Operations, Patient Care, Training

EMS Assessment and Treatment of Dogs and Cats Involved in Fires

Issue 12 and Volume 41.

As EMS providers, our minds race when we respond to a house fire, probably due to all of the unknowns. There are only two elements you can count on: a house and some fire. But, there are so many other factors to consider. Are there people in the house? Are they injured? Thankfully, we often arrive to find the home’s occupants safe and uninjured—the human occupants, that is.

Consider this scenario: You’re set up as forward first aid at the scene of a house fire. The fire department has a good handle on the blaze. The homeowners made it out of the home safely and didn’t require EMS. They’re huddled together near the command post and are visibly upset.

Suddenly, a firefighter emerges from the front door of the home with a limp dog. He sees you and your partner, the dedicated medical team, and heads straight for you. At the same time, the homeowners rush toward the firefighter. They reach him at the same time he reaches you. He hands you the dog, which is alive but in critical condition. What now?

EMS Assessment and Treatment of Dogs and Cats
Make sure to carefully inspect dogs and cats for burns to the face and
whiskers as well as for fur that’s burned to the skin. Photo Glen Ellman

According to the American Society for the Prevention of Cruelty to Animals, approximately 70–80 million dogs and 74–96 million cats are owned in the United States. This means that you’ll find a dog or cat in approximately 40% of all U.S. homes.1 These pets are just as susceptible to injury during a house fire as humans.

EMS doesn’t typically treat animals, nor do we have a set of protocols for emergency pet care if we find ourselves in a situation like the one described. However, given the high numbers of domesticated animals in the U.S. and the speed at which today’s structure fires develop, the chance of encountering an injured pet on scene is very real.

Fight or Flight?

When an animal is trapped in a structure fire, it will react very differently than a human. Sure, the animal will be scared and will probably panic, but most won’t attempt to escape from the building.

According to Jen Leary, a former Philadelphia firefighter and the founder of Red Paw Emergency Relief Team, animals always gravitate toward the place they feel safest, even when that place has turned dangerous. For almost every domesticated animal, that safe place is his or her home.2

EMS Assessment and Treatment of Dogs and Cats
Consider adding specially sized animal oxygen masks to your
complement of medical equipment. Shown here is the
SurgiVetPet Oxygen Mask from Smiths Medical.
Photos G. Christopher Griesser

Just as the American Red Cross does for humans, Leary and her Red Paw colleagues find temporary housing and shelter for pets displaced by fires and other residential disasters. Even after major structure fires, Leary has found pets still in their homes.

Dogs tend to hide under larger objects, like couches and beds. Cats will seek shelter in these places as well, but will also retreat to the corner of a deep closet or pantry. Cats can even force themselves inside an accessible hollow wall.2 Keep this in mind when the fire department is performing overhaul in homes that aren’t a total loss.

ABCs of Cats & Dogs

Humans and animals are different in many ways, but there are also striking similarities, particularly in the realm of anatomy and physiology. EMS providers go right to the ABCs in an emergency: airway, breathing and circulation. Emergency pet care can be approached with the same set of priorities as human patients.

Dogs and cats have the same airway features as humans, but these features are contained within a very different space. Most dogs have muzzles with protruding noses, though others may have short muzzles. Anatomical differences in dogs’ airways should be considered if rescue breathing is performed. Cats’ airways are more compact than human and dog airways. When compared to that of a dog, a cat’s trachea is slightly more difficult to visualize and access.

Respiratory rates of dogs and cats are slightly different than in humans. A normal respiratory rate for a puppy is 15–40 breaths per minute, while adolescent and adult dogs will breathe 18–24 times per minute. A cat will breathe 20–30 times per minute. Dogs pant more than cats, but some cats will pant when frightened, stressed and/or hot.

