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Trailer or Vehicle Accidents
S E C T I O N
I Trauma C H A P T E R
Trailer or Vehicle Accidents
1
REBECCA M. GIMENEZ
H
orses are transported more often than any other type of livestock, sometimes hundreds or even thousands of times in their working years. Drivers are frequently untrained, and trailers may be inadequately maintained or incorrectly hitched. An inappropriate towing vehicle or incorrect hitching may cause a sway that results in a jackknife incident. Best practices to prevent wrecks and horse injury are shown in Box 1-1. Incidents with horse trailers occur during all phases of transport: loading, underway, and unloading, but the injuries most frequently attended to by veterinarians are those incurred when horses scramble, rear, or rush onto or off of the trailer. This chapter mostly addresses accidents during transportation; in many instances, these wrecks become unloading operations that must be upgraded to emergency extrication by professional responders. These situations involve far more than opening the gate of the trailer and leading the horse out. Every wreck is different, and there is no standard operating procedure that can be applied to every incident, but best practices in equine technical rescue do exist for handling these incidents. Modern practitioners must be part of the local emergency response team using the Incident Command System (ICS; Box 1-2). By law, if an accident occurs on a roadway, a person must call 911 in the United States, 000 in Australia, or 999 in the United Kingdom. The veterinarian must communicate using the emergency response language of ICS to make the extrication of the horse as efficient and safe as possible. Medical stabilization often must be started before a horse’s extrication, because horses are physiologically fragile, and an injured horse may steadily be deteriorating inside the wreck. In many cases, hours to days after a seemingly successful rescue, horses can die unexpectedly as a result of stress, ischemia reperfusion syndrome, hypothermia, or complications of shock.
ALWAYS INVOLVE EMERGENCY SERVICES
Veterinarians should involve 911 emergency services personnel from the beginning, whether the incident is a trailer overturn, a horse trapped over or under a chest bar, or a hoof caught in a divider, for example, because it speeds up overall efficiency of the response. The 911 services have evolved tactics, techniques, and procedures that yield superior results because they are constantly evolving but also are built on a foundation of past field experience. Responders must
consider safety of both human responders and the animals; available human, equipment, mechanical, and logistical resources; the weather; medical issues such as the stability of the patient and arrival time of medical treatment; and any unusual situational concerns such as accessibility, stability of the wrecked vehicle or trailer, and structural integrity of involved fixtures. For example, is the overturned trailer still attached but yawing out over the side of a bridge? The 911 personnel attend to such situations daily; a veterinarian may attend such a wreck once in an entire career.
ROLE OF THE PRACTITIONER
Accidents present many dangerous scenarios in which the veterinarian is not the authority with jurisdiction over the scene; usually it is the fire department or police officer first on site. The practitioner must fit into the ICS because the incident commander is ethically and legally responsible for the safety of all personnel and must evaluate the risk and benefit of strategies for horse extrication. Firefighters and police officers control traffic, extricate people, and assist with bystanders and frantic owners. Paramedics deal with human injuries, and the incident commander will consider assisting the animals when the scene is stable and safe. The veterinarian should then assess horse viability and consult with the horse owner to make timely decisions regarding treatment or euthanasia. From the perspective of the animal, the wreck is very different from that perceived by rescuers. Rubber mats, horse bodies, and divider gates have each reacted to impact based on gravity and momentum vectors. Recumbent animals entrapped in an overturned trailer are subject to abnormal orientation. Gravity acting on the horse’s weight, sometimes for several hours, can lead to muscle ischemia, with subsequent hyperemia and reperfusion injury developing after rescue. These factors as well as injuries to body systems must be taken into account to provide appropriate owner advice and timely treatment of the animal (see Chapters 3 to 11). Head, neck, and lower limb injuries are the most frequently reported by practitioners after trailer wrecks. When the horse falls forward into the chest bar or bulkhead area at impact, the first area to absorb the blow is the face and neck, and then the lower limbs are injured as the animal scrambles to stand up. Horses are astonishingly capable of surviving even catastrophic trailer wrecks—as long as they remain inside the trailer. However, the mass of the horse creates
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Box 1-1 Best Practices for Horse Trailer
Transportation To increase horse comfort and safety, buy a trailer with the optimal level of safety options. Use a camera in the trailer to observe horses’ health status, fractiousness, or accidental injury. Use a wireless temperature gauge to determine the temperature in the trailer. Include tire pressure monitoring devices on tow vehicle and trailer tires, including spares. Keep a minimum of two spare tires for the trailer and the towing vehicle. Affix reflective colored tape on the rear and sides of trailer to increase its visibility when trailer lighting fails or when the vehicles are on the side of the road in an emergency. Include a roadside trailer service number and complete kit of tools and safety devices to change tires and respond to minor emergencies. Regularly monitor working brakes, lights, padding, and dividers. At least annually, check for safe walls and flooring, good-quality wheels, axles, and tires. Use a high-quality halter with a breakaway feature in the tie. Protect horse’s limbs with full-limb wrap, sports medicine boots, or Velcro shipping boots on both short and long trips. Ensure intensive driver training that includes hitching, driving habits, merging, emergency stopping, and turning with a variety of trailers.
