First Aid!

Dr. Michael Kent and Dr. Jamie Burkitt discusses life-saving protocols for our small animal companions in the event of an emergency. 

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The Vetrospective Podcast S01 E10 – First Aid

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Dr. Jamie Burkitt: Our recommendations, of course, as always, are for safety for the rescuer first. And then, yeah, there is no doubt that tourniquets save lives. 100%, they do.

Dr. Michael Kent: Hello, and welcome to today's episode of The Vetrospective, a podcast designed for animal lovers, advocates, and caregivers. This is your host, Dr. Michael Kent, coming to you from the UC Davis School of Veterinary Medicine. First aid is medical attention given right after an injury or accident before being seen by medical professionals. It could be life-saving, and while we usually think of this as for people, it is really important for pets as well. Emergencies for dogs and cats where owners can help stabilize their pets on the way to the hospital can range from trauma causing severe bleeding to respiratory distress and heat stroke amongst others. But what works and what doesn't? Does delaying time to get to a veterinary hospital for providing this care help or hinder your pet's treatment and recovery? What practical things can we do in an emergency? These are the issues we will talk to you about today. 

So, joining me is Dr. Jamie Burkitt. She is a professor of clinical small animal emergency critical care at UC Davis. She became board certified in emergency and critical care in 2005 and since then has practiced across the United States in both universities and private emergency and specialty hospital settings, until really coming here back in 2017 and setting down her roots. She serves as the guidelines co-chair for the RECOVER Initiative, which is an educational initiative that develops evidence-based consensus guidelines for life-saving measures in dogs and cats. Her area of interest include cardiopulmonary resuscitation, I can say that, prevention of recurrent feline urethral obstruction, and endocrine-related emergencies. So welcome to The Vetrospective, Dr. Burkitt, and thank you for joining me today.

Dr. Jamie Burkitt: Thank you so much, Dr. Kent, for that introduction, and thanks so much for having me today.

Dr. Michael Kent: Oh, no, this is so important. So, this first question is something I ask everyone. So why did you pursue a career in veterinary medicine?

Dr. Jamie Burkitt: Oh, that's a great question. Coming out of high school, going into college, I knew that I did, I was not probably prepared to spend my career sitting at a desk. And I was pretty strong in math and science. And so I actually went to undergrad planning to go to medical school. We'd always grown up with animals in the house though, and absolutely loved animals. And I had worked in a veterinary hospital a little bit here and there in high school. And then when I went to college and volunteered in some of the human emergency room settings and surgical ward settings and things like that, I realized that human medicine probably wasn't for me. 

Dr. Michael Kent: Fair. 

Dr. Jamie Burkitt: Yeah and sort of had a bit of a crisis and thought, my gosh, what am I going to do with myself? I've taken all these pre-med classes. I have, studied science and math and this has been my path the whole time. What am I going to do? And kind of search back to my roots and realized how much I really could apply that same, those same principles and all of that background to veterinary medicine and how much I loved animals and thought that would be a good path for me. So, here I am.

Dr. Michael Kent: Very cool. But then emergency and critical care, what drew you to this specialty area in veterinary medicine?

Dr. Jamie Burkitt: Oh, that's a great question too. So, I think the thing that drove me the most to emergency and critical care on a principal standpoint is that I really struggled to give up the practice of anything. So, I couldn't imagine my life, not doing any cardiology, not doing any diagnostic imaging, not doing any internal medicine, not doing any surgery or procedures, knew that I really wanted to be able to do all of those things. And when you're an emergency clinician or a criticalist, these are two kind of different hats that the ECC specialist wears in veterinary medicine. You really still get to do all of those things, a little bit of all of those things. So, I think that's why I really love it and what drew me to it. And originally I thought I might want to pursue something else, but the truth is when I came out of veterinary school, I realized the only jobs I was looking for were emergency jobs. That sort of spoke to me to realize, actually, you're really only trying to work in this space. Maybe that's what you love and was a bit of a wake up call for me. So shortly thereafter, I pursued residency training.

Dr. Michael Kent: This is great because I love hearing everyone has a different path and a different story. And that's why, you know, I asked this question first once and then I was like, oh, that's cool. So thank you for sharing that. And Kind of getting into what we wanted to talk about today, I'm really interested in the RECOVER initiative and want to talk to you more about this. You know, I believe it was initially formed to come up with guidelines for CPR or cardiopulmonary resuscitation for dogs and cats. How did you become involved in this and can you explain a little bit about the RECOVER initiative?

Dr. Jamie Burkitt: Yeah, absolutely. Thank you for this question because RECOVER has definitely become one of my main passions.

Dr. Michael Kent: That's why I asked you to talk about it today.