A quick pulse check can reassure us that a dog or cat’s pulse rate is within normal limits. A pulsating femoral artery can be felt on the inside of the upper rear thigh, near where the leg connects to the torso. Don’t attempt to find a pulse in the same area on a dog or cat’s front extremities, as it is difficult. A carotid pulse is even more difficult to appreciate, so skip that area as well.

A normal heart rate for a puppy is 90–120 beats per minute and a dog’s is 60–110 beats per minute. A normal heart rate for a cat is 120–140 beats per minute. Keep in mind that a cat’s pulse is more difficult to feel than a dog’s.

Perfusion is assessed very differently in dogs and cats than it is in humans. EMS providers typically check distal capillary refill to assess perfusion. Dogs and cats have hair and fur, which make the capillary refill assessment technique useless. Therefore, the main indicator of circulation in dogs and cats is the color of their gums. Normal dog and cat gums are pink. Pale, gray or white gums indicate very poor perfusion.

If you find a dog or cat with abnormally shaded gums, suspect shock. These animals require immediate transport to a veterinarian.

Injury Assessment

Even though dogs and cats are very resilient, many are injured or perish as a result of house fires. It’s believed that 40,000 pets die in U.S. house fires each year and approximately 500,000 pets are affected by these tragedies.3

Kenneth Drobatz, DVM, MSCE, chief of the Section of Critical Care and director of emergency services at the University of Pennsylvania’s Ryan Veterinary Hospital, sees many victims of structure fires in his ED. He reports that the major cause of death is smoke inhalation.3

A dog’s airway reacts similarly to a human airway after smoke and/or heat exposure. A coarse cough may be heard and the airway lumen will swell and may become edematous.

Cats’ airways, on the other hand, are far more susceptible to laryngospasm and bronchospasm. Rapid and continued oxygen delivery is a must for any dog or cat pulled from a structure fire.

A major byproduct of combustion is carbon monoxide (CO) gas. CO has a 200-times higher affinity for hemoglobin than oxygen. CO will displace the oxygen from hemoglobin and can result in cellular hypoxia and eventually brain damage.

The only way to reverse this insult is to remove the animal from the concentrated CO environment and flood its system with oxygen.

Carboxyhemoglobin measurement isn’t regularly performed on dogs or cats, but exposure to CO can be confirmed by gathering a good history from owners and assessing clinical signs and symptoms.

A study of 21 dogs that sustained smoke inhalation in a kennel fire supports this clinical practice. The study indicated that “the determination of whether carboxyhemoglobin levels consistently correlate with severity of signs requires further evaluation.”4 Dogs and cats with CO poisoning (and even cyanide poisoning) can present with bright red mucus membranes. Remember this when assessing gums for perfusion status.

Burn injuries are also common in animals exposed to a fire environment. Drobatz reports that it’s rare to see a dog or cat in the ED with severe burns from a house fire. Most are burned over a small- to medium-sized portion of their body, or succumb to full-body burns and are found deceased after the fire is extinguished.

Dogs and cats are usually found with burns to their whiskers, face and airway. Fur or hair burnt into the skin are major complicating factors specific to dogs and cats. This makes debridement at the hospital quite difficult.

Another consistency in dogs and cats is burns to the bottoms of their paws. Discovery of paw burns may elude EMS providers because human patients typically have shoes on. If paw burns are found, don’t let the animal walk. This will be very painful and can increase the chance for infectious material to enter the animal’s body.

Treatment

Any dog or cat exposed to smoke in a structure fire should receive oxygen therapy as soon as possible and the therapy should continue while en route to a veterinary hospital.3 This may be difficult based on the animal’s demeanor, but it’s absolutely crucial.

As previously mentioned, an animal’s airway will swell when exposed to smoke and heat, which will make it difficult for them to breathe. Couple this with toxic CO gas exposure and we have a recipe for rapid deterioration.

Many departments carry special oxygen masks on their EMS or fire apparatus that can be used on pets. These masks come in different sizes for different animals and are plastic with a rubber entry seal that will fit tightly around the muzzle or nose and mouth. They’re vented and have a port for oxygen tubing. Each mask is specifically designed for a certain size animal and has a recommended oxygen flow rate in liters per minute.