sufficient momentum to propel the horse through bulkhead walls, doors, and windows. If the horse is ejected or the trailer disintegrates, death is instantaneous, or the prognosis for survival is poor. Horses that appear to be lying calmly are actually extremely stressed; recumbent and trapped horses often lie quietly for a few minutes because of exhaustion, but their instinct is to rise to their feet, struggle, and run away. In the process, alpha horses may bite or kick horses with lower rank that are unable to escape. They do not reason that humans are there to assist. Horses can hear the voices, tools, vehicles, footsteps, and extrication equipment. Outside the trailer, they may be able to see shadows and reflections. Loud sounds such as those from sirens or cutting equipment must be limited until absolutely necessary, and once a tool is started, it should be kept running. Animals seem to accommodate to the sounds and vibration associated with such equipment if the tools are used efficiently. Remember that air chisels and reciprocating K-12 and chain saws are very loud, whereas others, like the hydraulic jaws of life, are silent but cut very jagged edges. Selection and use of cutting tools are the responsibility and expertise of the fire department; trailer construction materials run the gamut from wood to steel and fiberglass, and all require different strategies for extrication. Wrecked horse trailers can end up lying on either side (most common) or in dorsal, posterior, or even anterior recumbency (Figure 1-1). In a slant-loaded trailer, lateral recumbency results in horses being tied to either the trailer roof or floor. In a forward-facing trailer, being tied to the front of the trailer limits the animal’s ability to right itself. Posterior recumbency, which is common in incorrectly hitched, two-horse, forward-facing trailers, often results in
Box 1-2 Incident Command Framework
Item
Description
Planning
An incident action plan must be developed (simple and verbal, or complicated and written) depending on the size of scene and complexity or danger. The Incident Commander coordinates the incident response, is the leader, and shoulders responsibility for the entire scene. This is normally a firefighter or police officer who has extensive professional training and certifications in emergency response. Practitioners typically should not be the Incident Commander nor be part of the Operations team unless they have extensive TLAER* or Large Animal Rescue, Drowning Accident Rescue Team, and Incident Command System training in incident management and safely. One person can coordinate the activities of no more than five to seven responders. The incident commander is responsible for the safety of the victim and the rescuers. Individuals responding or acting on their own constitute a risk and a liability to others on the scene. The Incident Commander has the authority to forcibly remove such persons from the scene.
One coordinator
Span of control
Safety
No freelancing
*Technical Large Animal Emergency Rescue, Inc., Pendleton, SC.
posteriorly recumbent animals facing one another and tied to the front of the trailer. Anterior recumbency is the least common trailer wreck; to end up in this position, the trailer would have been incorrectly hitched, allowing it to leave the roadway and catapult into a ravine or treed embankment. Because of impact on the face and neck and mirrored anterior recumbency of their bodies, horses rarely survive such accidents. Two other scenarios that can be expected to have high injury and mortality rates are trailer floor failure and trailers hit by trains. Animals are often in shock, have endured severe injuries and pain, and rarely have sufficient remaining muscle or tendon structures to enable surgical repair.
ASSESSING THE SITUATION
There are almost no situations in which an overturned trailer should be turned back onto its wheels with live animals inside, but animals verified to be deceased may be left in the trailer for transport off scene. In most incidents, the trailer must be stabilized or moved to a safe area before the animals can be removed; examples include the trailer sliding down an embankment, hanging off a bridge, trapped in trees, or sinking in water. The orientation of the trailer should be noted, but doors or windows should not be opened until the horse’s behavior is evaluated and plans made to contain a horse that gets loose. A ladder may be needed to reach the windows or other access points on the top of the trailer. Trailers are actually lightweight and can move when in an
CHAPTER
1 Trailer or Vehicle Accidents
3
Lateral recumbency Right
Left
Posterior recumbency
Anterior recumbency
Dorsal recumbency Figure 1-1 Possible trailer orientations after an accident.
Figure 1-2 A large horse trailer that fishtailed on an icy interstate and stopped when it became upended on the guardrail. This demonstrates the difficult scenarios that may be encountered. This trailer provides plenty of room and access points to get to the four animals inside, but they are scrambling to maintain their balance, and the trailer must be stabilized before the horses can be extricated. (Photo courtesy Nancy Elberty.)
overturned configuration; they should be stabilized to minimize any chance of the trailer crushing a person or moving around as a horse attempts to unload. Difficult scenarios (Figure 1-2) may even require reorienting the trailer by a few degrees to provide better egress for the horse. Assessment of the inside of the trailer should determine the following: whether animals are dead or alive; what are the obvious external injuries; whether the animals are haltered and tied in the trailer; whether one is lying on top of the other; whether they are standing or lying down; whether the dividers, gates, or rubber mats are intact or fallen; whether you can assist the horse to extricate itself from the trailer;
and whether there is a safe way to cut or release the trailer tie without crawling over the horse’s body or head. The firefighters can make better decisions for extrication based on this type of information. Instruct responders to approach slowly while talking to the animals, evaluating their stress and orientation by looking in a window or other existing opening. Minimizing noise, sirens, and shadows and making your assessment without opening the back doors or ramps is safest and prevents escape. Horses accommodate quickly to consistent strobe lights, which are required for on-road safety. Disturbing the horse will cause it to struggle, perhaps causing additional injury. If a horse is able to get up, it will usually do so immediately after the incident. If it is still recumbent by the time you arrive, there is a reason. Slick floors, obstacles, and lack of leverage or space may contribute to failure to rise as much as does injury or exhaustion. The former conditions must be evaluated and, if possible, corrected. Horses may attempt to escape through openings too small for their body, and a panicked horse moving toward light is dangerous to itself and handlers. Fire or rescue personnel will have the equipment to safely stabilize the weight of the horse-laden trailer and to create an access route into the trailer. Cutting of metal or fiberglass may or may not be required, but any egress opening should be at least 4 feet wide and as tall as possible while providing structural integrity and an egress lane to lead the animal to a safe area off the roadway. Horses tend to fight to stand if physically possible, and then often stand quietly. Hay can be offered to keep them quiet while the veterinarian and ICS team evaluate the next steps. Horses that are down or entrapped should not be slapped or otherwise stimulated to rise, especially before the head tie and halter are evaluated. A short trailer tie, especially one that doesn’t break, will guarantee that the horse cannot get up. On the contrary, there will be no control over a horse wearing a broken halter. Bungee-type trailer ties under tension are extremely dangerous to people and horses. The
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best option for trailering a horse is to use a good-quality halter with a breakaway feature in the tie.
