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Endotracheal Intubation Training: Maiming and Killing Animals

Endotracheal intubation, a procedure in which a tube is passed through the mouth into the windpipe, is used on sick and injured children and adults who are experiencing breathing difficulties. Although humane training methods are readily available and have been scientifically proved to be the most effective way to train medical care providers to perform this vital skill, many cats, kittens, and ferrets are still tormented and killed in order to teach pediatric intubation to doctors, nurses, and others at a number of facilities across the country.

Chronic Injury or Death
During these training sessions, live animals endure repeated intubations by inexperienced students, and most are forced to undergo this trauma every few months, often for many years. Cats and ferrets often suffer bruising, bleeding, scarring, pain, chronic coughing, collapsed lungs, or even death.(1,2) Improperly anesthetized animals sometimes wake up during the procedure. PETA has found that at some facilities, cats and ferrets are so badly injured after being repeatedly intubated during a session that they must be killed.

Dangerous Differences
Experts agree that the anatomical differences between cats, ferrets, and humans are too great for students to be able to reliably apply the skills that they learn on animals to humans. Cats have larger, sharper teeth; proportionately larger tongues; more copious salivation; smaller anterior larynxes; dome-shaped arytenoid cartilages; and larger epiglottises than humans do. Ferrets and cats both have furry facial features and elongated jaws and snouts, unlike human infants.(3)
Where the Animals Come From
Some animals used for intubation practice are peoples’ former animal companions, or they are stray cats who were obtained by hospitals and universities from animal shelters. Others come from commercial breeders, where they are confined to cramped cages and then shipped off to various facilities to be abused in medical training and experimentation.

Modern Training Methods
Increasingly, medical experts and professional organizations object to the use of animals in medical training for financial, ethical, and educational reasons. The American Heart Association (AHA), which designs the curriculum for and sponsors the Pediatric Advanced Life Support (PALS) course, including intubation training, has stated that it “does not require or endorse the use of live animals in any of its training courses.”(4) Dr. Robert E. O’Connor, former chair of the AHA Emergency Cardiovascular Care Committee, told PETA in a letter that “[t]he use of lifelike training manikins for PALS courses is the standard accepted norm” and that “the AHA recommends that any hands-on intubation training for the AHA PALS course be performed on lifelike human manikins.”(5) Even so, a small number of the more than 1,000 facilities across the country that conduct PALS courses continue to use cats and ferrets.

Registered flight nurse and medical educator Cindy Tait, one of the original developers of PALS, has stated that she, too, is “adamantly opposed to the use of live or even dead animals in the American Heart Association (AHA) PALS curriculum” because “there [have] been no scientific studies proving that training on live animals is superior to human cadaver or manikin training.”(6) 

The American Academy of Pediatrics and the Emergency Nurses Association also exclusively endorse the use of non-animal pediatric intubation training methods such as specially designed human manikins. In an e-mail to PETA, the AAP stated that it “has never advocated the use of live animals” in resuscitation training and has “always used plastic infant resuscitation mannequins for training exercises.”(7) The overwhelming majority of pediatric residency programs for doctors use non-animal methods for intubation training.(8)

Cost-effective, anatomically accurate manikins are readily available for intubation training and represent the most common and effective training method. These models provide an exact replica of human anatomy and allow students unlimited opportunities to practice intubation and other procedures, unlike the use of live animals, which requires limiting the number of attempts students can make in acquiring the skill.

A study in Pediatric Emergency Care compared the intubation proficiency of medical care providers who had both completed an initial training program and then had either undergone additional training using didactics and manikins or a cat-intubation laboratory. The study found that those who did the additional manikin training instead of using animals were “significantly more successful on the first attempt at intubation and overall,” and it concluded that “training on mannequins allows for greater concentration by the trainee on technique. Without the urgency to place the tube, which is felt when practicing on animals or humans, the trainee is much more open to suggestions and corrections.”(9)

A manikin can be intubated repeatedly by many individuals and training classes without risk of harming the subject. With proper care, manikins can be used indefinitely, making them much less expensive than animals.
Training on cadavers is another option and provides valuable practice on an actual human body, allowing trainees to see the location and size of the components of the human oropharyngeal cavity.
What You Can Do
If you are in nursing or medical school and will be expected to undergo intubation training, raise your objection to using animals as soon as possible. List, in writing, your reasons for objecting; recommend the use of manikins instead of animals; and contact PETA for additional support.

If you are concerned about the use of animals for intubation training but are not in the health-care field, you can raise the issue in your community. Write letters to the editors of local publications explaining that excellent alternatives are available. Ask your local hospital or training institution to use manikins or cadavers.

For more information on current campaigns to end this cruel practice, please visit

1) E.H. Hofmeister et al., “Traumatic Endotracheal Intubation in the Cat,” Veterinary Anaesthesia and Analgesia 34 (2007): 213-16.
2) Cindy Tait, “On the Differences Between a Child and a Kitten,” Journal of Emergency Nursing 36 (2010): 78-80.
3) Tait.
4) American Heart Association, “Message From AHA ECC Programs: PETA Inquiries Re: Use of Live Animals in PALS Courses,” 27 Jan. 2009.
5) Robert O’Connor, letter to PETA, 3 Feb. 2009.
6) Cindy Tait, e-mails to PETA, 16 Jul. and 28 Aug. 2008.
7) S. Lazier, e-mail to PETA, 3 Aug. 2005.
8) Physicians Committee for Responsible Medicine, “Animal Use for the Teaching of Endotracheal Intubation in Pediatrics Residency Programs in the United States: An Ongoing Survey,” 14 Mar. 2011.
9) Kathleen Adams et al., “Comparison of Intubation Skills Between Interfacility Transport Team Members,” Pediatric Emergency Care 16 (2000): 5-8.

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