CAVMRC Disaster Response Training Syllabus

Animals in Disasters Common Medical Conditions November 5, 2023 8:45 AM-4:30 PM CAVMRC Disaster Response Training (Virtual)

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CAVMRC Disaster Response Training (Virtual) Animals in Disasters – Common Medical Conditions Sunday, November 5, 2023 | 8:45 AM – 4:30 PM Schedule at a Glance Time

Sessions and Speakers

8:45 AM

LOG IN

Welcome / Introduction Grant Miller, DVM

9:00 AM – 9:10 AM 9:10 AM – 10:10 AM 10:10 AM – 10:20 AM

10:20 AM – 11:20 AM

First Things First with the Chicken and The Egg: The Basics of Poultry Husbandry, Handling and Veterinary Care Jessica Robertson, DVM, DACZM BREAK

Duck, Duck… Chicken: Housing Considerations for Poultry in Emergency Shelters: Zoonotic Disease Considerations Jessica Robertson, DVM, DACZM

11:20 AM – 11:30 AM

BREAK

11:30 AM – 12:30 PM

Deploying to Help with Large Animals During a Disaster- What to Expect John Madigan, DVM, DACVIM, DACAW

12:30 PM – 1:00 PM

LUNCH BREAK

Triage and Stabilization of the Critical Patient Tracy Julius, DVM, DACVECC

1:00 PM – 2:00 PM 2:00 PM – 2:10 PM

BREAK

UC Davis CVET Team: Working with the CAVMRC to Help Animals in Disasters Ashley Patterson, DVM

2:10 PM – 3:10 PM

3:10 PM – 3:20 PM

3:20 PM – 4:30 PM

BREAK

Deployment in the CAVMRC Grant Miller, DVM

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Biography Jessica Robertson, DVM, DACZM Dr. Jessica Robertson obtained her DVM degree from the University of Illinois College of Veterinary Medicine. Upon graduation, Dr. Robertson completed a rotating internship in small animal medicine and surgery at the University of Illinois Veterinary Teaching Hospital followed by a specialty internship in avian, exotic, and zoological medicine at the Oklahoma State University Center for Veterinary Health Sciences. Dr. Robertson completed her residency in zoological companion animal medicine and surgery at the University of California Davis School of Veterinary Medicine. Following residency, Dr. Robertson joined the VCA West LA Animal Hospital and became a Diplomat of the American College of Zoological Medicine.

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First Things First with the Chicken and the Egg -The Basics of Poultry Husbandry, Handling and Veterinary Care Jessica Robertson, DVM, DACZM

CAVMRC Disaster Response Training (Virtual) Animals in Disasters-Common Medical Conditions – November 5, 2023 3

First Things First with the Chicken and the Egg - The Basics of Poultry Husbandry, Handling and Veterinary Care

Jessica Robertson, DVM, DACZM

WHAT IS BACKYARD POULTRY? • Backyard poultry = chickens, turkeys,ducks and geese – Less common = pheasants,quail,partridge, pigeon,guinea fowl and ratites

https://happydays365.org/poultry-day/national-poultry-day-march-19/

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H O U S I N G AND MANAGEMENT

HOUSING REQUIREMENTS • Poultry are adaptable to a wide variety of housing • Good husbandry is vital for welfare of the birds • Chicken coop goals – Easy to clean and disinfect • Cement floors • Insulated walls that are washable – Protect birds from predators

https://www.etsy.com/listing/972877376/chicken-coop-plans-9x42-diy-walkin?show_sold_out_detail=1&source=aw&utm_source=affiliate_window&utm_medium=a ffiliate&utm_campaign=us_location_buyer&utm_content=141392&utm_term=0&awc=62 20_1693441630_f8249bc46f11f645c202ea3a90e2a077