WHAT ARE THE OPTIONS IN THE DANGER ZONE?
Veterinarians routinely get close to horses in the course of delivering care and, because of work-related exposure frequency or complacency, get injured. Emergency services work to reduce the chance of injury to responders, and it is preferred that no one go into the trailer to halter a horse because it is a confined space where a person will be well within the danger zone of teeth, body, and hooves. It is easier and safer for responders to assist the animal to self-extricate. If possible, remove all obstacles like divider gates, equipment, removable tack rooms, ramps, and doors that can obstruct an exit path. Windows that have become holes in an overturned trailer’s “floor” should be covered with a backboard or rubber mat so the horse doesn’t step into them. If it is necessary to reposition the horse, it should be done with the aid of webbing straps placed around the limbs or head. It is preferable not to use the tail as an anchor point with which to drag an animal out of a space, because it can be permanently damaged or traumatically amputated. When a door or ramp is available, the opening should be covered with a tarpaulin to cover perceived escape routes and the door or ramp anchored so that it cannot slam back into place. Often, gates, dividers, and doors will have to be removed or cut even with the floor or walls before the standing animal can be safely extricated. Doors and metal do not make safe ramps when placed in abnormal configurations. Unintentional exit of the horse before responders are ready can be prevented by setting up secondary containment around the rear of the trailer with cattle panels, tarpaulins, parked vehicles, or snow fencing. Extra halters and lead ropes should be available to catch and control the horse. If these are not available, an emergency rope halter can be made. If a horse’s head is tied inside the trailer, it must be released before extrication is attempted. The safest way to release a trailer tie is to cut it without crawling over the horse’s body or head. No one should go inside the wrecked trailer for any reason without the horse being sedated or anesthetized unless the animal is standing and has a clear way out—then it may be possible for a person to go in, cut the trailer tie, and attach a lead before bringing the animal out safely. The tie can be cut by use of a seatbelt cutter or curved sharp knife taped to a long pole that allows responders to stay in a safe position outside the trailer. This prevents broken arms and fingers. A serrated knife can work, but the push–pull motion on the halter strap may stimulate the animal and cause an accidental stab wound, an outcome that can be prevented by use of a long pole. To sedate the horse without entering the trailer, a pole syringe can be fashioned by attaching a syringe to a long pole with duct tape. Unloading a horse on the side of the interstate highway is hazardous under the best of conditions and always requires law enforcement officers to stop traffic during the actual extrication and unloading–reloading operations. When extrication attempts are performed in the dark, in rain, or on steep hazardous terrain, these problems are compounded. Control of the head is crucial unless the animal is obviously not halter broken. Under no conditions should animals be removed from trailers until secondary containment is set up and traffic is stopped, because animals loose on the roadway can cause secondary wrecks and human fatalities.
ANIMAL HANDLER
If possible, the animal handler should be a person with largeanimal handling expertise, or an equine veterinarian or technician. Most policemen and fire officers don’t have experience with horses; large-animal handling skills for emergency situations are a specialty skill set. This lack of exposure or training may cause them to underestimate the extreme weight, strength, and speed of a terrified, trapped, or injured horse. The animal handler should be directed by the incident commander to take over the animal handling job from emergency responders on arrival at the scene. The handler is in the best position to advise operational personnel about the medical status or potential behavior or reactions of the animal, as well as to suggest approach techniques. The importance of safety should be emphasized by the handler to operational personnel, including demonstration of the use of long-handled tools to place appliances on animals that may otherwise kick, bite, or crush a person.
PRACTITIONER RESPONSIBILITIES
The veterinarian or technician should direct the medical stabilization, but should not go into the trailer, pull on assist devices, or perform the actual extrication. If possible, someone other than the veterinarian should take the role of animal handler. The professional emergency responders must be allowed to do their job. By taking a more managerial and hands-off approach for the extrication, veterinarians can plan and prepare for treatment options, advise the Incident Commander and the owner, and prevent injury to themselves by staying out of the danger zone. Many animal owners are emotional on scene, whereas the veterinarian has training to remain calm, make rational decisions, and handle the situation professionally. Close coordination with the owner can ensure better outcomes based on a correct diagnosis and recommendation of early treatment options, or recommendation of euthanasia at an appropriate time. Severely injured horses should not be transported to a care center without first being supported with appropriate methods for their injury: an animal with a fracture should not be loaded onto a trailer without placement of a splint, administration of pain treatment, and administration of fluids or other treatments for combating shock. Primary triage should be conducted on scene in an efficient manner, whereas secondary triage may be conducted at the clinic or at an off-site field hospital for mass casualty incidents.