Dr. Jamie Burkitt: Yeah, absolutely. So yeah, the RECOVER Initiative is this really amazing educational initiative. And our main mission really is to empower people, and not just veterinary professionals, but people, to be able to provide life-saving care to animals. And we kind of want to be able to do that through education and science, so evidence-based from science and community. I got involved in the RECOVER Initiative, which is now a non-profit organization, basically. I got involved in the RECOVER Initiative in, we think we can trace it back to the end of 2018, maybe. It's one of those things where they, some colleagues of mine, Dan Fletcher, Manu Boller, asked me, hey, we, you know, we had come out with these guidelines back in 2012, and now we're looking to update our CPR guidelines, and we're hoping to bring in some help. It's a huge endeavor, would you be interested kind of thing. And I joined them, we think sometime around 2018 and started working on the updated CPR guidelines for dogs and cats, which came out in 2024 with the pandemic in the middle. It took quite a while for us to get those out. But basically has become a growing initiative. Basically, we now have, we're forming a board as a new nonprofit, and we're really excited about this. however, is our first expansion out of the CPR space and into first aid. On the human side, there of course are, I think most people are probably familiar with, the American Heart Association here in the United States has guidelines that they promote and then teach in person for bystanders to be able to perform CPR in people. And then also, of course, they have a first aid kind of domain or section as well. And in that first aid domain, you can go to courses, of course, to learn how to provide first aid to other people who you may find in the community who are, you know, you're out hiking and someone gets hurt or something like that. And so similarly, RECOVER decided for our update in the 2020s that we were going to also start a first aid domain. And so it's on the precipice of publication now. So really excited about that. But this is our first dive, even though the initiative is now about 13 or 14 years old. This is our first dive into the first aid space.

Dr. Michael Kent: That's pretty exciting. Can I wheel you back just a little bit and talk a little bit about RECOVER CPR?

Dr. Jamie Burkitt: Oh yeah.

Dr. Michael Kent: Because I know for, so I'm, obviously you know this, but I'm a clinical veterinarian, I'm a radiation oncologist. And I anesthetize a lot of patients along with my technical staff. And we also felt it's really important, even though I'm not a criticalist, we are going to be the first people on the scene if one of my patients under anesthesia has problems. So we've done, as a team, we've done a little course to update us on CPR and keep us refreshed because fortunately this is not something I have to do very often. And while we immediately call for help, it takes a few minutes for someone to get to us. So we need to start. So these guidelines, I think, are essential for veterinarians, but they're also for laypeople, right, who have pets. And so can you talk a little bit about that, why that's important?

Dr. Jamie Burkitt: Yeah, sure. So kind of to touch on the exact scenario you're talking about, the interesting thing is that the best outcomes possible from CPR which of course CPR is something we do when an animal's heart stops beating and they stop breathing, which is a very critical moment of life. If something is not done immediately, that animal is going to die. So you're speaking exactly to the purpose of RECOVER, which is that the patients that have the best possibility of going home with a good outcome, doing great, quote unquote, back to themselves, are animals that are relatively healthy. I recognize you're anesthetizing cancer patients, but many times these animals are systemically quite well.

Dr. Michael Kent: Exactly. Most of the times my patient has cancer and otherwise is healthy. It might be elderly, but age is not a disease.

Dr. Jamie Burkitt: age is not a disease.

Dr. Michael Kent: You've heard me say that before.

Dr. Jamie Burkitt: Oh, we've all said it.

Dr. Michael Kent: Yes.

Dr. Jamie Burkitt: Oh, we all believe it. So basically, really, those animals that are systemically well do not have a terminal disease process, but especially those undergoing an anesthetic event, that could be for your radiation treatment. It could also be a spay or a neuter in a clinic. Those patients are in this really interesting subset that are the most likely to be successfully resuscitated if their heart stops beating or they stop breathing and they're the most likely to be able to go home and have a really good quality of life afterward. And sort of the, I don't know, it's a bit of an unfortunate intersection is that... It is so, it's great that it's so incredibly uncommon that we find these life-threatening events under anesthesia. That's great. It hardly ever happens.

Dr. Michael Kent: Yes, incredibly rare.

Dr. Jamie Burkitt: But what that also means is that the veterinarians and the veterinary staff who are encountering these animals, who are basically systemically well, who are undergoing anesthesia for what could be a fairly routine procedure, especially to the person, you know, going through this procedure, maybe not for the pet, but for the veterinarian and the veterinary staff, this is routine. They're hardly ever in the space where they need to be able to do CPR. They haven't done CPR in 6 or 12 months because it happens so infrequently.

Dr. Michael Kent: Or several years in my case.

Dr. Jamie Burkitt: Or several years. So then if an animal arrests or, you know, stops breathing, their heart stops beating under that anesthesia, this is also the team that is the least accustomed to having to perform CPR.

Dr. Michael Kent: Exactly.

Dr. Jamie Burkitt: So, the goal of the RECOVER initiative is to empower teams of veterinary professionals. And really when we get to the at-home space, even owners of pets, groomers, people who are dog walkers, people who are pet sitters, and of course also our first responders who work with canine officers for empowering all of these people to be able to provide high quality evidence and consensus-based care to animals in their times of need. So, we as an initiative have online coursework as well as provide in-person hands-on training, just like the American Heart Association does.

Dr. Michael Kent: So, if it's okay with you, we're going to post the website information where people can get more information and sign up for these type of online courses, because those are for lay people as well, right?

Dr. Jamie Burkitt: Yeah, we absolutely have a, we have a lay person, pet, what we call pet owner.

Dr. Michael Kent: Yeah.

Dr. Jamie Burkitt: But really it's, it is for pet owners, but also it would be appropriate for the kind of paraprofessional. So for a groomers, dog walkers, pet sitters, et cetera. And, people who own pets who have chronic illnesses, like I have two elderly cats that have to be medicated every day, things like that, because I'm a, just like being a vet, I'm also a pet owner. I have to be really careful who I ask to come watch my animals because they need to be prepared for there to be, 

Dr. Michael Kent: An emergency. 