– Protect birds from the elements – Provide adequate space

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TYPES OF HOUSING

Photo credit: https://www.chickenfans.com/chicken-coops-guide/

VENTILATION IS CRUCIAL IN ALL CLIMATES Lackof

Build upof ammonia

Destroycilia of the trachea

Allow infectious agents into the lower respiratorytract

• In hot climates – forced ventilation (fans) and/or misters may be necessary to maintain appropriate temperatures • Swamp coolers can also be beneficial and inexpensive

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TEMPERATURE AND SUBSTRATE • Ideally litter should be – absorbent,loose and inexpensive

• Temperature goal in the coop = 50-75oF • Extreme cold = frostbite

– Shavings

– Feet and head typically most effected

– Straw – Hay

• Extreme heat = heat stress – Panting, spread wings,increased water consumption, decreased food consumption

• Spot clean regularly • Full clean every 6-12 months

PERCHES, NESTING AND POOLS • Perches are not required by all poultry – Initially will use but body weight soon precludes continueduse • Do not recommend introducing nesting prior to 17 weeks of age

https://duncanspoultry.com/duncans-poultry-8-hole-roll-out-nestmade-in-usa/

• Ensure providing an appropriate nesting site based on the species • Minimal requirement for waterfowl = ability to dunk head and bath – Separate source from drinkingwater

https://www.hgtv.com/outdoors/gardens/animals-and-wildlife/how-to-keep-duckscool-in-the-heat-of-summer

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FEED AND WATER • Birds should have access to clean, fresh water at all times • Important to feed the correct food for life-stage of the bird – Important in egg laying hens especially supplementation

https://www.amazon.com/Waterer-Hanging-Poultry-Plastic-Fountain/dp/B091XV368V

calcium

• Scratch/single source feeds are not recommended as they can lead to nutritional deficiency • Prevent rodents from contaminating feed

https://depositphotos.com/photos/ hen.html?qview=4390306

ANATOMY https://www.vecteezy.com/vector-art/86610-chicken-bone-vectors

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SKELETAL ANATOMY Lightweight and fused skeleton Air sacs extend into the medullary cavities of the major bones Hens will deposit calcium into their medullary cavity prior to egg laying Incomplete pelvis ventrally

INTEGUMENTARY ANATOMY

Pollock C. Galliform anatomy: A dozen key facts. December 1, 2012. LafeberVet Web site. Available at https://lafeber.com/vet/galliform-anatomy-a-dozen-key-facts/

https://www.britannica.com/science/feather#ref150906

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https://nri.tamu.edu/learning/wildlife/the-anatomy-of-a-quail/

DIGESTIVE ANATOMY

https://www.hobbyfarms.com/chicken-digestive-health-chickens-guide-tips/

DIGESTIVE ANATOMY

Pollock C. Galliform anatomy: A dozen key facts. December 1, 2012. LafeberVet Web site. Available at https://lafeber.com/vet/galliform-anatomy-a-dozen-key-facts/

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RESPIRATORY ANATOMY

URINARY & RENAL PORTAL SYSTEM

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REPRODUCTIVE ANATOMY

https://www.chickenfans.com/chicken-reproductive-system/

CARDIOVASCULAR SYSTEM

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PHYSICAL EXAMINATION

https://www.alamy.com/stock-photo-poultry-health-and-veterinary-care-chicken-wearing-a-stethoscope-isolated-144660927.html

PHYSICAL EXAMINATION – VISUAL ASSESSMENT Should be done prior to physical assessment of the bird Mentation General stance Ambulation Interactions with the flock

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PHYSICAL EXAMINATION -RESTRAINT • Restrain wings to prevent flapping and prevent injury – Normal folded position againstbody • IMPORTANT – must allow normal excursions from keel

https://www.hsa.org.uk/catching-and-handling/geese

• Less = more • Most poultry strongly dislike their head being handled

https://opensanctuary.org/how-to-conduct-a-turkey-health-examination/

PHYSICAL EXAMINATION • Head – Symmetry of the beak, eyes,sinuses and nostrils – Ears • Discharge, blood,parasites – Combs • Colorations,texture • CRT – Evaluate for any trauma

https://ohio4h.org/sites/ohio4h/files/imce/animal_science/Poultry/Basic%20Information%20About%20Chickens.pdf

