When emergencies strike, are you ready?
Recognized as a pioneer in small-animal emergency and critical-care medicine, Rebecca Kirby, DVM, Dipl. ACVIM, Dipl. ACVECC, offers advice to practitioners on handling emergency situations. She sat down with DVM Newsmagazine for a recent Q/A session.
Kirby is executive director and director of education of the Animal Emergency Center, a 24-hour emergency and critical-care referral center in Glendale, Wis.
DVM: You have devoted a career to practicing emergency medicine. What intrigues you about the discipline?Kirby: For one, you have to be on your toes. The practice of emergency medicine involves all body systems. It also involves medicine, surgery and anesthesia. It's always exciting. No two days are ever the same. And you can never say that you're bored. What makes it fascinating on a daily basis is everything from the people you meet to the animals you treat.
DVM: What advice would you offer practitioners who are presented with an animal after a life-threatening accident?
Kirby: It all depends on the practitioner's level of comfort in dealing with critical patients. If they're not all that comfortable, I would recommend they call the closest facility and seek advice on what to do before transport.
If the practitioner has a level of comfort in handling the situation, he or she would want to get the animal stable as quickly as possible. Next, they need to get in touch with a specialist. I've found that, because emergency care is so specialized and the whole base of daytime practice is so much broader, the majority of practitioners don't feel as comfortable giving acute life-saving care. Therefore, my best advice: Call an emergency facility. In some instances the nearest one might be an hour away. Often we'll get calls from those facilities on what they should do. We're comfortable fielding those calls and offering some direction.
DVM: When an animal is released from care after an emergency, is wound-care compliance a concern?
Kirby: Yes, wound-care compliance is always a concern. We handle that primarily through the referring veterinarian. Depending on how extensive the case is, the client may bring the animal back to see our specialists for re-checks. If it's something their veterinarian is comfortable doing, such as follow-through, we expect the veterinarian to handle the compliance. In general, I can say that primary-care veterinarians are usually very diligent with compliance.
DVM: What makes up most of your emergency caseload (e.g., trauma, geriatric patients, etc.)?
Kirby: The bulk is going to be metabolic — vomiting, diarrhea, diabetes, if you look at cases over a whole year. Traumas are quite seasonal — from my days at Penn to here. As you might expect, there are not as many hit-by-car incidents in January and February as there are in July and August.
DVM: Are most private practitioners equipped to handle emergencies?
Kirby: It all goes back to the comfort level of the practitioner and how familiar they are with emergency situations. In some cases, they may have all the necessary equipment but have not seen a true emergency for five years. So one's comfort level may not be great. Another practitioner might say, 'I'm totally comfortable with handling emergencies, but we don't have the equipment.' The thing about emergencies that practitioners must realize is that they are very time-consuming. Most veterinarians have a very packed schedule. Although in many cases they may be quite capable, they simply may not have time.
DVM: What advice could you offer general practitioners about referral and transport of animals after emergencies?
Kirby: Whenever possible, call and see what the emergency facility suggests prior to transfer. The primary goal is to get them here fast. They may have the opportunity to save a life if they give the animal some ethanol in a case where it has ingested antifreeze. See if there's anything they can do quickly, prior to transport.