Clarification\advice re OOH visit to horse when SA vet please?

Re: Clarification\advice re OOH visit to horse when SA vet please?

An On MRCVS — Wed, 09 Apr 2014 18:41:56 GMT

Thank you for your opinions everyone, I feel less guilty about the whole thing although I would have been pretty rubbish if I had attended (the police controller sounded pissed when I tried to explain we weren't an equine practice!)

Re: Clarification\advice re OOH visit to horse when SA vet please?

ChrisBVSc — Tue, 08 Apr 2014 18:25:35 GMT

[quote user="Gillian Mostyn"]

Whilst our personal safety and doing what is best for the animal always come first (and that obviously includes getting someone there who actually knows what they're doing), using insurance and litigation as excuses for not helping is a bit lame.

[/quote]

I'm very against the blame culture, but these days I'd take it as quite a serious reason not to attend if you're not confident in these scenarios or fully covered - as far as I'm aware the veterinary surgeon is responsible for the safety of everyone present in situations like this, not just themselves and the animal, so I'd be very reluctant to attend an equine emergency unless there was absolutely no other option e.g. it happened just outside the practice, in which case I'd do what I could but call for an equine vet asap.

Anyway the original issue was do you need to brush up on equine knowledge just incase a call like this comes in, and I think the answer to that is no - I think you'd be very unlucky to be in a situation where there wasn't access to a nearby equine or large animal vet, and I can't see how you'd ever be in trouble for saying "sorry I don't deal with horses but I can put you in contact with someone who does."

Re: Clarification\advice re OOH visit to horse when SA vet please?

J G Wray — Tue, 08 Apr 2014 18:13:52 GMT

[quote user="Rebecca Benge"]Unfortunately at uni, it seemed pot luck as to who got to place an IV catheter in a horse on their anaesthesia rotation and who didn't -[/quote]

In November 1978 ( a few weeks in to our First Year) Chris Ridge and I had just finished our half day at the field station and were hanging around the stable block. Along came a very jolly man in overalls carrying a bucket and with a peremptory "Students?" - we nodded - hauled us into his ward round. We had each done half a dozen iv and catheter placements in the next hour and a half. We had no idea it was Prof Gerring until we asked a stable man. He had no entourage. I liked him.

Ah the Good Old Days, 70 in a year, plenty of work all round.

JGW

Re: Clarification\advice re OOH visit to horse when SA vet please?

Rebecca MacMillan — Tue, 08 Apr 2014 18:07:39 GMT

You obviously just looked like you were the catheter competent type!

Re: Clarification\advice re OOH visit to horse when SA vet please?

Cat Henstridge — Tue, 08 Apr 2014 17:43:19 GMT

[quote user="Rebecca Benge"]

Indeed, always a risk, and it certainly would have been preferable to make sure I was comfortable with my IV technique before having an emergency situation!

Unfortunately at uni, it seemed pot luck as to who got to place an IV catheter in a horse on their anaesthesia rotation and who didn't - depending on what case load there was on that particular week. Other than that I don't remember many opportunities to have a go at IV, unless it was just me... (maybe I didn't push myself forward enough!)

[/quote]

I once got an A for catheter placement on a rotation and I hadn't done one at all!

Re: Clarification\advice re OOH visit to horse when SA vet please?

Rebecca MacMillan — Tue, 08 Apr 2014 17:21:37 GMT

[quote user="Wren"]

[quote user="Rebecca Benge"]

... not that hitting a horse jugular is that tricky I guess.

[/quote]

Well it's not.... Except that pretty much every equine vet I know has at least once given an intra-carotid injection by mistake at some point in their career.I suspect the chance of doing that increase when the horse is upside-down or contorted into an odd position.

I will now make sure that the 4th year student with me this fortnight does some IV injecting while she's here, even if I have to volunteer one of my own horses!

[/quote]

Indeed, always a risk, and it certainly would have been preferable to make sure I was comfortable with my IV technique before having an emergency situation!

