If your dog gets nipped at the park by another dog, you might be able to wait a bit in the vet’s office before getting stitches. But what if he gets hit by a car? A severely injured animal needs care fast, but usually doesn’t have as many options as an injured human. Now, some veterinarians are looking to change that.
The Boston Marathon bombings highlighted how invaluable tightly coordinated hospitals and trauma care procedures are. Thanks to well-trained teams of doctors and an efficient disaster plan that made space for a sudden influx of patients, all those wounded in the blast are expected to survive. Modern medicine’s advantages aren’t just technological – they’re also structural. The advent of trauma centers, where high-level specialists and equipment are available 24 hours a day, seven days a week, was a big step forward.
“You may be airlifted past a hospital to go to one farther away,” Tufts University emergency veterinarian Armelle de Laforcade said in a phone interview. “But even if you have to go further to get to the Level 1 trauma center, studies suggest your odds of survival increase because that place has the expertise.”
Veterinarians will likely never see mass casualties as severe as the Boston bombings or the 9/11 attacks, but extreme cases do crop up. De Laforcade recalls a story from a colleague about a house fire in Pennsylvania that sent about 20 cats to the hospital with burns and smoke inhalation. Many local veterinary offices can’t handle that kind of sudden influx, or see an animal with severe trauma late at night – what's a distraught pet owner to do?
Recognizing this gap, the American College of Veterinary Emergency and Critical Care has embarked on an ambitious pilot program to develop the nation’s first network of veterinary trauma centers, modeled after the human centers evaluated by the American College of Surgeons.
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On Tuesday, nine veterinary hospitals and clinics were tapped by the ACVECC to become Veterinary Trauma Centers. The list includes Tufts’ Foster Hospital for small animals; North Carolina State University’s College of Veterinary Medicine; and the Southern California Veterinary Specialty Hospital in Irvine, Calif. It also includes the University of Minnesota's Veterinary Medical Center, which launched the first animal trauma center in the U.S. in 2011.
Finding the right places for the pilot program was no easy task, according to de Laforcade, who’s also executive secretary of the ACVECC.
“The requirements are hard to meet — you have to have access to surgery and a variety of specialties seven days a week,” she said. Not all veterinary offices have an anesthesiologist available at 3 a.m. on a Sunday.
The selected institutions have to keep track of their trauma cases and enter them into a registry that other veterinarians can learn from. Currently, the veterinary medical literature on trauma is a bit thin, according to de Laforcade.
“Most of us practice based on experience,” she said. “My clinical impression is that dogs with internal bleeding after being hit by a car do fine without surgery, but we need to study that.”
After a year, the ACVECC and the institutions will evaluate their experiences, and possibly name some new Level 1 veterinary trauma centers and other lower-level trauma centers.
One thing that complicates setting up a veterinary trauma center network is the lack of first responders. An injured human is picked up in an ambulance and worked on by EMTs on the way to the hospital, and the first responders play a big role in determining who needs to get sent to a trauma center and who doesn’t need that level of care.
Because animal ambulances aren’t all that common, owner education will be key, de Laforcade said.
“If I’m an emergency vet and work in a small clinic, and I get call from an owner who says ‘I’m on my way, a dog just got hit by a car, I can see his intestines,’ that vet should say ‘you need to go to such and such hospital.’”