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PHYSICAL EXAMINATION https://poultrydvm.com/condition/pendulous-crop

• Crop palpation • Evaluation of the keel – Straight with no deviations and “sloping” pectoral musculature – Wounds and/or feather loss • Auscultation – HR: 140-250 bpm – RR:15-30brpm – Ensure auscultating lungs and air sacs

https://www.reddit.com/r/chickens/comments/qex7n7/i_found_this_cute_stock_pic_1_what_breed_is_that/?rdt=56381

PHYSICAL EXAMINATION • Temperature

• Coelomic Cavity – Soft and doughy with no distension, palpable mass and/or fluid wave

– Typically, not obtained in awakebirds – Too high for most thermometers

– Ventriculus can sometimes be palpated

– No reflective of core body temperature • Temperature: 105-109.4oF

– Liver should not extend past the sternum

• Extremities – All long bones and joints

• Vent

– Plantar aspect of feet

– Clean and dry

15

PHYSICAL EXAMINATION • Integument – Feathers should be flat/smooth – Evaluate for ectoparasites – Evaluate for any signs of trauma

www.quora.com%2FDo-geese-have-teeth

• Oral examination – Evaluate for masses/plaques – Evaluate choanal slit and choanal papillae

https://www.123rf.com/photo_11501504_close-up-of-mallard-duck-feathers.html

DIAGNOSTIC SAMPLING https://www.mrclab.com/digital_clinical_centrifuge_8_tubes_15ml_4500rpm

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https://store.mavenimaging.com/products

BLOOD SAMPLES • Total blood volume = 10% of body weight • Blood collection – Healthy patients = 1% of body weight (10% blood volume) – Unhealthy patients = 0.5% of body weight (5% blood volume)

• Venipuncture sites – Jugular,ulnar (brachial) and/or medial metatarsal vein

• Collection = EDTA and heparin https://www.medonthego.com/BD-Microtainer-Tube-Blood-Collection

RADIOGRAPHS

Morishita, T.Y. and C.B. Greenacre, Backyard poultry medicine and surgery: a guide for veterinary practitioners. 2021: John Wiley & Sons.

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OTHER NONINVASIVE DIAGNOSTICS

• Oropharyngeal/Cloacal swabs – Pathogen identification • Molecular testing • Culture

• Fecal – Parasite identification – Culture

SO WHAT DO I DO IN A DISASTER?

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EMERGENCY RESPONSE PLANNING • Initial assessment = determine if support is appropriate – Is there already a preparedness plan?

• Forms of intervention – Feed – Water – Shelter – Veterinary support

https://ucanr.edu/blogs/blogcore/postdetail.cfm?postnum=52173

EMERGENCY RESPONSE PLANNING • Feed –Average backyard hen eats ~ ¼ cup of food perday – Plan to have at least 14 days worth of feed

https://www.blessthismessplease.com/diychicken-water-and-feeder-from-5-gallonbuckets/

– Commercial feeders or makeshift feeders • Ensure food does notbecome contaminated

https://www.diycraftsy.com/diychicken-feeder-plans/

https://www.pinterest.com/pin/4672485300 89871586/

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EMERGENCY RESPONSE PLANNING • Water – Drink approximately 2x’s that of what they eat – Plan to have 14 days worth of water – Portable waterer or low-walled container to portion water

https://www.pinterest.com/pin/134122895140 541148

https://www.blessthismessplease.com/diy-chicken-waterand-feeder-from-5-gallon-buckets/

• Ensure they are cleaned regularly

https://youtu.be/ouhBdsoDr6g?si=QQ3Zr6FoGWAYOPpi

EMERGENCY RESPONSE PLANNING • Shelter – Temporary plastic fencing – Metal cages – Available barn/stall

https://www.amazon.com/Portable-Protected-Enclosure-Fold-DownChickens/dp/B07X9LWWDN

