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Vet Nurses' role in responding to emergencies

In collaboration with BARTA, we've developed guidelines for utilising equine Registered Veterinary Nurses (RVNs) in veterinary response to civil emergencies.

These guidelines inform practices regarding the roles that equine RVNs can play in supporting civil emergencies and provide assurance for sending RVNs out with vets to attend emergency and rescue situations.

The BEVA BARTA Guidelines

These guidelines were created in collaboration with BARTA

 

Download the guide

 

Background

Cabinet Office guidance in support of the Civil Contingencies Act 2004, highlights the role of private veterinary surgeons in attending incidents alongside Category 1 (blue light) responders to deliver immediate care to animals suffering trauma or entrapment.

https://assets.publishing.service.gov.uk/media/5a78a4c740f0b6324769905a/Chapter15-oth er-sectors-involved-in-EP-amends-10112011.pdf (Chapter 15.20)

Additionally, animals displaced by localised or regional emergencies may require veterinary oversight during rescue, relocation, and temporary sheltering, as well as chemical control, medical care, and advice on biosecurity threats and measures.

Emergency services respond to high-risk and/or complex incidents within a framework known as the Incident Command System (ICS). Additionally, multi-agency incidents follow Joint Emergency Services Interoperability Principles, known as JESIP. These systems are designed to provide clear lines of responsibility and accountability, delegate operational tasks in support of tactical plans and bring in sufficient resources to deal effectively with the scale, number of tasks or specialist incident advice as determined by the nature of the problem. They are founded on principles of shared situational awareness, co-location of leadership and joint understanding of risk. https://www.jesip.org.uk/

It is recognised that during an emergency event, Category 1 responders may encounter animals in many different contexts and it is likely that veterinary support will be required to satisfy a duty of care for those with temporary control or responsibility, as defined by the Animal Welfare Act 2006. https://www.gov.uk/guidance/animalwelfare

Further information about the role of veterinary professionals during civil emergencies can be found in the linked BVA In Practice article, by BARTA Director, Jim Green MICPEM.

https://bvajournals.onlinelibrary.wiley.com/doi/epdf/10.1002/inpr.459

Large animals are affected by emergencies in a range of circumstances. Some examples include:

• Physical entrapment

• Loose and straying

• Trapped in structure fires

• Trapped in transportation incidents

• Impacted by wildfire

• Marooned, stranded or swept away in a water environment

Response to a call for assistance from a private veterinary practice is normally to send the nearest available veterinary surgeon. Occasionally, situations require further support from additional vets or RVNs when capacity allows. When resourcing an incident, there are no guidelines that highlight when the complexity or nature of an incident might trigger a greater level of veterinary response. Initial information from the scene is often limited and therefore, veterinary surgeons attending a scene alone, are often placed in a situation where they are not in a position to deliver against multiple simultaneous tasks and objectives.

For that reason, this document sets out roles and opportunities for a veterinary team approach to large animal emergencies and in particular, roles and capabilities of RVN’s and what incidents might trigger their potential deployment. It will also highlight what training and Personal Protective Equipment (PPE) is essential to allow them to participate in operational environments safely.

Large animal incidents range from a single animal, welfare centred issue, where an inability to stand requires assistance from an agency equipped to perform casualty relocation techniques, through to multi-animal, complex entrapments such as in transportation or the result of a fire in animal housing where multiple acute medical issues are present. Long-term exposure to flood water or near drowning may also present a component of wider community risk events.

Therefore, simultaneous veterinary tasks that need to be performed will vary based on the type of incident, nature of injuries and number of casualty animals. Veterinary led intervention should focus on a casualty centred approach and the ability to make an assessment of resource requirements, including personnel skills and attributes, should be a priority for initial attending veterinary surgeons.

Incidents that would be considered appropriate for the deployment of further veterinary professionals, including RVNs include;

Single animal entrapments

● Complex rescues

● Significant entrapments

● High stress environments (road traffic incidents, shows and events)

● Difficult access (Entrapments in transport, structures, pits etc)

● Major trauma

● Prolonged incident

● Highly public location

● General anaesthesia or Continuous Rate Infusion (CRI) sedation

Multi animal incidents which require

● Rapid triage

● Simultaneous casualty stabilisation and treatment

● Simultaneous phases of an incident or functional roles (triage, euthanasia, rescue, treatment, post incident care)

● High intensity activity

● Coordination of veterinary resources

● Consultation, recording and referral

The Veterinary Surgeons Act 1996 (Schedule 3 Amendment) Order 2002

The Veterinary Surgeons Act 1966 (Schedule 3 Amendment) Order 2002 provides that veterinary surgeons may direct registered or student veterinary nurses who they employ, to carry out limited veterinary surgery. Under this Schedule 3 exemption, the privilege of giving any medical treatment or carrying out minor surgery, not involving entry into a body cavity, is given to:

Registered Veterinary Nurses (RVNs) under the direction of their employer to animals under their employer's care. The directing veterinary surgeon must be satisfied that the RVN is qualified to carry out the medical treatment or minor surgery.

