EMS Discussion - Live Tissue Training (LTT)

Live Tissue Training: An Overview

Live tissue training (LTT) involves using live, anesthetized animals to practice surgical and medical skills. While LTT has historically played a role in medical education- particularly in military trauma training - it is also a highly controversial practice due to ethical concerns surrounding animal welfare.

Arguments For LTT

Realism & Fidelity: LTT provides a level of realism that even high-fidelity simulators struggle to replicate, including the dynamic response of living tissue, active bleeding, and physiological changes.

Psychological Fidelity: The lifelike nature of LTT can evoke a stronger emotional and psychological response in trainees, potentially preparing them more effectively for the stress and urgency of real trauma situations.

Hands-on Experience: LTT offers opportunities to practice complex procedures in a setting that delivers immediate feedback based on the animal’s responses.

Confidence Building: Some research suggests that LTT increases self-efficacy and confidence among participants, particularly those preparing for combat deployments.

Arguments Against LTT

Ethical Concerns: Using live animals in training raises significant ethical questions regarding animal rights and welfare. Critics argue that it is inhumane and causes unnecessary harm.

Availability of Alternatives: Advances in simulation technology—including high-fidelity human patient simulators, cadavers, and realistic part-task trainers—are increasingly capable of replicating many aspects of LTT, often at lower cost and without ethical concerns.

Limited Transferability: Anatomical and physiological differences between animals and humans may reduce the direct applicability of skills learned on animals to human patients.

One-time Use: Animals used in LTT are typically euthanized after training, limiting opportunities for repetitive practice and skill refinement.

Policy and Regulations: The U.S. Department of Defense has implemented policies aimed at reducing and replacing LTT with alternative methods where feasible. Additional legislation has been proposed to further restrict its use.

Current Trends

The use of LTT has declined in many civilian trauma training programs, such as the American College of Surgeons’ Advanced Trauma Life Support (ATLS) courses.

However, LTT continues to be used by the military for combat casualty care training, particularly for developing complex procedural skills and preparing personnel for the stresses of battlefield trauma.

Ongoing debate and research continue to evaluate the effectiveness of LTT compared with alternative training modalities, with some studies suggesting comparable skill acquisition and proficiency.

There is also a growing push to apply the 3Rs of humane animal use to LTT:  Replacement, Reduction & Refinement, seeking to minimize reliance on animals and improve their welfare when training does occur.

In Conclusion

Live tissue training presents a complex ethical and educational dilemma. While advocates emphasize its realism and benefits for skill development in high-stakes situations, critics highlight the ethical implications and the growing availability of effective alternatives. 

The overall trend suggests a reduced reliance on LTT, particularly in the civilian sector. However, it remains a component of certain specialized training programs, especially in the military, as efforts continue to balance training effectiveness with animal welfare concerns.

Further Reading

American College of Surgeons (ND). Advanced Trauma Life Support (ATLS)® Program. https://www.facs.org/quality-programs/trauma/education/atls/ Accessed August 13, 2025

Department of Defense Instruction (2019) Use of Animals in DoD Programs. www.esd.whs.mil/Portals/54/Documents/DD/issuances/dodi/321601p.pdf Accessed August 13, 2025

Liang, J. N., Ciampa, M., Kobylarz, F., Anklowitz, A. J., Barzanji, N. K., Sherman, W., & Faler, B. (2024) Impact of Live Tissue Training on Provider Confidence for Operative Trauma Management. Military Medicine, 190(3–4): e784 - e789. https://doi.org/10.1093/milmed/usae403 Accessed August 13

NAEMT (ND) Tactical Combat Casualty Care www.naemt.org/education/trauma-education/naemt-tccc Accessed August 13, 2025

National Academies of Sciences, Engineering, and Medicine (2018) A Review of the Department of Defense’s Programs for the Use of Animals in Military Medical Training. Washington, DC: The National Academies Press

Physicians Committee for Responsible Medicine (2025) National Physicians Group Celebrates St. Elizabeth for Replacing Animals in Surgeon Training. https://www.pcrm.org Accessed August 12, 2025

Swain, C. S., Cohen, H. M. L., Helgesson, G., Rickard, R. F., & Karlgren, K. (2023) A systematic review of live animal use as a simulation modality (LTT) in the emergency management of trauma. Journal of Surgical Education, 80(9): 1320–1339 https://doi.org/10.1016/j.jsurg.2023.06.018 Accessed Aug 12, 2025