• Ensure birds cannot escape • Ensure predators can not get in

https://blog.meyerhatchery.com/2019/04/ho w-to-turn-a-horse-stall-into-a-chicken-coop/

https://www.amazon.com/BestPet-Playpen-Cover-Rabbit-Enclosure

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EMERGENCY RESPONSE PLANNING

• Veterinary care

https://yubanet.com/california/california-veterinary-emergency-team-ready-to-help-animals-in-wildfires/

https://www.universityofcalifornia.edu/news/uc-davis-vets-rescue-animals-wildfires

REFERENCES

Practice 2012 34(3): p 136 145

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QUESTIONS

Email:jessica.robertson3@vca.com

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Duck, Duck… Chicken: Housing Considerations for Poultry in Emergency Shelters & Zoonotic Disease Considerations

Jessica Robertson, DVM, DACZM

CAVMRC Disaster Response Training (Virtual) Animals in Disasters-Common Medical Conditions – November 5, 2023 23

DUCK, DUCK….CHICKEN: HOUSING CONSIDERATIONS FOR POULTRY IN EMERGENCY SHELTERS & ZOONOTIC DISEASE CONSIDERATIONS

Management-Related Diseases[1, 2] Cannibalism Pecking/cannibalism is a common and difficult problem in poultry, especially in certain species (pheasants, quail) and breeds. If it is noted in a group of young birds, it is typically secondary to insufficient feed or diarrhea (soiled vents). If it is occurring in older birds, can attempt control by: • Reduction of lighting • Reduction of bird density • Increased numbers of feeders • Trimming beaks Trauma This is the most common “disease” of backyard poultry. While predation is the most common cause of trauma, entrapment of limbs in caging or other equipment, cannibalism, crush injuries and self-trauma can also be noted.

Most adult poultry highly resilient and seem to recover from extensive injuries. Deep wounds should be thoroughly explored to ensure that there is no communication/penetration with the coelomic cavity. For this reason – caution should be used when cleaning/lavaging any wounds that may penetrate the coelomic cavity. Primary closure may be considered for larger wounds. Minor injuries – most birds appear to recover with 2-3 days. Treatment typically involves topicals and basic wound care. Parenteral antibiotics may not be required for treatment of severe wounds. It is important to keep injured birds inside until they are healed to prevent contamination/secondary infection of the wounds and/or myiasis.

Pododermatitis (Bumblefoot) Inflammatory condition of foot characterized by swelling, ulceration, and erythema and is commonly localized to plantar metatarsal pad or plantar digital pads in any aged bird. Birds that are overweight and/or have unequal weight bearing are at higher risk for development of pododermatitis. Inappropriate/rough substrate and primary trauma/injury to the foot can lead to secondary infections most commonly with Staphylococcus sp. and Escherichia coli. Management is multifactorial and include changing/modifying the flooring (soft, padded) and medical (soaking feet, topical medications, bandaging and analgesia)

Infectious Diseases[1-3] Coccidiosis Coccidia is species specific and found primarily in intestinal tract of most poultry but can be seen in the kidney of geese and leads to GI disease, poor growth and possible mortality. Typically diagnosed in young birds (1-4 months), but older birds can be affected. Birds under 1 week of age do not have chymotrypsin and bile salts for breaking apart oocysts so they are not susceptible to disease. If disease is mild, it will lead to immunity as they get older.

Diagnosis of infection can be made based on clinical signs and wet, watery feces and confirmed via fecal. Infections should be treated with an effective coccidiocide (toltrazuril, amprolium). Prevention and control of infections is important – appropriate hygiene (prompt and regular removal of feces and contaminated bedding) and ensuring there are no damp areas within the enclosure (monitor waterers for leakage).