Re: Clarification\advice re OOH visit to horse when SA vet please?

Matt Hilary — Tue, 08 Apr 2014 15:59:25 GMT

[quote user="J G Wray"]

As far as advice goes, why not contact VDS and if you do come into contact with RCVS, do emails and retain all correspondence?

[/quote]

Unreasonable delay?

Re: Clarification\advice re OOH visit to horse when SA vet please?

Thomas Johnson — Tue, 08 Apr 2014 15:06:07 GMT

As somone who has worked in mixed practice, and has helped the fire brigade get a pony out of the ditch, but for the past 3 years has only done small animal work I wouldn't have gone unless there was no other option. I would have helped put them in touch with the nearest equine, or failing that farm animal, practice.

If I had only been 5 minutes away rather than an hour, I would have done the same, but if the equine vet couldn't get there straight away I would have gone as well to see if there was anything I could do to help until they arrived.

Re: Clarification\advice re OOH visit to horse when SA vet please?

Gillian Mostyn — Tue, 08 Apr 2014 13:34:08 GMT

While I agree that a small animal vets shouldn't see a species they are unfamiliar with unless the circumstances are dire, I don't think we can remove ourselves entirely from any responsibility at all. We have all trained in all species for good reason - so that we can help all animals! Whilst our personal safety and doing what is best for the animal always come first (and that obviously includes getting someone there who actually knows what they're doing), using insurance and litigation as excuses for not helping is a bit lame. None of us are doctors but surely we'd all offer to help a person in an emergency until better trained help arrived?

Re: Clarification\advice re OOH visit to horse when SA vet please?

ChrisBVSc — Tue, 08 Apr 2014 12:57:27 GMT

Small animal vet here, as far as I'm concerned once I've put the fire brigade/police/owner or whoever in contact with a suitable equine (or at least farm) vet, then I've achieved my duty of care requirements i.e. I've done what is best for the animal that was (very briefly) committed to my care (if it ever was in the first place). I did quite a lot of equine work during my first 2 years in practice, but that was a few years ago now and I certainly wouldn't feel confident attending an equine emergency today, besides not having suitable drugs & equipment available in small animal practice to do a safe or satisfactory job. Plus I highly doubt I'd have any suitable insurance cover if things went wrong. Nobody would worry about refusing to see a lion at a zoo, you'd just refer them on to someone suitable - I don't see how this is any different.

Re: Clarification\advice re OOH visit to horse when SA vet please?

Wren — Tue, 08 Apr 2014 08:55:52 GMT

[quote user="Rebecca Benge"]

... not that hitting a horse jugular is that tricky I guess.

[/quote]

I will now make sure that the 4th year student with me this fortnight does some IV injecting while she's here, even if I have to volunteer one of my own horses!

Re: Clarification\advice re OOH visit to horse when SA vet please?

Glenn Hodgson — Mon, 07 Apr 2014 20:19:59 GMT

I would have reasonably refused. Enough of us said it now for you not to have Been negligent? It would be unreasonable to have a distressed animal waiting for 1 hour for someone who Can't really help it!

I'd forget about it after passing on the contact details of a nearby equine vet (I'd tell them to call back if stuck though) I would also expect equine vets to point injured dogs our way!

Re: Clarification\advice re OOH visit to horse when SA vet please?

Hannah Wynne Richards — Mon, 07 Apr 2014 18:19:47 GMT

Well done Rebecca - though it's terribly sad you hadn't done an equine IV at uni.That was one of the tasks listed in our "green books" which we had to be signed up as competant at before we were even allowed to sit finals.

Wynne

Re: Clarification\advice re OOH visit to horse when SA vet please?

Rebecca MacMillan — Mon, 07 Apr 2014 17:56:41 GMT

[quote user="Wren"]

I went to a horse stuck in a drainage *** last week and used romifidine, torb, ketamine, flunixin, dex and antibiotics. Not only do you need to be competent in field anaesthesia (you might not need to use it but in a lot of these situations you do), you also need to be confident in directing people, taking charge and knowing where best to place ropes/slings and direct manpower. Sometimes you have to put your personal safety at risk to administer IV drugs in a distressed upside-down horse in several feet of water.There is also a lot of skill in knowing when a let a horse make an attempt to stand and when it is better to try to keep it down for a bit longer.