Dr. Jamie Burkitt: An emergency, yeah, something wrong with one of my animals at home. So as an owner of pets, I really want to have people helping me with my pet sitting or whatever that have some of these skills.

Dr. Michael Kent: Now you said something interesting to me too. You needed evidence-based, consensus-based guidelines. So why do we need guidelines and how do you go about validating them? I assume this is why it took from 2018 to 2024 to come up with these first CPR guidelines.

Dr. Jamie Burkitt: Yeah, that's a great question. It's, you know, this is a double-edged sword, evidence and consensus-based. So, we think that it's really important to have evidence, the best evidence we could have would be large-scale evidence available in the species in question. So dogs, cats, foals, rabbits, you know, all of these different companion animals. At this stage, we have almost no evidence in these species to inform what we should do in these emergency situations. There is some. A lot of it actually comes out of laboratory experimental space, but we have more and more in the clinical space. But almost all the evidence that we find available is from the human space, the human clinical trials area.

Dr. Michael Kent: So ,we're using humans as the guinea pigs in a sense, right? And taking it back to our patients.

Dr. Jamie Burkitt: Yeah, that's exactly right. So, what we did was we used a a process called the grade evaluation technique and scores really hundreds of veterinary professionals, both veterinarians as well as veterinary nurse technicians, to review the evidence and to rate it, for instance, for any risk of bias of that evidence. How directly do we think these findings apply to dogs and cats, or if we're talking about the large animal guidelines, foals, things along those lines, how directly do we think they apply? Kind of synthesize all that and come up specifically with veterinary recommendations based on the information, which again, we considered, of course, the human evidence, because that's what there mostly is. But where veterinary and animal experimental evidence was available, we also used that.

Dr. Michael Kent: So it's a starting point that you can use. 

Dr. Jamie Burkitt: Yeah

Dr. Michael Kent: And then you can actually, from there, gather data and actually validate it in a sense. So take the consensus and make it more evidence-based, which is what we try to do, right?

Dr. Jamie Burkitt: Yeah, and I think we really used the evidence that we found. synthesized it as a group of kind of subject matter experts, how does this apply, wrote treatment recommendations for dogs and cats, and then we released them for international consensus for a month in the summer of 2023, basically for the CPR guidelines. And during that month, we got feedback from around the world about the treatment recommendations that we were making. We then went back as a committee, an executive committee and domain chairs, and altered our treatment recommendations based on the reality of what the people on the ground were recommending and saying we should do, making sure that still was aligned well with the evidence that was available, and then had all of those published in the summer of 2024 as pertains to the CPR guidelines.

Dr. Michael Kent: So I know, I mean, I know that for my team, this has been important because basically what I was taught in vet school a long time ago was different from what I learned when we ran our practice drills. And it was also a good refresher. So are you collecting information on how how well this is being disseminated and who this is reaching. Are you're trying to get that kind of information as well as part of the RECOVER initiative?

Dr. Jamie Burkitt: Yeah, that's a great question. Absolutely, because we definitely want to know our, does it matter is what we say matters. Is it helping? And then also to part of our process is also to generate new evidence, of course, but also to recognize knowledge gaps or critical gaps in knowledge that need to be explored. So, what we've done is pose a bunch of knowledge gaps in our guidelines and in our domain papers that we hope investigators will look into. And then from the research side, Dr. Manu Boller is the co-chair that is in charge of our research and registry pillar. And there is a registry where a variety of different veterinary hospitals, small animal hospitals at this time, from around the world provide CPR incident information into a registry, and we have thousands of cases at this point that have undergone CPR. And then researchers, basically, in the veterinary space apply to use that information from the registry and produce papers or publish papers. Regarding CPR, how is it going? Are there changes in practice compared to what used to be before the guidelines came out, et cetera?

Dr. Michael Kent: And what's most effective?

Dr. Jamie Burkitt: And what's actually working, yeah.

Dr. Michael Kent: So, this is a pretty big deal.

Dr. Jamie Burkitt: Yeah, we're proud of it. And we, yeah, we're still growing. So we also hope, we hope that what we're doing is helpful. That's our goal.

Dr. Michael Kent: Yeah, of course. So I'm going to. What I told you I was going to ask you about, and of course I go down rabbit holes all the time, but I was going to ask you about the upcoming first aid guidelines a little bit for dogs and cats. So why did you decide to tackle it next? Was it just the next big hole that you saw or, you know, what led you down this path?

Dr. Jamie Burkitt: That's a great question. So we are interested in helping people, empowering people and teams to help animals, using this evidence and consensus-based process, and so we know that... all of us as pet owners, people who are paraprofessionals or professionals outside the veterinary space, like first responders who have, canine officers with them… 

Dr. Michael Kent: Really important.

Dr. Jamie Burkitt: That all of these individuals need to be able to help their pets in the best or canine companions as it were, canine officers in the best, most evidence-based way possible. And there really were no guidelines out there, which means that, you know, if my neighbor had a problem with their dog. For instance, say their dog stepped directly into a caustic substance in the kitchen that they were cleaning the kitchen floor with, and their dog has a chemical burn on its paw pad, you know, what are they supposed to do? And the truth of the matter is that for many of these interventions and many of the questions we're asking in the first aid space, first of all, a lot of them are based on the human first aid questions and the human first aid, you know, guidelines.

