriers to contamination.

  2. Biopace

    When my dad (1970s British Army) did medic training he talked about doing a rotation at a central London hospital.
    I would have thought a rotation at a Chicago hospital could have a better result than doing it on pigs?

    1. RLTW

      And you get the experience of having to shoot your way into and out of the CASEVAC site without air cover or indirect fires.

      1. Steve M.

        If SF had to shoot their way into and out of certain areas of Chicago, I’m guessing there would be a huge drop in crime. Some blocks might get leveled in the process. It would save many pigs and goats, though.

        Possibly even a spotted owl. Who knows?

    2. Hognose Post author

      SF medics do do rotations in ERs as part of training. (Initial and recurrent). They maintain some paramedic certification — not sure which one, there are several in the US). Unlike the hospital rotations, the certification requirements are mostly a waste of time, but the lawyers, always looking to empire build, insisted.

    3. DSM

      Our Pararescuemen do a tour in a city’s emergency trauma center during their training for that very reason–experience. I don’t know if they use goat lab in their training though I’d be surprised if they didn’t along the line somewhere.

      1. Hognose Post author

        Most SOF medical trainees (and, I think, Navy Independent Corpsmen — think sub corpsmen) get the same trauma lab from a Joint SOF med training facility. Then each one gets MOS specific stuff from his own branch. PJs get lots more altitude injuries, SF gets communicable diseases and epidemiology, etc. etc. The exact contents of the trauma lab do change from time to time and they’re kept close hold because of the political sensitivity of the issue.

        Back in the Vietnam era, the patients were dogs.

        The trainees do not injure the patients, ever. That is the responsibility of the instructional cadre. The trainees are held responsible for care and for outcomes. If the patient dies, there is a Death Board, and if it’s the trainee’s fault, he’s out. As trauma lab winds on, and there’s some attrition, exhausted trainees are handling multiple patients. It’s the hardest training intellectually in SOF, and it’s physically brutal, also. (The trainee not only must be EMT, surgeon and anesthesiologist, but also nurse, phlebotomist, and lab technician. They run all their own lab tests).

        Then, in SF, the medics must crosstrain their team members on trauma. After all, if the doc’s hit, somebody’s got to treat him. (You have 2 medics per team on paper, but not always in the real world, and of course a patrol or outpost is often a split team and the medic a mile away might as well be on Mars).

        1. GQ

          Hey Hognose, for a Bravo you’re pretty clever. Your response here is a most excellent, most accurate and succinct description of the purpose and execution of live tissue training. Well done. I’m sure you had help to lay it out like this. But the credit goes to you.
          All I’ll add, is that Live Tissue Training is about building the confidence to save a life with what is in your pockets. I’ve had mountains of medical training and certifications; but any practical skill or instinct I possess about field medicine was taught to me by my betters who were medic’s.

    4. Aesop

      No, because
      1) military medics are officially unlicensed personnel, meaning they have Jack and Squat legal authorization or protection for committing medical battery on patients, let alone malpractice.
      They would be limited to very basic procedures, like splinting a wound. They wouldn’t even be allowed to start IVs in the real world, let alone suture wounds, or a hundred other things.
      If you can find a hospital that doesn’t mind extra lawsuits and unlimited liability, go ahead on with that.

      2) A fully-trained 18D is generally an E5/6 guy trained as an admixture of paramedic/P.A./N.P./D.D.S./D.V.M./M.D. By express design.
      Only a military program can do the hands-on to that level, for less than gazillions of dollars, and without violating numerous state laws covering the practice of those specialties. The only place they have carte blanche to do so is on military bases, undergoing military training.
      Actual human patients are protected by state and federal medical practice acts, and tort law.
      Army goats are protected only by the skill of their practitioners.