MEDICAL CONCERNS SPECIFIC TO TECHNICAL EXTRICATION OF HORSES
Horses entrapped in abnormal positions (dorsal, posterior, or lateral recumbency) are subject to a variety of adverse consequences: hypoxia of the spinal cord, atelectasis, myelopathy, and forelimb or hind limb paralysis. Improper prioritization of the maximal rescue effort over initial medical stabilization has sometimes resulted in fatal consequences for animal victims; a medical patient may require treatment immediately, before, or during the extrication effort to offset metabolic changes that are occurring. Most animals need postextrication examination and treatment, even if they appear stable, for example, are eating hay, which can be interpreted by laypersons as a sign that the horse is fine. Even when a trained large-animal rescue team makes an efficient rescue and an on-scene veterinarian treats the animal immediately, it can still die. In particular, failing to immediately treat a horse for accidental hypothermia (Box 1-3) in cold or wet rescue situations is a common iatrogenic cause of death.
CHAPTER
Box 1-3 Risk Factors Affecting the Onset and
Severity of Thermal Instability Factor
Explanation
Dehydration
A dehydrated horse is less able to regulate body temperature. Very young and older and animals are less able to regulate body temperature. Obese horses overheat more readily. Very thin horses may lack the metabolic reserves to combat the stresses of accidents. In the face of thermal stresses, body temperature of large horses (small surface-to-volume ratio) is maintained for longer than in small or thin horses (large surface-tovolume ratio). General anesthetics and sedatives can aggravate hypothermia. The stress of rough handling may alter the circulatory function necessary for thermoregulation.
Age
Body condition
Body size
Drugs Rough handling
Box 1-4 Personal Emergency Kit Cell phone to call 911 Leather and latex gloves Boots: rubber and steel-toed Protective head gear (OSHA-approved hardhat with chin strap) Jacket or vest (reflective and brightly colored) Goggles Knife or Leatherman-type multitool Ear protection Professional shirt, jacket, or scrubs with your professional identification or logo Primary and secondary identification badge (one for yourself and one for “manpower accountability” OSHA, Occupational Safety and Health Administration.
Practitioners should carry basic equipment and tools to facilitate extrication of a horse that is trapped or injured, inside or outside a trailer (Boxes 1-4 and 1-5). Trailer incidents are widespread emergency responses for practitioners, so it makes sense to be prepared. These lists assume medical first aid supplies are available in the veterinarian’s vehicle.
Suggested Readings Cregier S. Reducing equine hauling stress: a review. J Equine Vet Sci 1982;2:186-198. Ferguson DL, Rosales-Ruiz J. Loading the problem loader: the effects of target training and shaping on trailer-loading behavior of horses. J Appl Behav Anal 2001;34(4):409-423. Friend TH. A review of recent research on the transportation of horses. J Anim Sci 2001;79(E Suppl):E32-E40.
1 Trailer or Vehicle Accidents
5
Box 1-5 Vehicle Emergency Kit A road hazard warning kit, reflective tape on rear surfaces of vehicles, working flashers on your vehicle, and a reflective vest for personnel on the side of the road First aid kit for both horses and humans A sharp curved knife or seatbelt cutter to be used for emergencies only, capable of cutting through tie straps and rope that may be entrapping the head or limbs A 30-foot-long piece of 3- to 4-inch-wide webbing with loops at each end (e.g., a tow strap) to control a limb or use around the body to maneuver the animal into a safer position A human cane, boat hook, or extendable painter’s pole to manipulate or webbing for cutting, or to make and use a pole syringe without having to get too close to the horse; use with interchangeable accessories such as cutters, carabiner, hold-open, or S-hook A hammer to drive the pins out of a chest bar or divider gate A towel or blanket to cover the head of a recumbent horse in order to calm it Emergency rope halters ( 12-inch kernmantle rescue rope 20 to 25 feet long) Rope-type horse halters Horse whole head protection (or human life vest, towel, sweat shirt, etc.) to protect the eyes Heavy-duty insulated horse blanket Large animal physical restraint such as twitch* 33-meter (100-foot) containment portable fencing (construction plastic fencing with polyvinyl chloride handles every 10 feet) Heavy-duty tarpaulin A source of high-quality hay to allow trapped or extricated horses to eat and relax while waiting for assistance *Udderley EZ, a division of EZ Animal Products and Wheeler Enterprises, Inc., Humboldt, IA. Gimenez T. Accidental hypothermia in the horse. Retrieved January 22, 2013, from http://www.saveyourhorse.com/ The%20Hypothermic%20Horse.pdf. Gimenez T. The golden hours of equine emergency rescue. Equine Vet 2012;2. Retrieved January 22, 2013, from http:// issuu.com/bocapublishing/docs/equine_veterinarian_mar-apr _2012?mode=window&backgroundColor=%23222222. Gimenez R, Gimenez T, May K. Technical Large Animal Emergency Rescue. Ames, IA: Wiley-Blackwell, 2008. Knubben JM, Furst A, Gygax L, Stauffacher M. Bite and kick injuries in horses: Prevalence, risk factors and prevention. Equine Vet J 2008;40(3):219-223. Lee J, Houpt K, Doherty O. A survey of trailering problems in horses. J Equine Vet Sci 2001;21:237-241. Pearson G. Advancing equine veterinary practice by application of learning theory. Proceedings of the International Society for Equitation Science. Royal (Dick) Veterinary School, Edinburgh, July 18-20, 2012. Quarterly horse trailering: USrider.org maintenance and safety publication. Retrieved January 22, 2013, from http:// www.usrider.org/HitchupPastIssues.html. Welfare of horses during transport. Retrieved September 18, 2012, from http://www.animaltransportationassociation.org/ Resources/Documents/Past%20Conferences/Brussels/J_Woods _presentation.pdf.
