How can gender considerations be better integrated into animal health emergency preparedness and response?

Global and national authorities have not historically approached animal health emergencies through a gendered lens. Yet these events almost certainly have gendered dimensions, such as differential engagement of women or men depending on their culturally accepted or assigned roles for animal care; risk of exposure to zoonoses; and access to emergency resources during response and recovery. Despite the role that gender seems to play with respect to animal health emergencies, little research has been conducted to better understand such dynamics, and little policy has been promulgated to address it in a way that optimizes response while ensuring equitable outcomes. This piece summarizes 3 key themes that emerged from a panel discussion on gender and animal health emergencies at the World Organisation for Animal Health Global Conference on Emergency Management in April 2023. These themes were differential gendered exposure to pathogens; a lack of equitable gender representation in animal health decision-making; and enhancement of pathways for recognizing gender in national and international actions in preparing for, detecting, and responding to animal health emergencies. Beyond increasing opportunities for women to engage in leadership, the animal health and veterinary communities will benefit from connecting practitioners with gender experts to develop more integrative approaches to emergency preparedness and management. Animal health professionals should also advocate for further research to elucidate gender-specific dynamics in human populations in the context of animal emergencies and the promulgation of evidence-based policies. Such transformative efforts will lead to better outcomes for all people who depend on and provide care for animals.

The application of biosecurity practices for preventing avian influenza in North-Eastern Italy turkey farms: An analysis of the point of view and perception of farmers.

INTRODUCTION: Italian and international outbreaks of highly pathogenic avian influenza (HPAI), particularly in densely populated poultry areas (DPPAs), have increased over the past few decades. These emerging risks, which endanger both human and animal health and the entire poultry industry, can be effectively limited by biosecurity measures implemented at human-animal food chain interfaces. Some problems, however, persist in the application of these measures on the part of poultry farmers, prompting the need to explore those aspects and causes that limit their implementation. MATERIAL AND METHODS: A qualitative approach was selected for the study and a semi-structured interview technique was applied to collect data among turkey farmers (n = 29) working in the north-east of Italy. The aim of this technique was to gather data on farms in order to understand the biosecurity practices adopted and the reasons for and impediments to farmer implementation, or lack thereof. This article presents and discusses the main data collected. RESULTS: The study revealed that farmers were familiar with the biosecurity measures necessary to contain avian influenza (AI) and other poultry diseases; personal disinfection and animal isolation practices were particularly prominent. Based on the reported procedures, managerial, economic, and psychosocial factors were among the barriers behind the failure to implement biosecurity measures. These obstacles were variously intertwined and associated with the different action settings. In particular management factors, such as lack of time to apply the rules and difficulties contingent on the farm's structural characteristics, mediate the application of biosecurity measures. In terms of communication channels, the company, particularly its technicians, proved to be the primary source of information for farmers in case of emergencies, as well as the primary source of information on the application of biosecurity measures. However, other sources of information were indicated, such as word of mouth among farmers or other non-institutional figures (relatives and acquaintances). CONCLUSIONS: What emerged, was the need to improve not only the biosecurity management skills, but also to implement forms of cooperation among the various key stakeholders in the poultry sector. The information presented in this pilot study needs to be discussed among competent authorities, public and company veterinarians, company technicians, and farmers. Furthermore, this information will help in participatory co-planning of risk prevention and communication strategies to implement a long-term, sustainable, effective approach to address future epidemic emergencies.

ACVIM Consensus Statement on the management of status epilepticus and cluster seizures in dogs and cats.

BACKGROUND: Seizure emergencies (ie, status epilepticus [SE] and cluster seizures [CS]), are common challenging disorders with complex pathophysiology, rapidly progressive drug-resistant and self-sustaining character, and high morbidity and mortality. Current treatment approaches are characterized by considerable variations, but official guidelines are lacking. OBJECTIVES: To establish evidence-based guidelines and an agreement among board-certified specialists for the appropriate management of SE and CS in dogs and cats. ANIMALS: None. MATERIALS AND METHODS: A panel of 5 specialists was formed to assess and summarize evidence in the peer-reviewed literature with the aim to establish consensus clinical recommendations. Evidence from veterinary pharmacokinetic studies, basic research, and human medicine also was used to support the panel's recommendations, especially for the interventions where veterinary clinical evidence was lacking. RESULTS: The majority of the evidence was on the first-line management (ie, benzodiazepines and their various administration routes) in both species. Overall, there was less evidence available on the management of emergency seizure disorders in cats in contrast to dogs. Most recommendations made by the panel were supported by a combination of a moderate level of veterinary clinical evidence and pharmacokinetic data as well as studies in humans and basic research studies. CONCLUSIONS AND CLINICAL RELEVANCE: Successful management of seizure emergencies should include an early, rapid, and stage-based treatment approach consisting of interventions with moderate to preferably high ACVIM recommendations; management of complications and underlying causes related to seizure emergencies should accompany antiseizure medications.

