I recently had to stop on the side of the road to help out a family whose trailer had rolled over, trapping their horse inside. By the time I'd got past the queue of stationary holiday traffic, they'd already done the first aid basics, and it was great to see how well they'd coped. However, it made me think about what owners can do in emergency situations for shock, trauma and blood loss in horses.
[caption id="attachment_2528" align="alignright" width="275" caption="Not an emergency! I like to use ketchup and a good natured pony for Pony Club First Aid Training. If you want to know more, contact your vet - many practices run great first aid training courses for clients"][/caption]
In serious accidents, the most common injuries are probably bruises and lacerations - jagged cuts, caused by broken metal and debris cutting through the skin. However, puncture wounds and broken bones are also not uncommon, and it can be really difficult to determine what's a mild graze, and what's a deep, dangerous puncture wound in the field, let alone by the side of a busy road! If you're faced with a real emergency like this, remember three things - first, make sure you and anyone else around are not at risk. Second, get someone to call a vet and any other emergency services (e.g. the police to close the road, the fire brigade to cut horses and people out of the wreckage, and of course ambulances for any human casualties). Finally, assess the horse(s) and do what first aid you can at the scene.
When assessing the injured horse, I find it really useful to look at it in two stages - the Primary and Secondary surveys. The Primary Survey is designed to find injuries that are immediately life-threatening, and need addressing NOW.
This would include serious fractures, significant bleeding, breathing difficulties and any neurological disorders (half a tonne of fitting horse is a danger to itself and everything within ten to twenty feet).
I like to start at the nose and work rapidly to the tail, running my hands over the horse, looking for wounds or areas that don't feel right, and assessing how the horse responds. If you find a wound that's gushing blood, it needs to be stopped; a "grating" feeling under your hands when you feel along a canon bone often indicates a fracture, which must be stabilised.
In an emergency situation, the key is to stabilise the horse until it can be moved to a safer location for further workup, and it is vital to be quick, but also smart. Don't get so bogged down with relatively minor injuries that you miss somethng life-threatening! A wound that that oozes can be left until you've finished the primary survey; one that's running with dark blood needs seeing to, one that's spurting may kill the horse before you've finished unless you address it immediately.
To stop bleeding, apply pressure - even a major arterial bleed can be slowed, if not stopped, by a padded up numnah pushed into the wound by one or two people (ideally two, so you can swap over when you start to get tired). One of my horses was staked on a hack many years ago, when a piece of wood flicked up into his groin and tore the femoral artery. His life was saved by two of the people out riding with him, who pulled off their jackets and forced it into the wound, slowing the bleeding until a vet could arrive to pack it closed. The major risk areas for bleeding are the groin and neck, where major blood vessels run close to the surface and can easily be damaged.
It is really important when doing a primary survey to check for signs of shock - horses are incredibly tough, but they can still suffer internal bleeding and blood loss, even if nothing's obvious, so roll up the horse's lip and check the colour of his gums. Then press on them so they go white, and time how long it takes for the colour to return. A normal, healthy horse will have nice, pink gums and a capilliary refill time of less than 2 seconds. White or very pale gums indicate shock, probably from blood loss, as can a prolonged refill time, while blue gums may indicate heart problems.
A horse that is behaving abnormally need to be treated with extreme caution - concussion is uncommon, but it does happen, and is often more dangerous to the people around than it is to the horse! There's nothing you as an owner can do about it, so make sure you're ready to jump clear if needed.
A suspected fracture is a nightmare for any horse owner; however, it's worth remembering that some fractures in some horses can be repaired surgically. The most effective form of first aid is to immobilise the limb with a thick bandage and/or splints - however, unless you know exactly what to do, don't try to apply splints without a vet's instructions. Some fractures, sadly, are irreparable - I once got called to a horse that had fallen over trotting across its field, the person who called said it had a "small cut". When I arrived, his hock was pointing the wrong way round, and sadly I had to tell the owner that there was nothing that I could do, except put him down to remove the suffering.
Once the primary survey is completed, and everything addressed as best you can, you need to consider moving the horse to safety. If possible, wait for the vet to arrive first, but this may not be possible if you are in an unsafe or inaccessible location. Remember, a horse with anything significant on the Primary Survey isn't fit to be moved anywhere until it has received veterinary treatment! In the case of my roadside horse, we were able to borrow a box to move him off the road to a nearby restaurant car park (I know, not perfect, but we had to improvise at the time!).
As soon as you've got him to a safe place, it's time to carry out a Secondary Survey. When they arrive, the vet will probably repeat what you're doing - but if you've already carried out a survey, you can bring anything important to their attention, speeding up treatment.
The Secondary Survey is a full examination of the horse, checking every lump or bump, scrape or cut for further significance. If a vet is doing it, we'll often clean up wounds and probe them for depth as we go along; however, please don't do this yourself! We need to see everything as far as possible as it is if we're to properly assess it. We'll always be grateful, though, if you can tell us what there is and where - e.g. "three grazes and a cut on the left flank, swelling over the right eye and a deeper wound on the right hock" allows us to prioritise the swollen eye and the deep wound, before we check over the grazes.
Now is the time to apply pressure to any oozing or dribbling wounds, to check the feet (I've seen otherwise apparently normal horses prove to have deep cuts in their soles from climbing over broken metal to escape - and immediately after the incident, appear completely sound under the influence of adrenaline). Periodically, recheck the gums to make sure that the horse isn't becoming "shocky".
