Tampa Bay Regional Disaster Symposium 2008

1. Tampa Bay Regional Disaster Symposium 2008 Small Animal Disaster Medicine: Common Emergencies Dr. Jo Ann Daniels Central Pasco Veterinary Care Director of Disaster Medicine Suncoast Veterinary Association, PART Centralpascovetcare@hotmail.com

2. Common emergencies and how to prepare for these at your practice • Changes to plan ahead for. • Tips to practice within these limitations. • Common injuries and conditions. • Supplies to pre-stock. • Client and staff education to prevent these emergencies. • Re-open your practice as soon as possible.

3. Changes: Power Failure • Radiographs • Autoclave • Surgical Monitors • Laboratory Machines • Air Conditioning • Hot water/well pumps • Refrigerators • Rechargeable Equipment • Generators

4. Changes: Power Failure • Phone System • Call your phone service provider and “Call Forward” your practice phone number to a cell phone. • Purchase a hand crank rechargeable lantern that has an outlet to plug in your cell phone car charger. ($19.99 at Home Depot)

5. Changes: Limited Supplies • Reordering of products • Limited access by delivery drivers • Limited storage of perishable supplies when power fails • Emergency care to patients may deplete supplies quickly • Be familiar with sampling programs from your preventative care product representatives. Many have programs for disaster aid.

6. Ocular • Traumatic injuries • Ulcers/erosion • Foreign bodies • Fight wounds • Search and Rescue • Herpes • Allergies

7. Ocular • Welch Allyn Ophthalmoscope/otoscope sets • C-Cell converter for 3.5v power handles - Part # 710168-501 - Remove the rechargeable module and rechargeable battery; replace with two c-cell batteries and the converter. - $16.98 - $19.99 Welch Allyn also makes a “pocket” ophthalmoscope

8. Ocular Supplies • Eye Wash • Eye Stain • Medicated Ointments • Sterile Lube • Eye Surgical Pack • Ophtho suture material • E-collars

9. Gastro-intestinal • Foreign body ingestion • Toxicities • GI indiscretion • Stress • Diet Change • Parasitism • Viral and Bacterial

10. Your clients houses …

11. …and patients environments

12. Gastro-intestinal • Client Education. • Pre-stock of appropriate diet esp. prescription diets. • Ingestion of debris during clean up process. • Collapsable crates. • Supportive and symptomatic care. • Use precautions for contamination – Glove up ! • Drinking and eating sources. • Deceased wildlife, contaminated drinking sources from sewage, uncollected garbage piles, spoiled food

13. GI Supplies • Dewormers • Sucralfate • Pepcid • Metronizadole • Albon • Panacur Packets • Caution with motility meds without radiographs • Replacement Fluids – Normosol R • Bland Diets - i/d, low residue

14. Integument • Traumatic injury • Lacerations • Burns • Impalements • Fight wounds • Infected wounds • Necrotic lesions • Allergies • Parasitism

15. Integument Supplies • Bandage materials • Battery operated clippers • Telfa pads • Wound irrigation saline • Penrose Drains • Skin staplers • Suture • Lac-packs • Antibiotics, analgesics, anti-inflammatories

16. Musculoskeletal • Fractures • Emaciation/dehydration • Weakness • Injuries from other animals • Tendon/ligament tears • Impalements • Crushing Injuries • HBC of roaming animals

17. Musculoskeletal supplies • Splints • Bandage supplies • Surgery packs and suture • Antibiotics • Analgesics • Anti-inflammatories

18. Other conditions • Dehydration • Hypoglycemia • Non-regulated diabetes • Addisonian crisis • Heat stress and heat stroke • Lost pets/found pets • Pets with no identification • Establish a plan for intake of pets

19. Diagnostics • Battery powered glucometers • Refractometer • Urine Dipsticks • Azo-Bun Sticks • Jorgensen • $27.00 for 25 pack

20. Diagnostics • Heartworm Tests • Idexx snaps can be removed from the refrigerator and have a 90 day shelf life • Felv/FIV Tests • ACT Tubes • Vet-Lab Supply 1-800-330-1522 100 pack for $65.00

21. Diagnostics • Reference Laboratories – driver may have difficulty reaching your practice. • Air card and lap-top computer may allow access to on line results if fax machine is out of order. • Disaster relief sites may have federal response VMAT that have in house diagnostic machines. • If you have a generator, you may have enough power to use a microscope for fecal and blood film examination. • Most centrifuges will work from generators for manual HCT/TP, UA sedimentation and sample preparation.

22. Diagnostics • Most X-ray machines draw too much power load to work with a portable generator. • Establish relationships with other practices in the surrounding areas that may have power for in-house diagnostic machines - Hematology and Chemistry – or they may have a working radiology suite.

23. Surgical Injuries/ Monitoring • Battery Powered Doppler • One 9v battery • New Jorgensen • Refurbished Medfurbish • F air canisters to attach to your anesthetic machine, if your powered scavenger systems is not operational. • Battery SPO2/HR Monitor.

24. Surgery • Gloves, Disposable Gowns, Masks • Battery Powered Clippers • Individual Scrub Brushes (BD E-Z Scrub 205 Iodine) Merritt Vet Supplies 1-800-477-5167

25. Surgery • Penrose Drains • 60 cc syringes and red rubber catheters for suction • Chest tube set-up • Lighting Source • Battery powered loops

26. Surgery • Lac-Packs • Individually wrapped mini packs of instruments to save major packs for abdominal surgeries. • Olsen Hegar, Brown Adson, Towel clamps, Metzenbaums, curved forceps, blade handle, 4 x 4’s • Consider Hemoclips for efficient ligation and skin staplers for efficient closure • Rica Instruments via Merritt Veterinary Supplies • Rep. Fred VanNorman 813-477-0955

27. Fluid Therapy • Without IV Pumps. • Replacement fluids. • Dextrose fluids. • Dial-up drip sets (5 ml/hr – 250 ml/hr Abbott $5.97) • Create a chart for macro and micro drip sets in your treatment area to indicate ml/hours rate conversions to drops per ml. • Irrigation saline.

