LAFD/ Robert Wilcox

Small animal pre-veterinary care

Published:  25 June, 2018

The frequent presence of pets at the scene of road accidents and house fires in his home state of Colorado prompted firefighter Michael Davis to develop a training programme for small animal pre-veterinary care for first responders.

I am a firefighter for a rural department outside Denver, Colorado. It’s a mountain paradise filled with hiking trails and parks. It seems every vehicle on the road has a dog with its head out the window, and every home I visit has at least one pet in residence. I often refer to my district as ‘Doggy Disneyland’.

So, it comes as no surprise that when we respond to a motor vehicle accident, pets are often involved. While their owners are protected by seat belts and air bags, the dogs are unsecured in the vehicle. And in structure fires, we often encounter four-legged victims who didn't understand the smoke alarm’s warning and lacked opposable thumbs with which to operate closed doors.

Sensing a need in my community, I set out to create training on pet first aid and CPR. As my research progressed, I was pleased to learn that aside from size and a little anatomy, there isn’t a great deal of difference between humans and small animals.

My target audience for the training is fire and emergency medical personnel. I limited the topics to injuries we might encounter during our regular duties: trauma from an auto accident, hypothermia from falling through the ice of a frozen pond, hyperthermia from being left inside a hot vehicle, and smoke inhalation.

Legal considerations

I began with a review of the legal aspects of providing medical care to pets. Would firefighters be practising veterinary medicine without a license? The answer, at least in Colorado, is no. Colorado statutes allow for ‘the immediate medical stabilisation of a dog or cat by an EMS provider, in an emergency to which the EMS provider is responding’. A citizen can’t call us to attend to an injured pet, but if we’re responding to an emergency call and a dog or cat needs our attention, we are allowed to help.

However, we are here to serve the citizens of our community and can only help pets when we have adequate resources to do so. You will never see one of our ambulances running lights and a siren with a medic in the back coaching a pregnant Border Collie on her pre-delivery breathing exercises. If we have a utility vehicle available, we may transport, but ambulances are for people.

Financial considerations

When discussing emergency pet care, you must consider financial liability. What happens if we respond to a fire where the homeowners are away, but a pet is inside? We extinguish the fire and transport an injured animal to a veterinary office. The veterinarian treats the pet, and when the owner arrives, he or she is unable or unwilling to pay the bill. In this case, the fire department might be responsible for the cost of treatment. I have met with my local veterinarians, and they have agreed that if we deliver an animal to them in need of emergency treatment, they will run the risk of not getting paid in favour of saving the animal.

Responder safety

Our top priority is always the safety of our personnel. This is where knowledge of animal behaviour comes into play. As with any human patient, I start sizing up an animal as soon as I see it. Dogs use body language to communicate with other animals. They are good at letting us know what’s going on – as long as we understand how to read the signals. By the time I’m within a few feet of a pet, I have a good idea about whether I can safely approach the animal.

However, dogs are complex creatures and can quickly transition from one emotion to another. A dog demonstrating submissive behaviour can become aggressive if it believes you mean it harm. Keep in mind that an injured animal – even your own dog – may lash out at you. We have to continually evaluate the animal’s behaviour lest we become patients ourselves.

I emphasise dog behaviour because dogs, especially large ones, have the potential to do serious harm to a rescuer. Cats, on the other hand, exhibit only a handful of behaviours. If they are happy, they rub against you, leaving copious amounts of hair on your uniform pants. If they are angry, they try to attach themselves to your thigh with razor-sharp claws. And if they are in distress, you probably won’t be able to find them.

Even if you have experience with pets, I encourage you to invest the time in studying animal behaviour as this is an invaluable tool in small animal care.

Evaluation of an injured animal is always a two-person job. One rescuer restrains the pet to ensure safety, as the other performs the examination. There are several skills you need to master. These include how to take a medium to large dog from a standing position to right-side lateral recumbent, and how to transition from this gentle, controlled take-down into a restraining posture. The standard neck and body restraint is also essential, as well as proper lifting and transportation techniques. There are videos available online that teach these skills.

It is always recommended to place a muzzle on any responsive dog you examine. To make an improvised muzzle using medical gauze, close the dog's jaw and apply two wraps of gauze around the snout. Join the cloth beneath the jaw and then tie the ends of the dressing behind the animal’s head, below the ears. Wrap a cat in a towel for examination. One responder always holds the animal so that it can neither injure itself or the second responder.

Examination

In the emergency medical service, we rely on communication with our patients. The first thing a new EMT learns is how to take a SAMPLE medical history (asking about symptoms, allergies, medication, etc), but aside from some entertaining videos on the Internet, in my experience pets don’t talk. We have to observe their behaviour and rely on the results of our examination to tell us what they need. The good news is that all your pre-hospital patient care skills will transfer seamlessly to pre-veterinary care.