Distribution of equine and food animal emergency caseload by time of day, day of week, time of year, holiday, and phase of moon at an academic ambulatory and referral hospital.

OBJECTIVE: Determine the association of time of day, day of week, time of year, holiday, and phase of moon on academic ambulatory and hospital emergency caseload for equine and food animal species. DESIGN: Retrospective study. SETTING: Large animal teaching hospital emergency service. ANIMALS: Equine and food animals. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The hospital database was searched for after-hours on-farm and in-hospital emergencies seen from 2014 to 2020. Variables included date and time of admission, species (equine or food/fiber animal [FA]), and hospital service (field or in-hospital). The association of the caseload with time of day, day of week, day of year (holiday, full moon, or new moon), and season of year was defined and examined. The majority of equine field-based emergencies occurred on the weekend, in contrast to 44.8% of hospital cases. Most equine emergencies occurred between 4:00 p.m. and midnight on weekdays and between 8:00 a.m. and 4:00 p.m. on weekends for both field (89.1% and 46.9%) and hospital (82.8% and 48%) services. The same was true for FA cases on the farm (90% and 49.2%) and in the hospital (85% and 51.4%). More equine cases (67%) were seen in the field than FA. Winter had the fewest emergency cases for all species and locations, and spring had the most for FA. The majority of holiday equine emergencies were seen in the field (62.2%), but the majority of holiday FA emergencies were seen in the hospital (66.3%). Moon phase had no significance on caseload for all species and locations. CONCLUSIONS: Saturdays and Sundays were the busiest days for all species and services. Winter was the slowest time for emergencies for all species and services. Most emergencies were seen between 4:00 p.m. and midnight on weekdays and between 8:00 a.m. and 4:00 p.m. on Sundays and Saturdays.

Retrospective evaluation of factors associated with emergency frequency and survival in equids presenting for emergency care (2019-2020): 3071 cases.

OBJECTIVE: To determine factors associated with frequency and outcome of equid emergencies in private practice. DESIGN: Retrospective study from February 2019 to January 2020. SETTING: Private practice large animal hospital. ANIMALS: A total of 3071 equids of various breeds and ages presenting for emergency care. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Variables included for analysis of daily emergency frequency included day of the week, month, and daily climate data. A Poisson regression model found the maximum temperature (P = 0.05), average barometric pressure (P = 0.005), and decreases in barometric pressure (P = 0.05) were associated with an increasing daily number of emergencies. Overall survival for all emergencies was 89% (2748/3071). Variables included for analysis of nonsurvival for emergencies included signalment, body system, clinical examination findings, laboratory data, and experience of the veterinarian. A logistic regression model for primary emergencies (nonreferral) found that increasing age, increasing heart rate, and decreased gastrointestinal sounds were associated with an increase in nonsurvival. Body system and experience of the veterinarian affected nonsurvival. A logistic regression model for all emergencies (primary and referral) found that absent gastrointestinal sounds and an increasing PCV were associated with increased nonsurvival. CONCLUSIONS: The number of daily emergencies in this practice was affected by the month of the year and day of the week. Additionally, hotter days, increased barometric pressure, or drops in barometric pressure are likely to be associated with a higher emergency caseload. Nonsurvival of primary equid emergencies in private practice increases with age, higher heart rates, and decreased gastrointestinal sounds.

Quality of reporting of prospective in vivo and ex vivo studies published in the Journal of Veterinary Emergency and Critical Care over a 10-year period (2009-2019).

