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ER for animals

Emergency clinics take over when veterinarians go home

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• The Dalmatians had pulled out their stitches; the female needed her incision cleaned and the male needed his re-sutured.
• Three male cats had urinary blockages.
• One Siberian Husky needed a Cesarean section to save her and her puppies and another had inhaled smoke at a house fire.
• The Whippet had tried to squeeze through the cat door and tore a large section of skin on his hind leg.
• The black mixed breed dog had been hit by a car, the Shetland Sheepdog had swallowed several ibuprofen tablets
• The Yorkshire Terrier had licked a puddle of anti-freeze.

Another winter weekend at the Cincinnati Emergency Veterinary Clinic was in full swing.

Working in the emergency clinic is a combination of variety, long hours, and intense stress, said Dr. Marcia Mahle.

Now in her eighth year at the clinic, Dr. Mahle said she “kind of fell into emergency medicine and grew into it.”

Sometimes “there are too many critical patients and too much death,” she said, and the stress is high because there are no days when emergency doctors vaccinate puppies or remove stitches or do other routine treatments. The overnight hours are tiring, there is little or no opportunity to discuss cases with other veterinarians, and there is little opportunity to follow up with patients when they leave the clinic.

In spite of the difficulties, Mahle said, the work is very rewarding.

“The fruits of your labor are right there,” she said.

Dr. Kathleen Hutton, the newest member of the team, agreed that the work is both challenging and rewarding.

“You can have minor emergencies and life and death emergencies,” she said. “It's really exhausting, physically and mentally exhausting, but when you can help someone, it's very rewarding.”

Triage

Like a human hospital emergency room, an animal emergency clinic uses a triage system to determine the order of treatment. There are no appointments; patients are seen in the order of arrival unless a critical case comes in. Then doctors and technicians go to work to check symptoms and vital signs and stabilize the patient.

All animals are taken from the owners into the treatment area, a situation that Dr. Mahle said upsets some owners. This procedure alleviates some stress on the animal, helps the staff to gain the pet's trust so treatment can take place with a minimum of fuss, and avoids adding owners to a crowded treatment area where the staff may be preparing one pet for surgery, suturing a wound, on another, and setting up an intravenous fluid drip on a third.

“People who bring an animal to the emergency clinic don't want to be here,” Dr. Mahle said. They go to their regular vet out of choice, but they come here by necessity.” And they are very worried about their pet. So with every client, emergency veterinarians have to break a barrier of distrust for this doctor who took a suffering Fido or Fluffy into an area off-limits to family members and who might report that surgery is necessary to save the life or that treatment will be prolonged, uncomfortable, and expensive.

Chronology of a visit

The clinic staff would like to be prepared for each patient, so they ask that owners call before leaving home with a brief report about the pet's condition and an estimated time of arrival. They also want the owners to be prepared for the $52 initial charge for the visit. Upon entering the clinic, a technician or assistant takes the pet into the back treatment area for evaluation while owners fill out paperwork describing the pet and its problem. Then they wait, sometimes for an hour or more, while the staff takes the pet's vital signs and determines the seriousness of its condition.

Each animal is called by name and handled gently but firmly. Temperature, heart-rate, respirations, and weight are checked, gums are inspected for color, and obvious wounds, lumps, and bumps are examined.

The veterinarian talks to the owners before starting critical treatment, even if minutes can make a difference, Dr. Mahle said. If surgery or other immediate measures are needed, the dog moves to the top of the line. Owners are apprised of the situation and given the options.

“We never give people less information than what they want,” Dr. Mahle said. “We tell them what is going on so they can make an informed decision. This is their family member.”

Telling owners what's going on involves showing them x-rays, explaining the condition and the treatment alternatives, and talking about the cost of the procedures.

“We always offer the best medicine, but if finances interfere, we can trim corners. I hate it when it comes down to that,” Dr. Mahle said. However, there are some corners that cannot be trimmed she said, because surgery is the only option in some cases.

If an animal is hospitalized for the night, the owner must pick it up before 8 a.m. the next morning. If continued hospitalization is indicated, the dog must be taken to its regular veterinarian for follow-up. If prolonged hospitalization and monitoring are necessary, the animal may return to the emergency facility the following night.

The emergency clinic staff works closely with the pet's regular veterinarian. Records are faxed to the clinic so that each veterinarian is apprised of the pet's condition, treatment, and prognosis.

Services

The emergency clinic has a veterinarian on the premises when it is open. If things are slow, a doctor may grab a nap on a cot, but the hospitalized animals are never left unattended. At least three additional staff members are also on hand during the busiest hours; technician and assistant hours are staggered so that these times are well covered. If necessary, back-up veterinarians are available.

The clinic has exam rooms, a surgery, an x-ray room and darkroom, a lab for diagnostic tests, and a treatment area for patient assessment and care and minor surgeries. Most hospitalized patients are kept in cages in the treatment area so that the staff can constantly check on their conditions and be aware of any changes; animals with infectious diseases are kept in an isolation room a few steps away.

Surgical instruments are sterilized after each use. Pets are monitored throughout surgery on an electrocardiogram machine, an oximeter, or both. The clinic stores fresh frozen plasma and packed red blood cells for transfusions and has a clinic dog on hand for whole blood transfusions. The plasma and packed red blood cells come from a canine blood bank in California and are used to give the dog only the blood component it needs. Up-to-the-minute testing equipment gives the clinic the ability to do up to a dozen blood chemistry tests at one time.

When shifts change, the veterinarian or technician goes over each hospital case with the incoming staff member. Each doctor also completes treatment on the animals he admitted and prepares detailed case reports before leaving.

Although one person is generally assigned to answer phones, other technicians an assistants jump in when the lines are busy. Many calls are not emergencies; some are from pet owners wanting routine appointments and others are from concerned owners who are not sure if they have an emergency problem or not. Staff members ask questions about the pet's symptoms and encourage owners to bring the pet in if it has signs of serious trauma or illness. (See "Is it an Emergency?")

A typical hour in the clinic may find one veterinarian checking the condition of a cat, then leaving the treatment area to talk to the owners; a second veterinarian staying past the end of a shift to stitch a wound or work on patient charts; a technician or assistant bottle-feeding puppies from a Cesarean surgery, another technician taking vital signs on a dog that's been hit by a car, and yet another checking the intravenous fluids dripping into a dog or cat prior to surgery. After the puppies are fed and the fluids checked, the technicians might take an x-ray of a cat with a broken leg or a dog with possible broken ribs or prepare the surgery room for a dog with bloat.

The staff works with an easy camaraderie, gentle and efficient with the animals, teasing and jiving with each other. But when a critical case comes in, they are all business, responding quickly to the doctor's request for information and equipment, working to save a life. When they fail, there is silence for a few minutes, then a subdued resumption of responsibilities to the animals in the hospital and those still coming in the door.

One clinic

This is a story of one emergency veterinary clinic, but it is representative of the many such clinics that help pet owners cope with after-hours illnesses and injuries. The advances in emergency animal medicine and the public demand for off-hours facilities for pet care combine to provide clinics that increase the potential for prolonging the lives of family pets.

[For a list of life-threatening conditions requiring immediate care see Dog Owner's Guide: Is it an emergency?]

Norma Bennett Woolf

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