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JESSICA ROBERTSON, DVM, DACZM

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DUCK, DUCK….CHICKEN: HOUSING CONSIDERATIONS FOR POULTRY IN EMERGENCY SHELTERS & ZOONOTIC DISEASE CONSIDERATIONS

Histomoniasis (Blackhead) Histomonas meleagridis is considered the most important parasitic disease for turkeys and can lead to significant mortalities in other game birds and chickens. Clinical signs include diarrhea and other nonspecific signs (weight loss, poor feathers).

Chickens can be patent hosts for the parasites including the Heterakis nematode that serves as a paratenic host Turkeys, quail, grouse cannot be raised in the same area as chickens and pheasants. Raising turkeys in enclosures previously had chickens can also lead to outbreaks. Various antihelmentic can be useful in the prevention/treatment of disease.

Mycoplasmosis Many species that affect poultry (some lead to clinical disease, some are considered commensal) and do not all cause respiratory disease. Many mycoplasmas that lead to clinical disease in turkeys and peafowl can lead to asymptomatic disease in chickens. This disease can not only spread from bird to bird, but it can also be transmitted from hen to chick through the egg. Clinical signs vary by type of poultry infected with Mycoplasma gallisepticum. In chickens, the disease is typically referred to as chronic respiratory disease; turkeys and peafowl typically present with distended infraorbital sinus.

PREVENTION by only purchases birds from mycoplasma free flocks and quarantine all new birds. Commercial vaccines are available, but have been known to cause clinical disease in turkeys. No antibiotics totally eliminates the organism, but tylosin and tetracyclines can decrease clinical effects of the infection. It is important to note that clinical signs will typically reoccur after the antibiotics have been discontinued.

Infectious coryza Caused by Avibacterium paragallinarum and can lead to acute death in flocks of chickens, pheasants and/or guinea fowl.

Clinical signs typically include oculonasal discharge, facial swelling, and/or swollen infraorbital sinuses. This disease is most commonly seen in the southern United States and California.

PREVENTION of disease by depopulation of disease carriers. Cleaning and disinfection and then letting the enclosure sit empty (no poultry) for a period of time (typically minimum of 3 weeks). Treatment with sulfonamides, tetracyclines or erythromycin may reduce clinical signs.

Biosecurity[2-4] Important for any part of avian health management. “Bio” means “life” and “security” implies protection; programs are designed to protect life.

Goal – Keeping the infectious agents away from the poultry and keeping the poultry away from the infectious agents.

Minimization of the occurrence and spread of disease can be taken to decrease the interaction of poultry and infectious agents • Evaluation of how infectious agents can be introduced to the birds through humans, other poultry, food/water, infected equipment and other animals (pests, pets, predators, etc) • Implementing a routine cleaning and disinfection protocol.

The USDA and APHIS published a good resources for implementing biosecurity protocols.

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JESSICA ROBERTSON, DVM, DACZM

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DUCK, DUCK….CHICKEN: HOUSING CONSIDERATIONS FOR POULTRY IN EMERGENCY SHELTERS & ZOONOTIC DISEASE CONSIDERATIONS

https://www.michigan.gov//media/Project/Websites/mdard/documents/animals/exhibitions/signs/sign_poultry_biosecurity.pdf?rev=414af006236643f 6a4491081e621f407 https://upload.wikimedia.org/wikipedia/commons/f/f3/Backyard_biosecurity_practices_to_keep_your_birds_healthy_%28 IA_CAT31013763%29.pdf Person protective equipment is also an important biosecurity measure.

• Feet = dedicated pair of shoes that only get worn around the flock is recommended • Clothing = Regular clothes can be warn, but should be washed after contact with the flock; overalls/coveralls only worn when working with the flock can also be implemented • Head = hair net and masks should be warn to reduce the risk of spread of infectious agents.

• Hands = gloves should be warn; good hand hygiene – washing hands after handling birds even if glove were worn Other methods can be used to reduce the interaction of poultry and infectious agents • Minimizing human contact and establishing a visitor policy • Reduce exposure from contaminated feed and water • Reduce exposure to pests • Reduce exposure from new poultry introductions – quarantine and/or all in, all out approach Cleaning and disinfecting is another important component to biosecurity.