Dr. Michael Kent: Again, a starting point, right?

Dr. Jamie Burkitt: Exactly. Many of them are absolutely what you could do for an animal in that first 10 to 15 minutes. In other words, another way of saying that is before you can get to the vet hospital, before you could possibly get there, is absolutely life-changing and sometimes life-saving what you could be able to do for them. So, we felt like it was really important to provide people with this guidance as well. And I'm so excited to have worked on this domain. It's a really, really fun domain.

Dr. Michael Kent: It's cool. And it's really broad applicability.

Dr. Jamie Burkitt: And it's really broad applicability. That's exactly right. Like super broad applicability.

Dr. Michael Kent: So, if you'll give us the website links, we will put them on our website so people can go to it because I assume it's going to be on the RECOVER website as this builds out and it's released.

Dr. Jamie Burkitt: Yeah, absolutely. We should be available, we hope, before the end of the second quarter published, yeah.

Dr. Michael Kent: So you were talking a little bit about a dog or cat coming into the kitchen, stepping in something caustic. So how do you think about this? So what kind of things do dogs and cats usually get covered in, first of all? So what different types of toxins do we think about? when doing this.

Dr. Jamie Burkitt: Certainly I think the most common that I'm aware of, although we didn't actually look into this evidence wise, but that I'm aware of would be the example that I gave you as far as a caustic substance would be stepping in something that is caustic, for instance, bleach or some other type of cleaning solution. I personally have managed dogs that, you know, were owned by people who also owned restaurants. And they would walk through the kitchen as they had cleaned the floor of the restaurant at the end of their day at the end of their shift and burned all four paw pads. 

Dr. Michael Kent: Paw pads

Dr. Jamie Burkitt: Exactly. It's, just can be really actually life ending, sometimes, because it certainly causes such significant burns on their feet, or could do, that it requires weeks of surgical management and in-hospital management and things like that that's frankly super painful for the dog and also can be cost prohibitive for the owner.

Dr. Michael Kent: So, Dr. Burkett, my dogs just walked through the kitchen and we've just put something really nasty on our kitchen floor. Do I wash their paws? Do I irrigate it with water? Should I use soap? Like, how long do I rinse the area? What do I do?

Dr. Jamie Burkitt: That's a great question. So, we are leading in every situation with no, just like they do on the human side, no risk to the rescuer. So, we are first and foremost, an owner or caregiver of an animal has to think about their own safety. So, we would only encourage doing things where the animal seems amenable And so….

Dr. Michael Kent: You don't want to get bit. 

Dr. Jamie Burkitt: Yeah. And it, even our animals who love us, we care for them. They might, let's be honest, I have a cat that sleeps on the pillow next to my head every single night.

Dr. Michael Kent: Mine often sleeps on me.

Dr. Jamie Burkitt: So, we we're all very close to our animals. They do love us and we love them. And when they are in pain, they really have, or scared, or both, they only have a couple of ways that they can react and biting even their pet parents is a totally natural reaction. So, I think none of us should believe that our animal would never bite us because sometimes they might.

Dr. Michael Kent: So this is any of emergency situations.

Dr. Jamie Burkitt: So we have to be really careful. Yeah. So first and foremost, we watch out for our human selves. We don't want to end up in the emergency room too. But the answer to your question, after ensuring that we are safe for ourselves is that we think that the best recommendation for caustic substance exposure is running water. So running water, truly a hose, one of your sink attachments that kind of comes off and acts like a hose, 

Dr. Michael Kent: Sprays.

Dr. Jamie Burkitt: Exactly, for 15 minutes over that area. So really, really important. Dousing or holding in water is probably not enough. Really that running over is important because it's constantly clearing away whatever that toxin may be.

Dr. Michael Kent: So now I've rinsed them as best I can and I'm on my way to the vet. What if they lick at it? Or should I try to stop them from doing that?

Dr. Jamie Burkitt: That's a great question. I think the best you can do is to hope that they don't lick at it. Again, you yourself should be, if you have at home latex gloves or non-latex vinyl type gloves or something like that at home, even when you pursue this attempt to rinse their feet, again, you're watching out for your own well-being.

Dr. Michael Kent: Oh yeah, wear gloves.

Dr. Jamie Burkitt: Obviously, you're gonna wear gloves if you have those available to you, even dishwashing gloves, anything like that. And then ideally, if you are to keep them from licking themselves, that would be great. But if you've done the 15 minutes, chances are you're probably in decent shape there. As much as possible, yeah, it would be ideal if they not then lick that area.

Dr. Michael Kent: So maybe if you had an E-collar at home from a previous... you could pop that on.

Dr. Jamie Burkitt: Yeah. That would be perfect.

Dr. Michael Kent: I'm just trying to think of things like, I'm wondering if we should almost come up or if you haven't thought of this, like an emergency kit to have for your dog at home.

Dr. Jamie Burkitt: Yeah, that's kind of in our list that will likely appear in these guidelines. Yeah.

Dr. Michael Kent: So, we were just talking about a toxic substance, but I think probably more common is like your dog eats something. They eat, because they eat something they shouldn't eat. This could be rat poison, snail bait, antifreeze, prescription medications for you or them, or foods that can be toxic to pets, like let's say grapes or chocolate.

Dr. Jamie Burkitt: Yeah.