28. Heat Stroke

29. Heat Stroke • Client Education • Encourage clients to purchase a rectal digital thermometer and demonstrate its proper use • Board pets until their houses are powered again • Collapsable crates with fan if clients have their own generator at home • Discourage use of walled kennels that offer minimal air circulation • Ask clients to evacuate early so they are not stuck in long traffic jams with their pets in a hot car.

30. Blood products • Animal Emergency of Pasco Blood Bank • 8740 US 19, Port Richey 727-841-6575 • Packed rbc’s, fresh frozen plasma, frozen plasma • If you generator supports a mini-fridge/freezer, stock plasma for heat stroke and snake bite victims • Whole blood products for traumatic injury, Packed Rbc’s also available for canine and feline patients. • Have blood collection sets on hand. • Blood typing cards from Rapid Vet do not need to be refrigerated

31. Other Supplies • Water, water and more water • Cardboard Carriers – inexpensive and easy to store • Jorgensen product • J-133 • $95.00 for 20 pack • ($4.75 each)

32. Other Supplies • Keep the shipping coolers and ice packs that your vaccines arrive in. They make great temporary housing for vaccines and perishable medications and products during brown outs. • Spare scrubs for a quick change after examining a contagious patient. • Staff care items – non perishable snacks and drinks, hand sanitizers, baby wipes for hygiene • Extra biohazard boxes in case your pick up service is unavailable.

33. Other Supplies • Disposable sanitation supplies • Kennel Pads • Disposable paper food bowls/trays • Less dishes to wash if your don’t have running water • Jorgensen J-974 • Manual Can Opener • Disposable water bowls • J-975 • Extra leashes

34. Other Supplies • Disposable litter boxes. • Contractor Bags for debris collection. • Shed supplies • Plywood • Chainsaw • Tarp and nails to cover roof damage • Duct tape

37. Record Keeping • Paperless practice – need pink and blue hand written medical records. • All practices need pre-printed prescription labels so directions can be hand written below hospital information. • Patterson Office Supplies 1-800-637-1140 Item 073-2594 • Treatment Flow Sheets • Stray and clients pets identification bands • Digital Camera

38. Record Keeping • Off site information back up monthly service • Portable external hard drive. • Set on timer • Automatic • Daily • Best Buy or Dell • $100- $150

39. Finances • Credit Card Machines • Call merchant services company and order a manual imprinter. ($22.00-$24.00) • Utilize cell phones to call in authorizations.

40. Finances • Care Credit Pre-print out care credit applications to phone in authorization requests – you may not have access to the web applications. • Keep records of any products used and services performed during disaster aid for your end of year accounting.

41. Insurances • Meet with your insurance agent • Building damage • Review your lease for your responsibilities • Do you have wind insurance • Contents Insurance • Professional Overhead • Short-term/ Long term disability • General Liability • Professional Liability and Animal Bailee • www.avmaplit.com

42. Hospital Policies • Create a Severe Weather Guidelines chapter to your employee manual. Have each member of your staff read and sign these policies. • Create a flexible schedule so staff can rotate duties to allow time for them to get home for their own pets. • Discuss job responsibilities with staff for before, during and after disaster events. • Do not offer boarding to clients if you are in an evacuation or flood zone. • Choose one media representative from your practice. Use caution with interviews.

43. Staff Education • Schedule a staff meeting to go over disaster guidelines and client education. • Provide staff with resources • brochures • phone lists • website addresses • www.hsus.org • $20.00 for 100 pack

44. Staff Education • Educate staff of universal precautions and for isolation protocols. • Prevent contamination of your hospital by limiting one staff member to interact with isolated patients during a shift.

45. Client Education • Post disaster preparedness guidelines on your website. • For an example, visit www.CentralPascoVetCare.com please cut and paste any portion of this guide.

46. Client Education • Ask clients if they live in an evacuation zone • Familiarize your clients with your boarding policies. • Brochures and practice handouts. • List of pet-friendly hotels in the area. • www.petfriendlytravel.com • Get involved in your community. • Write an article for your local paper. • Offer first aid classes at your practice.

47. Client Education • Discuss proper identification for all pets • Scan all patients on very visit to assess microchip function, inquire if registration is current and demonstrate to clients what we would look for if their pet was micro-chipped and lost. Res Q Universal Scanner Bayer 1-800-633-3796 $200.00

48. Client Education • Collars on all pets • ID tags on all pets • Include name, • Address • phone numbers • alternate contact number

49. Reopen as soon as it is safe to • Follow local emergency service coordinators directions for safe return to the practice. • GPS Coordinates of your practice forwarded to the FVMA and AVMA – street signs are gone • Go to http://maps.google.com/ • Type in your practice address, city, state and zip • Right click over your exact location and scroll down to ‘center map here.’ Coordinates will appear in location box.

50. Resources • Attend your local VMA and regional FVMA meetings to introduce yourself to fellow veterinarians and establish a network of resources. • Discuss disaster plans with other hospital owners and managers to see if resources can be consolidated. • Know the emergency hospital policies in your area so you can educate your clients accordingly. • The American Veterinary Medical Foundation accepts applications for disaster relief funding.