OBJECTIVE: To evaluate the reporting of key items associated with risk of bias and weak study design over a 10-year period. DESIGN: Literature survey. SETTING: Not applicable. ANIMALS: Not applicable. INTERVENTIONS: Papers published in the Journal of Veterinary Emergency and Critical Care between 2009 and 2019 were screened for inclusion. Inclusion criteria consisted of prospective experimental studies describing in vivo or ex vivo research (or both), containing at least 2 comparison groups. Identified papers had identifying information (publication date, volume and issue, authors, affiliations) redacted by an individual not involved with paper selection or review. Two reviewers independently reviewed all papers and applied an operationalized checklist to categorize item reporting as fully reported, partially reported, not reported, or not applicable. Items assessed included randomization, blinding, data handling (inclusions and exclusions), and sample size estimation. Differences in assessment between reviewers were resolved by consensus with a third reviewer. A secondary aim was to document availability of data used to generate study results. Papers were screened for links to access data in the text and supporting information. MEASUREMENTS AND MAIN RESULTS: After screening, 109 papers were included. Eleven papers were excluded during full-text review, with 98 papers included in the final analysis. Randomization was fully reported in 31.6% of papers (31/98). Blinding was fully reported in 31.6% of papers (31/98). Inclusion criteria were fully reported in all papers. Exclusion criteria were fully reported in 60.2% of papers (59/98). Sample size estimation was fully reported in 8.0% of papers (6/75). No papers (0/99) made data freely available without a requirement to contact study authors. CONCLUSIONS: There is substantial room for improvement in reporting of randomization, blinding, data exclusions, and sample size estimations. Evaluation of study quality by readers is limited by the low reporting levels identified, and the risk of bias present indicates a potential for inflated effect sizes.

Acid-base imbalances and the association of blood-gas variables, electrolytes, and biochemical analytes with outcome in hospitalized calves undergoing abdominal surgery.

BACKGROUND: Surgical abdominal emergencies in calves are associated with a guarded prognosis and have the potential for complex metabolic derangements including acid-base imbalances. OBJECTIVES: To perform a comprehensive analysis of acid-base status and to assess the prognostic relevance of preoperative clinicopathologic variables in calves undergoing abdominal surgery. ANIMALS: Hospital-based study samples of 535 (dataset 1; DS1) and 83 calves (dataset 2; DS2). METHODS: Retrospective (DS1) and prospective (DS2) case series. RESULTS: In DS1, acidemia (pH <7.33) was present in 49.9%, whereas alkalemia (pH >7.37) was present in 30.7% of calves. Plasma L-lactate, chloride, and serum inorganic phosphorus concentration accounted for 51.9%, 11.6% and 9.4% of the variation of venous blood pH, respectively. Classification tree analysis indicated that a negative outcome (death or euthanasia during hospitalization) was associated with venous pO2 ≤33.6 mm Hg, anion gap >18.3 and >22.9 mEq/L, serum albumin concentration ≤36.5 and ≤29.4 g/L, serum urea concentration >4.4 mmol/L, and plasma ionized calcium concentration ≤1.26 mmol/L. The area under the receiver operating characteristic curve of this model was 0.85 (95% CI: 0.82-0.89, P < .001) and the resulting sensitivity and specificity for the prediction of nonsurvival at the optimal probability cut-point of 0.5 was 89.8% and 65.7%, respectively. In DS2 the model had a similar sensitivity and specificity of 90.5% and 70%, respectively. CONCLUSIONS AND CLINICAL IMPORTANCE: Clinicopathologic imbalances and associated changes of acid-base status are common in calves with surgical abdominal emergencies and have clinical utility for the prediction of a negative postoperative outcome.

Perception of challenges in management of neurological cases in the emergency room.