Student Veterinary Nurses (SVNs) under the direction of their employer to animals under their employer's care. In addition, medical treatment or minor surgery must be supervised by a veterinary surgeon or RVN and, in the case of minor surgery, the supervision must be direct, continuous and personal. The medical treatment or minor surgery must be carried out in the course of the SVN’s training (RCVS, 2024).

The RCVS has interpreted these terms as follows (RCVS, 2024):

'Direction' means that the veterinary surgeon instructs the RVN or SVN as to the tasks to be performed but is not necessarily present.

'Supervision' means that the veterinary surgeon or RVN is present on the premises and able to respond to a request for assistance if needed.

'Direct, continuous and personal supervision' means that the veterinary surgeon or RVN is present and giving the SVN their undivided personal attention.

The British Equine Veterinary Association (BEVA) has produced Schedule 3 guidance for the utilisation equine RVNs in practice: https://www.beva.org.uk/careersupport/nurses/schedule- three.

The utilisation of equine RVNs in response to civil emergency must fall within the criteria set out in Schedule 3 of the Veterinary Surgeons Act 1966.

Utilisation of equine RVNs at large animal incidents

● Triage - Prioritise treatment of animals through effective triage. Support veterinary surgeons in performing rapid triage at multi animal incidents

● Immediate Emergency Care - First aid and stabilisation as directed by the veterinary surgeon

● Euthanasia - Support the veterinary surgeon in delivering safe and effective euthanasia to non-viable casualties when directed to do so by the supervising veterinary surgeon

● Medical support - Administering medications, applying wound dressings and bandages, placing IV catheters, taking blood samples, performing radiography, managing IV fluids, assessment of clinical parameters and pain scoring. All medications and fluids must be prescribed by the directing veterinary surgeon.

● Chemical Control protocols - Supporting delivery of chemical control tactics including CRI sedation and anaesthesia for complex and/or prolonged rescues. All medication must be prescribed by the directing veterinary surgeon. For anaesthesia, an individual, species-specific protocol must be agreed upon between the directing veterinary surgeon and the RVN. It is not appropriate for equine RVNs to carry out incremental dosing of medication to effect.

● Recovery and post-incident care - Providing professional support during anaesthesia recovery and post-incident care

● Animal advocacy - Using knowledge of species-specific considerations to inform and guide other responders to ensure stress free handling and reassurance

● Multi-agency liaison - Provide relevant information to inform safety measures at large animal incidents, feed into multi agency tactical briefings and participate in post incident debriefs and investigations

● Owner liaison - Regularly update owners on clinical progress, involve owners in decision-making, answer questions, and provide advice and reassurance throughout the incident. Encourage and facilitate owner concordance with any treatment plans and decisions.

Training

Attending large animal rescues as part of a veterinary response team will expose RVNs to a range of operational workplace environments, all of which contain foreseeable risks which fall under criteria of the Health and Safety at Work Act 1974.

Therefore, a level of training is recommended to satisfy an employer's duty of care if staff are deployed to operate in these contexts.

Essential

● Introduction to large animal incidents, operating within a multi-agency environment, safe working principles at large animal rescues, basic casualty relocation and rescue techniques using standardised equipment and protocols, debriefing options

● Large animal triage and first aid

● Euthanasia methodology and application in non-clinical based environments

● Field anaesthesia and assisted recovery techniques

Desirable

• Triage and viability assessment for mass casualty events

• Advanced rescue techniques training

• Low-stress animal handling training

Optional

• Water responder (floodwater response)

• Safe working at height (work restraint, work positioning)

PPE

Risks associated with operating around distressed large animals can never be totally eliminated. There are also risks from the environment at a rescue, some of which require specialist PPE and operating protocols.

Non-emergency service responders, performing a support function will not be expected to possess specialist PPE.

Basic PPE, however, is considered essential to operate at a large animal rescue and a recommendation is made below, for all to have available. This may be a personal issue, or for occasional use, provided for an attending responder.

Essential PPE

• Safety helmet

• Eye protection

• Safety footwear

• Gloves

• Hi-visibility tabard with role identified

• All weather clothing

Occasionally, a veterinary responder may be required to enter an environment or wear PPE for which they are untrained or unqualified.

This would be undertaken in consultation, on an individual risk basis and under strict supervision of the authority with jurisdiction and with proportional control measures.

Equipment

The nature and scale of an incident will dictate the specific needs of an incident.

It is recommended that equipment and supplies for a standard large animal

response be arranged in a suitable containment facility ready for immediate deployment with the attending veterinary responder/s.

A recommended kit checklist can be found on the BARTA website.

Discussion

Jim Green from BARTA and our very own Marie Rippingale discuss the new guidelines in a podcast recording. 

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