Your evaluation should begin before you lay hands upon a pet. Appraise the animal’s level of consciousness from a distance. Look to see if the pet is alert and orientated. Does it follow you with its eyes? Does it seem curious or fearful? Are there any visible injuries?

If a pet is unresponsive, tap at the edge of the eye toward the nose to trigger a blink response, or pinch the skin between the claws to elicit a pain response.

Attend to the ABCs (airway, breathing, and circulation). Align the head and neck with the body to ensure a patent airway. Dogs have long tongues, which can obstruct breathing. Reach into the mouth and pull the tongue straight out between the canine teeth. Put your face next to the unresponsive animal’s snout and look, listen, and feel for breathing. Watch for chest rise. Check capillary refill by pinching the gums. Refill should occur within two seconds.

Check the eyes – a responsive animal should be able to focus on you. The sclera should be white, and the pupils should be Pearl (pupils equal and reactive to light). Any abnormality indicates the need for veterinary care. Cats have a third eyelid, the tertia palpebral. If the third eyelid is visible, it means the pet is in severe pain or is otherwise in medical distress.

In pre-veterinary care, temperature is a critical vital sign. Always take a rectal temperature with a digital thermometer. Have your partner support the animal with an arm around the neck to control the head, and the other arm under the abdomen to keep the animal standing. Sitting is a typical response when you touch a dog's rear end, so do not use a glass thermometer. Many pets have been injured when glass thermometers have broken as the pet attempts to sit.

Normal temperature for adult cats and dogs is 37.8-39.2°C (100-102.5°F). New-born puppies and kittens have a slightly lower normal temperature of between 34.4-36.1°C (94-97°F), but by ten weeks they should be at 37.8°C (100°F). An adult animal is sick if its temperature is below 37.2°C (99°F) or above 39.4°C (103°F).

Check the heart rate by palpating the femoral artery or by placing a stethoscope on the left side of the chest behind the front leg. Adult cats at rest should have a heart rate of between 140 and 220 beats per minute. Dogs at rest average 60 to 160bpm. Toy breeds can have heart rates as high as 180bpm. A puppy’s heart rate at birth will be between 160 and 200bpm, increasing to 220 at two weeks of age.

Canine pulse rates are ill-defined because of the vast range in size. The smallest living dog is a Chihuahua named Miley who weighs just over 0.45kg (1lb). The largest is Zorba, an English Mastiff who tips the scales at 155.6kg (343lbs). This represents a 30,000% variable in weight between our subjects. And it follows that Miley has a heart rate like a hummingbird, topping 180bpm, while Zorba is likely 60bpm or less.

An adult dog at rest has a respiratory rate of 10 to 30 breaths per minute. Panting is normal in dogs as long as quiet, open airway sounds are present. Adult cats breathe at between 24 and 42 breaths per minute. Panting in cats is never normal. A panting cat is in distress.

Pets with respiratory issues can be given mouth-to-snout rescue breaths, O2 via blow-by, non-rebreather, or a special pet O2 mask. In extreme cases, pets can be intubated, and a bag-valve mask used to provide respirations. Brachycephalic dog breeds (pugs) are at higher risk of respiratory complications. Selective breeding has resulted in compromised sinus structure and an undersized trachea. If a pug is having difficulty breathing, be on guard for respiratory failure.

LAFD/ Harry Garvin

Trauma

For pets involved in a motor vehicle accident, perform the same head-to-toe trauma assessment you would for a human patient. Dogs have seven cervical vertebrae as we do and are subject to the same stresses. The canine spinal column has roughly the same configuration as ours, except that where we have four fused vertebrae forming our coccyx, the canine has a coccygeal with 20 to 23 vertebrae in the tail. Due to artificial selection, breeds such as the dachshund or ‘weenie dog’ are especially prone to spinal injury.

A pet with a broken extremity should be immobilised to prevent further damage. Only qualified personnel should attempt realignment of a fracture or dislocation.

Small animals can be rolled in a towel and held. Use a folded blanket or pillow to immobilise a larger dog's extremity. Placing a pillowcase over a pet’s head may reduce the pet’s stress and give the caregiver added protection from being bitten.

Bleeding due to traumatic injury must be controlled. Fur may have to be trimmed to close a wound. Manage capillary bleeding by applying a dressing over the wound and applying pressure for at least five minutes. Venous bleeding is best controlled with a pressure dressing. Apply a clean dressing to the wound and wrap with gauze to maintain pressure.