OBJECTIVE: To investigate emergency clinicians' comfort level in assessing neurological emergencies and to identify opportunities to foster enhanced training of clinical neurology in the emergency room. DESIGN: Internet-based survey. SETTING: University teaching hospitals and private referral centers. SUBJECTS: One hundred and ninety-two emergency and critical care specialists and resident trainees (ECC) and 104 neurology specialists and resident trainees (NEUR) in clinical practice. INTERVENTIONS: An internet-based survey was distributed via veterinary professional organizations' listserves and message boards and responses were collected between March and April 2020. ECC completed a survey evaluating stress levels associated with neurological emergencies, confidence with neurological examinations, and neuroanatomical localization. NEUR completed a similar survey to report their perception of their ECC colleagues' confidence in the assessment of neurological cases. Chi-square and Mann-Whitney U-tests were used to compare categorical responses and confidence scores between groups. P < 0.002 was considered significant. MEASUREMENTS AND MAIN RESULTS: Fifty-two percent of ECC found neurological emergencies slightly challenging, whereas 85% of NEUR found them moderately to extremely challenging for ECC (P < 0.0001). ECC's median self-reported confidence score in performing a neurologic examination on a scale of 0-100 was 75 (interquartile range [IQR], 27), while NEUR reported a median ECC confidence of 44 (IQR, 25; P < 0.0001). Median self-reported ECC confidence in localizing intracranial, spinal, and neuromuscular disease was 67 (IQR, 40), 88 (IQR, 21), and 60 (IQR, 37), respectively, which was significantly higher than median NEUR-reported ECC confidence of 35 (IQR, 38), 51 (IQR, 31), and 18 (IQR, 20), respectively (all P < 0.0001). Following case transfer, 34% of ECC received NEUR feedback in >75% of cases. CONCLUSIONS: Noticeable discrepancies between ECC and NEUR perceptions of ECC clinical confidence were seen, while no firm evidence of neurophobia could be inferred. Improvements in interdepartmental communication and teaching of clinical neurology may be warranted.

Evaluation of presentation, treatment and outcome in hypertensive emergency in dogs and cats: 15 cases (2003-2019).

OBJECTIVES: Hypertensive emergency is well recognised in human medicine, yet there is limited veterinary evidence. This study aimed to determine the presentation, treatment and outcome in dogs and cats with hypertensive emergency. MATERIALS AND METHODS: A retrospective case series of dogs and cats with hypertensive emergency identified as follows: acute history with non-invasive Doppler systolic blood pressure greater than 180 mmHg and target organ damage including acute onset seizures, altered mentation with or without lateral recumbency or blindness. Data collected included signalment, history, physical examination and clinicopathological findings, systolic blood pressure, antihypertensive treatment and outcome. RESULTS: Seven dogs and eight cats were included presenting with seizures (n=9), blindness (n=4), altered mentation with (n=2) or without (n=2) lateral recumbency. Median age was 9 years (range 1 to 15) and duration of clinical signs before presentation was 1.5 days (range 1 to 15). Median systolic blood pressure on presentation was 230 mmHg (range 190 to 300). Amlodipine was the most common first-line agent (n=10), followed by hydralazine (n=4) and hypertonic saline (n=1). Aetiology of hypertensive emergency was acute kidney injury (n=9), idiopathic hypertension (n=3), hyperthyroidism (n=1), lymphoma (n=1) and suspected cutaneous and renal glomerular vasculopathy (n=1). Five cats and three dogs survived to discharge with an overall survival of 53.3%. CLINICAL SIGNIFICANCE: Hypertensive emergencies had various presenting signs in this series. AKI was considered to be the cause of hypertension in the majority of patients. Further evaluation of treatment for hypertensive emergencies is warranted, considering almost half of the cases did not survive to discharge.

Focusing on paediatric emergencies.

While all emergency cases can be stressful, paediatric emergencies may be particularly so given the young age of the animal involved. Aoife Reid will be passing on some top tips to delegates at BVA Live to help them rise to the challenge of dealing with big emergencies in little animals.

Peritoneal fluid analysis in equine post-partum emergencies admitted to a referral hospital: A retrospective study of 110 cases.