Dr. Michael Kent: And so, what should an owner do if they see their dog or cat eating one of these things? Besides making them stop if you can.

Dr. Jamie Burkitt: Yes, exactly. Remove if possible.

Dr. Michael Kent: Yes, remove so they don't get more because everything's dose dependent, right?

Dr. Jamie Burkitt: Pretty much. We think so. Most things are anyway.

Dr. Michael Kent: You want evidence?

Dr. Jamie Burkitt: Most things are. Some things are what we call idiosyncratic, so may not actually be as dose dependent, but it is possible. 

Dr. Michael Kent: Like grapes…

Dr. Jamie Burkitt: That probably is dose dependent, interestingly, but different dogs seem to need different doses.

Dr. Michael Kent: And idiosyncratic means it can happen and like just.

Dr. Jamie Burkitt: Tiny amounts.

Dr. Michael Kent: Tiny amounts, but not every case.

Dr. Jamie Burkitt: Most not cases, right? Exactly. So it's hit or miss as it were. But for the most part, I completely agree with you. Doses really do matter. You know, it's interesting that this is the one we are talking about in that ,the human, on the human side, this is answered. You really should not induce emesis at home. 

Dr. Michael Kent: Emesis, meaning don’t make them vomit.

Dr. Jamie Burkitt: Vomiting, right, that's right. On the human side, this was actually some of the largest studies we found. One study we found was from a human poison control center that included almost or just over 750,000 calls to poison control. And they included outcomes for did the individual need to go to the hospital and also did the individual die or not die? Almost a million people.

Dr. Michael Kent: Important outcome point.

Dr. Jamie Burkitt: Yeah, really important, two important outcome points. And the answer was that it made no difference if you induced vomiting at home or not.

Dr. Michael Kent: I've heard use ipecac or hydrogen peroxide. And I know there's dangers for that too, right?

Dr. Jamie Burkitt: Both of these things actually have the considerable risk to dogs and cats at home. So, this is not without risk to try. And there is not strong evidence. And one might actually argue that there is evidence that it is not helpful. So, I will say though, and I feel like…

 Dr. Michael Kent: This is counterintuitive.  

Dr. Jamie Burkitt: I understand, I get it. 

Dr. Michael Kent: No, that's why I want you to talk more. That's why you're here.

Dr. Jamie Burkitt: Well, it also is not agreed upon in the veterinary space yet. So, in other words, we've found this information. We found smaller studies in like children that eat the red berries off of plants at home. 

Dr. Jamie Burkitt: We found overdoses of acetaminophen in particular. This is a big, big one. 

Dr. Michael Kent: So, Tylenol, or the brand name, of acetaminophen.

Dr. Jamie Burkitt: or paracetamol, depending on where our clients are living. 

Dr. Michael Kent: Yes, yes in the UK

Dr. Jamie Burkitt: Exactly. But the, You know the evidence in these cases in human beings is that home vomiting does not help. It does not matter. Now, that doesn't mean they don't need to see a medical professional. Animals that eat things they should not eat should see a veterinarian.

Dr. Michael Kent: You see a dog eating blue stuff in your backyard or your neighbor's yard.

Dr. Jamie Burkitt: As soon as possible.

Dr. Michael Kent: That's rat poisoning, probably right.

Dr. Jamie Burkitt: As soon as possible, yeah. It depends on the blue thing, but yeah.

Dr. Michael Kent: Blue is bad, 

Dr. Jamie Burkitt: Blue is bad, green is bad. 

Dr. Michael Kent: So I know there's a poison control hotline for animals too. Is this something that they should be calling on the way to the vet? Is this, and maybe we should, we'll put their numbers in if you could provide those to me as well. We'll put them on the website also.

Dr. Jamie Burkitt: That's a great question. So I think it depends a little bit. If you live 10 minutes from a veterinary hospital that is open at the time of the problem, you're probably just as good to take your animal to that veterinary hospital as soon as possible. If it's eaten something that you are concerned about, period, whether you know it's toxic or not, or maybe you just saw them swallow a piece of a tennis ball. I mean, it could also be that, right? Which isn't toxic, 

Dr. Michael Kent: An obstruction.

Dr. Jamie Burkitt: but blocks the way. 

Dr. Michael Kent: It could kill them.

Dr. Jamie Burkitt: Exactly. And so many of these cases, once they reach the veterinarian, the answer to the vomiting question is different. So, the downside is that for home vomiting is that both things we have available to us for inducing vomiting at home pose really significant dangers to dogs and cats. That's syrup ipecac and hydrogen peroxide, both quite dangerous for dogs and cats at home. I think our recommendation is going to be not to do it. But again, this hasn't been through consensus process, and there is a lot of disagreement on this, even among subject matter experts.

Dr. Michael Kent: So, this is something that we need to learn more about.

Dr. Jamie Burkitt: We need to learn more.

Dr. Michael Kent: But we do know that probably if they get to the veterinary hospital, we are going to induce vomiting with a safer drug.

Dr. Jamie Burkitt: With a safer drug. That's exactly right.

Dr. Michael Kent: And then we're probably going to try to absorb whatever toxin is if we have, let's say, activated charcoal or something like that. And if not, or if it's been too long, we'll dialyze them, right, and pull it out of their blood. because toxins are not good. Great. I appreciate that. That's so calling the poison control center while you're getting there, but not if it's going to delay you getting there.