I wouldn't even send a fully kitted-out new-ish grad equine vet to one of these,

[/quote]

My first ever ever equine visit as a new grad was to a horse stuck in a d -yke in East Anglia and therefore my first ever IV injection on a horse was whilst being held round the waist by a fireman.

Quite sad state of affairs when I think about it, in that I never gave or put anything into a horse IV whilst at uni... not that hitting a horse jugular is that tricky I guess. Just would have preferred the first time I did it not to have been in front of a couple of fire crews, a panicky owner and friend and the police that had cordoned off the road!!

(ps thankfully I sedated the horse fine and we managed to pull it out, though it was touch and go for awhile)

Re: Clarification\advice re OOH visit to horse when SA vet please?

J G Wray — Mon, 07 Apr 2014 16:42:49 GMT

[quote user="An On MRCVS"]What does "not unreasonably refuse" even mean? [/quote]

Ah this is a perennial question. RCVS will say that the Code is not prescriptive and uses plausible phraseology like "reasonable" or "unreasonable", yet does nowt to define this. They expect us to conduct ourselves clinically using the absence of doubt through EBVM principles, which as scientifically trained people we can relate to. However, the Code is operated by non-scientists, lawyers of various hue, for whom precision is to be avoided because of accountability for advice given, so I received this comment from RCVS ProfCon only the other day in respect of a stray cat being rehomed whilst being microchipped with a non-ISO chip from the US (2002) and declawed i.e. a cat with considerable investment by someone behind it.

"..In terms of effort and time, there are no set guidelines. Clearly there is a limit to what vets can be expected to do. We expect vets to act reasonably, but we do not expect them to search for an owner indefinitely. If all reasonable steps have been exhausted and a reasonable period of time has passed the animal may be re-homed. ..."

Utterly "reasonable", but who knows what this means? It feels weird to operate clinically in one way yet professionally in some nebulous fluffy unspecific way. Funny old world

As far as advice goes, why not contact VDS and if you do come into contact with RCVS, do emails and retain all correspondence?

JGW

Re: Clarification\advice re OOH visit to horse when SA vet please?

tess — Mon, 07 Apr 2014 14:03:54 GMT

I would contact VDS for their take on it. As far as I know my insurance is for small animal and exotics (to cover the odd snake/tortoise we see).

There's potential to do more harm than good. At best an assessment of pain/ circulation/shock etc I could do, and poss get a line it but wouldn't have a clue about sedation etc. If you agree to go then cock things up does that render you more at risk of discipline than saying you can't go at all??

Re: Clarification\advice re OOH visit to horse when SA vet please?

Sally Everitt — Mon, 07 Apr 2014 13:10:02 GMT

We (BSAVA) had an article in the January 2014 issue of companion on just this issue. BEVA also have a list on their website of Equine Practices equipped to asset the emergency services in equine rescue. All the emergency services should have access to this list which is on the BEVA website under Useful info / Directories.

Sally Everitt

Re: Clarification\advice re OOH visit to horse when SA vet please?

Evelyn Barbour-Hill — Mon, 07 Apr 2014 13:03:18 GMT

[quote user="An On MRCVS"] I advised them that we were not an equine practice, but if desperate could attend [/quote]

I say you did exactly right. If need be you could offer to contact a suitable equine practice for them, although the police don't usually need that kind of help.

If you agreed to attend, that would arguably be counter-productive and against the interests of both animal and client, if it meant further delay in attendance of a suitable veterinary surgeon.

[quote user="An On MRCVS"]Am I expected to keep my equine knowledge more up to date "just in case".[/quote]

No.

[quote user="An On MRCVS"]"not unreasonably refuse"[/quote]

It means "not refuse without good reason". You didn't refuse, and you had good reason.