      3) We constantly train military doctors, nurses, P.A.s, and medics/corpsmen at civilian trauma hospitals all the time.
      (Which was how I knew we were going to invade Iraq six months before you knew: we were training them in 2002, because “You guys have more gunshot wounds here in a week than the entire military saw in Afghanistan in 6 months’ talking it over from the Taliban.” Which was true.)
      IIRC, 18Ds do those rotations too. But chiefly as observers, compared to what licensed MDs, P.A.s, and R.N.s can legally do. But in SF’s 18D Goat Lab, whatever the current/official name, they’re doing stuff surgical residents don’t even get trained in doing, and under Trashcanistan field conditions that would never happen at any American hospital (at least, any one that was not run by the V.A.).
      Because they can.

      4) Medical simulators are to medical practice as military music is to music: pretty f***ing little.
      They are nigh to worthless, in terms of teaching or conveying actual skills, and are, on their best day in most instances, like teaching pilots to fly aircraft by using Playskool toys to teach concepts and hands-on skills.
      These two douchebag congressscum are going to kill people, for generations, if this sort of assininity is passed into law.
      They should be shot and stabbed, and treated by surgeons who learned their arts on human simulators.
      If possible, multiple times per year.
      Selling tickets to watch, and telecasting it as reality TV pay-per-view could fund SF for the next decade, right there.
      And it would be an excellent use of at least two otherwise worthless congressmen.

      Dear Secretary Mattis:

      Subject: A Modest Proposal…

      1. Aesop

        And, exactly as explained by our Gentle Host, the reason they acquire and hold civilian paramedic certification: that lets them start IVs legally, draw blood for lab work, and IV push a certain few drugs.
        But even that wouldn’t (and doesn’t, outside a military training program under Big Green’s auspices) allow them to do surgical procedures of any type, including suturing wounds, nor administering antibiotics, anesthetics, or a host of other things far beyond any and every paramedic’s scope of legal practice, but all the entire raison d’etre for SF trauma training.

  3. whomever

    I just looked it up – the US consumes 112 million hogs a year for food. And we’re worried about 8500?

    They don’t even gently anesthetize the food ones either.

    (the really depressing thing about Hank Johnson – he’s been reelected 2 or 3 times since the Guam remark)

    1. Hognose Post author

      Gerrymandered Dem/Black district. An incumbent protection racket that pleases both parties. Dems are guaranteed some token black congressmen — even if they’re dullards like Johnson, who has to make Georgians wonder if maybe the Klan had it right — and Republicans are guaranteed districts “ethnically cleansed” of black Dems. Win-win — for Washington insiders.

      1. Mike_C

        >guaranteed districts “ethnically cleansed” of black Dems.
        Not any longer. Aggressive use of section 8, such as buying houses in suburban or upscale neighborhoods is fulfilling every American’s right to enjoy vibrant diversity (not necessarily black, but definitely diverse) and all its associated benefits. As but one (of literally hundreds) example, take a look at what rents are being paid from the government spigot for diversity enhancement on the Chicago lakeshore where apartments go for thousands per month.

        As to getting rid of live-tissue lab, I’d argue that computer lab is like learning to be a chef via watching YouTube cooking videos on knife work. Sure you can learn something, but there is no substitute for the physical feedback and developing the muscle memory. As an example, you can watch videos on how to put in, say, an IJ central venous catheter, but you have to get hands-on experience to get actually good enough to do it under pressure in suboptimal conditions.

  4. Reltney McFee

    Simply wondering: can training on journalists, ref the invitation for Ms. Klimas to volunteer herself, even translate into caring for humans?

  5. Steve M.

    I wouldn’t say the two jackasses pushing the bill hate soldiers exactly. They’re likely too stupid to do so. After all Hank’s asinine thoughts of an island capsizing prove his limited capacity for serious thought.

    As an American, I really, really get beyond words aggravated at the millions of morons in this nation who fail to realize there that isn’t a us and them separation. Military and civilian technology whether medical or mechanical, (and many other fields) have labored hand in hand for years.

    The only reason some lame leftist can get a helicopter to a hospital after wrapping his Prius around a tree is due to the military having done it first. That is only one very small glimpse of life saving methods from the military from which we have benefited greatly.

    Some people are just so unbelievably stupid.

  6. Alan Ward

    Unfortunately, those are the ones the system fights to save after the Tesla battery fire.