Dr. Jamie Burkitt: Yeah, exactly and I also think it's a different story if you are camping. and your dog eats something and you're 2 hours away from anyone, but you can get a cell signal, call Animal Poison Control. That's the answer. And then do what they say. Or call the vet that you normally use and see what they say. They may make a recommendation if they're open, you know, may make a recommendation to you. Oh, you don't need to worry about that one specific thing you just saw your dog eat.

Dr. Michael Kent: You just ate a small bit of milk chocolate and the weight of your dog, your dog's not going to seizure. 

Dr. Jamie Burkitt: Don't worry about it. 

Dr. Michael Kent: Don't make them vomit and risk getting pneumonia from aspiration.

Dr. Jamie Burkitt:  Exactly. Yeah.

Dr. Michael Kent: Thank you. That's cool. So I guess another emergency I think of is bleeding. You know, let's say dog's got a big laceration or something. And I know the basics is apply pressure.

Dr. Jamie Burkitt: Pressure.

Dr. Michael Kent: But it's severe. Can you put a tourniquet on? Like, where can you do this on a pet? Like, what should we use? A belt? how tight should you apply it and how long can you keep it on?

Dr. Jamie Burkitt: So we answered some of this for our investigation for first aid and RECOVER. Some of that we've addressed. The yes, no, is it worthwhile putting on a tourniquet if you have an extremity? So tourniquets only work on extremities, and that's basically in dogs and cats, that's limbs and tails.

Dr. Michael Kent: Legs and tails, okay.

Dr. Jamie Burkitt: Yeah, that's legs and tails. So we would really only recommend applying A tourniquet if bleeding is excessive. So, I mean, and what does that mean? You know, 

Dr. Michael Kent: If you see something squirting. 

Dr. Jamie Burkitt: If there's something squirting, yep. If you are applying pressure, the animal will allow you to apply pressure and bleeding is coming through your pressure bandages. You know, maybe there is some concern there. Of course, the amount of blood that can be lost from a Great Dane is dramatically different than the amount of blood that can safely be lost from a Chihuahua. So, everything is kind of, you know…

Dr. Michael Kent: Relative. 

Dr. Jamie Burkitt: relative. That's exactly right. However, that being said, On the human side, and that's where all of our information came on this one, was only from the human side. There is absolutely no question that tourniquets save lives and people. Now, when a person is still conscious but bleeding and needs a tourniquet placed, they know that the person placing the tourniquet is trying to help them.

Dr. Michael Kent: Yeah, so they're not going to bite them, hopefully.

Dr. Jamie Burkitt: They don't bite, right? They may scream and it may be terrible and painful, but they're not going to stop the person doing it or try to stop the person doing it. I would say that of all of the recommendations we've made, this is the one that actually concerns me the most for caregiver safety.

Dr. Michael Kent: Both for applying a pressure and for putting a tourniquet on.

Dr. Jamie Burkitt: Really, yes. Because if you have a conscious animal, that whatever is bleeding that much is going to hurt a lot. So our recommendations, of course, as always, are for safety for the rescuer first. And then yeah, there is no doubt that tourniquets save lives. 100%, they do. So, we think that probably our recommendation here is going to land most relevantly to the first responder group. And there is the knowledge that it is possible that you may actually need to wait for the pet to be relatively lying down or lose consciousness before it is safe to do this, unless you have really good control of that animal.

Dr. Michael Kent: Like a basket muzzle.

Dr. Jamie Burkitt: Like a basket muzzle.

Dr. Michael Kent: Something else for your to-go kit?

Dr. Jamie Burkitt: Yeah. So, I think, there is no doubt that tourniquets save lives. Obviously, tourniquets need to be placed above the area of bleeding, in other words, toward the body, from the site of bleeding, and really need to be tightened down as tightly as you can do, which is, it feels scary to do that, but to save their life, it needs to be as tight as you can make it to the point that bleeding stops.

Dr. Michael Kent: And if you're driving to the vet and it's an hour away, do you release it every 20 minutes? 

Dr. Jamie Burkitt: You do not. You leave it and drive. You just keep driving.

Dr. Michael Kent: As quickly and safely as you can.

Dr. Jamie Burkitt: That's exactly right. That's exactly right. And really, tourniquet release times matter, but at the same time, in the human medicine side, they're routinely having to leave tourniquets in place for one to two hours. Just this is reality for them as well. And so there is evidence on that. And their biggest worries, of course, is saving lives with high quality, same as us. But also, their priority of saving the limb is very, very high. And there is some controversy to this from an emotional standpoint as well. But one might argue that the value of a limb in a dog or a cat is less than the value of a limb in a human being. In that one limb, an animal can live a very happy life. Three limbed animal.

Dr. Michael Kent: Being an oncologist I know this. Tripods do great.

Dr. Jamie Burkitt: They're happy, happy, happy pets. So that may not be the same for a human being who requires a limb amputation. It's a really different story. And we respect that. And at the same time, saving the limb in a dog or a cat, it probably does not maintain the same priority that it does in a person. 

Dr. Michael Kent: So if they're going to die otherwise. 

Dr. Jamie Burkitt: Absolutely. Yeah. We would leave that tourniquet in place.

Dr. Michael Kent: I'm going to make another jump. 