Re: Clarification\advice re OOH visit to horse when SA vet please?

Martin Atkinson — Mon, 07 Apr 2014 10:56:40 GMT

My take on this is that if I am a small animal vet an hour away that must by any reasonable calculation mean 50 miles. Unless I lived in the highlands there must be many equine/large animal vets between me and the casualty so I would refuse. As Michael says however if it was round the corner I would give the number of a large animal vet but if they couldn't get there immediately I would attend until someone else better qualified could attend.

What would bother me then is that my VDS insurance is pretty minimal for my practice, what would would happen if this was a very valuable horse and it went tits up because with my lack of experience I did the wrong thing. Also I wonder if I would have enough Vetergesic/Ketamine or whatever in the cupboard anyway to treat a horse.

Re: Clarification\advice re OOH visit to horse when SA vet please?

Hannah Wynne Richards — Mon, 07 Apr 2014 10:17:05 GMT

Oh for the good old days when the profession wasn't so compartmentalised

Wynne

Re: Clarification\advice re OOH visit to horse when SA vet please?

Michael Woodhouse — Mon, 07 Apr 2014 10:15:05 GMT

You're a pet vet an hour away. I'm sure not going was exactly what I would have done in your situation.

Personally I see the clause there so that is a horse is knocked down in the street around the corner from your surgery you can't sit there saying you won't (reasonably) help.

It doesn't take a lot to figure you can anaesthetise a horse with the diazepam and ketamine in a small animal practice. If you have injectable injectable meloxicam that's ok in horses. Pentoject will kill them quite nicely.

I agree with Wren, these are tricky situations and can be unsafe. Equine or farm vet is what you want.

Re: Clarification\advice re OOH visit to horse when SA vet please?

Hannah Wynne Richards — Mon, 07 Apr 2014 10:13:15 GMT

Wren Good thing you're not in Holland, or even East Anglia.!!!!!!!!!!!!!!!!!!!!!!!!!! Sigh - good old PC gone mad - yet again

Wynne

BTW just how do geography teachers describe land use in Holland these days?

Re: Clarification\advice re OOH visit to horse when SA vet please?

Gillian Mostyn — Mon, 07 Apr 2014 09:38:49 GMT

I would do everything I could to persuade them I wasn't the right person to attend, including ringing an equine vet myself if necessary. However, If the situation was dire and there was literally no one else available, then I would attend. I'd be likely to be as useful as a chocolate teapot but my knowledge would be better than the average police/fireman/passerby etc and I'd do my best to advise until someone better than me could get there!

Re: Clarification\advice re OOH visit to horse when SA vet please?

Wren — Mon, 07 Apr 2014 09:17:21 GMT

How hilarious - it appears my use of the word 'd yke' has been deemed rude and asterisked out!

Re: Clarification\advice re OOH visit to horse when SA vet please?

Wren — Mon, 07 Apr 2014 09:15:16 GMT

These situations are both difficult and dangerous. I went to a horse stuck in a drainage *** last week and used romifidine, torb, ketamine, flunixin, dex and antibiotics. Not only do you need to be competent in field anaesthesia (you might not need to use it but in a lot of these situations you do), you also need to be confident in directing people, taking charge and knowing where best to place ropes/slings and direct manpower. Sometimes you have to put your personal safety at risk to administer IV drugs in a distressed upside-down horse in several feet of water.There is also a lot of skill in knowing when a let a horse make an attempt to stand and when it is better to try to keep it down for a bit longer.

I wouldn't even send a fully kitted-out new-ish grad equine vet to one of these, let alone a SA vet who may have done some equine work 6 years ago but has no drugs or equipment, and if I were the horse owner (supposing there was an owner - a lot of these tend to be fly-grazed or 'itinerant' ponies/cobs) I would certainly want a well equipped and experienced equine vet and failing that a farm vet.

I think you did the right thing re the RCVS situation. Decline and offer a number of someone close who is better equipped.