I Trauma C H A P T E R
Trailer or Vehicle Accidents
1
REBECCA M. GIMENEZ
H
orses are transported more often than any other type of livestock, sometimes hundreds or even thousands of times in their working years. Drivers are frequently untrained, and trailers may be inadequately maintained or incorrectly hitched. An inappropriate towing vehicle or incorrect hitching may cause a sway that results in a jackknife incident. Best practices to prevent wrecks and horse injury are shown in Box 1-1. Incidents with horse trailers occur during all phases of transport: loading, underway, and unloading, but the injuries most frequently attended to by veterinarians are those incurred when horses scramble, rear, or rush onto or off of the trailer. This chapter mostly addresses accidents during transportation; in many instances, these wrecks become unloading operations that must be upgraded to emergency extrication by professional responders. These situations involve far more than opening the gate of the trailer and leading the horse out. Every wreck is different, and there is no standard operating procedure that can be applied to every incident, but best practices in equine technical rescue do exist for handling these incidents. Modern practitioners must be part of the local emergency response team using the Incident Command System (ICS; Box 1-2). By law, if an accident occurs on a roadway, a person must call 911 in the United States, 000 in Australia, or 999 in the United Kingdom. The veterinarian must communicate using the emergency response language of ICS to make the extrication of the horse as efficient and safe as possible. Medical stabilization often must be started before a horse’s extrication, because horses are physiologically fragile, and an injured horse may steadily be deteriorating inside the wreck. In many cases, hours to days after a seemingly successful rescue, horses can die unexpectedly as a result of stress, ischemia reperfusion syndrome, hypothermia, or complications of shock.
ALWAYS INVOLVE EMERGENCY SERVICES
Veterinarians should involve 911 emergency services personnel from the beginning, whether the incident is a trailer overturn, a horse trapped over or under a chest bar, or a hoof caught in a divider, for example, because it speeds up overall efficiency of the response. The 911 services have evolved tactics, techniques, and procedures that yield superior results because they are constantly evolving but also are built on a foundation of past field experience. Responders must
consider safety of both human responders and the animals; available human, equipment, mechanical, and logistical resources; the weather; medical issues such as the stability of the patient and arrival time of medical treatment; and any unusual situational concerns such as accessibility, stability of the wrecked vehicle or trailer, and structural integrity of involved fixtures. For example, is the overturned trailer still attached but yawing out over the side of a bridge? The 911 personnel attend to such situations daily; a veterinarian may attend such a wreck once in an entire career.
ROLE OF THE PRACTITIONER
Accidents present many dangerous scenarios in which the veterinarian is not the authority with jurisdiction over the scene; usually it is the fire department or police officer first on site. The practitioner must fit into the ICS because the incident commander is ethically and legally responsible for the safety of all personnel and must evaluate the risk and benefit of strategies for horse extrication. Firefighters and police officers control traffic, extricate people, and assist with bystanders and frantic owners. Paramedics deal with human injuries, and the incident commander will consider assisting the animals when the scene is stable and safe. The veterinarian should then assess horse viability and consult with the horse owner to make timely decisions regarding treatment or euthanasia. From the perspective of the animal, the wreck is very different from that perceived by rescuers. Rubber mats, horse bodies, and divider gates have each reacted to impact based on gravity and momentum vectors. Recumbent animals entrapped in an overturned trailer are subject to abnormal orientation. Gravity acting on the horse’s weight, sometimes for several hours, can lead to muscle ischemia, with subsequent hyperemia and reperfusion injury developing after rescue. These factors as well as injuries to body systems must be taken into account to provide appropriate owner advice and timely treatment of the animal (see Chapters 3 to 11). Head, neck, and lower limb injuries are the most frequently reported by practitioners after trailer wrecks. When the horse falls forward into the chest bar or bulkhead area at impact, the first area to absorb the blow is the face and neck, and then the lower limbs are injured as the animal scrambles to stand up. Horses are astonishingly capable of surviving even catastrophic trailer wrecks—as long as they remain inside the trailer. However, the mass of the horse creates
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Box 1-1 Best Practices for Horse Trailer
Transportation To increase horse comfort and safety, buy a trailer with the optimal level of safety options. Use a camera in the trailer to observe horses’ health status, fractiousness, or accidental injury. Use a wireless temperature gauge to determine the temperature in the trailer. Include tire pressure monitoring devices on tow vehicle and trailer tires, including spares. Keep a minimum of two spare tires for the trailer and the towing vehicle. Affix reflective colored tape on the rear and sides of trailer to increase its visibility when trailer lighting fails or when the vehicles are on the side of the road in an emergency. Include a roadside trailer service number and complete kit of tools and safety devices to change tires and respond to minor emergencies. Regularly monitor working brakes, lights, padding, and dividers. At least annually, check for safe walls and flooring, good-quality wheels, axles, and tires. Use a high-quality halter with a breakaway feature in the tie. Protect horse’s limbs with full-limb wrap, sports medicine boots, or Velcro shipping boots on both short and long trips. Ensure intensive driver training that includes hitching, driving habits, merging, emergency stopping, and turning with a variety of trailers.
