Pet CPR: Updating Fauquier EMS Protocols
Karin E. Hernandez
Lord Fairfax Community College
Pet CPR: Updating Fauquier EMS Protocol
In a survey conducted by American Pet Products Association, 68% of American households contain pets. Fauquier County contains approximately 27,000 housing units; using the national average, 18,245 of those households contain pets. The likelihood of a responding to a household containing an injured pet is great, and the job of the public servant is to care for citizens—both two and four legged. Approximately 500,000 domesticated animals are injured in fires annually. Over 40,000 animal deaths are accounted for annually: statistically ten times greater than the human death equivalent. Felines and canines are the most commonly domesticated household animals, therefore, a protocol with specific treatment for animal cardiopulmonary resuscitation (CPR) should be outlined and disseminated to Fauquier Fire and Rescue, followed by training of all rescue personnel.
Cost is often an obstacle for a government funded operation. Fauquier County Department of Fire, Rescue, and Emergency Management (DFREM) was gifted 5 reusable pet oxygen masks in 2014. For humans, equipment is mostly single use, sterile, and disposable. However, transmission of pathogens between pets is not a concern, therefore pet oxygen masks are washable and reusable. The standard human bag-valve mask (BVM) can be detached from the human face mask and applied in the same way to the pet mask if ventilations are deemed necessary, but mouth to mask is also feasible. In the direst situations, mouth to snout is a ventilation method approved by the American Veterinary Medical Association during CPR. Ultimately, the price per treatment is as expensive as the cost of one disposable BVM and oxygen, or as inexpensive as a few moments of the rescuers time.
The Social Readjustment Rating Scale was created to rank some of life’s most stressful events to predict stress-induced breakdown; the more stressful the event, the higher the score. Ranking at number 5 with a point score of 63 is death of a close family member. Withholding life-saving treatment from a patients human family member is unacceptable, unethical, and illegal. According to a survey conducted by Harris Insights & Analytics, 91% of pet owners consider their pets to be family members. Perception is reality, and through personification of animals, we now have a new consideration of what family is to to the communities we serve. Public relations and public service play hand-in-hand, as poor service creates poor image. However, providing service to the residents that exceeds their expectation and further protects their family will be praised. Implementing Pet CPR is an outstanding way to build public support and reflects positively upon the department, the individuals within it, and the Fire Chief.
Finances, equipment, instructors, and time are all obstacles to training. Luckily, each licensed provider in the county is required to obtain and maintain a basic life support certification. Adult CPR closely mirrors the proposed treatment for pets, though there are few exceptions. The adult is placed supine, whereas the pet is placed laterally recumbent. The hand placement is central thorax instead of sternal. Pulses must be checked in humans, whereas unresponsiveness is acceptable criteria for beginning pet CPR. There are many similarities however. The compression ratio, ventilatory rate, and depth of compression remain constant. Due to the similarities, training first responders in proper technique should smoothly transition. An hour long in-service training should be sufficient to familiarize personnel with proper techniques and equipment. Training could be provided by a Licensed Veterinarian Technician or Veterinarian who may donate time for public education. Several nonprofit organizations also facilitate training, equipment, and education for the public since the removal of Pet CPR from American Red Cross certification courses.
The proposed protocol would include three defined scenarios. Unresponsive & Apneic, Spontaneously Breathing, and Difficulty Breathing. Each scenario contains a simple to follow pathway similar to human adult CPR. Instead of a pulse check, a hand to the thorax of the cat or dog is utilized to feel for chest wall rise and fall. The focus, just as in human CPR, is early recognition of arrest and compressions. The apnea pathway focuses on delivery of positive pressure ventilations and oxygen delivered via pet mask. Simple inhalation of smoke coupled with spontaneous breathing focuses on administration of oxygen via pet mask. The protocol is designed to parallel a familiar algorithm to facilitate its use, minimize confusion, and streamline training.
Laws and statutes protect EMS workers from criminal prosecution for injuries sustained to the patient during care. Unfortunately, even efforts made in good faith can be exploited and used against providers. Although there are no specific regulations or codes in Virginia protecting providers against injuries, Virginia code 3.2-6570 defines cruelty as “willfully inflict[ing] inhumane injury or pain” to an animal. The core concept behind providing CPR to an animal is a compassionate effort toward both the owner and the pet, nullifying any claim that the resuscitative efforts are cruel or inhumane. The final foreseen obstacle is transport of an injured pet. The nearest 24-hour emergency veterinary hospital is in Fairfax, VA. While definitive care offers the best prognosis for any human or animal, transporting a non-human patient or decedent is not fiscally responsible or technically reasonable; this responsibility would fall on the owner.
Emergency first responders are tasked with a monumental responsibility of caring for very critical patients at some of the worst moments in their lives. Ultimately death is inevitable, but we do not use ignorance to defend an unnecessary, treatable death in a human. We should not use ignorance to defend why an animal in need is not treated. Out-of-hospital cardiac arrest has poor prognoses for canine, feline, and human- but assuming the human subject is still viable, treatment action is taken. First responders may terminate human cardiopulmonary resuscitation based solely on exhaustion of efforts: they are simply too fatigued to continue. Offering 5 minutes of effort and attention to the most overlooked family member may at best, revive them. At worst, first responders may soothe the fresh wounds of a devastated family.
References
Corso, R. A. (June 10, 2011). The Harris Poll. Retrieved October 4, 2018, from https://theharrispoll.com/americans-have-always-had-interesting-relationships-with-their-pets-whether-that-pet-is-a-cat-dog-parakeet-or-something-else-the-pet-industry-is-thriving-and-for-good-reason-more-than-three-in-f/.
Hopper, K., Epstein, S. E., Fletcher, D. J., & Boller, M. (2012). RECOVER evidence and knowledge gap analysis on veterinary CPR. Part 3: Basic life support. Journal of Veterinary Medicine and Critical Care, 22, 1st ser. doi:https://doi.org/10.1111/j.1476-4431.2012.00753.x
Springer, J. (2017-2018). American Pet Products Association, Inc.. Retrieved September 22, 2018, from https://americanpetproducts.org/Uploads/MemServices/GPE2017_NPOS_ Seminar.pdf.
Virginia Department Of Fire Programs. (2017). Retrieved September 24, 2018, from https://www.vafire.com/fire-and-data-statistics-2/.
Wag’N O2 Fur Life. (2018). Retrieved September 8, 2018, from https://www.petoxygenmasks.org/about_us.html.
Proposed Pet CPR Protocol Algorithm