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Prepare for [almost] Anything

That-which-shall-not-be-said Rule

We learn through social cues that there are certain things you just don’t say and questions you just don’t ask. Like “taboo” topics at dinner, there is a list of phrases that never have a place at the table. This code of conduct was born out of superstition and irony, particularly in emergency situations. Breaking this unspoken rule is a punishable offense, earning the perpertrator anything from a glare to absolute discontempt.

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The most grevious offenses are those commited on a Friday with an hour left on the clock, or at any emergency. Any mention of it being a quiet day on call willl surely be met with a hefty dose of animosity from co-workers. Point out that the work-day was slow, and 5 minutes later there will inevitably be an emergency flying through the front doors.


The Law of Impecable Timing

Along the same lines as the “jinxed” list, emergencies follow the law of impecable timing. If you want to guarantee you receive an emergency call, make any sort of plans. Schedule a haircut. See a movie. Tell a friend you’ll call them at 6. Schedule an oil change for the car. Set a 10pm bedtime. You can even think to yourself, ‘I’ll finish that load of laundry when I get home.’ That load of laundry will be mocking you six hours and two ERs later.

The law of impecable timing – it’s a thing.


The Art of Preparedness

I was on call last weekend, but made plans to meet friends for coffee at 9AM. And like clockwork, mid-order, I received an ER call at 9:04. The barista mouthed the words, “your usual?” She knew the deal.

The hysterical voice was difficult to understand, cutting in and out with fragments of sentences. I caught snipits as she recounted events: police siren, car honking, horse reared again, fence broke, bolting around, fence attached, cut up, blood, painful, shock, trembling, wounds, won’t put weight on the leg.

Monroe, a 7 year old paint gelding, had been tied to a fence. Spooked by the police sirens racing by, he reared back and broke off the part of the fence he was secured to. He bolted, the section of the fence chasing him through the paddock. I left the coffee shop, triaging with the owner over the phone. We were coming up with a plan she could put into action while I made the 30 minute drive to her house.

He was bleeding. No bandaging material.

He was pacing, unwilling to bear weight on one leg. No extra lead rope.

He was trembling. No banamine. No bute.

Only one laceration required stitches, and the remainder of the wounds were small, superficial cuts and abrasions. By the time I arrived, he was also willing to walk on the injured leg. After the initial assessment and treatment, there didn’t appear to be any life-threatening injuries and he was already looking more comfortable. As we were getting ready to depart, the owner approached my window. “Do you guys have an emergency kit or something that I can buy? I’ve never needed one up until now and I want to be prepared next time.”

The list I gave her sparked the idea for this post.


Equine Emergency First Aid Kits

You can spend a pretty penny buying ready-to-go kits. A quick google search will show you that kits range anywhere from $75 to $1,000. I put together a list of supplies that I would recommend for a fairly comprehensive emergency kit.

Most of the medications are prescritption and would require a vet to sign off on dispensing them. These are medications that I would be okay with clients having on hand, so long as they were routinely seen for annual exams (established doctor-patient relationship regulations).

ESSENTIAL SUPPLIES OF AN EQUINE FIRST AID KIT

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KEY ITEMS

  • Thermometer
  • Stethoscope
  • Headlamp
  • Spare Halter & Lead Rope
  • Gloves
  • Clippers
  • Hoof pick
  • 60ml dosing syringe

BANDAGING

  • Bandage
  • Scissors
  • Non-Sterile Gauze – 4″x4″ Squares (1 package)
  • Elastic Adhesive Bandage (Elasticon®) 3″ (2 rolls)
  • Cohesive Bandage (Vetrap®) 4″ (2 rolls)
  • Non-Adhesive Wound Dressing (Telfa® pads)
  • Non-Sterile Gauze – 4″x4″ Squares (1 package)
  • Elastic Adhesive Bandage (Elasticon®) 3″ (2 rolls)
  • Cohesive Bandage (Vetrap®) 4″ (2 rolls)Non-Adhesive Wound
  • Dressing (Telfa® pads)
  • Rolled cotton
  • Brown gauze (2 rolls)
  • Baby diapers
  • Duct tape

SOLUTIONS AND SCRUBS

  • Betadine® Solution (4 oz)
  • Chlorhexidine solution
  • Bottle of isopropyl alcohol (1/2 gallon)
  • Paper Towels (1 roll)
  • Chlorhexidine solution
  • Bottle of isopropyl alcohol (1/2 gallon)
  • Paper Towels (1 roll)
  • Sterile saline (1 liter)

