February, 2018 South Cook County EMS Site Code: E1218

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1 February, 2018 South Cook County EMS Site Code: E1218

2 Review animal behavior Discuss initial assessment and treatment of burn injuries Discuss initial assessment and treatment of lacerations Discuss cardiac arrest (CPR) and the Heimlich Maneuver. Discuss the pathophysiology and signs/symptoms of rabies.

3 The ambulance crew is on standby at a house fire. The homeowners are safe and didn t require EMS. Suddenly a FF emerges from the front door with a limp dog. He heads straight for you with the family right behind. He hands you the dog, which is alive but in critical condition. What now?

4 According to the American Society for the Prevention of Cruelty to Animals, there are approximately million dogs and million cats that are owned in the US. This means that you will find a dog or cat in about 40% of all US homes. Approximately 40,000 pets die in house fires each year. The major cause of death is smoke inhalation.

5 EMS doesn t typically treat animals, nor do we have a set of protocols for emergency animal care, however, given the high number of pets in the US, the chance of encountering an injured pet on the scene is very real.

6 When an animal is trapped, say in a structure fire, it will react very differently from humans. It will be scared and may panic, but most won t run from the building. They will gravitate toward the place that they feel safe, even if it has turned dangerous. It is their home and their safe place may be their bed, under a bed, in a basement, retreat to a corner, etc.

7 Airway, breathing, circulation is the same as humans for emergency care: Airway: Dogs may have muzzles with protruding noses, or a short muzzle and this must be considered for rescue breathing and oxygenation. Cats are more compact and have smaller airways

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9 Dogs will normally pant more than cats, but some cats will pant when frightened, stressed and/or hot.

10 A pulse should be checked on both dogs and cats in the femoral artery: Inside of the upper rear thigh, near where the leg connects to the torso. (don t attempt to find a pulse in the same location for the front extremities, it is nearly impossible and carotid pulses are even more difficult to assess) Perfusion is best assessed by the color of the animals gums. Normal gums are pink. Pale, gray or white gums indicate very poor perfusion.

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13 A dog s airway reacts similarly to a human airway after smoke and/or heat exposure. A coarse, raspy cough may be heard and the airway lumen may swell and become edematous. A cat s airway is more susceptible to laryngospasm and bronchospasm. Both dogs and cats may be victims of CO poisoning as well and require high flow O2 therapy.

14 Remove the animal from the site and administer high flow oxygen. There are pet oxygen masks available for prehospital use. These masks come in varying sizes and should fit snuggly around the muzzle. Each mask has a recommended O2 flow rate in liters per minute.

15 An adult or pediatric O2 mask can be used if there are no pet O2 masks available. Human O2 masks will be much easier to use on animals with short muzzles. Deliver the oxygen at the typical high-flow rate for each device. If the animal won t tolerate a mask, blow-by oxygen delivery is a viable alternative Continue all oxygen therapy (if possible) until the animal can be transported to a veterinary facility.

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17 Procedure to ventilate (if the rescuer is comfortable doing so) Dogs: Hold the dog s mouth closed and ensure a good seal around their mouth with your cupped hands. Place your mouth around their nose and breathe at their normal respiratory rate. Cats: Rescue breaths are delivered into the mouth and nose at the same time, maintaining a good seal. In all cases watch for chest rise and fall to ensure adequate breath delivery.

18 CPR can be initiated for dogs or cats found in cardiac arrest. Successful prehospital resuscitation is extremely rare and even in the veterinary hospital, cardiac arrest has only a 6% survival rate. PROCEDURE: Place animal in a lateral recumbent position Move the animal s top elbow back and target the costochondral junction where the elbow meets the chest. With the heel of two hands (one hand, if small dog), compress 1/3 to ½ the width of the animal s chest.

19 For cats, you may use one hand in a squeezing motion on the chest wall (see picture, next slide) The compression rate for dogs is and cats may begin at 120. Ventilations are interspersed as in human CPR

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22 CPR Certified This dog is not CPR Certified

23 Most dogs will chew anything; bones, toys, shoes, socks, etc. If the dog is suffocating, it will often panic. A dog may paw at its mouth if something is lodged. If there is a partial airway, attempt oxygen therapy and have the animal transported to veterinary care as soon as possible. Immediate Care: Be very careful, even calm animals may panic when they cannot breathe, you may need to restrain the dog, but do not MUZZLE it. 1. Use both hands to open the mouth, with one hand on the upper jaw and other on the lower. 2. Look inside the mouth and remove the obstruction with your fingers or perhaps a flat spoon handle (or something similar) to pry object away from the teeth or roof of the mouth and remove it. Heimlich Maneuver 1. Lie the dog on its side, place one hand on the back for support and use the other hand to exert pressure on the abdomen upwards and forwards. 2. Check the dog s mouth and remove any objects that may become dislodged. You may need to repeat #1 several times.