Remember, horses are almost unbelievably tough - it is amazing what they can survive. My horse who got staked lost about half his total blood volume, but he made a complete recovery and lived for another ten years in excellent health; and the horse in the road accident, despite being thrown across the road, appears to have got away with cuts and bruises.
So, even if it looks a disaster, it's always worth trying first aid until a vet tells you otherwise, because it really can save a horse's life.
Check with your vet to find out if they run first aid courses so you can be prepared.
One recent morning, in the middle of the snowy weather, it was a real struggle to get to work. The main roads were open and gritted, but the side roads were hazardous with patches of snow and ice. After a difficult journey, I was surprised to find that the nurse was already checking in a patient. A motorist had found a seriously injured fox which had been hit by a car.
He hadn’t seen the accident happen, so he did not know how long the fox had been lying by the road, and we can only hope that no-one was injured in the accident. All the cars in front of him had pulled out round the fox, but he had stopped. On finding the fox was still alive, he picked it up and put it in his boot and brought it to the surgery.
Great care should be used if handling an injured wild animal because, understandably, they are liable to panic and to bite if frightened and in pain, and will not understand that you are trying to help them. In most cases it is better to telephone for advice first from either your local veterinary surgery or the RSPCA. If the animal is to be moved, it is much safer with the right protective clothing and equipment. However, this fox offered no resistance.
We examined the fox and found it was a young adult male which was in reasonable condition before the accident. Unfortunately it was barely conscious and had at least one hip fracture. A more detailed examination and x-rays would be needed to find out what other injuries it had, but as our fox was not yet well enough he was given pain relief by injection and placed in a warm, quiet, kennel in a darkened room.
Unfortunately this particular story does not have a happy ending because our fox died later in the morning. However, I am glad that he was not left to suffer and to freeze slowly to death by the side of the road. If he had survived the initial trauma of the accident, decisions about further treatment would have been made based on what was in his best interests, including whether he could make a successful return to the wild after a period of recovery.
Different veterinary practices may have different policies on the treatment of wildlife. Some may offer treatment in the practice, while others may refer animals to nearby treatment centres such as the RSPCA or other charities, depending on the facilities in the area. Often there are local people known to practices who may take in particular types of wildlife for rehabilitation such as injured birds, hedgehogs, badgers etc. In coastal areas there are specialist charities which deal with injured or stranded dolphins, seals and whales, and with oiled birds.
Some wild animals or birds which appear to be in difficulties may be best left where they are rather than being moved. Fledgling birds in particular are often still under the watchful eye of a parent even if they appear to be abandoned, so if you find one and are not sure what to do, try to get some telephone advice before moving or handling it.
If you are worried that your dog or cat may have been hit by a car, contact your vet or use our Interactive Pet Symptom Guide for advice on what to do next.
[caption id="attachment_211" align="alignright" width="300" caption="Joe the TV vet performs difficult pelvis surgery on a cat."][/caption]
Cats lead dangerous lives, dodging traffic, fighting over territory and being chased by dogs, so it is not surprising that we vets spend a reasonable proportion of our working lives patching up the results of their adventures. Whether it’s repairing serious damage caused by road traffic accidents, or patching up less severe injuries from bite wounds, cats that have been in the wars certainly keep us vets busy everyday of the week.
Most of the time these injuries are not too severe – cat bites, and bruises and strains from over-energetic leaping and climbing usually heal well and require nothing much more than antibiotics and painkillers to help the cat recover. Sometimes, however, cats are less fortunate and that is when things get much more serious and the outcomes can be less positive. Road traffic accidents are by far and away the main cause of these more serious injuries, and repairing the damage that a tonne of car can do to 5 kilos of fragile cat can be a very involved and difficult process.
Thankfully there are now many highly specialised vets who can offer amazingly hi-tech operations and treatments that can quite literally put broken cats back together. A friend of mine from university, Toby Gemmill, is now an eminent orthopaedic surgeon in Birmingham and I truly believe that provided the pet’s head and chest are in one piece, there’s not much he couldn’t put back together successfully. Using all manner of techniques, including external fixators (metal frames that hold shattered legs back together from the outside rather than the inside), bone grafts and much more, vets like Toby can work wonders on even the most severely injured animals.
There is a problem though, and that’s the age-old issue of money. The state-of-the-art treatments that Toby and other orthopaedic vets carry out are understandably expensive with costs often reaching many thousands of pounds. This puts them out of the reach of many pet owners, unless of course they have pet insurance, leaving them faced with some very difficult decisions – should they try to beg, borrow or steal the money required for a potentially life-saving operation? Or should they simply call it a day and opt to have their pet put to sleep? These are terrible decisions to have to make, and it is one of the reasons why vets like myself, who are general practitioners rather than specialists, end up tackling complex operations that are well outside our comfort zone.
Take Portia the cat underneath the drapes in this picture for example. She was hit by a car and suffered severe injuries to her pelvis and back legs, and required a major orthopaedic operation if she was going to have any chance of surviving. However, her owner had no pet insurance and could not afford to consider visiting a specialist – but she was desperate to try and save her beloved cat, so I offered to try my best and have a go myself.
The operation Portia required was something I have attempted before, but it really is not something I’m that comfortable with, so it was a very long and stressful operation. The end result was pretty good – definitely not as good as if Toby had done the procedure, but a whole lot better than nothing and I think there’s every chance that she will pull through as a result. In fact it’s me that I’m more worried about – I need a stiff drink and a lie down to recover from the stress!
Joe Inglis BVSc MRCVS is the vet for the One Show, This Morning and BBC Breakfast. He runs his own line of natural pet food called Pet's Kitchen