BACKGROUND: Peritoneal fluid analysis has both diagnostic and prognostic value in colic but is little reported in the post-partum mare. Multiple conditions may present similarly in this period, and peritoneal fluid findings may aid a prompt diagnosis. OBJECTIVES: To describe the peritoneal fluid findings and their association with diagnosis in mares presenting to a single referral hospital for treatment of post-partum emergencies. STUDY DESIGN: A retrospective clinical study. METHODS: Clinical records of 110 Thoroughbred mares were reviewed. Details of peritoneal fluid analysis from samples obtained at admission were recorded, in addition to history, physical examination, presenting clinicopathological data. Cases were classified by their primary diagnosis into groups of gastrointestinal tract (GIT), urogenital trauma (UGT) and post parturient haemorrhage (PPH). Univariable analysis was performed to compare findings between groups, using one-way ANOVA and post hoc Tukey/Kruskal-Wallis, as appropriate. A multinomial logistic regression was performed for variables significant in the univariable analysis. RESULTS: When separated into their diagnostic categories, 33/110 (30%) mares were classified as GIT, 55/110 (50%) UGT and 22/110 (20%) PPH. Peritoneal fluid packed cell volume (PCV), nucleated cell count (WBCC) and cytological findings were significantly different between diagnostic categories. The likelihood of diagnosis of PPH increased with an increase in peritoneal fluid PCV, the absence of degenerate neutrophils on peritoneal fluid cytology and a decrease in the peritoneal fluid WBCC. Overall survival to discharge was 55%. MAIN LIMITATIONS: The study is referral hospital-based and retrospective in nature. Missing data reduced the power of analysis for several variables. CONCLUSIONS: Peritoneal fluid analysis may guide diagnosis in post-partum emergencies, but no one factor is uniformly diagnostic. Mares with PPH presented with a non-septic peritonitis with higher peritoneal PCV.

Managing Reproduction Emergencies in the Field: Part 1: Injuries in Stallions; Injury of the External Portion of the Reproductive Tract and Gestational Conditions in the Mare.

Selected emergency conditions of male and female reproductive tracts in horses are described, including injuries affecting the external genitalia of male horses and emergent conditions arising during gestation in mares. Conditions affecting male horses are discussed in the context of breeding stallions, but kicks or other mechanisms of trauma in the groin can also affect geldings. Priapism, paraphimosis, trauma to the scrotum and testicles, and penile injury are discussed. In mares, traumatic vestibular injury, placentitis, hydropsic conditions, prepubic tendon and abdominal wall compromise, and uterine torsion are included. Clinical recognition of the problem, diagnostic procedures, and treatments are summarized.

Managing Reproduction Emergencies in the Field: Part 2: Parturient and Periparturient Conditions.

Selected conditions affecting broodmares are discussed, including arterial rupture, dystocia, foal support with ex utero intrapartum treatment, uterine prolapse, postpartum colic, the metritis/sepsis/systemic inflammatory response syndrome complex, and retained fetal membranes. Postpartum colic beyond third-stage labor contractions should prompt comprehensive evaluation for direct injuries to the reproductive tract or indirect injury of the intestinal tract. Mares with perforation or rupture of the uterus are typically recognized 1 to 3 days after foaling, with depression, fever, and leukopenia; laminitis and progression to founder can be fulminant. The same concerns are relevant in mares with retention of fetal membranes.

Emergency Management of Equid Foals in the Field.

Foal emergencies can be intimidating to manage in the field, yet many conditions will respond well to the supportive care possible on the farm. Triage of the foal targets focused supportive care to stabilize the foal before referral to a hospital or to facilitate the management in the field. There are many diagnostic and therapeutic options available in the field setting to support a successful outcome on the farm.

Management of Colic in the Field.

Colic is one of the most frequent emergencies necessitating veterinary attention. Referral is not an option in many cases; therefore, the ability to diagnose and treat colic in an ambulatory setting is paramount. Portable imaging and point-of-care testing has improved the ability to identify lesions and assess the patient's status. In cases when field management is the only option, practitioners should be aware of the various treatment options available.

Emergency Management for Donkeys and Mules.

This article provides an overview of initial assessment and management of common emergency presentations in donkeys and mules. The principles are similar to those in horses (and ponies), but clinicians must be aware of differences in recognition of signs of pain/disease, approach to handling, pharmacology of some drugs, and subtle differences in the physiology and local anatomy in donkeys and mules. The epidemiology of common disease presentations will vary between pet/companion or working/farmed donkeys and mules. Regular dental checks, deworming, vaccination, and monitoring of behavior and quality of life are important aspects of preventive care.

Effect of anesthesia duration on the quality of recovery in horses undergoing elective and emergency surgeries using the same anesthetic protocol.

