Developing a Plan for Emergency Medical Treatment

Indepth Equine Podiatry Symposium Notes Written and presented January 2009 by R.F. (Ric) Redden, DVM

If you were to be in a car accident, have a heart attack or suffer a severe injury most anywhere in America, a trained, competent EMT unit will come to your assistance within moments. Regardless of severity or type of injury, EMTs have a good plan in place, adequate training to deal with the problem and a well equipped unit. Their mission is to administer efficient emergency treatment and deliver the patient to the closest hospital for evaluation and appropriate treatment. This incredibly valuable service is state of the art for humans, but severely lacking in equine medicine. Veterinary medicine desperately needs an equine emergency medical team, well trained and equipped to deal with typical equine emergencies, whether they occur at televised sporting events, on the interstate or in the barn.

Unfortunately, the need for such a service has never been taken very seriously. Consequently even at top level events such as the Kentucky Derby, veterinarians hired to be there in case of an emergency are often not trained for emergency scenarios, are poorly equipped to physically deal with most catastrophic breakdowns and have little or no direct experience with orthopedic surgery or knowledge of potential options that may exist for horse and owner. As a result horses are often euthanized immediately, sometimes in full view of the public, without the benefit of efficient emergency medical treatment and a thorough review of available options. The goal of any emergency medical treatment should not be to make a life or death decision, but to provide emergency aid and transport the horse to a location where a thorough exam can be performed by surgeons who are experienced with catastrophic injuries and the options available to them.

Current Emergency Practices

When a horse goes down on the racetrack or other sporting event, the typical scenario unfolds like this: the track or on call vet gets to the horse's side within minutes along with an ambulance that is capable of transporting most any injury once the limb or limbs are stabilized. The life of the animal rests solely in the hands of the vet who for all practical purposes is a well respected veterinarian, but has little or no experience providing adequate emergency care. Without experience or knowledge of state of the art surgical procedures or amputation, the availability of such options would never cross the minds of those attending a fallen athlete. Oftentimes the horse is euthanized on the spot, or he may be fitted with a Kimzey splint, loaded onto the ambulance and far too often euthanized on the backside, out of sight of the public. In some cases the horse may be headed to surgery only to be euthanized en route when the ambulance team believes the situation to be hopeless, a conclusion that may be supported by other surgeons who get a description of the injury over the phone.

It is important to understand that everyone involved is doing the best they can, and making decisions they believe to be in the best interest of the horse. We simply do not have a well established plan that can be quickly executed in a timely fashion for all injuries, nor a proper training program to prepare veterinarians and other officials for these catastrophic injuries. To do a better job we must be better prepared.

Pain as a Reason for Euthanasia

The most common reason stated for immediately euthanizing an injured horse is that he is suffering inhumanely without hope of recovery. Owners have no choice but to agree with the conclusion of the professionals. But let's closely analyze this statement. The typical pain indicators used by veterinarians are heart rate and respiration. But a horse that has just run the race of his life or competed in a strenuous event will appear to be in respiratory distress as he pulls up, even when not injured. His cardiovascular system has been maxed out, and it will be several minutes at best before he can take a deep breath and not look as if he just saw a ghost. The horse with the broken leg looks essentially the same, so the usual indicators cannot be relied on. Pain is often confused with physical exertion and fear, which is caused when the horse can't find the limb to support them. This causes anxiety and even fear if he can't get away from a flailing limb.

In my experience, all catastrophic cases I have treated became quite comfortable for hours to days after being fitted with a cast that stacked the bones and allowed them to load the limb. Was it painful? Strangely enough it was not for any of my former cases. Even when the limb was completely detached they would stand on the end of the stump, dispensing the thought that they should be euthanized as quickly as possible due to inhumane suffering. Therefore, pain is apparently not a good reason to immediately euthanize a horse before a proper exam has been performed and all the options considered.

Alternative Options

Last May, the filly Eight Belles was euthanized in front of millions of television viewers within moments of her catastrophic breakdown due to one badly broken lower limb and one suspensory apparatus breakdown. Either or both had surgical options that potentially could have offered her a quality life and given her owner, trainer, caretaker and farrier a chance to repay her for her brilliant effort, speed and courage as a super race filly, but the premature decision to euthanize her precluded any options from being exercised. I'm certain the fact that she injured both limbs played a role in the quick decision to euthanize her, but was this in the best interest of the filly, owner, trainer and industry? I do think it could have been a more acceptable situation had she received state of the art EMT and been moved to a local surgical facility for a thorough exam, review of the options and consideration of short and long term goals. While it still might have been most feasible to euthanize her following this preconceived EMT protocol, at this point euthanasia would at least be justified as all options would have been reviewed, discussed with the owner and the decision made accordingly.