An adult or pediatric oxygen mask can be used if there are no pet oxygen masks available. If the animal won’t tolerate a human mask, blow-by oxygen delivery is a useful alternative. Human oxygen masks will be much easier to use on animals with short muzzles. Oxygen should be delivered at the typical high-flow rate of each device.

One difference between human and veterinary medicine that EMS providers may find interesting is the approach to advanced airway management. Even after a dog or cat is exposed to smoke, a vet may choose not to immediately intubate. A retrospective study performed by Drobatz on several dogs exposed to smoke from structure fires concluded that “monitoring progression of respiratory problems on the day after the fire may provide clinicians with clues about the severity of each dog’s condition.”5 Oxygen therapy initiated on-scene will be continued in-hospital and should be considered our main treatment.

EMS Assessment and Treatment of Dogs and Cats

If a dog or cat is in respiratory arrest and the provider is comfortable with rescue breathing, the following procedures should be followed to ventilate the animal: For dogs, hold the animal’s mouth closed and ensure a good seal around their mouth with your cupped hands. Then, place your mouth around their nose and breathe at their normal respiratory rate. For cats, rescue breaths can be delivered into the mouth and nose at the same time. Watch for chest rise and fall to ensure adequate breath delivery.

Rabies transmission to humans, although extremely rare, occurs through infected animal saliva so keep this in mind if you choose to initiate rescue breaths. Rabies can only be transmitted if the animal is infected and shedding rabies at the time. Cats have a higher incidence of rabies, but only if they’re primarily outdoor animals. A tag with proof of rabies vaccination is usually found on an animal’s collar.

Burns may be dressed in the same way as human burns, and animals should be transported to a veterinary ED as soon as the dressings are applied. To avoid delaying care, consider applying dressings during transport.

Just as in humans, when an animal is burned, their skin is compromised. This can impact thermoregulation and make the animal more susceptible to hypothermia, especially in colder temperatures. If they’re wet, this issue will
be magnified.

CPR can be initiated for dogs or cats found in cardiac arrest. Successful out-of-hospital animal reseuscitation is extremely rare, and even in-hospital cardiac arrest has only a 6% survival rate.6 However, if you do choose to initiate CPR, lateral recumbent has proven to be the most effective position for both dogs and cats.

Move the animal’s top elbow back and target the costochondral junction where the elbow meets the chest. With the heel of your hand, compress one-third to one-half the width of the animal’s chest. (See Figure 1, below.)

Figure 1: Proper CPR hand positioning to deliver
chest compressions on a dog or cat

EMS Assessment and Treatment of Dogs and Cats

The compression rate for dogs is 100–120 compressions per minute. Since cats have a higher resting heart rate, the compression rate for cats may be increased to 120 compressions per minute. Ventilations should be performed the same way as rescue breathing.

Animal Behavior

If you decide to treat an injured animal on scene, remember that they don’t know you’re trying to help them. Animals are unpredictable, and even a seemingly friendly animal will defend itself when it feels threatened or is injured.

The go-to defense mechanism in dogs and cats is to bite, so keep your guard up even if you think you have control of the injured animal. Animals respond best to a calm, somewhat higher pitched voice (i.e., baby talk). Use this to gain their trust.

EMS Assessment and Treatment of Dogs and Cats
CPR can be performed on a canine cardiac arrest patient. Photo Glen Ellman

When treating an injured animal, it will be necessary to handle them. Both dogs and cats can be picked up, but care must be taken to keep you, as well as the animal, safe. Medium- and large-sized dogs should be picked up using both arms. One arm should be placed around the dog’s front legs and the other around its hind legs. Scoop the dog up and cradle it as you carry.