MEDICATIONS

  • Electrolytes (paste or powder)
  • SSD ointment
  • Bute
  • Banamine
  • Trimethoprim-Sulfa Tablets (SMZs)
  • Acepromazine tablets
  • Dormosedan gel
  • Mag60 paste

KITS AND CARTS FOR AN EQUINE FIRST AID KIT

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The other part of the emergency kit is the actual kit itself. I prefer to use hard-sided containers or carts, because bags and cloth can easily become wet/mold. Replacing everything in the kit because of a water leak, spills, manure etc.. would be quite costly. I don’t recommend cutting corners on whatever carrier you use. I’ve seen some barns buy surplus medical crash carts, stackable tool organizer kits from Home Depot etc…the nice thing is all the supplies can easily be moved by one person, vs. grabbing individual bags/boxes.


Other considerations …

On the subject of preparedness, I would recommend having “cheat sheets” or info-posters reviewing what constitutes an emergency and very brief info on what common horse emergencies are. A diagram of basic horse anatomy and vitals would also be helpful. Below are some examples of these materials.


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VET LIFE STEP BY STEP – HOW TO LOSE A CLIENT

I unintentionally discovered one method for ensuring you will not have repeat business from a client. And for the sake of showing my humility, while sharing my mishaps, I created a simple step-by-step guide on how to lose a client.


HOW TO LOSE A CLIENT IN 5 SIMPLE STEPS

1. Ask client if they would be willing to move their appointment up to an earlier time, preferably if it will involve them rushing or canceling previously made plans. Schedule them for this earlier appointment time.

2. Show up 1 hour late.

3. Promise you can accomplish all the appointment goals by a particular time.

4. While they are helping hold your patient in preparation for a dental float, spray them directly in the face using a dosing syringe full of dirty water from the horse’s water bucket.

5. Finish the appointment 30 minutes later than you promised so that it interferes with the plans they had to rearrange in order to meet you at the time you requested.

 


When my boss couldn’t make it to her appointment at a nearby barn, I offered to step in and help carry some of the appointment load. Not only was this my first time meeting the client, but it was also the same barn that I had visited earlier in the morning for an emergency colic appointment. This client had one horse scheduled for a dental and two horses scheduled for vaccines. Having been on emergency calls all night, and reporting to the Colic first thing in the morning, I never had time to get vaccines. When I agreed to take the appointment (Since I was already at the barn), I also realized I was out of tetanus, West Nile and flu/rhino vaccines. While my office staff arranged for the client to come to the barn at 11 am instead of 2pm, I embarked on what I thought was going to be a quick trip to the office for more vaccines. But phone calls, questions, client drop-in and various other events resulted in my taking an hour longer than I had hoped.

By the time I showed up at 12pm, the client had already called my boss to see what the deal was. She let me know what her wait time had been, and I apologized profusely. With a riding lesson scheduled at 1, she was skeptical I could get everything done in an hour. Determined to regain her trust and confidence, I promised I’d have it done.

I set up my dental equipment, vaccinated the horses and got ready to sedate the gelding for his dental. “Oh yeah, he doesn’t sedate well just so you know. He’ll look like he’s about to fall over asleep, but as soon as you start working on him he’s wide awake.” Let’s just say she knew exactly what she was talking about. And after I felt confident in his sedation level, I filled a large dosing syringe full of water from his dirty bucket. I put the tip of the syringe in his mouth, and as I shoved with all my might on the plunger…he almost reared up. It was perfectly coordinated and timed, and instead of the water going into his mouth…the water shot full-force straight into the client’s face.

Basically, she got a power-wash to the face and was soaked. She did not laugh. She looked absolutely pissed and annoyed. I told her I was mortified, and that I was sorry. To which she responded, “I’ve had much dirtier and nastier things on my face.” I laughed, and went to work.

What would’ve normally been a 15 minute dental float was a 45 minute struggle between a horse’s buckling knees and his frantic swinging head. By the time I was done, the client had her own client waiting to begin the riding lesson. Embarassed, mortified and disappointed by the multi-modal failure, I left one more apology with her before I drove off to the next appointment.

As soon as a left the barn driveway, I was dialing the office to give them the step-by-step account, and share my new found method to ensure that I’ll never be the vet she requests to work on her animals. We all had a good laugh before the office manager said, “Well, I doubt it cost us any money. She’s had an outstanding balance of over 3 grand for the past couple years and refuses to put a dime toward it.” She paused. “Maybe after spaying her point blank in the face, she’ll get the hint that we kinda want to be paid for our previous services.”

Despite her account delinquency and bad attitude in general, I still felt horribly unprofessional and foolish…though after talking with the Office manager, I felt a little less guilty.
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