sufficient momentum to propel the horse through bulkhead walls, doors, and windows. If the horse is ejected or the trailer disintegrates, death is instantaneous, or the prognosis for survival is poor. Horses that appear to be lying calmly are actually extremely stressed; recumbent and trapped horses often lie quietly for a few minutes because of exhaustion, but their instinct is to rise to their feet, struggle, and run away. In the process, alpha horses may bite or kick horses with lower rank that are unable to escape. They do not reason that humans are there to assist. Horses can hear the voices, tools, vehicles, footsteps, and extrication equipment. Outside the trailer, they may be able to see shadows and reflections. Loud sounds such as those from sirens or cutting equipment must be limited until absolutely necessary, and once a tool is started, it should be kept running. Animals seem to accommodate to the sounds and vibration associated with such equipment if the tools are used efficiently. Remember that air chisels and reciprocating K-12 and chain saws are very loud, whereas others, like the hydraulic jaws of life, are silent but cut very jagged edges. Selection and use of cutting tools are the responsibility and expertise of the fire department; trailer construction materials run the gamut from wood to steel and fiberglass, and all require different strategies for extrication. Wrecked horse trailers can end up lying on either side (most common) or in dorsal, posterior, or even anterior recumbency (Figure 1-1). In a slant-loaded trailer, lateral recumbency results in horses being tied to either the trailer roof or floor. In a forward-facing trailer, being tied to the front of the trailer limits the animal’s ability to right itself. Posterior recumbency, which is common in incorrectly hitched, two-horse, forward-facing trailers, often results in
Box 1-2 Incident Command Framework
Item
Description
Planning
An incident action plan must be developed (simple and verbal, or complicated and written) depending on the size of scene and complexity or danger. The Incident Commander coordinates the incident response, is the leader, and shoulders responsibility for the entire scene. This is normally a firefighter or police officer who has extensive professional training and certifications in emergency response. Practitioners typically should not be the Incident Commander nor be part of the Operations team unless they have extensive TLAER* or Large Animal Rescue, Drowning Accident Rescue Team, and Incident Command System training in incident management and safely. One person can coordinate the activities of no more than five to seven responders. The incident commander is responsible for the safety of the victim and the rescuers. Individuals responding or acting on their own constitute a risk and a liability to others on the scene. The Incident Commander has the authority to forcibly remove such persons from the scene.
One coordinator
Span of control
Safety
No freelancing
*Technical Large Animal Emergency Rescue, Inc., Pendleton, SC.
posteriorly recumbent animals facing one another and tied to the front of the trailer. Anterior recumbency is the least common trailer wreck; to end up in this position, the trailer would have been incorrectly hitched, allowing it to leave the roadway and catapult into a ravine or treed embankment. Because of impact on the face and neck and mirrored anterior recumbency of their bodies, horses rarely survive such accidents. Two other scenarios that can be expected to have high injury and mortality rates are trailer floor failure and trailers hit by trains. Animals are often in shock, have endured severe injuries and pain, and rarely have sufficient remaining muscle or tendon structures to enable surgical repair.
ASSESSING THE SITUATION
There are almost no situations in which an overturned trailer should be turned back onto its wheels with live animals inside, but animals verified to be deceased may be left in the trailer for transport off scene. In most incidents, the trailer must be stabilized or moved to a safe area before the animals can be removed; examples include the trailer sliding down an embankment, hanging off a bridge, trapped in trees, or sinking in water. The orientation of the trailer should be noted, but doors or windows should not be opened until the horse’s behavior is evaluated and plans made to contain a horse that gets loose. A ladder may be needed to reach the windows or other access points on the top of the trailer. Trailers are actually lightweight and can move when in an
CHAPTER
1 Trailer or Vehicle Accidents
3
Lateral recumbency Right
Left
Posterior recumbency
Anterior recumbency
Dorsal recumbency Figure 1-1 Possible trailer orientations after an accident.
Figure 1-2 A large horse trailer that fishtailed on an icy interstate and stopped when it became upended on the guardrail. This demonstrates the difficult scenarios that may be encountered. This trailer provides plenty of room and access points to get to the four animals inside, but they are scrambling to maintain their balance, and the trailer must be stabilized before the horses can be extricated. (Photo courtesy Nancy Elberty.)
overturned configuration; they should be stabilized to minimize any chance of the trailer crushing a person or moving around as a horse attempts to unload. Difficult scenarios (Figure 1-2) may even require reorienting the trailer by a few degrees to provide better egress for the horse. Assessment of the inside of the trailer should determine the following: whether animals are dead or alive; what are the obvious external injuries; whether the animals are haltered and tied in the trailer; whether one is lying on top of the other; whether they are standing or lying down; whether the dividers, gates, or rubber mats are intact or fallen; whether you can assist the horse to extricate itself from the trailer;
and whether there is a safe way to cut or release the trailer tie without crawling over the horse’s body or head. The firefighters can make better decisions for extrication based on this type of information. Instruct responders to approach slowly while talking to the animals, evaluating their stress and orientation by looking in a window or other existing opening. Minimizing noise, sirens, and shadows and making your assessment without opening the back doors or ramps is safest and prevents escape. Horses accommodate quickly to consistent strobe lights, which are required for on-road safety. Disturbing the horse will cause it to struggle, perhaps causing additional injury. If a horse is able to get up, it will usually do so immediately after the incident. If it is still recumbent by the time you arrive, there is a reason. Slick floors, obstacles, and lack of leverage or space may contribute to failure to rise as much as does injury or exhaustion. The former conditions must be evaluated and, if possible, corrected. Horses may attempt to escape through openings too small for their body, and a panicked horse moving toward light is dangerous to itself and handlers. Fire or rescue personnel will have the equipment to safely stabilize the weight of the horse-laden trailer and to create an access route into the trailer. Cutting of metal or fiberglass may or may not be required, but any egress opening should be at least 4 feet wide and as tall as possible while providing structural integrity and an egress lane to lead the animal to a safe area off the roadway. Horses tend to fight to stand if physically possible, and then often stand quietly. Hay can be offered to keep them quiet while the veterinarian and ICS team evaluate the next steps. Horses that are down or entrapped should not be slapped or otherwise stimulated to rise, especially before the head tie and halter are evaluated. A short trailer tie, especially one that doesn’t break, will guarantee that the horse cannot get up. On the contrary, there will be no control over a horse wearing a broken halter. Bungee-type trailer ties under tension are extremely dangerous to people and horses. The
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SECTION
I Trauma
best option for trailering a horse is to use a good-quality halter with a breakaway feature in the tie.