Small dogs and cats should be picked up and fully cradled in the rescuer’s arms. It’s best to gently contain their legs within your folded arms so they’re less likely to squirm and jump. If you fear a cat will bite or scratch you when you attempt to handle it, a safe approach may be to grasp the cat by its scruff with one hand and use the other hand to scoop it up.

To prevent dog bites, makeshift muzzle protection may be used. Every EMS unit has plenty of gauze, which can be wrapped circumferentially around a dog’s snout to reduce bite risk.

EMS Assessment and Treatment of Dogs and Cats
Medium- and large-sized dogs should be picked up using both
arms with one arm placed around the dog’s front legs and
the other around its hind legs. Photo G. Christopher Griesser

Legal Considerations

In most cases, each provider has the choice of whether to treat an injured animal; however, there are legal issues to consider. First, not all states specifically permit first responders to treat animals. When operating as EMS providers, we’re held to the limits defined by our scope of practice. If we depart from those limits and provide care to an injured animal, we’ve entered into the arena of veterinary medicine. Fortunately, some states do permit EMS providers to render emergency care to animals. In fact, a law recently enacted in Ohio (R.C. Sec 4765.52) specifically permits EMS providers to provide treatments mentioned in this article.

The other side to this issue is that animals are considered personal property. Therefore, if an injured animal is discovered at the scene of a house fire, it’s safe to assume that there’s implied consent from the homeowner to preserve that property.

EMS Assessment and Treatment of Dogs and Cats
Cats and small dogs should be picked up and fully cradled in the
rescuer’s arms, with their legs gently contained within the folded arms.

Photo G. Christopher Griesser

Attorney and EMT/firefighter Matthew S. Valocchi, of Berwyn Fire Company in Chester County, Pa., offers a legal perspective: “There has been little to no litigation in the area of treating a pet in an emergency situation. It’s important to understand the specific laws of your state and to have a policy in place that was drafted with these laws in mind. Ultimately, any action can bring legal ramifications.

However, states have started to recognize that there’s a need to protect emergency responders who are making the right decision in helping pets on the scene of emergencies.”7

EMS Assessment and Treatment of Dogs and Cats
To avoid cat bites and scratches, grasp the animal by its scruff
with one hand and use the other hand to scoop it up.
To avoid a dog bite, use gauze to construct a makeshift muzzle
circumferentially around a dog’s snout. Photos G. Christopher Griesser

Final Thoughts

The main priority for EMS providers while at the scene of a fire is the preservation of human life, but there’s always a chance that we may encounter an injured pet. As each state begins to recognize that EMS providers may be able to make a positive difference in the life of an injured dog or cat, we’ll need to consider how we may react in these situations.

Dogs and cats are loved by their owners and should be considered just as much a part of a family as any human. This is important to consider if you ever find yourself in a position where your clinical skill and expertise can make a positive difference in the outcome of an injured pet.

References

1. Shelter and intake surrender: Pet statistics. (2016.) American Society for the Prevention of Cruelty to Animals. Retrieved Sept. 5, 2016, from www.aspca.org/animal-homelessness/shelter-intake-and-surrender/pet-statistics.

2. Leary J. (Sept. 4, 2016, September 4). Phone interview.

3. Drobatz K. (Aug. 31, 2016). Personal interview.

4. Ashbaugh EA, Mazzaferro EM, McKiernan BC, et al. The association of physical examination abnormalities and carboxyhemoglobin concentrations in 21 dogs trapped in a kennel fire. J Vet Emerg Crit Care. 2012;22(3):361–367.

5. Drobatz KJ, Walker LM, Hendricks JC. Smoke exposure in dogs: 27 cases (1988–1997). J Am Vet Med Assoc. 1999;215(9):1306–1311.

6. New guidelines for CPR in dogs, cats. (July 3, 2012.) American Veterinary Medical Association. Retrieved Sept. 5, 2016, from www.avma.org/news/javmanews/pages/120715g.aspx.

7. Valocchi M. (Sept. 10, 2016.) Email interview.