Chemical restraint at rescues what a fire service specialist should know

Transcription

1 Vet Times The website for the veterinary profession Chemical restraint at rescues what a fire service specialist should know Author : Jim Green, Josh Slater Categories : Vets Date : April 11, 2011 Jim Green and Josh Slater discuss what vets can expect from animal rescue specialists, and outline the benefits of training vets for emergency situations Summary The purpose of this article is to explain to veterinarians the depth of knowledge they can expect from a trained member of the fire service who has been trained to the level of AR3 (animal rescue specialist). A fire and rescue service that has adopted national standards for animal rescue training will have three levels of skills and knowledge, namely: AR1 awareness: all firefighters with general awareness of the dangers at large animal rescues but with specific roles and responsibilities at the scene for human safety; AR2 responder: strategically placed teams of firefighters who have animal handling, psychology and rescue training. AR3 specialist: fire officers with enhanced animal rescue knowledge and a more advanced knowledge of veterinary capabilities in particular, chemical restraint. The AR3 will be responsible for advising the incident commander on the best strategy and will be the attending vet s main liaison. Key words Fire, Rescue, Service, Chemical, Restraint Many vets will be aware of the Safer Large animal Initiative, which was launched at Buckingham Palace in 2007 and is still gaining momentum. 1 / 6

2 Some vets will have attended undergraduate training during an elective period or the two-day BEVA rescue and emergency medicine course at Hampshire Fire and Rescue Service. But in these pioneering days where fire and rescue services and vets are becoming more aware of the complexities of rescue situations and the need for greater skills on both sides not everyone will be familiar with each other s capabilities or needs. Around 150 fire service personnel nationally have now been trained; vets may bump into a fire officer who has attended an animal rescue specialist course in Hampshire and will start to speak your language, particularly in relation to chemical restraint. What I hope to achieve with this article is to provide an understanding of what fire officers know and in what terms they may communicate this to veterinarians. Adaptive Remember Captain Flack and the Trumpton firemen Pugh, Pugh, Barney, McGrew and so on? They always came to the rescue and saved the day in an emergency, but often got into a bit of bother when attempting to carry out someone else s specialism such as when they tried sticking up their own band posters, most unsuccessfully. An essential historical quality of the firefighter is to have enough knowledge about a subject to make safe judgements and know when to bring in expertise to safely conclude an emergency situation. For instance, when at training school, I was tested in around 40 different subjects, ranging from radiation to lifts and escalators, and from building construction sites to nuclear submarines. Traditionally, some fire officers may have asked for an animal to be sedated to carry out the rescue, but as we are now fully aware, sedation is not just sedation. Lack of knowledge in this area will lead to poor decisions and deployment, with the potential to injure or kill rescuers and members of the public. The four-day animal rescue specialist course begins with a day covering the basic ethos. Subjects covered include why large animal rescues are carried out, the dangers associated with animals in distress and influencing factors, such as the behaviour of the equine s owner, farmers or the public. Did you know that in the US, a survey concluded that 83 per cent of the public would happily risk their lives for an animal (American Hospital Association)? This is borne out at the majority of our rescues, where a structured approach, control and recognised techniques are the key to a successful conclusion. The second half of the day reflects the vets training day with firefighters learning the basics of animal rescue techniques, taking animal welfare and safety into consideration ( Figure 1 ). All our techniques are endorsed by BEVA and BCVA as being most appropriate for animal welfare. 2 / 6

