para veterinary medic?

[Veneficus]

So at work today an interesting question was raised at lunch.

One of the instructors (a paramedic) related to the rest of us his service just instituted protocols for the treatment of law enforcement canine units. These treatments included ALS measures of intubation, IV access, and medication administration for the purpose of resuscitating a wounded K9. It did not include euthanasia nor transport of the animal. Nor did it stipulate who to contact for direction.

He raised several legal questions with a medical director (Emergency physician) of another area who was an adjunct instructor. Perhaps the most important is:

Under what license are you performing?

The medical treatment of an animal requires a license to practice veterinary medicine as far as any of us know. Can a veterinarian act as medical control for a paramedic? What additional education is required or even recognized that would allow a paramedic to perform treatment of an animal?

Various species have different physiologic norms from homosapiens. They have different reaction to medication.

Once you have the beast intubated, an IV started, and medication or fluid administered, where are you transporting to? Even if the ED takes exception and lets you in, an ICU certainly would not.

Is there a animal level I trauma center open with available staff 24/7 or even an emergency animal clinic? Can you justify taking a unit out of service to transport an animal and clean up?

Are you simply prolonging the animal's suffering?

Remember, we are not talking about giving O2, or managing pain. we are talking about full invasive procedures and treatments with all the tools a paramedic has at their disposal.

What are your thoughts on this?

 

[firetender]

Puttin' on the Dog!

We've done so well with our save rate for humans, why would we want to depress our loyal four-legged Brethren?

If a Medic is assigned to do Police duty, and part of that duty is to work up their animals, then that's what you do. In many areas, Police Dogs are Officers of the Law. DON'T however unless you feel totally confidant with the anatomy and procedures. (Where is that damn antecubital?)

A life is a life. We all wish to live. If there's time and it has been examined and found to be acceptable under specified circumstances, then I see no reason for NOT treating an animal to relieve pain and suffering and deformity and death. It needs be a conscious choice that in no way interferes with the potential to save a human life, however.

That might involve the jusrisdiction to "drop what you're doing" to respond to another, human, call. Therein lies the tricky part.

 

[medicdan]

There is training available as a VEMT (although I cant find info when I just googled quickly). I know there was an ethical discussion a few years ago in the Boston area re: whether a Vet ambulance should be allowed to use L&S. Does that change if a Police K9 is aboard? I don't know. ICUs do exist at veterinary hospitals, and I know the large hospital in Boston has an ER of sorts.
Unless you have specific training, protocols, and proper infrastructure, I would steer away from treating animals. (How would you tell your hospital pharmacy when you needed to restock your Morphine or Versed after using it on a dog?)

 

[alphatrauma]

Intriguing topic but...

Is this something we REALLY need?

 

[usalsfyre]

How would you tell your hospital pharmacy when you needed to restock your Morphine or Versed after using it on a dog?

No sir, no last name just Fido. F....I....D.....

 

[phideux]

One of the depts. I've been riding with has all sorts of dog and cat resuscitation stuff under the seat. They dog and cat O2 masks make great blow by masks for kids too.B)

 

[FF-EMT Diver]

Very interesting and certainly a plausible and good idea I think.

There is a LOT of time and money put into a Law dog and IMHO should be treated the same as an officer, now I don't wanna run all over town code 3 for Fido and Fluffy hacking up grass and hairballs but for the Law k9's among us I say it's a really good idea and one that I will for sure be looking into.

 

[MrBrown]

I have heard of something like this happening once or twice here, if memory serves I remember HEMS being called once to take a wounded Police dog to the vet.

 

[MasterIntubator]

Being of both fields, I can tell you there are a lot of similarities. Working in a "Trauma center" for animals that is 24/7 with full surgical, CT scan, radiology, full in house lab, internists, cardiologist specialists in every topic and even a chemo dept( although they do not use the same level designations as human hospitals )... we have seen our share of service canines come in.

