Calling the vet out of hours: what you need to know *H&H Plus*

  • Andrea Oakes discovers what happens when illness or injury occurs “out of hours”

    Accidents tend to happen at the most inopportune moments as horses owners are only too aware, and sickness rarely saves itself for a convenient time. Thankfully, if disaster strikes at night or over the weekend, veterinary help is usually just a phone call away.

    But who answers these out-of-hours emergency requests and drives to the scene if hands-on treatment is required?

    In the UK, the Royal College of Veterinary Surgeons (RCVS) requires that veterinary practices make provision for 24-hour emergency cover. The majority achieve this by running a rota within the existing team, or with neighbouring practices, meaning that the on-call vet often works the day before their night-time shift — and will most likely be back at work the following morning.

    As an owner, the promise of round-the-clock care is reassuring. Yet vets in equine-only practices can expect the heaviest workload in the veterinary world, ahead of colleagues in mixed, small and farm animal practices. A 2019 RCVS survey revealed that full-time equine vets work an average of 50.5 hours per week – with on average an additional 25.5 hours per week on call.

    Certainly, it is debatable whether a horse will receive the best possible care if the vet has been working both night and day.

    Welfare concerns

    What happens out of hours to keep our equine vets so busy?

    “Colic accounts for roughly one in three visits,” explains Professor Tim Mair MRCVS of Bell Equine. “We helped with a University of Nottingham study, which also revealed that wounds account for a further 20% of call-outs, and lameness for another 11%.

    “These tally with our own out-of-hours statistics,” adds Tim. “After these are recurrent airway obstruction, choke, foaling and post-foaling visits and painful eyes, with recumbency, neurological issues, foal problems and diarrhoea largely accounting for the remainder.

    “It’s not really the case that horses are more likely to develop certain illnesses in the hours of darkness,” Tim explains, adding that serious colic is sometimes not discovered until the following morning. “More tend to be stabled at night, however, and being fed only hay or eating straw bedding leaves a horse more prone to impaction colic.

    “Horses who are unobserved at night may also break into feed stores,” he adds. “Gorging on sugar beet can result in choke, while a glut of concentrates can cause grain overload.”

    It’s clear that certain issues require urgent attention, whatever the hour. A delay in the diagnosis and treatment of surgical colic, for example, can significantly lower a horse’s chance of survival while a major bleed or a foaling difficulty represents a life-or-death situation.

    Balancing immediate equine welfare needs with the ongoing mental health and work-life balance of our vets on call is not easy, but an emerging solution is the evolution of new equine emergency services clinics.

    “These are integrated with regular veterinary practices, but respond solely to out-of-hours emergency calls,” explains Tim. “This relieves the demands on vets in the regular host practices, who then don’t need to cover both day- and night-time work. Those attending out-of-hours calls are fresh, not tired, and can become more skilful in treating emergency cases.”

    Earlier this year, the RCVS approved a new category in its practice standards scheme, to ensure that these “ambulatory” (outpatient) clinics provide the most appropriate and up-to- date service.

    “It is incredibly tough to work all night and all day,” explains Tim, who adds that long working hours with irregular nightshift patterns are a proven cause of ill health. “These new clinics can help lighten this load, improving the welfare of both the vets and their patients.”

    Open all hours

    According to Ian Bellis MRCVS of Equicall, a dedicated out-of-hours service, the key to success is a solid relationship with the daytime practice, and skilled equine vets who are accustomed to equine emergency care.

    “In a crisis, an owner wants someone there promptly,” says Ian, who set up the pioneering service in 2018 with James Hopkins MRCVS. “It’s nice if they know the vet but, in a large practice, this is not always possible with an urgent daytime call-out. A quick and effective veterinary response is most important.

    “We work closely with multiple equine practices, carrying out emergency work for nights, weekends and bank holidays,” he adds. “An owner will still call their regular practice, but one of our team will respond.”

    Equicall’s busy workload is dominated by colic cases.

    “It is amazing how sensitive some horses are to things such as changes in climate and moisture levels in the grass,” says James. “But we’re called to a range of emergencies. We do at night what a daytime vet would do; for a joint wound, for example, we’d arrange X-rays and if necessary, refer the horse to the closest hospital.

    “A good handover to the daytime team is essential; all case details should be itemised and communicated by email or phone.”

    Without traffic priority, vets cannot provide a true “blue light service”. They will triage cases to prioritise the most urgent, however, and attend emergencies as promptly as possible.

    “We would encourage all owners to phone their practice if they are worried, whatever the hour,” says Ian, adding that in two years Equicall has seen 2,500 emergencies and handled 4,000 advice calls. “Sometimes, a brief chat with a vet is enough.”

    Emergency measures

    Be prepared for an out-of-hours visit by:

    ● Knowing the postcode of your yard or field, ideally making sure that the premises are signposted clearly from the road.
    ● Maintaining a well-stocked first-aid kit for basic treatment such as bandaging.
    ● Checking your horse’s passport is easily accessible.
    ● Keeping your trailer and towing vehicle or lorry in good repair or identifying a reliable 24-hour equine transport service and keeping contact details handy, in case urgent hospital treatment is necessary.
    ● Taking extra care when handling a horse who is in pain to prevent personal injury.
    ● Where possible, providing lighting, hot water, soap and a clean towel for the visiting vet. Remember your masks, with current Covid security, and minimise numbers of people.
    ● Thinking ahead about whether you would want your horse to undergo surgery for serious colic, for instance. Indecision can waste valuable time, jeopardising the chances of a successful outcome. It may be too late to change your mind once you’ve ruled surgery out.
    ● Considering insurance exclusions, upfront hospital costs and any necessary permissions in advance, briefing anyone left in charge of your horse in your absence.

    Can it wait?

    “A veterinary emergency is usually obvious, such as profuse bleeding that won’t stop, difficulty in breathing or any obvious or suspected fracture,” says H&H vet Karen Coumbe MRCVS.

    “But other problems may require immediate attention. Continuous diarrhoea can cause dangerous dehydration, for example, while eye injury or ulceration can lead to permanent loss of vision.

    “If in doubt, call and ask for professional advice,” she advises. “Be ready with the basics, such as the frequency and duration of any signs of pain, the horse’s temperature, pulse and respiratory rate, or the location and appearance of a wound or swelling. Sending an image or a video is often useful, particularly with lameness or wounds.”

    This feature was also published in H&H magazine, 25 February 2021

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