  7. Seacoaster

    Irreplaceable and necessary is dead on. Should be mandatory for all infantrymen, at a minimum, during initial training. The hard skills confirmation is good, but the confidence it provides the trainee is the most important outcome.

  8. John Spears

    When all we train on is rubber mannequins, our military will have the best cared for rubber mannequins in the world.
    Someone has been trying to get the SOCOM medical community to adopt a realistic simulated trainer for decades.
    This stupidity comes around regularly, predating even my time at medlab.
    As irritating as this is, it is very unlikely to gain any traction in the congress. I think we have little to worry about.

  9. John Distai

    What are Veterinary and Medical schools using these days? Live animals that are eventually euthanized, or simulators?

    1. whomever

      At least some is synthetic. I have a machinist friend who sometimes gets jobs from the folks below. They use an amazing variety of high tech manufacturing methods to e.g. make fake knees for surgeons to practice on:

      www DOT sawbones DOTcom /Content/AboutUs_SawbonesCatalog

      everything you need for your surgical hobby :-)

      They are more practice surgery than trauma care, so maybe not what you had in mind.

    2. John Distai

      I’m not arguing against live tissue training, I’m comparing standards. Veterinary and Medical schools deal with this issue, and they need to graduate competent professionals. Those institutions may have reviewed and approved simulated methods, and changed their surgical training methods accordingly. If those training methods are approved by those institutions, I don’t know why the military wouldn’t follow suit.

      1. Hognose Post author

        The freshly graduated surgeon will not be doing surgery alone, without preparation and imagery, in austere conditions. There is that.

      2. Aesop

        Medical students dissect animals (cats usually, pigs occasionally, frogs, fish, etc., perenially) as far back as their initial college pre-reqs.
        In medical school it’s actual human cadavers.
        And even cadavers, millions of times more accurate than simulators, are a pale imitation of live bodies.
        I trained on IV starts on a “high-quality” training arm.
        It was like training to put a knitting needle into a garden hose.
        Actual IV starts on live people (let alone live people trying to bleed out from massive traumatic injuries) would be like trying to thread fiber-optic cable into the eye of a needle.
        Blindfolded, in the dark. By touch.
        While someone in agony jerks the needle’s eye around.

        This is why surgical residency involves four to six years of training on actually doing surgeries, on live patients, after four years of college, and four years of medical school.
        Then they just have to pass their specialty boards, and find a hospital that’ll hire them, to actually get good at it.

        Spitballing, but I’m thinking SF doesn’t want to invest 12-14 years to train medics “the way private institutions do it”, right?

    3. medic09

      I’m married to a physician. Medical schools use real, live vicitms – er, patients. During the last half of school, med students start rotating through hospitals and clinics. They learn their first skills at the patients’ expense (under the sort-of watchful eye of a resident). In residency this continues. I recall my wife coming home one day and relating how she had just done a new-to-her procedure. Her attending had never done this one, either. So with the patient waiting (this was in a rural clinic), they went in the next room and looked it up. Then they did a quick plan, and my wife (the resident) did a first-time procedure on the patient.

      1. Mike_C

        Yes, exactly. “See one, do one, teach one” is very much alive and well. (The first-local-procedure-at-this-site-evar by a resident (trainee who has an MD but is not yet fully qualified to be independent) is, however, *highly* unusual and speaks well of the confidence they had in Mrs Medic09.)

        >will not be doing surgery alone, without preparation and imagery, in austere conditions
        This is a key point. The first time I did nearly any procedure (as a medical student or intern) was under the eyes of a physician senior/more-experienced than I was. This could be putting in a peripheral arterial line, to taking out a gallbladder (this as a med student*, I am not a surgeon). But on none of these things did I ever (have the opportunity to) practice on a simulator. The only thing I remember having a dummy simulator was routine venous phebotomy. You were given this rubbery arm with “veins” filled with red fluid. That may have been useful, but it was NOTHING like drawing blood from a person, apart from that you stuck something with a butterfly needle. The amount of force needed, how you held the limb, all of that was different.