Dr. Jamie Burkitt: Do it

Dr. Michael Kent: This is like an emergency room where you see case after case. A hot sunny day in California or somewhere else. Someone's left their dog or cat in the car maybe?

Dr. Jamie Burkitt: It does happen.

Dr. Michael Kent: And we see heat stroke. So when else does this happen besides the hot sunny car? What can happen with that? And then I kind of hope you could walk me through what are the signs that an owner's seeing in a dog in heat stroke? And then why is it bad? And then We'll get to treatment. Should you cool them down before you get there? What do we need to do? What's most effective? Alcohol on their pads, a fan, hosing them down? Like, again, make me smart.

Dr. Jamie Burkitt: I'm so glad we're talking about this one. I think in total, we're going to end up with, you know, a couple or three dozen recommendations throughout our first aid guidelines. But I have to say, I think this might be one of my very favorite questions because it is so incredibly relevant and because what clients or any caregiver to an animal does in this situation is 100% life-saving. So, I mean, the first part of treating heat stroke is prevention. So just like for children, we would never leave a dog or a cat locked in a car, really, on ideally any day. This is ideal.

Dr. Michael Kent: It can happen by mistake, too. I mean, we hear the tragic cases of children being left, and it happens with dogs too.

Dr. Jamie Burkitt: Absolutely does. Prevention, though, is incredibly important. I would also say to remember that some of our most devastating cases of heat stroke happen on the first warm days of the year. And that is because every single year we acclimatize, every single year we acclimate to more 

Dr. Michael Kent: People and dogs, 

Dr. Jamie Burkitt: People and dogs and cats, acclimate to warmer weather. So in other words, you know, you maybe live somewhere where the winter has been brutal and spring is the lamb and the lion that it is. It's so difficult, you know, so much back and forth with maybe wet weather and cold weather and my gosh, it's April and it's still snowing. I can't believe it. And that beautiful first day comes in springtime and you're like, we're going on a hike. And you go out there and take a four hour hike in 75 or 80 degree weather, Fahrenheit, which doesn't even to us sound that hot today. we think, 75, 80, not that hot. But that is actually the dangerous weather.

Dr. Michael Kent: And they're wearing a fur coat.

Dr. Jamie Burkitt: And they're wearing a fur coat and they haven't been in this weather for six months. 

Dr. Michael Kent: And they have their winter coat.

Dr. Jamie Burkitt: It's their first exposure and they're walking for two hours. So I think that is the main thing is remembering that those first hot days of the year are very dangerous. Any day that feels hot to you is dangerous for them to be exercising. You know, a walk is okay. If there's ever a point though where your dog or cat, but cats generally don't participate this way, but where your dog lies down. on a walk, on a hike, they lie down. You need to respect them lying down and they're telling you they need to stop. 

Dr. Michael Kent: Listen to your dog. 

Dr. Jamie Burkitt: Yeah, they need to stop for a little while. Most dogs that are hot will pant. Panting is pretty much always seen in dogs that need to cool down. But panting is also seen in dogs that are perfectly happy and don't need to cool down and it can be behavioral and excitement, right?

Dr. Michael Kent: Yeah, they're happy, you know, they're playing ball.

Dr. Jamie Burkitt: But I think remembering that on those walks or you've taken them to the dog park, whatever the case may maybe, especially those first days of the spring, and also when it's really hot outside and you are feeling hot, if they are panting, panting is a sign that they are hot. They need to be able to drink water, fresh water. So if you're taking them to the beach, remember they can't drink that water. They need fresh water to drink. 

Dr. Michael Kent: No, salt water would be bad. 

Dr. Jamie Burkitt: And yet, We do see this too. And just remembering that anytime they act like they're tired, they need to be allowed to sit and rest and not push to do more.

Dr. Michael Kent: So what are the signs? You said panting, 

Dr. Jamie Burkitt: Panting, 

Dr. Michael Kent: Lying down, when maybe they would play otherwise.

Dr. Jamie Burkitt: Yeah, when they might otherwise play. Some of them though will play themselves to death quite literally in the heat. So you can't rely on them to lie down and tell you. So other signs would be disorientation. So just seeming not quite right.

Dr. Michael Kent: They're not quite there anymore. They're not your dog.

Dr. Jamie Burkitt: Not quite there, or they kind of stumble a bit or fall down at all. These would be really, really concerning signs, actually.

Dr. Michael Kent: Okay, so getting to first aid.

Dr. Jamie Burkitt: What to do?

Dr. Michael Kent: What to do?

Dr. Jamie Burkitt: Yeah. So this is another running water. And the running water part is really, really important. So we obviously never recommend dousing an animal anywhere in front of the neck. So we keep the water away from the nose and mouth. 

Dr. Michael Kent: You don't want to drown them. 

Dr. Jamie Burkitt: Which could absolutely accidentally happen. And we don't want to see that. So the best place to try and cool them with running water is on the least haired part of the body.

Dr. Michael Kent: So their belly.

Dr. Jamie Burkitt: The belly. That's what we recommend. So, aiming for the belly if at all possible. And really that large surface area of the abdomen compared to the paw pads is the important piece. Kind of in human beings, now human beings are really different here. So our recommendation is different. In human beings, there is a recommendation that it is reasonable if you can't full body dunk a person, because it's not always possible, you don't always have a full body dunk option. They can actually cool people by putting their hands and feet into water bath. However, this really is different for a dog or a cat. The surface area is different paw pads compared to hands and feet. Of course, the top aspects of paws have fur again. So it's such a smaller surface area than it is in people. And you can't like ask them to sit there with it. It's just simply not as effective. We run water over the belly.