24 If the dog is standing: 1. Put your arms around the belly, joining your hands. Make a fist and push firmly up and forward, just behind the rib cage. 2. Continue #1, checking for object, if unable to dislodge and dog becomes unconscious; attempt the Heimlich on the dog in the recumbent position.

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26 Burn injuries are common in animals exposed to a fire. Most are burned over a small to medium sized portion of their body, they usually would succumb to the wounds of a full body burn. Animals are usually found with burns to whiskers, face and airway. Fur or hair burnt into the skin are major complicating factors and are difficult to clean/debride. Another common finding are burns to the bottoms of their paws. If the paws are burned, do not let them walk, it will be painful and increase the chance for infectious material to enter the wounds.

27 Burns may be dressed in the same way as human burns. The animal may also have thermoregulation issues as their skin may be compromised due to the burn, so keep them warm, if possible, covering them with a sterile burn sheet.

28 Try to assess the wound and clean it with saline, if able. If a foreign object has caused the cut do not remove the object Using dry, sterile dressings apply pressure to the wound for a minimum of 20 min If the wound appears to be arterial, or will not stop bleeding, continue to apply pressure and add new dressings over the older ones. Do not remove dressings once applied. Do not use a tourniquet or hemostatic dressings unless told to do so by a veterinary professional.

29 If you decide to treat at the scene remember: They don t know you are trying to help Their behavior may become unpredictable They may try to defend themselves, which may lead to biting keep your guard up. Animals respond best to a calm, reassuring attitude. Use a somewhat higher pitched voice (i.e. baby talk). This may help gain their trust.

30 Picking up an injured dog or cat: Medium large dogs should be picked up using both arms. One arm around the dog s front legs and the other arounds its hind legs. Scoop and cradle as you carry. Small cats and dogs should be fully cradled in the rescuers arms Contain their legs within your folded arms so they are less likely to squirm and jump. A cat may be picked up by the scruff of the neck with one hand and the other hand will scoop and cradle. This may be best if biting is a possibility.

31 Rabies transmission to humans, although extremely rare, occurs through infected animal saliva so keep this in mind if you choose to provide rescue breaths. Cats have a higher incidence of rabies, but only if they are primarily outdoor animals. A tag with proof of rabies vaccination is usually found on an animal s collar.

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34 All animals are susceptible to rabies. This not only includes dogs and cats but livestock and humans as well. Rabies is known as zoonotic, which means it can affect both humans and animals. In the U.S. 93% of all rabies occurs in wild animals. Bats are the most common, with skunks, raccoons, and fox also susceptible.

35 In the early stages rabies is very difficult to detect. It may take 2 to 12 weeks before the animal shows any symptoms, sometimes even longer. This is the incubation period. 1. Flu-like symptoms, human patients will complain of feeling tired with some pain and stiffness. 2. Neurological dysfunction paralysis, anxiety, sleeplessness, paranoia and delirium 3. Production of large quantities of saliva and tears (foaming of the mouth) The ability to swallow and speak are also lost. 4. May show signs of aggression, this makes animals more likely to bite Once the onset of symptoms has begun, the animal usually dies within 7-10 days. Rabies is almost always fatal.

36 In Illinois Every owner of a dog 4 months or more of age shall have each dog inoculated against rabies by a licensed veterinarian. Every dog shall have a second rabies vaccination within one year of the first. Terms of subsequent vaccine administration and duration of immunity must be in compliance with USDA licenses of vaccines used (usually 1 to 3 years duration) Stay Safe: Never handle wild animals, especially skunks, raccoons and bats. Never try to nurse sick animals back to health Never purposely feed wild animals. Never handle wild animals that are acting unafraid of humans. Never handle wild animals that approach you.

37 Griesser, G. Christopher. EMS Assessment and treatment of Dogs and Cats Involved in Fires. JEMS. November, Shelter and intake surrender: Pet Statistics(2016).American Society for the Prevention of Cruelty to Animals. Ashbaugh EA, Mazzaferro EM, McKiernan BC, et al. The association of physical examination abnormalities and carboxyhemoglobin concentrations in 21 dogs trapped in a kennel fire. J.Vet Emerg Crit Care. 2012;22(3): Drobatz KJ, Walter LM, Hendricks, JC. Smoke exposure in dogs: 27 cases( ). J.Am Vet Med Assoc 1999;215(9): New guidelines for CPR in dogs, cats (July 3, 2012) American Veterinary Medical Association.