WHAT ARE THE OPTIONS IN THE DANGER ZONE?
Veterinarians routinely get close to horses in the course of delivering care and, because of work-related exposure frequency or complacency, get injured. Emergency services work to reduce the chance of injury to responders, and it is preferred that no one go into the trailer to halter a horse because it is a confined space where a person will be well within the danger zone of teeth, body, and hooves. It is easier and safer for responders to assist the animal to self-extricate. If possible, remove all obstacles like divider gates, equipment, removable tack rooms, ramps, and doors that can obstruct an exit path. Windows that have become holes in an overturned trailer’s “floor” should be covered with a backboard or rubber mat so the horse doesn’t step into them. If it is necessary to reposition the horse, it should be done with the aid of webbing straps placed around the limbs or head. It is preferable not to use the tail as an anchor point with which to drag an animal out of a space, because it can be permanently damaged or traumatically amputated. When a door or ramp is available, the opening should be covered with a tarpaulin to cover perceived escape routes and the door or ramp anchored so that it cannot slam back into place. Often, gates, dividers, and doors will have to be removed or cut even with the floor or walls before the standing animal can be safely extricated. Doors and metal do not make safe ramps when placed in abnormal configurations. Unintentional exit of the horse before responders are ready can be prevented by setting up secondary containment around the rear of the trailer with cattle panels, tarpaulins, parked vehicles, or snow fencing. Extra halters and lead ropes should be available to catch and control the horse. If these are not available, an emergency rope halter can be made. If a horse’s head is tied inside the trailer, it must be released before extrication is attempted. The safest way to release a trailer tie is to cut it without crawling over the horse’s body or head. No one should go inside the wrecked trailer for any reason without the horse being sedated or anesthetized unless the animal is standing and has a clear way out—then it may be possible for a person to go in, cut the trailer tie, and attach a lead before bringing the animal out safely. The tie can be cut by use of a seatbelt cutter or curved sharp knife taped to a long pole that allows responders to stay in a safe position outside the trailer. This prevents broken arms and fingers. A serrated knife can work, but the push–pull motion on the halter strap may stimulate the animal and cause an accidental stab wound, an outcome that can be prevented by use of a long pole. To sedate the horse without entering the trailer, a pole syringe can be fashioned by attaching a syringe to a long pole with duct tape. Unloading a horse on the side of the interstate highway is hazardous under the best of conditions and always requires law enforcement officers to stop traffic during the actual extrication and unloading–reloading operations. When extrication attempts are performed in the dark, in rain, or on steep hazardous terrain, these problems are compounded. Control of the head is crucial unless the animal is obviously not halter broken. Under no conditions should animals be removed from trailers until secondary containment is set up and traffic is stopped, because animals loose on the roadway can cause secondary wrecks and human fatalities.
ANIMAL HANDLER
If possible, the animal handler should be a person with largeanimal handling expertise, or an equine veterinarian or technician. Most policemen and fire officers don’t have experience with horses; large-animal handling skills for emergency situations are a specialty skill set. This lack of exposure or training may cause them to underestimate the extreme weight, strength, and speed of a terrified, trapped, or injured horse. The animal handler should be directed by the incident commander to take over the animal handling job from emergency responders on arrival at the scene. The handler is in the best position to advise operational personnel about the medical status or potential behavior or reactions of the animal, as well as to suggest approach techniques. The importance of safety should be emphasized by the handler to operational personnel, including demonstration of the use of long-handled tools to place appliances on animals that may otherwise kick, bite, or crush a person.
PRACTITIONER RESPONSIBILITIES
The veterinarian or technician should direct the medical stabilization, but should not go into the trailer, pull on assist devices, or perform the actual extrication. If possible, someone other than the veterinarian should take the role of animal handler. The professional emergency responders must be allowed to do their job. By taking a more managerial and hands-off approach for the extrication, veterinarians can plan and prepare for treatment options, advise the Incident Commander and the owner, and prevent injury to themselves by staying out of the danger zone. Many animal owners are emotional on scene, whereas the veterinarian has training to remain calm, make rational decisions, and handle the situation professionally. Close coordination with the owner can ensure better outcomes based on a correct diagnosis and recommendation of early treatment options, or recommendation of euthanasia at an appropriate time. Severely injured horses should not be transported to a care center without first being supported with appropriate methods for their injury: an animal with a fracture should not be loaded onto a trailer without placement of a splint, administration of pain treatment, and administration of fluids or other treatments for combating shock. Primary triage should be conducted on scene in an efficient manner, whereas secondary triage may be conducted at the clinic or at an off-site field hospital for mass casualty incidents.