Dr. Michael Kent: So you run water over the belly. Five minutes, 10 minutes, 15 minutes.

Dr. Jamie Burkitt: 15

Dr. Michael Kent: 15 minutes again. So this is easy, 15 minutes for caustic toxin exposure, 15 minutes for a heat stroke.

Dr. Jamie Burkitt: Minimum 15.

Dr. Michael Kent: And then get to the vet because there are…

Dr. Jamie Burkitt: Always, every time, every time go to a vet. So even if they seem really much better, you know, they fell over in the heat, seemed not quite right, maybe excessive panting, you've cooled them and you've done an effective job, 15 minutes at home, still strong recommendation for taking them to a veterinarian. There can be sequelae or results of heat stroke that happened three to four days later that really a veterinarian should at least be involved enough to have a baseline examination of the animal, even if it's looking pretty darn good, and make some offerings to you as far as any baseline testing they might recommend. They may, and they may not, which is also fine.

Dr. Michael Kent: Their core temperature might be normal when they see him and they went, okay, it was only 5 minutes. Maybe he wasn't really, he or she wasn't overheated.

Dr. Jamie Burkitt: Yeah. Recommendation from a veterinary professional though is really, really important there.

Dr. Michael Kent: This has been really cool. And I just, I know I told you we weren't going to go so long and we've already gone over, which I've done many times. And I mean, there's so many other things that we could talk about in first aid. And I guess the best I can do at the moment is say, I'd love to speak with you again when the guidelines are finalized and that we will post to our website a link there so you can find out other things. Can you maybe just give me a list of a couple of the other things that you guys are creating guidelines for, you know, 

Dr. Jamie Burkitt: Within first aid? 

Dr. Michael Kent: Within the first aid.

Dr. Jamie Burkitt: Oh yeah. So we do, a really exciting one, I think, is handling low blood sugar at home. So certainly, we have a lot of animals that are known diabetics who are just, can be fragile diabetics, just like people and can have low blood sugar incidents at home.

Dr. Michael Kent: And who get insulin at home?

Dr. Jamie Burkitt: Yeah, who are getting insulin at home. So I mean, that is a ripe area for evaluation, and we do have some recommendations coming out about that. We also have some recommendations that are aimed a bit more, like I mentioned, in first responders and canine officers. So the administration of Narcan in the field for drug sniffing dogs. 

Dr. Michael Kent: For opioid crisis or for dogs who get into maybe their owner's medication.

Dr. Jamie Burkitt: Yeah, for sure. And oxygen provision on the way to the hospital and things like that.

Dr. Michael Kent: I'm actually really excited to see these come out. I think they're they are game-changing, right? And then our director, producer, Danae Unti, had a question that I hadn't really thought about so much, but Let's say you have goats or cows or a horse at home. You may not be able to just get them and transport them. Are there guidelines in the works for those? Like you have RECOVER guidelines for other species. Are we thinking first aid for some of our larger companions that we have?

Dr. Jamie Burkitt: That's a great question. So specific to first aid, I think almost all of our first aid guidelines will translate really well to other species. Because so many of them are sort of practical, hands-on measures that you can do for animals at home, like overheating or caustic substance. There is not going to be a difference there. In many ways, skin is skin. The covering of hair particularly depends a little bit on the species, but especially, you know, many goats might have very short fur. Same with horses, things like that, have very short fur that's actually almost more almost more directly applicable to a person than a dog that's real fluffy or something like that and maybe has a little more protection. So a lot of what we've recommended in first aid will be applicable across multiple species. And as far as looking into other species, yes, they almost certainly we will stick with domestic species or companion animals. So non-domestic companions as we evolve. But I do think over the next five years, we do have a full domain that is actively working right now, looking into life-saving measures for CPR and prevention of cardiopulmonary arrest in foals. And certainly, a non-domestics companion animal, for instance, for birds and reptiles and smaller mammals is very likely to appear in the next few years.

Dr. Michael Kent: I am sure I'm going to be imposing upon you and asking you back as more of this unfolds. And I'm actually interested in some of your other areas that you're interested. So I really appreciate you coming today to talk with me. I think this is going to be really helpful for people. And, you know, it's pragmatic advice on what to do in an emergency, right? How to stay safe, but try to save your pet's life.

Dr. Jamie Burkitt: Absolutely.

Dr. Michael Kent: So thank you for joining me today on The Vetrospective.

Dr. Jamie Burkitt: Yeah, thank you so much, Dr. Kent. Really appreciate it.

Dr. Michael Kent: Michael, please, Jamie.

Dr. Jamie Burkitt: Thank you for having me, and I appreciate it.

Dr. Michael Kent: No, this is great.

Dr. Jamie Burkitt: Yeah, you're welcome.

Dr. Michael Kent: The Vetrospective, as with life, takes a village. I want to thank those who suggested I start this project and everyone who has encouraged and supported me along the way. Particularly, I want to thank our producer and director, Danae Blythe Unti, Nancy Bei, who is our program coordinator, our sound mixer, Andy Cowitt, and theme music was composed and produced by Tim Gahagan. Thank you all, and we'll see you next time.