A pressure dressing should also be attempted for arterial bleeding, but if the flow of blood cannot be checked, a tourniquet may be used. Be sure the tourniquet material is at least one inch in width. Using a narrow cord for a tourniquet may result in permanent nerve damage in the extremity.

Keep in mind that animals are far more tolerant of pain than humans. A dog that has been in a crash may compensate for quite some time before showing signs of injury.

Choking

If a pet is choking, open the mouth and look for obstructions. Do not perform blind finger sweeps as you might push a hidden object further into the throat. In the case of large dogs, you might lose that finger if the dog suddenly bites down.

For medium to large dogs, if no obstruction is visible, lift the dog’s hind legs to place it into a head-down wheelbarrow position and allow gravity to help to clear the blockage. If this is not successful, while still in the wheelbarrow position, apply five sharp slaps across the front shoulders to help force out the obstruction. For small dogs and cats, lift them by their thighs, hang the head down and shake them.

If these techniques do not resolve to choking, immediately perform a Heimlich manoeuvre. For large animals, stand over the animals back, facing toward its head. Place the fist of one hand on the dog's stomach below ribs and above the pelvis. Wrap your other hand over the first and thrust up towards and forward toward the dog's head. Place small dogs or cats on a table. Hold the pet with one hand over the back and use two fingers on the stomach to deliver forward thrusts.

Near drowning

For an animal that has experienced near drowning, the first step is to remove water from the lungs. Hold a medium to large dog upside down by its waist. Allow water to drain out the dog's mouth and nose. For small dogs or cats, grasp the animal by its thighs and hold it upside down to drain water from the body, then position the animal on its right side and begin cardiopulmonary resuscitation (see CPR below).

Be aware that animals submerged in icy water have survived extended periods of cardiac arrest. Extended resuscitation time may be warranted.

Hypothermia

A dog that has fallen through the ice of a frozen pond or has been left outside in the extreme cold is likely to be suffering from hypothermia.

Move the animal to a warm environment. Dry the fur with towels, as wet fur has no insulating value. Wrap the animal in a warm blanket and take a rectal temperature. If the temperature is 35°C (95°F) or above, continue warming with blankets. A dog struggling to escape a pond will expend all its energy and exhaust its glucose stores, resulting in low blood sugar levels. Encourage the dog to swallow a sugar solution such as honey, or four teaspoons of sugar mixed in one pint of water to restore blood glucose levels.

If the pet's temperature is below 35°C (95°F), begin rapid warming. Place warm (not hot) water bottles wrapped in towels in the animal’s groin area. Keep the animal wrapped in a blanket, change warming packs and monitor temperature every ten minutes until the pet's temperature reaches 37.8°C (100°F). Do not apply warming packs directly to the animal’s skin or attempt warming with a hairdryer.

Hyperthermia

For a pet suffering from hyperthermia after being locked in a hot car, move the animal to a cool environment. If the animal's rectal temperature is below 104°F, moving to an air-conditioned space may be sufficient treatment.

If the pet's temperature is above 40°C (104°F), begin rapid cooling. The dog or cat may be sprayed with water for cooling and placed in front of a fan while wet. In extreme cases, the animal can be put into a cool bath (not ice water) for up to two minutes. Place cool packs in the animal’s groin area. Wiping the paws with cold water may also help reduce the temperature. Check temperature every ten minutes, and once readings fall below 39.5°C (103°F), stop rapid cooling. Further cooling may push the animal into hypothermia.

Cardiopulmonary resuscitation (CPR)

If your patient is apneic (not breathing) and pulseless, lay them on their right side and begin CPR. For medium to large dogs, kneel behind the animal’s back, place the heel of one hand over the widest portion of the chest. Place the other hand over the first and provide compressions to a depth of one-quarter to one-third of the depth of the rib cage. Deliver 120 compressions per minute (roughly the same beat as the Bee Gees’ song Staying Alive or Queen’s Another One Bites the Dust).

For puppies, small dogs, and cats, place the animal on a flat surface, right side down. Place your cupped hands on either side of the rib cage over the heart. Deliver 120 squeeze compressions per minute.

Provide two rescue breaths for every 30 compressions. For large dogs, hold the jaw closed with your hands, place your mouth over the snout and blow until you see chest-rise. For puppies, small dogs, and cats, your mouth will cover both the nose and mouth. Blow gently; being careful not to overinflate the lungs, doing so could rupture the lung resulting in a pneumothorax.

The preceding pages offer the only briefest possible discussion of pre-veterinary medicine, but if this article has inspired you to learn how to help our four-legged friends, then I will count it as a success. As long as animals are saved, and their suffering is reduced, I’m all in.

  • Operation Florian

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