Health

An Inside Look at Emergency Clinics

In this article veterinarian Dr. Ashley Whitehead prepares horse owners for an emergency or referral visit to an equine hospital.

Ashley Whitehead photo

By: Ashley Whitehead, DVM, BSc, DVSc, DACVIM | February 28, 2014

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you're listening to an article from horse canada.com. an inside look at emergency clinics by: ashley whitehead, dvm, bsc, dvsc, dacvim. while we all hope we never need to go, we should be prepared for emergency hospital visits in advance to avoid having to make crucial decisions in times of stress. most horse owners dread the idea of having to ship their horse to an equine clinic or referral centre due to an emergency or severe medical condition. it’s a trip nobody wants to make, and is often surrounded with stress and uncertainty. i practice veterinary medicine in a referral centre, and encounter many overwhelmed owners. as such, i have prepared this article in order to answer any questions you might have and offer some simple steps to prepare you for a pre-arranged appointment or an emergency visit at an equine clinic. advertisement scroll to continue with content what is a referral centre? a referral centre, also known as an equine clinic or hospital, is a facility that provides advanced equine veterinary medicine, and where there are specialists in various equine medical disciplines. referral centres have advanced diagnostic testing equipment that may not be available in general veterinary practices, such as digital ultrasound and radiographic imaging, video endoscopy, nuclear scintigraphy, magnetic resonance imaging (mri) or computed tomography (ct). on-site laboratories are usually able to provide rapid blood work results, which is important when you are dealing with a medical emergency and time is critical. most referral centres provide 24-hour emergency care. some locations, however, may be limited to a single type of referral case, such as lameness or ophthalmology, and will, therefore, only provide daytime appointments. a referral clinic can be either privately owned by veterinarians or run by a veterinary school at a university (usually known as a veterinary teaching hospital or vth). what is a veterinary specialist? veterinary specialists are veterinarians who have advanced training in various equine medical disciplines and are board-certified. to become board-certified (also known as becoming a diplomate), a veterinarian must have completed, at a minimum, four years of veterinary college, a one-year internship and two to three years in a residency program. there are additional training and caseload requirements that must be met during the residency program and, finally, the veterinarian must pass a series of rigorous examinations. when you take your horse to an equine referral centre, you will likely see a board-certified large animal surgeon, a large animal internal medicine specialist or a theriogenologist (a specialist in veterinary reproduction).other specialists that practice in equine referral centres include anesthesiologists, medical imaging specialists (including radiology, ultrasound, mri, ct and nuclear medicine), equine rehabilitation and sports medicine specialists, neurologists, ophthalmologists, cardiologists, and critical care/emergency specialists. when should i go to a referral centre? referral centres are not just for when there is a big emergency, such as when your horse needs an emergency colic surgery. your regular vet will provide you with the option of referral if they feel a consultation with a specialist would be beneficial, especially in difficult or complicated medical or surgical cases, if advanced diagnostic procedures are required, or if your horse requires intensive veterinary care that is not possible on-farm. what information should i collect during an emergency prior to referral? an emergency journal can be extremely helpful to your vet emergencies can be hectic and emotional and it can be difficult to recall details of your horse’s condition. assign one person to record what the horse is doing (i.e., rolling, eating shavings, drinking, urinating) and at what time they are doing it. record what medications were given, how much was given, and at what time. how do i get an appointment at a referral clinic? in most emergency situations, it is important to contact your regular vet and have a preliminary evaluation of your horse done. assessment of your horse will determine if the horse is safe to transport or if they need immediate care to stabilize prior to referral. some referral centres require your regular vet to request a referral appointment while other clinics accept cases without referral. whenever possible, a referral is preferred, as this ensures that the specialist can obtain all necessary medical information and communication can be established between the specialist and referring vet. what should i bring? when visiting a referral hospital for a scheduled appointment it is extremely helpful to have your horse’s medical history sent ahead of time to the clinic to allow the vet time to evaluate the information, especially the information related to the current problem. blood work, diagnostic testing results and medical imaging (including radiographs and ultrasounds etc.) should be sent ahead of time. if this is not possible, bring them with you. if test information is not readily available to the specialists at the referral centre, tests may need to be repeated so that the complete picture of the horse’s condition is known. in an emergency situation, and if the referral clinic does not provide your horse’s routine preventative medical care, it is useful to bring along your horse’s health care information, including vaccination and deworming history, past illnesses, lamenesses, and/or injuries. i recommend keeping a binder or folder for each horse so it is easy to grab when required. the referring vet will usually discuss the case with the specialist; however, it can be very helpful to bring your journal with you. also bring along any medications your horse is currently receiving so that the vet knows what has been given and, if the horse is going to stay on that medication, you won’t have to purchase more. if your horse is on a special diet, it may be helpful to bring some of your horse’s feed, even if you don’t think your horse will be staying over, as some appointments may require a hospital stay. a book or other reading material for yourself is a good idea to pass the time. much like human hospitals, it can take time to perform all the testing necessary to determine what is wrong with your horse. waiting can be difficult, especially when you are