        In my own area, I’ve gotten to play with some transeophageal echocardiography simulators which are pretty impressive, but they don’t teach you everything (are not a substitute for working with a real person). Sure you learn how to manipulate the probe (this is a flexible ultrasound probe about 1/2″ in diameter that you put down someone’s esophagus under semiconscious sedation) and the computer shows you the images you get with the probe and controls just so. That part is amazingly realistic, but it does NOT teach you how to get the probe down the throat of a bite-y patient or one with a strong gag reflex. It does not teach you how much force to use, and how to modify your technique if it is a fat patient with a stiff neck, etc.

        I was trying to not go here, instead using the “cooking” and knife skills analogy, but I think I will go here. Learning to do a medical procedure via video alone is like thinking you can be a great lover by watching lots of porn. Most medical simulators that I have seen (but I’m older) are like a cheap blow-up doll: maybe you get some of the basic mechanics down, but it’s nowhere like the real thing (or so I imagine!). Some more modern simulators are probably like one of those (creepy!) RealDoll** things, but it’s still very artificial and limited.

        Anyway, the TL;DR is that you don’t want to be trying to figure out all the basic, background stuff the simulators didn’t teach you, out in the field. Doing the procedure in a controlled environment offers plenty of opportunities to do things in a suboptimal or inefficient fashion, so you learn how to plan ahead and to do them more efficiently the next time around. Also, the burst of fear and adrenaline you get when you lose control of a patient’s groin (blood is now spurting out of their femoral artery through a hole *you* made and just failed to hold closed properly) is not something a simulator will teach you. It’s easily recoverable (usually) but until you’ve had that panic and learned that you can deal with the situation, knowing that you have backup present, you don’t know it. In the field is not the best place to experience it the first time.

        *I got to take out a gallbladder (entirely solo, but under the eye of the attending surgeon) as a 3rd year medical student not because I was good, but because the attending was showing contempt for the surgical resident scrubbed in with us. He didn’t let her do anything on that surgery. “just step back from the table.” (Ouch.)
        **Ask Ryan Gosling’s character “Lars” in that eponymous movie.

  10. TF-BA

    The Navy has an entire school set up in LA county shock trauma for running IDC’s, FMF cats and surgical techs through the gauntlet on real people. The Navy nor the SOF med pipeline will ever give up LTT. IF LTT gets cut back it will be because of internal funding issues, not congress. Just as a humorous FYI, you can see the PETA head office building from the Navy’s primary LTT facility for surgeons, I mean direct line of sight across the river.

  11. staghounds

    Some proportion of people, no matter what the training, just can’t reach inside and do things. No insult, some people just can’t bring themselves to rappel off a building, touch a snake, or urinate in public.

    I think that when we find that out about a medic trainee, it ought to be a pig that suffers and not some human bleeding out from a truck wreck.

    1. whomever

      “…ought to be a pig that suffers…”

      IIUC, the pigs don’t suffer, they are anesthetized.

  12. Swamp Fox

    US Capital Switch Board: 202 224 3121

    Please call and tell your Representative that the military still needs live tissue training. High fidelity simulation does not get any higher then LIVE Tissue.

  13. LSWCHP

    I was a shooter not a doc so I never did this stuff. I do recall some survival training where I killed and field dressed a sheep one time, drank some of its blood and then cooked and ate it with my mates. That was over 30 years ago and I still remember those chops as the best I’ve ever eaten.

    It was commonplace stuff back then, but I suspect it would get all involved jailed for animal cruelty these days.

    1. DSM

      The USAF Survival School has a contract with a local rabbit farmer to provide fluffy bunnies for the newly minted zipper suited sun gods to learn how to dress simple game. “SV80” is a stop aircrew and some ground folks have to pass through on their training pipeline complete with basic survival and evasion skills and simulated POW camps. The students have to ferry the rabbits around for a few days until the day comes they string it up and whack it in the head, then they get to hear it scream when they inevitably don’t do it right.
      On a side note my buddy that was an instructor up there said they had a class loaded up on a bus that hit a deer on the way out to whatever training location. Not one to waste an opportunity for training, they dressed the deer right there on the side of the road and portioned out chunks of meat for roasting later.

