The following steps can help you protect and stabilize your patients.
1. Contain the horses
If you are the first responder to a barn fire, it's important to know that horses may instinctively run back into a burning
barn, returning to their traditional place of safety, according to Harris. "Once you get them out of the barn, put them in
a safe place far away from the fire so that they are contained and can't attempt to run back in," Harris says.
2. Cool the tissue
Gently rinse burned skin with cool water, says Harris. Using ice or very cold water may further damage already compromised
tissue. Keep in mind that the extent of burn injury to the lungs or skin is usually not obvious for several days.
3. Introduce fluids
"Depending on the extent of injury, these horses can require intensive care, including intravenous fluids, as they can have
extreme fluid shifts within their body," says Harris. "Keeping their cardiovascular system stable is critical."
The fluid loss from the damaged skin and internal lining of the airway may cause the horse to lose protein and experience
cardiovascular shock. "Intravenous fluids to stabilize blood pressure and volume is one of the first treatment regimens,"
Sweeney says. Intravenous fluids typically include balanced electrolytes, hypertonic saline solution, plasma extenders (e.g.,
hetastarch) or even plasma itself—all in an attempt to maintain an animal's fluid volume to support tissue perfusion.
4. Administer oxygen
Administering oxygen is the next important step, "particularly if the lungs are damaged and may have reduced ability to exchange
oxygen," says Sweeney.
Hyperbaric oxygen therapy has been reported to benefit human patients with smoke inhalation. Although its use has been reported
less frequently in lung-compromised horses, it has been used to assist healing of burn-compromised skin graft wounds in horses
(see "A closer look at hyperbaric therapy"). Sites with hyperbaric oxygen units for horses are limited, but among them are
the University of Tennessee Veterinary Medical Center and Hagyard Equine Medical Institute in Lexington, Ky.
A closer look at hyperbaric therapy
5. Mitigate the inflammatory response
"While IV fluids and oxygen are the mainstays of the first response, caregivers can then begin to abrogate the body's severe
inflammatory response using vitamin E and nonsteroidal anti-inflammatory drugs, among others," says Sweeney. Dimethyl sulfoxide
(DMSO) is often used because of its oxygen radical scavenging ability, and pentoxifylline is a commonly used anti-inflammatory
Reactive oxygen species, peroxides and oxygen free radicals mediate a lot of the inflammation in these patients. "That is
the reason for the supplemental vitamin E, which may help as an antioxidant," Sweeney says. A study in sheep found that pretreatment
with vitamin E (1,000 IU alpha-tocopherol) ameliorated the acute lung injury caused by burn and smoke inhalation exposure.4