3 For me, day two never fails to be interesting. Josh Slater, who has been a visionary for developing veterinary awareness and rescue training since the start, begins with a fascinating outline of large animal anatomy ( Figure 2 ), underpinning the reasoning behind our techniques and offering insight into how a casualty animal may be compromised when recumbent, particularly dorsally. This is adequately highlighted during a practical anatomy session at the hunt kennels, where we cut up a pony or heifer and examine its viscera. Then we get to the meat of the session chemical control. I have had the privilege of hearing lectures from a number of experts, such as Andrew Harrison, Eddie Clutton, Al Taylor and Mark Senior. Despite having a greater layman s knowledge than most, I still start to cloud over when they begin quoting suggested dose rates for each particular drug regime. For the average animal rescue specialist, this depth of knowledge would be totally inappropriate. However, Josh has developed a seminar that is levelled directly at our needs and captures some analogies that we firefighters can understand and use without having to spend five years at veterinary school. Firstly, the dimmer switch. If we consider a horse s anxiety level to be controlled by a dimmer switch, it helps us to understand why you will need a different drugs regime to that you may be more accustomed to for regular treatment. When the dimmer switch is turned up and, therefore, the lights are fully on, this represents a stressed, adrenaline fuelled equine that has only one intention to be as far away from danger as possible. When the dimmer switch is turned off and, therefore, the lights are out, it is the other extreme, meaning either death or anaesthesia. Therefore, if you were called out to rasp a horse s teeth, in a calm environment, the dimmer switch might be on 30 per cent: the horse is alert but not unduly anxious, and you will be able to achieve satisfactory results with a single bolus of an alpha-two agonist more often than not, right at the lowest end of the manufacturer s data sheet dose rate. At a rescue, however, we must assume that the animal will be stressed. The adage is that we meet the animal on the very worst day of its life. We could say the same about the owner, but sadly we can t discuss his or her sedation regime. If this stressed animal with its dimmer switch at 90 to 100 per cent were to be injected with the same dose of alpha-two agonist that you gave the relaxed horse at 30 per cent excitation/ anxiety, you may have a horse that appears sedated, but still reacts to minimal stimulation from fire crews because the adrenaline overrides the relatively small dose. Given that failure of the first bolus to achieve adequate levels of restraint is well proven to reduce the effectiveness of top ups, it is clearly vital that the vet gets the sedation regime right first time. Therefore, the first role of any trained fire crew will be to minimise stimulation by attempting to lower the adrenaline level so that the drugs regime will be more effective. Educating owners to not 3 / 6

4 stimulate the horse prior to arrival is also essential ( Figure 3 ). Josh then goes on to provide a clear interpretation of how you can turn the dimmer switch from 90 per cent down to 10 per cent or an acceptable level with which the fire service can operate, utilising cocktails of alpha-two agonists and opioids, or ACP, alpha two-agonists and opioids. Then by adding ketamine and maybe Valium you can achieve a totally safe scene by fully anaesthetising the horse. The animal rescue specialists understand that you can provide several times, maybe up to eight times, the everyday dose of alphatwo agonists without exceeding the doses recommended in manufacturers data sheets and, importantly, that there should be little chance of killing the healthy animal by overdose. They also acknowledge the difference in sedating an equine against a bovine, which is usually far more sensitive to alpha-two agonists, thus requiring lesser doses and a different cocktail of drugs ( Figure 4 ). Another essential factor in planning rescues is anaesthetised equines or sedated bovines becoming recumbent and, therefore, unable to assist themselves, or sedated horses remaining standing and having the ability to walk, albeit slowly. The nature of entrapment may also dictate the drugs regime, as there may be no option for allowing an animal to fall. Viability will also impact on the assessment, particularly from a safety aspect, if the desired level of control cannot be achieved. Incident strategy The animal rescue specialist and vet must have enough knowledge of each other s capabilities to have a professional conversation around strategy. I would fully expect an animal rescue specialist to explain his or her preferred rescue method, predicted timescales, level of anticipated stimulation expected from the equipment and also what potential position of danger he or she would need to expose his or her crews to in order to achieve the objective. Add to this the vet s diagnosis of injuries, potential pain stimulation, likelihood of further trauma, ultimate safe destination and need for further examination. Then, between you, planning for the appropriate chemical restraint regime will be decided ( Figure 5 ). It may be that there is a requirement for stages of sedation and anaesthesia during a prolonged or complicated rescue. Timescales may lead you to consider constant rate infusion sedation for a long duration when the less predictable single bolus top-up is not reliable enough ( Figures 6 and 7 ). In terms of application, the animal rescue specialist may not consider access to a vein for initial sedation is safe enough or achievable due to the positioning of the animal or nature of entrapment, and, therefore, IM administration may be required to gain initial control. AR3 specialists are aware 4 / 6