worried about your horse, so having a distraction can be helpful. don’t forget your credit card. many referral clinics require owners to leave a deposit when a horse is hospitalized and payment is usually due at time of service for out patient cases. your regular vet can usually obtain a quote from the specialist during the referral process if you request one. who are all those people at referral centres? you may feel like you have been bombarded with a lot of new personnel upon arriving at the referral clinic. this can be intimidating. each person has their own specific task, however, and together, they work as an efficient veterinary team. in most referral situations, the leader of the team is a veterinary specialist. in addition to specialists, referral clinics may have vets who are completing their residency or internship training programs. there may also be vets who work in the field as general practitioners, but also have some advanced training in various aspects of equine veterinary medicine. registered veterinary technicians or animal health technologists, who are college-trained in veterinary sciences, will be assisting the vets with various procedures and treatments. other staff at referral clinics may include veterinary assistants, receptionists, barn staff, animal care attendants and clinic volunteers. student vets are an important part of the veterinary team at veterinary teaching hospitals, and they will work closely with their supervising vets on each case. most private referral clinics will also provide externships for student vets, as externships are a valuable part of the education of student vets who are interested in equine medicine. by visiting equine clinics, students learn different techniques and are exposed to a much broader variety of equine cases than they may see at their own veterinary teaching hospital. why do horse hospitals have set visiting hours? most veterinary hospitals offer visiting hours, thereby allowing owners to spend time with their horses during the hospitalization period. these times are designed to help both horse and human stay connected in much the same way one would expect in a human hospital. what is important to consider is that like us, animals – whether dogs, cats or horses – need their rest while sick and/or recovering from an illness or surgery. while it may be comforting for you to be near your horse, many horses do not quiet down or adequately rest when their owner is hovering stall-side. in addition, normal patient care may be inadvertently compromised when the owner is ever-present. under normal circumstances, the vets and technicians will enter the stall to do frequent quick patient evaluations and give medications and treatments. concerned owners, understandably, have many questions and often request updates, which further slows down the flow of treatments and evaluations of not only your horse, but other hospitalized patients as well. although visits are indeed important for the well-being of both you and your hospitalized horse, it is preferable to keep them to a minimum. instead request pre-arranged phone updates with a vet involved in your horse’s case. the goal is to provide your horse with sufficient rest and optimum care. this will ensure your horse returns home as quickly as possible. what should i expect when my horse needs an elective surgery? for most elective surgeries, such as arthroscopies (joint surgery) or upper airway surgery, you will be given an assessment appointment with tentative surgery scheduled for the following day. the assessment appointment will allow the surgeon to determine what is the best course of treatment and if further diagnostic testing is required. depending on the type of surgery, your horse may be ready to go home the same day or require a few days of hospitalization. what should i expect after the appointment or hospitalization? it is important to understand that a referral is not a complete transfer of your horse’s care from your regular vet; rather, it is an extension of the care your regular vet has already initiated. regular communication between your primary veterinarian and the specialist, during hospitalization and after discharge, will ensure that everyone understands your horse’s ongoing medical needs and that treatment protocols are optimized. most hospitalized cases will be sent home with written discharge instructions. these instructions are also sent to the referring vet. take time to read the instructions before leaving the clinic. it is much easier to have treatment procedures demonstrated at the clinic than having them described to you over the phone. don’t be shy; ask as many questions as needed for you to have a good understanding of your horse’s condition and treatment plan. reasons to visit an equine clinic. your horse has a complicated, uncommon or undiagnosed condition. your horse’s condition is not responding well to current treatments or as expected. your horse requires emergency or elective surgery. your horse requires more specialized diagnostic testing than what is available in the field. your horse requires 24-hour care and monitoring. your horse requires large volume intravenous fluids or a transfusion. your horse requires general anesthesia for a procedur. you want an informed secondary opinion from a neutral party. 7 ways to prepare for an emergency. 1. keep your vet’s number by each phone, including an after-hours contact number. 2. consult with your regular vet regarding a back-up or referring vet’s number in case you cannot reach your regular vet quickly enough. 3. have a transportation plan prepared ahead of time in case you need to bring your horse to a referral centre. for example, have the phone number available of trailering companies that do emergency transportation. 4. know, in advance, the most direct route to an equine referral center, in case you need to transport your horse. 5. post the names and phone numbers of nearby friends and neighbours who can assist you in an emergency while you wait for the vet. 6. prepare a first aid kit and store it in a clean, dry, readily accessible place. make sure that family members and other barn users know where the kit is. 7. keep a first aid kit in your horse trailer or towing vehicle, and a pared down version to carry on the trail. &&>

While we all hope we never need to go, we should be prepared for emergency hospital visits in advance to avoid having to make crucial decisions in times of stress

Most horse owners dread the idea of having to ship their horse to an equine clinic or referral centre due to an emergency or severe medical condition. It’s a trip nobody wants to make, and is often surrounded with stress and uncertainty.

