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Every vet practice is different. Some are large corporate-run practices, others small family run businesses. Some treat only pets or horses or farm animals, others are a mix. Every one will have different team members with different specialties and interests. When doing your research to find a new practice, you may come across a practice offering ‘emergency and critical care’. What is this? Is it important? What if your vets do not offer it?
What is Emergency and Critical Care?
Emergency and critical care (ECC) is the initial response to critical illnesses. Critical illness is defined as “any immediately life-threatening, reversible condition”, that without treatment often leads to severe disease or death.
ECC for veterinary emergencies involves an assessment, quick stabilisation and management, and subsequent intensive care and observation. The main goals of ECC are to prevent further deterioration or death. And stabilise a patient to the point that time is no longer a critical factor and slower treatment can be started. Once a patient is stable, ECC ends and regular veterinary care can begin. Though many patients are at risk of deterioration and requiring further ECC.
ECC is important because it gives patients with critical illnesses a better chance at survival. Without, many of these critical cases would die or suffer needlessly. For many acute critical illnesses, intense ECC is required before any treatment can begin.
Practices that offer ECC are likely to have extensive experience in dealing with emergencies and critical illness, some of the staff may hold qualifications in ECC, they are likely to have their own hospital, and may even have dedicated intensive care staff and equipment. By stating they offer ECC on their practice website, they are advertising they are equipped to deal with most veterinary emergencies.
What Situations Require ECC?
Let’s give three example cases that are critical illnesses requiring ECC
A cat came through the cat flap breathing with his mouth open wide and has now collapsed.
The sensible owner knows this is serious and rushes down to their vets. The vet’s first step is initial assessment, checking the cat’s circulation, breathing and airways, temperature and mentation. The vet quickly sees the cat is breathing very fast, so administers an emergency sedative to calm him down. This helps, but we aren’t sure what is going on, so an ultrasound of the cat’s chest is recommended. This reveals his pleura (the space between the lungs) is full of fluid and making it hard for him to breathe.
Emergency drainage of the pleura is performed and the cat improves dramatically now his lungs can function properly. The cat had chronic undiagnosed heart disease that caused fluid to build up around the lungs, resulting in an acute respiratory crisis. The vets hospitalise the cat with diuretics to shift the fluid, oxygen therapy, medication to slow the heart, and nursing care. During the cat’s stay, the team is aware that the cat could enter respiratory distress again and become an emergency once more. But the cat stabilises and is sent home the next day with medication, ending ECC care.
A client comes running into the building cradling their 10-month-old puppy that was run over by her husband.
While a receptionist calms the owner down (ECC can sometimes extend to people too!), a vet looks over the puppy. They can see the puppy’s leg is broken, but this isn’t what we check first. As with the cat, it is critical we identify the most serious problems. As she isn’t bleeding anymore, the puppy won’t die from a broken leg. So the puppy’s circulation, breathing and airways are checked first, and confirmed that everything is functioning properly and there are no other wounds.
A strong pain medication is administered and ECC ends here, allowing an orthopaedic surgeon to take over for fracture repair. In this case, ECC was very brief and involved only a basic clinical exam and pain relief. But it was important that the vet examined the dog properly for hidden complications that could have required further ECC. Animals hit by cars may have internal bleeding, damage to their lungs or head trauma that are more severe than the obvious broken leg. If any of these were suspected, we may want to perform an x-ray or ultrasound as part of ECC.
A client is having a routine appointment with their vet. Their dog is on regular anti-seizure medication, and is bright and well today. As the vet finishes their notes, the owner shouts that their dog is having a seizure.
The vet rushes the dog out to the back and starts their assessment, checking the circulation, breathing, airways, temperature, and so on. As part of ECC, the team tries to stop the seizures using powerful drugs. This works and the dog recovers, so ECC ends. The vets decide to keep him in for monitoring, but he starts seizuring again. ECC starts again and this time, we cannot stop the seizures.
While the nurses try to keep the dog cool and administer further medication, the vet rings the owner and advises that if we cannot stop the seizures, serious damage may occur. It is decided that the kindest option is to euthanise the dog humanely. Unfortunately, this time ECC ends with a bad outcome. But the team knows they did all the right treatment and prevented suffering, and the owner is grateful.
These cases vary but demonstrate how ECC is important for a wide variety of cases.
Without ECC, the cat would likely have died from heart failure; the puppy with the broken leg wouldn’t have received pain relief and more serious issues wouldn’t have been checked for; and the seizuring dog would have died painfully from hyperthermia or a heart attack. In all cases, ECC prevented further suffering. According to the Royal Veterinary College, the most common cases needing ECC are:
- Bleeding disorders
- Respiratory distress
- Gastrointestinal disease
- Heart disease
- Kidney and urinary disease
- Metabolic disease
What if my Practice Doesn’t Offer ECC?
Technically, all practices will offer some form of ECC, even if not advertised on their website. All vets and veterinary nurses are trained for emergencies and can administer basic ECC as described above. The RCVS Code of Conduct for veterinary surgeons states that “all veterinary surgeons in practice must take steps to provide 24-hour emergency first aid and pain relief to animals according to their skills and the specific situation.”
This means that if someone turns up to any vets with a bleeding dog or a collapsed cat, the staff must offer basic first aid and initial stabilisation (though we always advise to ring ahead first to warn the staff). There are limitations to what care may be offered, and a practice may only prevent further deterioration or suffering. It is down to the practice what qualifies as ‘first aid’ – once this threshold has been met and the emergency has passed, vets do not have to continue care if they feel they cannot, for reasons such as limited owner finances, stray animals with no owner, lack of equipment or lack of staff members to assist, or the animal has a poor prognosis. Humane euthanasia can be a part of first aid, as we will discuss below.
If there is a daytime emergency and vets have started ECC and stabilisation but cannot continue more intensive treatment for whatever reason…
They may refer to a specialist practice with experts in ECC. ECC-trained staff can be better placed to deal with certain tricky cases, so even practices that advertise ECC may occasionally refer cases to specialists. However, there are restrictions on travelling with very sick animals, and stopping ECC for even a brief period may result in unnecessary suffering.
In these cases, vets may arrange a pet ambulance to take the animal to the ECC specialists, take them themselves if they are licensed to do so, or may have no choice but to continue stabilisation until the animal is well enough to travel. For legal reasons, vets will not send an animal home or to another practice unless it is safe.
Many practices do not offer 24 hours care (out of hours care/OOH), meaning you cannot ring your local vet at midnight with an emergency.
However, as the Code of Conduct states, practices must ensure their clients have access to 24 hour care, including ECC. As such, practices without in-house OOH will rely on a dedicated practice to provide OOH care for their patients once they close for the night. Should one of their patients have a critical illness after this time, their designated OOH practice will initiate ECC until the regular practice opens in the morning. In some cases, ECC can continue there, or the vets may recommend they stay at the OOH practice if they are more suited or if the animal cannot yet travel.
If all of the above options are not possible, and the ECC provided is either not sufficient or not working, the final option to avoid further suffering and a painful death is to consider euthanasia.
Despite all our best intentions, not every critical case can be stabilised without suffering or at all. In these cases, euthanasia is always a humane and appropriate option. Of course this will need to be discussed with the owner first, so good vets will have made the owners aware it is a possibility early on. Euthanasia does not mean failure on the part of the owner or veterinary team, and it sometimes is the only option available. A vet’s job is not to fix every animal, but to prevent unnecessary suffering.