The objective of this study was to investigate the effect of anesthesia duration on the quality of recovery in horses. The medical records of horses that were anesthetized and underwent surgery for elective and emergency soft tissue and orthopedic conditions from 2013 to 2019 were reviewed. Horses included in the study (N = 305) fulfilled the following requirements: all had the same premedication/induction protocol and the same balanced anesthesia for maintenance and were anesthetized by the same, experienced Board-certified anesthesiologist. A standardized anesthetic recovery score was completed for all horses to evaluate their recovery and the following interactions were assessed: age, body weight, breed, sex, American Society of Anesthesiologists status, type of surgical procedure, occurrence of hypotension, use of dobutamine, number of additional doses of xylazine/ketamine after isoflurane discontinuation, anesthesia duration, post-anesthetic sedation, and end-tidal isoflurane concentration during maintenance and at the time of transfer to the recovery room. These interactions were assessed based on the quality of recovery score using logistic regression. Duration of anesthesia (P = 0.021) and age (P = 0.003) negatively affected the quality of recovery. The odds of a worse recovery score were increased by 1.20-fold (1.03, 1.41; lower and upper limits) for every additional 30 min of anesthesia duration, while the odds of a worse recovery score were increased by 1.09-fold (1.03, 1.16) for every additional 1 y of age. In conclusion, the results of this retrospective study indicate that increasing the anesthesia duration negatively affects the quality of recovery in horses undergoing routine and emergency surgical procedures.

L'objectif de cette étude était d'étudier l'effet de la durée de l'anesthésie sur la qualité de la récupération chez les chevaux. Les dossiers médicaux des chevaux qui ont été anesthésiés et ont subi une intervention chirurgicale élective et d'urgence des tissus mous et orthopédique de 2013 à 2019 ont été examinés. Les chevaux inclus dans l'étude (N = 305) remplissaient les conditions suivantes : tous avaient le même protocole de prémédication/d'induction et la même anesthésie équilibrée pour l'entretien et ont été anesthésiés par le même anesthésiste expérimenté et certifié par le Board. Un score de récupération anesthésique standardisé a été réalisé pour tous les chevaux afin d'évaluer leur récupération et les interactions suivantes ont été évaluées : âge, poids corporel, race, sexe, statut American Society of Anesthesiologists, type d'intervention chirurgicale, survenue d'hypotension, utilisation de dobutamine, nombre de doses supplémentaires de xylazine/kétamine après l'arrêt de l'isoflurane, la durée de l'anesthésie, la sédation post-anesthésique et la concentration d'isoflurane en fin d'expiration pendant l'entretien et au moment du transfert en salle de réveil. Ces interactions ont été évaluées sur la base de la qualité du score de récupération en utilisant la régression logistique. La durée de l'anesthésie (P = 0,021) et l'âge (P = 0,003) ont affecté négativement la qualité de la récupération. Les probabilités d'un pire score de récupération ont été multipliées par 1,20 (1,03, 1,41; limites inférieure et supérieure) pour chaque 30 min supplémentaire de durée d'anesthésie, tandis que les chances d'un pire score de récupération ont été multipliées par 1,09 (1,03, 1,16) pour chaque année d'âge supplémentaire. En conclusion, les résultats de cette étude rétrospective indiquent que l'augmentation de la durée de l'anesthésie affecte négativement la qualité de la récupération chez les chevaux subissant des interventions chirurgicales de routine et d'urgence.(Traduit par Docteur Serge Messier).

Ophthalmic Emergencies in the Field.

Ophthalmic problems account for up to 20% of emergencies in equine practice. Presenting problems may involve the periocular region, adnexa, or globe. Practitioners must have the experience to restrain horses with painful ocular conditions and the knowledge of how to perform a thorough eye examination. A range of clinical skills is required for the necessary diagnostic tests such as corneal cytology, ultrasound and tonometry, and common standing surgical procedures such as eyelid repair or instillation of a subpalpebral lavage system. Therapy, which may involve frequent administration of multiple medications, must be targeted to the specific diagnosis.

Fracture Stabilization and Management in the Field.

Management of fractures in the field starts with successful assessment and stabilization of the patient by the practitioner on the front lines. A careful examination is vital to succesful patient management. This includes identifying the fracture location and severity, evaluating skin integrity and potential contamination of the fracture, and treating any ongoing hemorrhage, hypovolemia or stress. Appropriate application of splints in the field will minimize ongoing tissue damage and improve patient comfort. This ultimately aids further assessment, facilitates referral, and improves opportunities for successful fracture repair.