I practice veterinary medicine in a referral centre, and encounter many overwhelmed owners. As such, I have prepared this article in order to answer any questions you might have and offer some simple steps to prepare you for a pre-arranged appointment or an emergency visit at an equine clinic.

Scroll to continue with content

What is a referral centre?

A referral centre, also known as an equine clinic or hospital, is a facility that provides advanced equine veterinary medicine, and where there are specialists in various equine medical disciplines. Referral centres have advanced diagnostic testing equipment that may not be available in general veterinary practices, such as digital ultrasound and radiographic imaging, video endoscopy, nuclear scintigraphy, magnetic resonance imaging (MRI) or computed tomography (CT). On-site laboratories are usually able to provide rapid blood work results, which is important when you are dealing with a medical emergency and time is critical.

Most referral centres provide 24-hour emergency care. Some locations, however, may be limited to a single type of referral case, such as lameness or ophthalmology, and will, therefore, only provide daytime appointments.

A referral clinic can be either privately owned by veterinarians or run by a veterinary school at a university (usually known as a veterinary teaching hospital or VTH).

What is a veterinary specialist?

Veterinary specialists are veterinarians who have advanced training in various equine medical disciplines and are board-certified. To become board-certified (also known as becoming a Diplomate), a veterinarian must have completed, at a minimum, four years of veterinary college, a one-year internship and two to three years in a residency program. There are additional training and caseload requirements that must be met during the residency program and, finally, the veterinarian must pass a series of rigorous examinations.

When you take your horse to an equine referral centre, you will likely see a board-certified large animal surgeon, a large animal internal medicine specialist or a theriogenologist (a specialist in veterinary reproduction).Other specialists that practice in equine referral centres include anesthesiologists, medical imaging specialists (including radiology, ultrasound, MRI, CT and nuclear medicine), equine rehabilitation and sports medicine specialists, neurologists, ophthalmologists, cardiologists, and critical care/emergency specialists.

When should I go to a referral centre?

Referral centres are not just for when there is a big emergency, such as when your horse needs an emergency colic surgery. Your regular vet will provide you with the option of referral if they feel a consultation with a specialist would be beneficial, especially in difficult or complicated medical or surgical cases, if advanced diagnostic procedures are required, or if your horse requires intensive veterinary care that is not possible on-farm.

What information should I collect during an emergency prior to referral?

An emergency journal can be extremely helpful to your vet Emergencies can be hectic and emotional and it can be difficult to recall details of your horse’s condition. Assign one person to record what the horse is doing (i.e., rolling, eating shavings, drinking, urinating) and at what time they are doing it. Record what medications were given, how much was given, and at what time.

How do I get an appointment at a referral clinic?

In most emergency situations, it is important to contact your regular vet and have a preliminary evaluation of your horse done. Assessment of your horse will determine if the horse is safe to transport or if they need immediate care to stabilize prior to referral.

Some referral centres require your regular vet to request a referral appointment while other clinics accept cases without referral. Whenever possible, a referral is preferred, as this ensures that the specialist can obtain all necessary medical information and communication can be established between the specialist and referring vet.

What should I bring?

When visiting a referral hospital for a scheduled appointment it is extremely helpful to have your horse’s medical history sent ahead of time to the clinic to allow the vet time to evaluate the information, especially the information related to the current problem. Blood work, diagnostic testing results and medical imaging (including radiographs and ultrasounds etc.) should be sent ahead of time. If this is not possible, bring them with you. If test information is not readily available to the specialists at the referral centre, tests may need to be repeated so that the complete picture of the horse’s condition is known.

In an emergency situation, and if the referral clinic does not provide your horse’s routine preventative medical care, it is useful to bring along your horse’s health care information, including vaccination and deworming history, past illnesses, lamenesses, and/or injuries. I recommend keeping a binder or folder for each horse so it is easy to grab when required. The referring vet will usually discuss the case with the specialist; however, it can be very helpful to bring your journal with you.

Also bring along any medications your horse is currently receiving so that the vet knows what has been given and, if the horse is going to stay on that medication, you won’t have to purchase more. If your horse is on a special diet, it may be helpful to bring some of your horse’s feed, even if you don’t think your horse will be staying over, as some appointments may require a hospital stay. A book or other reading material for yourself is a good idea to pass the time. Much like human hospitals, it can take time to perform all the testing necessary to determine what is wrong with your horse. Waiting can be difficult, especially when you are worried about your horse, so having a distraction can be helpful.