Now.... when it comes to para-vet medicine, that typically falls under a licensed veterinary technician. And they trained and empowered by staff veterinarians to do all the proceedures that typical paramedics do. In addition, they are multi-cross trained as well. A single well trained LVT can start treatments ( protocols ), X-ray, IV, Intubate, Emergency meds, anesthesiology, lab work, blood gases, central lines and so forth. The veterinarian generally directs until it is time for various invasive proceedures ( kinda like nurses vs docs in the ED ).

There are programs that teach paramedics how to do basic treatments, and some departments have standing orders/protocols which the human medical director and the veterinarian have a set plan for said emergencies in service animals, which can be involving a person who has both the NREMTP certs and LVT licensure.

And a well trained LVT will know the species differences as well as a multitude of drugs dosing info. ( which, most all of the drugs in vet useage is the same.... propofol, ketamine, valium, D50, EPI, and the list goes on.... General anesthesia is the same as well.... Halothane, aerane, etc etc )

A 24/7 animal hospital with critical care capability is a FAR FAR cry from a regular veterinary office. You would be comparing the pediatrics office vs a childrens hospital.

Been there, done it and do it.

Take care and be safe

 

[ExpatMedic0]

Something like that is already in place pre-hospital. Although they are more EMT-I level Emergency Animal Medical Technician's. http://www.youtube.com/watch?v=t4uvIr51UKE&feature=player_embedded

http://www.azhumane.org/artman2/publish/programs/rescue.shtml

 

[mcdonl]

CEH's....

Even though I have two cats and two dogs, I am not a big animal fan... or maybe BECAUSE I have two cats and two dogs... anyway... I received an email from one of my instructors regarding a PET CPR class, and that you would get CEH's from attending the class.

I thought that was odd. Actually, at first I thought PET was an acronym for something else and I made a total douche out of myself but that is neither here nor there.

 

[rjddvm]

I'm a veterinarian who is just about done with paramedic school.

Treating an animal with IVs, medications, intubation, etc. is practicing veterinary medicine. In many states licensed/certified veterinary technicians can do those things if a veterinarian is on the premises and authorizes them.

An MD medical control is not legally able to allow that, since MDs are not licensed to practice on animals, just as my veterinary license does not allow me to practice on humans. So if an ambulance service is going to have official protocols about treating animals, they ought to have a veterinary medical director who can determine protocols and serve as veterinary medical control. Unless there is some exception under state law about paramedics treating law enforcement animals, and there may be in some states, I don't know. Yes, a lot of the same drugs are used, but some drugs that work well in humans don't work well in animals, and vice versa, and the doses are more weight-based. And some are toxic--give one Tylenol to a cat, and it will die of liver failure.

Even oxygen is considered a "drug" in that you have to have a prescription for it--but I can't imagine anyone filing a complaint against a firefighter who puts an oxygen mask on Fluffy after pulling her out of a burning home.

In practical terms, if a paramedic intubates an injured law enforcement dog and ventilates it, or places an IV catheter and runs fluids, I would hope that no one would file a "practicing veterinary medicine without a license" complaint, and if someone did, I would hope that no action would be taken.

But you never know what someone might do, and we've all worked too hard for our various licenses to risk them unnecessarily. So if caring for law enforcement animals is going to be part of the official protocols, better to have some sort of veterinary medical control, unless state law allows exceptions for police dogs etc. I'm not sure which states, if any, do.

Most cities now have 24-hour veterinary emergency clinics where animals can be taken. Whether the MD medical control would allow transport of an injured police dog in the ambulance from the scene to the e-clinic would depend on the service and the MD, I suppose. The dog would probably be cleaner than many of the human patients!

One of my friends tried to save an FBI dog who was shot; the cops cleared an LZ and the helicopter actually landed on the highway in front of the clinic. Unfortunately he could not be saved.