5 that sedation regimes can be provided by a variety of routes, the different onset times and peak effects of the different routes. A jabstick or other remote injection technique may be the only safe way of applying the IM injection. We are encouraging vets to have access to a jabstick, and this could also be an important addition to a fire crew s animal rescue kit for use by a vet on scene. Now, I wouldn t expect a fire fighter to comment on which alpha-two or opioid to use or doses, as this is out of his or her skill set. What I would expect is for him or her to explain, in simple terms, how much control is needed for the team to complete extrication during all stages. So, for that purpose, you may hear specialists refer to an animal s controlled state on a scale of one to 10, with 10 being fully anaesthetised. This is known as the Yorkshire scale. To prevent stimulation of the animal during rescue, experience tells us that to apply heavy chemical restraint right from the outset is far more favourable. The old phrase let s give it a bit and see how we go is really not acceptable at most rescues because of the levels of stimulation from so many sources. Confined-space rescues will certainly be problematic and possibly prolonged, which will provide cause for concern. The arena of rescue will also dictate levels of required consciousness for example, when at a road incident, where a more significant public safety issue presents itself. However, the big one for me is lifting ( Figure 8 ). Generally, we will opt for the simplest, lowest-tech method, as this is usually the quickest and safest way for rescuer and casualty. Ninety per cent of rescues in Hampshire will not involve mechanical lifting, as the techniques developed lend themselves to human power, which allows a much more casualty-centred approach, with immediate attention to problems occurring. Mechanical devices do not know when to stop, and animals cannot effectively communicate pain. The chances of accidentally damaging an animal during a rescue are far higher with a winch or crane, compared to using manual techniques. The stimulation is also high and if the drugs regime is too little, then an excited animal is almost inevitable. Quick-release harnesses are essential, but our experience tells us that to be professional and reduce the element of danger to an acceptable level, heavy sedation is required on the scale of one to 10 with 10 being anaesthetised, we often need a nine. The biggest problem with lifting is release. Even an animal that has behaved impeccably up until the point it senses freedom, can place itself, rescuers and onlookers in extreme danger. Having said this, sometimes lifting is the most appropriate and first choice of the animal rescue specialist and, therefore, the right control is imperative. We need uneventful rescues, minimal stimulation and, above all, safe teams and viable animals. 5 / 6

6 Powered by TCPDF ( Reluctance One thing I have picked up from the vet courses we have run since 2008 ( Figure 9 ) is a slight reluctance from some vets to use heavy enough levels of control (Figures 10 to 12 ). Maybe this is because of the extreme nature of the incidents we attend in relation to your routine work. For me, apart from being surrounded by 4,500 New Forest ponies and handling horses during training, my contact with animals is predominantly during desperate situations (or perceived ones). Last year in Hampshire we carried out 300 rescues, with around 80 being large stock, so it is quite a regular part of life. What fills me with confidence is greeting vets who have been on a course ( Figure 9 ), know how significant their role is and have an instinctive knowledge about what I need from them. We have moved on so far in the UK in relation to animal rescue techniques in a very short time, but one thing is evident. In the same way I wouldn t want to attend a road accident without a paramedic, I now wouldn t want to attempt an animal rescue without a large animal veterinarian by my side. I cannot over emphasise just how important his or her role is and, with general acknowledgement of this within the UK Fire and Rescue Service, be prepared for a rise in your calls to this type of incident. We see the two-day rescue course as essential training for large animal vets prepared to assist at emergencies. While Lyndhurst in Hampshire is the current venue, the University of Glasgow s veterinary school is due to be another provider in April. By the end of the year, we hope to be assisting Northamptonshire Fire and Rescue in establishing itself as a venue. Please check out these courses on the BEVA website. But in the meantime, before you get a chance to participate, I hope this has given some indication of the level of knowledge that fire and rescue animal rescue specialists will have. 6 / 6