Don’t forget your credit card. Many referral clinics require owners to leave a deposit when a horse is hospitalized and payment is usually due at time of service for out patient cases. Your regular vet can usually obtain a quote from the specialist during the referral process if you request one.

Who are all those people at referral centres?

You may feel like you have been bombarded with a lot of new personnel upon arriving at the referral clinic. This can be intimidating. Each person has their own specific task, however, and together, they work as an efficient veterinary team.

In most referral situations, the leader of the team is a veterinary specialist. In addition to specialists, referral clinics may have vets who are completing their residency or internship training programs. There may also be vets who work in the field as general practitioners, but also have some advanced training in various aspects of equine veterinary medicine.

Registered veterinary technicians or animal health technologists, who are college-trained in veterinary sciences, will be assisting the vets with various procedures and treatments. Other staff at referral clinics may include veterinary assistants, receptionists, barn staff, animal care attendants and clinic volunteers.

Student vets are an important part of the veterinary team at veterinary teaching hospitals, and they will work closely with their supervising vets on each case. Most private referral clinics will also provide externships for student vets, as externships are a valuable part of the education of student vets who are interested in equine medicine. By visiting equine clinics, students learn different techniques and are exposed to a much broader variety of equine cases than they may see at their own veterinary teaching hospital.

Why do horse hospitals have set visiting hours?

Most veterinary hospitals offer visiting hours, thereby allowing owners to spend time with their horses during the hospitalization period. These times are designed to help both horse and human stay connected in much the same way one would expect in a human hospital. What is important to consider is that like us, animals – whether dogs, cats or horses – need their rest while sick and/or recovering from an illness or surgery.

While it may be comforting for you to be near your horse, many horses do not quiet down or adequately rest when their owner is hovering stall-side. In addition, normal patient care may be inadvertently compromised when the owner is ever-present. Under normal circumstances, the vets and technicians will enter the stall to do frequent quick patient evaluations and give medications and treatments. Concerned owners, understandably, have many questions and often request updates, which further slows down the flow of treatments and evaluations of not only your horse, but other hospitalized patients as well.

Although visits are indeed important for the well-being of both you and your hospitalized horse, it is preferable to keep them to a minimum. Instead request pre-arranged phone updates with a vet involved in your horse’s case. The goal is to provide your horse with sufficient rest and optimum care. This will ensure your horse returns home as quickly as possible.

What should I expect when my horse needs an elective surgery?

For most elective surgeries, such as arthroscopies (joint surgery) or upper airway surgery, you will be given an assessment appointment with tentative surgery scheduled for the following day. The assessment appointment will allow the surgeon to determine what is the best course of treatment and if further diagnostic testing is required. Depending on the type of surgery, your horse may be ready to go home the same day or require a few days of hospitalization.

What should I expect after the appointment or hospitalization?

It is important to understand that a referral is not a complete transfer of your horse’s care from your regular vet; rather, it is an extension of the care your regular vet has already initiated. Regular communication between your primary veterinarian and the specialist, during hospitalization and after discharge, will ensure that everyone understands your horse’s ongoing medical needs and that treatment protocols are optimized.

Most hospitalized cases will be sent home with written discharge instructions. These instructions are also sent to the referring vet. Take time to read the instructions before leaving the clinic. It is much easier to have treatment procedures demonstrated at the clinic than having them described to you over the phone. Don’t be shy; ask as many questions as needed for you to have a good understanding of your horse’s condition and treatment plan.

REASONS TO VISIT AN EQUINE CLINIC

Your horse has a complicated, uncommon or undiagnosed condition
Your horse’s condition is not responding well to current treatments or as expected
Your horse requires emergency or elective surgery
Your horse requires more specialized diagnostic testing than what is available in the field
Your horse requires 24-hour care and monitoring
Your horse requires large volume intravenous fluids or a transfusion
Your horse requires general anesthesia for a procedur
You want an informed secondary opinion from a neutral party

7 WAYS TO PREPARE FOR AN EMERGENCY

1. Keep your vet’s number by each phone, including an after-hours contact number.

2. Consult with your regular vet regarding a back-up or referring vet’s number in case you cannot reach your regular vet quickly enough.

3. Have a transportation plan prepared ahead of time in case you need to bring your horse to a referral centre. For example, have the phone number available of trailering companies that do emergency transportation.

4. Know, in advance, the most direct route to an equine referral center, in case you need to transport your horse.

5. Post the names and phone numbers of nearby friends and neighbours who can assist you in an emergency while you wait for the vet.

6. Prepare a first aid kit and store it in a clean, dry, readily accessible place. Make sure that family members and other barn users know where the kit is.

7. Keep a first aid kit in your horse trailer or towing vehicle, and a pared down version to carry on the trail.