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I am troubled that St. Louis Children's Hospital and Washington University still use cats and ferrets to teach Pediatric Advanced Life Support (PALS) trainees how to intubate a baby's windpipe. Students drive plastic tubes down the fragile windpipes of cats, despite public objection and the American Heart Association's endorsement of "lifelike human manikins for the AHA PALS course." Please modernize all PALS and pediatric residency programs with human-focused simulators that impart knowledge more relevant to human medical emergencies. Drills on animals are needless, given availability of high-fidelity simulators such as Laerdal's SimNewB, Gaumard's Premie HAL and PREMIE Blue, and METI's SimBaby. Animal-free models can be used repeatedly, thereby cutting cost. Moreover, infant simulators better replicate a newborn's airway. The internal organs of human and nonhuman animals are very dissimilar in terms of size, location, texture and elasticity. Information acquired from animals may deceive trainees and foster false assurance in their own capabilities. Over 90 percent of U.S. pediatrics residency programs rely on human-related tools instead of cats, ferrets, pigs, dogs, goats or any animals. Nearby Cardinal Glennon Children's Medical Ctr., St. Louis University School of Medicine and St. Louis Community College conduct animal-free PALS courses. Intubation exercises can cause animals to bleed, swell and scar. Their lungs can collapse. Improperly routed tubes even kill them. When drills end, animals are destroyed. "I have found that using cats is often a distraction for participants who are emotionally troubled by harming animals," says Cindy Tait, president of Center for Healthcare Education Inc. in Calif., and an original PALS course developer. Tait, published in academic journals such as the Journal of Emergency Nursing, cites numerous studies that show people trained with simulators are more adept at infant intubation than those who practiced on animals. "There is no evidence in scientific literature to indicate that [animal use] to teach this procedure is effective on its own or that it improves the skills of those trained on simulators." It is unnecessary to reduce any animal's life to isolation, pain and death. Plus, human safety is at risk when future practitioners learn with outdated methods. Thank you for acknowledging my concerns. Sincerely,

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