MEDICAL CONCERNS SPECIFIC TO TECHNICAL EXTRICATION OF HORSES
Horses entrapped in abnormal positions (dorsal, posterior, or lateral recumbency) are subject to a variety of adverse consequences: hypoxia of the spinal cord, atelectasis, myelopathy, and forelimb or hind limb paralysis. Improper prioritization of the maximal rescue effort over initial medical stabilization has sometimes resulted in fatal consequences for animal victims; a medical patient may require treatment immediately, before, or during the extrication effort to offset metabolic changes that are occurring. Most animals need postextrication examination and treatment, even if they appear stable, for example, are eating hay, which can be interpreted by laypersons as a sign that the horse is fine. Even when a trained large-animal rescue team makes an efficient rescue and an on-scene veterinarian treats the animal immediately, it can still die. In particular, failing to immediately treat a horse for accidental hypothermia (Box 1-3) in cold or wet rescue situations is a common iatrogenic cause of death.
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Box 1-3 Risk Factors Affecting the Onset and
Severity of Thermal Instability Factor
Explanation
Dehydration
A dehydrated horse is less able to regulate body temperature. Very young and older and animals are less able to regulate body temperature. Obese horses overheat more readily. Very thin horses may lack the metabolic reserves to combat the stresses of accidents. In the face of thermal stresses, body temperature of large horses (small surface-to-volume ratio) is maintained for longer than in small or thin horses (large surface-tovolume ratio). General anesthetics and sedatives can aggravate hypothermia. The stress of rough handling may alter the circulatory function necessary for thermoregulation.
Age
Body condition
Body size
Drugs Rough handling
Box 1-4 Personal Emergency Kit Cell phone to call 911 Leather and latex gloves Boots: rubber and steel-toed Protective head gear (OSHA-approved hardhat with chin strap) Jacket or vest (reflective and brightly colored) Goggles Knife or Leatherman-type multitool Ear protection Professional shirt, jacket, or scrubs with your professional identification or logo Primary and secondary identification badge (one for yourself and one for “manpower accountability” OSHA, Occupational Safety and Health Administration.
Practitioners should carry basic equipment and tools to facilitate extrication of a horse that is trapped or injured, inside or outside a trailer (Boxes 1-4 and 1-5). Trailer incidents are widespread emergency responses for practitioners, so it makes sense to be prepared. These lists assume medical first aid supplies are available in the veterinarian’s vehicle.
Suggested Readings Cregier S. Reducing equine hauling stress: a review. J Equine Vet Sci 1982;2:186-198. Ferguson DL, Rosales-Ruiz J. Loading the problem loader: the effects of target training and shaping on trailer-loading behavior of horses. J Appl Behav Anal 2001;34(4):409-423. Friend TH. A review of recent research on the transportation of horses. J Anim Sci 2001;79(E Suppl):E32-E40.
1 Trailer or Vehicle Accidents
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Box 1-5 Vehicle Emergency Kit A road hazard warning kit, reflective tape on rear surfaces of vehicles, working flashers on your vehicle, and a reflective vest for personnel on the side of the road First aid kit for both horses and humans A sharp curved knife or seatbelt cutter to be used for emergencies only, capable of cutting through tie straps and rope that may be entrapping the head or limbs A 30-foot-long piece of 3- to 4-inch-wide webbing with loops at each end (e.g., a tow strap) to control a limb or use around the body to maneuver the animal into a safer position A human cane, boat hook, or extendable painter’s pole to manipulate or webbing for cutting, or to make and use a pole syringe without having to get too close to the horse; use with interchangeable accessories such as cutters, carabiner, hold-open, or S-hook A hammer to drive the pins out of a chest bar or divider gate A towel or blanket to cover the head of a recumbent horse in order to calm it Emergency rope halters ( 12-inch kernmantle rescue rope 20 to 25 feet long) Rope-type horse halters Horse whole head protection (or human life vest, towel, sweat shirt, etc.) to protect the eyes Heavy-duty insulated horse blanket Large animal physical restraint such as twitch* 33-meter (100-foot) containment portable fencing (construction plastic fencing with polyvinyl chloride handles every 10 feet) Heavy-duty tarpaulin A source of high-quality hay to allow trapped or extricated horses to eat and relax while waiting for assistance *Udderley EZ, a division of EZ Animal Products and Wheeler Enterprises, Inc., Humboldt, IA. Gimenez T. Accidental hypothermia in the horse. Retrieved January 22, 2013, from http://www.saveyourhorse.com/ The%20Hypothermic%20Horse.pdf. Gimenez T. The golden hours of equine emergency rescue. Equine Vet 2012;2. Retrieved January 22, 2013, from http:// issuu.com/bocapublishing/docs/equine_veterinarian_mar-apr _2012?mode=window&backgroundColor=%23222222. Gimenez R, Gimenez T, May K. Technical Large Animal Emergency Rescue. Ames, IA: Wiley-Blackwell, 2008. Knubben JM, Furst A, Gygax L, Stauffacher M. Bite and kick injuries in horses: Prevalence, risk factors and prevention. Equine Vet J 2008;40(3):219-223. Lee J, Houpt K, Doherty O. A survey of trailering problems in horses. J Equine Vet Sci 2001;21:237-241. Pearson G. Advancing equine veterinary practice by application of learning theory. Proceedings of the International Society for Equitation Science. Royal (Dick) Veterinary School, Edinburgh, July 18-20, 2012. Quarterly horse trailering: USrider.org maintenance and safety publication. Retrieved January 22, 2013, from http:// www.usrider.org/HitchupPastIssues.html. Welfare of horses during transport. Retrieved September 18, 2012, from http://www.animaltransportationassociation.org/ Resources/Documents/Past%20Conferences/Brussels/J_Woods _presentation.pdf.