New State Legislation

Several US states now allow EMS personnel to provide some form of emergency care to animals. Additional states have proposed similar legislation. Some state legislation is limited to LEK9s, while other states include pets. As more states consider these laws, it is possible that EMS treatment and transport of LEK9s and house pets may become legal in more areas of the country. Currently, Illinois, ⁸ Michigan, ⁹ Mississippi, ¹⁰ and New York ¹¹ allow ambulance transport of injured LEK9s if no human patient needs the ambulance. In 2014 and 2016, Colorado and Ohio, respectively, enacted laws that allow EMS personnel to provide emergency medical care to a dog or cat being transferred to a veterinarian. ^12,13 This emergency care is limited to an EMS practitioner’s current scope of practice level for services provided to a human patient. In 2017, Maryland passed a law stating that, in certain emergency situations, “prohibitions relating to the practice of veterinary medicine do not apply” and those giving care to an animal will be protected from civil liability. ¹⁴ In 2018, California and Wisconsin enacted new laws that allow appropriately trained EMS personnel to provide prehospital emergency care to dogs and cats and exempts EMS from civil liability. ^15,16

In addition to enacted laws discussed above, several states have proposed new legislation related to prehospital treatment and transport of animals. In 2019, Massachusetts, Minnesota, New Jersey, New Mexico, New York, Pennsylvania, Texas, and Washington introduced legislation to allow for prehospital emergency care of dogs, cats, or LEK9s. ¹⁷ All 2019 bills failed to advance. In 2020, Illinois introduced a bill which would allow EMS to render prehospital emergency care to a dog or cat to the extent they have received commensurate training, ¹⁸ and New Jersey introduced multiple bills that would provide EMS immunity from civil liability when providing emergency care or transport to an animal at the scene of an accident or during disasters. ¹⁹

States have also passed recent laws facilitating the rescue of trapped animals from vehicles. In 2018, Louisiana ²⁰ and Pennsylvania ²¹ enacted laws that limit liability for vehicle damage resulting from rescuing animals in apparent distress due to extreme temperature or other dangerous circumstances. Louisiana’s law applies to the general public, while Pennsylvania’s law specifically addresses emergency responders. In 2017, Colorado, ²² Indiana, ²³ and New York ²⁴ enacted laws similar to that of Louisiana.

Treatment

In the wake of these new laws, a significant void was created. There are no standardized EMS protocols for the safe prehospital care of LEK9s or pets, and the importance of safety when working around animals cannot be overstated. Most EMS personnel lack training by veterinary professionals to properly handle an injured pet or working dog, which presents a potential risk to the health of both EMS personnel and animal patients. The risk of injury to EMS personnel can be substantially reduced by the correct placement of a basket muzzle. A basket muzzle is necessary to have on hand and is the only type of muzzle recommended, as it allows the dog to pant (an essential cooling mechanism for preventing heat-related conditions).

Emergency Medical Services may be able to provide life-saving treatment to an injured animal depending on local legislation, presence of trained personnel, available equipment (human patients take priority), and overall scene safety. When these criteria are met, EMS often have the required equipment and knowledge to save an animal’s life. The three most common life-saving and easily accessible treatments are covered below.

Naloxone—In a 25kg (55lb) canine patient who has experienced a suspected opioid overdose, 4mg of naloxone can be administered intranasally or intramuscularly. ^{Reference Palmer and Gautier25}

Please note: Many LEK9s are strong and potentially dangerous, especially when injured or protecting the handler. Even when sedate (eg, opioid overdose), dogs can have violent outbursts. Naloxone administration can cause profound behavioral changes that pose a safety risk to personnel, including increased aggression or agitation. Muzzling prior to administration is recommended.

Oxygen and Ventilatory Support—In a 25kg (55lb) canine patient who is spontaneously breathing and suspected to have hypoxemia, oxygen delivery via a loose-fitting face mask or alternate delivery device to the nose and mouth can be provided at a flow rate of 2-3L/min. If a patient has suffered respiratory arrest, and trained personnel with appropriate equipment are available to intubate, positive pressure ventilation can be initiated.

Please note: Mouth-to-snout ventilation should not be attempted, and intubation should never be attempted in a conscious animal.

Hemorrhage Control and Fluid Therapy—Hemorrhage can be controlled by placing a tourniquet proximal to the injured artery. When a tourniquet cannot be placed, pressure should be applied to the hemorrhaging area only if there is no risk of internal damage. An isotonic solution can be administered intravenously at a dose of 20mL/kg as an initial bolus, during which time a veterinarian should be contacted via phone to assess additional fluid therapy needs.

Readers are directed to previously published comprehensive treatment protocols for additional guidance. ^{Reference Mitek, McMichael, Weir, Smith and Schneider26,Reference Hanel, Palmer and Baker27}

Transport

The lack of EMS protocols for animal transport also presents challenges. Transport destination for animal patients is unlikely to be previously determined or programmed into vehicle GPS. Veterinary clinics and emergency facilities may not have the appropriate equipment or staff to treat a severely injured animal. Operating hours differ, and not all facilities are open continuously. Ideally, a board-certified veterinary criticalist and a board-certified veterinary surgeon would be available at all times. This assures that the clinic is capable of handling severe trauma and equipped to perform emergency surgery.

In the absence of specialists, experienced emergency veterinarians should be contacted. Transporting an animal with severe trauma to a clinic that is not equipped to handle this type of care will prolong the time until necessary interventions can be initiated and may increase patient mortality. Establishing and building a relationship with the nearest, appropriately equipped veterinary emergency facility prior to an incident will be invaluable for communication and will enable an EMS agency to properly plan for potential animal patients. For further information, readers are directed to the previously published transport protocol for LEK9s developed by veterinarians, EMS directors, EMS physicians, and LEK9 handlers. ^{Reference Weir, Mitek, Smith, Schneider and McMichael28}

Ambulance decontamination protocols also need to be established for the vehicle to safely return to use for human patients. Dogs and cats that do not receive routine preventive veterinary care (ie, timely vaccinations and parasite control) are more likely to be a source of common zoonotic diseases (ie, infectious diseases transmitted from animals to humans) ^{Reference Monath29,30} and caution should be taken. Rabies, leptospirosis, borreliosis (Lyme disease), bartonellosis (cat-scratch disease), dermatophytosis (ringworm), multiple types of gastrointestinal and external parasites, and antimicrobial resistant strains of cutaneous flora are among the most commonly cited zoonotic pathogens transmitted from pets to humans. ^{Reference Chomel31-Reference Damborg, Broens and Chomel33} Standard precautions for personal protective equipment ³⁴ are likely sufficient to protect EMS personnel against most common zoonotic diseases, but further study is warranted and infection prevention protocols are needed.