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Breathing a Little Easier The deer you shot last November could wind up saving someone's life.
To say A.J. Cummings is an avid deer hunter is an understatement. During the fall, when he's not at work or spending time with his family, there's a pretty good chance you'll find him somewhere out in the woods, sitting in a tree stand with a bow in hand, waiting for a big buck to walk by. Cummings also is a physician in the emergency room at Peoria's Saint Francis Medical Center, and a clinical assistant professor of emergency medicine at the University of Illinois College of Medicine in the same city. It was during a deer hunting trip a few years ago that his passion and his profession were melded together, resulting in an idea that might revolutionize the way one aspect of emergency medicine is taught. Cummings was field dressing a deer he had shot when he took notice of the animal's neck and airway. Upon further examination, he concluded that deer and humans had very similar airways. "The most important thing we teach in emergency medicine is to keep the airway open and the patient breathing," Cummings said. "If a patient is not breathing, it doesn't matter what else you're doing to help him. First and foremost, you have to keep the person breathing." With that thought in mind, doctors working in emergency situations have to be experts in emergency airway management. The medical school in Peoria, as well as other teaching hospitals and medical schools, use lab animals and manikins to teach and practice these procedures. But lab animals— usually dogs, pigs or sheep—cost more than $200 each, so they are purchased sparingly. Using manikins is much less expensive, but they simply cannot duplicate the intricate nature of living tissue. Dr. Cummings decided that deer heads could be used to teach different airway management procedures at a fraction of the cost. "There are somewhere around 200,000 deer killed by sportsmen in Illinois each year, so they are readily available for this use," Dr. Cummings said. "Promoting con-
No, Dr. Cummings doesn't hunt wearing his scrubs and stethoscope, but we thought it was a pretty good way to illustrate how his passion and his profession came together one day while he was deer hunting. (Photo by Gary Thomas.) servation in outdoors sports is one of my passions, and this just seemed to be a natural." His idea was simple. He would schedule a class to teach airway procedures following the first weekend of the Illinois firearm deer season, obtaining the deer heads from a local meat processing plant. Doctors would then practice airways medicine using the parts of this animal that normally are discarded. "I felt that even anti-animal research groups would approve," Dr. Cummings said. "This gives us the opportunity to make use of another part of an animal that has already died—using a part that is going to be thrown away—instead of sacrificing a dog, pig or a sheep which has been bred to be used for laboratory purposes." Paul Shelton, forest wildlife program manager for the Department of Natural Resources, assisted the research by providing technical information about Illinois whitetails. Dr. Cummings then made arrangements through Echo Valley Meats in Bartonville to save 50 deer heads for him. He sprayed each deer head with insecticide, then put them in a rented trailer along with an insecticide fogger bomb to kill any ticks that might have been on the animals. I should point out here that the meat processer was asked to save eight inches of the neck area that contains edible meat, so hunters bringing in deer had to be asked if they would sacrifice about a pound of meat for medical research. Only a couple of hunters declined that request. The following day, Cummings set up the classroom and gave a brief lecture on various airways techniques. Each doctor was then given a deer head and began trying the procedures. Although participation was optional, all doctors chose to take part in the experiment. There were 33 doctors in attendance—six attending physicians, 20 residents and seven medical school students. Afterward, they were asked to rate the usefulness of the model as compared to a human patient, marking each procedure as either excellent, very good, good, fair or poor. By the way, the fact that each doctor had his own animal to practice on is rare. Due to the high cost of using laboratory animals, three or four doctors usually have to make
Dr. A.J. Cummings explains to another doctor how he used deer heads to teach airways medical procedures at a conference on emergency medicine in Chicago last year. (Photo courtesy of Dr. A.J. Cummings.)
use of the same animal. In fact, the cost of lab animals can be a limiting factor for many residency programs. Did using deer heads for teaching these procedures work? According to the doctors' ratings, deer heads seemed to work just fine for most of the procedures. While one doctor marked every procedure as poor, saying she was not in favor of using a deer as a teaching tool, the "excellent" rating scored highest for all seven procedures, and "very good" was right behind. "We only had a small number of participants in our first study, but technically we learned that it is a very workable idea," Dr. Cummings said. "The objective was to develop a new airways model, to see if deer heads would serve as realistic models for the practice of advanced airways management procedures. I do know the deer airway system is very similar to the human airway— being just a little larger. But that actually makes it easier to learn or do a refresher on. Most of the doctors that participated thought it was a good idea. We'll do some more testing and also compare it directly with some other animals." One other fact is clear: Cummings saved the school about $7,000. That is what it would have cost if they were using laboratory animals. The total cost of the experiment was the rental of a trailer and the insecticides. Does Dr. Cummings believe other schools and teaching hospitals will begin using deer heads to teach these procedures? "There's a very good chance they will," he said. "We made a presentation on this subject in Atlanta this past May at the national meeting of the Society for Academic Emergency Medicine, and also had an abstract published in the Academic Emergency Medicine medical journal. It's getting a lot of interest from other emergency room doctors, plus a medical school in West Virginia has already contacted us about this. No one has done this sort of thing before, but I think we'll see more of an interest, particularly in areas where deer hunting is good. The savings alone makes this viable." And Dr. Cummings will be using deer heads to teach the procedures again this November following the first half of the firearm deer season. "I look at this as an opportunity to use natural resources to teach physicians and medical students how to keep humans alive," Dr. Cummings said. "Practicing emergency airway procedures is essential, and anything we can do to help doctors be better at their jobs is important. Doctors have to be experts in treating airway difficulties, particularly emergency room doctors, trauma surgeons and anesthesiologists. Aldo Leopold once wrote: "Conservation is the wise use of natural resources." What Dr. Cummings is doing goes to the heart of that statement and beyond. More importantly, it also might result in the saving of human lives.
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