  14. jim h

    “He said simulators offer better combat training than live animals, are more humane and are ultimately more cost-effective.”

    So much fail in that sentence. As an aside, Johnson is not well thought of in most of the metro Atlanta area.

    1. medic09

      “He said simulators offer better combat training than live animals”. Certainly one of the stupidest things I’ve heard in a while.

      I work for a civilian air medical company that does their best to keep us trained. Hospital rotations (OR and ER) have become hard to come by in the last few years. We do have expensive computerized somewhat-realistic simulators for every stage of human life, and obstetrics. They are definitely useful to keep us up-to-date and practice certain bits of muscle memory. We also do cadaver labs, mostly for practicing chest tubes and airway procedures. Bottom line? All that is helpful and we are glad the company invests in all that. But it doesn’t come close to the real thing. Animal and human patients don’t read the textbooks, so they all react just a little differently. And THAT bit of nuance is really important to experience and get used to. No doubt live tissue animal labs, like in the military, would be a very useful tool in our sector as well. We do the best we can since it isn’t available. To say that there is any replacement for live patient experience is simply ignorance. Head-up-the-rectum ignorance. Military medics should have most possible exposure to real blood and guts and how they behave before they first get out there; and then yearly refreshers to refine skills and learn new things. Too bad those legislators don’t have to be treated by clinicians who’ve had their education compromised.

  15. Cap'n Mike

    I was an Army Combat Medic, but at my level we didnt get that kind of high speed training. I sure wish we did. I worked rotations on Ambulances with EMTs and Paramedics, I worked rotations in hospital emergency rooms and ICUs. I did CPR 4 or 5 times on real people and assisted on a bunch of live human case.

    I never treated a gunshot wound on a real live living breathing thing.

    That kind of training cant be replaced by a simulator.

  16. jakew7

    Thoughts about 18D’s.

    One of our scuba team’s medics performed a vasectomy on our team sargent at TMC13 on bragg. With proper supervision.

    Told clinic that wanted the procedure performed by his team guy.

    “They said a planned “Oops!” during the thing. Everyone except the team sargent had a chuckle…then him afterwards.
    Procedure was successful.
    Fierce dedication to team and betting on, teaching, testing, and knowing what your folks are capable of, is the mark of a true leader, by the team sergeants….E-8’s, Master Sargents.

    Not to often that you let just anyone cut on your balls.

  17. AlanH

    I would prefer to offer homage to the medics, rather than sling the well-deserved insults toward the various congressmen proposing the changes. As for the slingees being suitable deciders of SF Medic training practice, that would be like having a professional boxer decide the appropriate methods for training attorneys. I wouldn’t want to argue with the boxer about it, but there is no way I’d allow his product to second-seat me.

    In 1971 recon teams (SOG) would vary in composition, but the most common arrangement for insertion/extraction was to have two hueys for the team (or what remained of them coming out), and two hueys as backup, carrying a pair of chase medics. A pair of gunships was a nice occasional extra. The air assets were not dedicated, but volunteers on a rotating basis.

    The medics, typically E-5 or -6, seemed to be nearly or just 21. (I was 19.) I can only say that as a voyeur with a machine gun, I was amazed at how quickly the chase medics would go to work with absolutely no apparent notice of the tracers flying around nor the gore which lay before them. I have no idea how they got that good in such a short training interval, assuming most came in at age 18. If it was goats and pigs that did it, then absolutely keep the LTT. I’ll call on Monday.

    One of those chase medics, eventually on a team, later as an MD edited the SF Medics Field Manual, and became SOCOM’s command surgeon. Two of the others, brothers, became, respectively, an ophthamologist and a surgeon. Back then they were just hard core, eager to earn the respect of a very intense bunch of SpecOps stars. It is, in retrospect, astounding how far young men can rise to meet the occasion of war.

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