BTW, you can make an effective muzzle out of roll gauze or Kerlix or a cravat. Just wrap it around the muzzle a couple of times and tie it behind the ears; the dog should still be able to breathe through his nose (assuming no trauma to that area, of course). To secure an ET tube, tie the gauze around the tube and then tie it behind the ears. Tape won't work well, obviously, because of the fur, and you're not going to get far shaving with those little razors in the EKG supplies.

 

[rjddvm]

Someone pointed out something I didn't think to address...how you could have veterinary medical control for personnel who don't hold veterinary-related licenses, like certified veterinary technician, since things like intubating animals can't legally be performed by just anyone.

So I wonder if a legal exception could be made for licensed paramedics to be trained by a veterinarian in how to put IVs and ETTs into animals, restricting it to law enforcement animals injured in the field with paramedics already on scene, and potentially animals which are removed from fires. Just to stabilize them until they can be taken to a veterinarian.

It involves different positioning and vein selection, and restraint techniques, but could be taught fairly quickly to people like paramedics who already have a good knowledge base. And you wouldn't need to do the entire veterinary technician education, since paramedics don't need to know how to clean teeth, monitor anesthesia, and do the many other things vet techs do!

We vets tend to be very territorial about people practicing vet med without a license--there are a lot of MDs and RNs out there who seem to think that they are qualified to treat their own animals--but I would hope not too many vets would object to this type of emergency field medicine conducted by licensed, specially-trained paramedics, since it could make the difference between life and death, and law enforcement dogs are very highly thought of by the veterinary community.

Of course this whole thing would involve legislation...

 

[Melclin]

Weird.

Some paramedics a while back euthanased a dog who latched onto someone and wouldn't let go. Pancuronium, Fentanyl and Midazolam so I've heard...no tube though h34r:

 

[Melclin]

Special Animal EMS gear.

Now I'm quite interested in the topic..

http://www2.tbo.com/content/2009/mar/27/cat-gets-one-its-lives-back-thanks-gift-firefighte/


(MODs: Merge with the previous post? I just missed the window for editing.)

 

[MasterIntubator]

......
We vets tend to be very territorial about people practicing vet med without a license--there are a lot of MDs and RNs out there who seem to think that they are qualified to treat their own animals--but I would hope not too many vets would object to this type of emergency field medicine conducted by licensed, specially-trained paramedics............

In our area, the emergency veterinarians are not territorial at all, and are really supportive of the idea, and have been since the 80's. Now, regular practice vets... that is another story. A few tend to be very territorial, as the emergency hospital is shareholder funded and the board frowns on emergency clinics doing any routine procedures that have no impact/or need for during an emergency ( like vaccine admin, etc ), but that has eased up quite a bit in the late 90s and we all work together much better ( a lot of old school ways that no one wants to update ). All of our Vet techs are very supportive of self practical care by the layperson as well... which if the owners are so inclined and ask us, they can order vaccs, etc thru Jeffers or so... and we will teach them how to administer them and provide some of their basic care at home ( and I know that is SUCH a touchy subject amongst vets, its profit loosing stuff, and each State law is different as well governing that )... That is client education.
( much more than anyone really needs to know in this thread.... and not dissing any DVMs out there, just pointing out that there are differences, and much flexibility in the topic at hand. Many are just scared to touch it with a 10 foot pole. AAHA leaves many grey areas and each state and juristiction has them too)


Woof...

 

[rjddvm]

Good points, definitely worth discussing...I do think that most vets would be on board with properly-trained paramedics stabilizing injured law enforcement animals in the field long enough to get to an e-clinic; my friend who tried to save the FBI dog wouldn't have had a problem with it.

By "territorial" I was referring more to RN/MD clients getting drugs, not vaccines, on their own and treating their pets without consulting a vet at all. Like giving their cat Tylenol for pain and then wondering why it's turning yellow, or treating a respiratory infection with Augmentin they got from work.

Anyhoo...

 

[fma08]

Last I checked, we didn't cover canine anatomy in paramedic school. I wouldn't feel comfortable doing anything past providing blow-by oxygen.

 

[MasterIntubator]

DVM... I hear you loud an clear on that one.