• Cleaning = removal of organic matter such as bedding or feces from the enclosure • Disinfection = the use of disinfectant/chemical to kill or neutralize potential pathogens

Zoonotic Diseases[1-10] Zoonotic diseases = infectious disease that can be transmitted either directly or indirectly from animals to humans. The risks of zoonosis to people that are exposed to backyard poultry is variable depending on several factors including: immune status and biosecurity practices.

Reportable zoonotic diseases (most states): Salmonella gallinarium, Salmonella pullorum, eastern equine encephalomyelitis, west nile virus, avian influenza, New castle disease and avian chlamydiosis.

Salmonella Most of the cases of human salmonellosis in the US is secondary to ingesting contaminated food items, but there have been increasing cases of infection secondary to direct exposure to poultry.

All salmonella serovars associated with poultry are of the species S. enterica. Avian specific salmonella serotypes of concern include: Salmonella gallinarium and Salmonella pullorum. These infections typically lead to sepsis with high mortality in poultry, but only rarely been isolated from humans.

Salmonella enteritidis is the most common Salmonella serovar associated with egg contamination, and approximately one in 20,000 chicken eggs in the United States is internally contaminated with S enteritidis. Human infection results from ingestion of contaminated products (meat, eggs) or direct contact with an infected animal or their feces. Signs in humans

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JESSICA ROBERTSON, DVM, DACZM

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DUCK, DUCK….CHICKEN: HOUSING CONSIDERATIONS FOR POULTRY IN EMERGENCY SHELTERS & ZOONOTIC DISEASE CONSIDERATIONS

may vary from asymptomatic, self-limiting gastroenteritis, sepsis and/or death. More severe cases typically occur in those that are immunocompromised, elderly, young children and/or person with large exposure.

PREVENTION of spread from backyard poultry to humans can be achieved by following specific guidelines. CDC specifically recommends that due to high rate of salmonellosis in children less than 5 years of age and increased risk of fecal shed from young poultry, that young children should NOT handle chicks and ducklings. Eggs should be collected as soon as possible after laying; eggs that are cracked and/or excessively soiled should not be consumed. Collected eggs that have visible debris should be cleaned. Eggs should be washed in water that is 10o F warmer than the egg (pressure gradient between warmer and cool environment can lead to migration of bacteria across the shell) and dried completely.

Follow FDA safety recommendations in regards to egg consumption/storing (recommend refrigeration).

Other enteric bacteria that may have zoonotic potential from poultry include: Campylobacter jejuni, Escherichia coli, Clostridium perfringens type A and type C, Listeria monocytogenes, Staphylococcus spp, Streptococcus spp, and Enterococcus spp. Human infection can occur from direct animal contact or by ingestion of contaminated products.

Human illnesses typically includes gastroenteritis.

Avian Chlamydiosis (Chlamydia psittaci) Human exposure typically occurs at processing plants, backyard poultry can carry the disease and typically exhibit no clinical signs, most often thought of as asymptomatic carriers. The organism can be transmitted by either inhalation or ingestion of the elementary bodies phase of the lifecycle.

PREVENTION of disease includes ensuring that those individuals that are cleaning and/or handling infected cages/birds should wear appropriate PPE. It is important to quarantine all new birds.

Chlamydiosis in humans is a notifiable disease and avian chlamydiosis is a reportable disease in most states. The public health department typically becomes involved in the case of human infections.

Mycobacterium Mycobacterium avium subspecies avium is the most common isolate in poultry (pheasants and waterfowl are more suspectible). Clinical signs in poultry are variable and nonspecific and is typically transmitted by ingestion or inhalation of contaminated water and soil. Treatment in all birds is controversial and has variable success. Treatment of poultry is not recommended. Depopulation or the flock and moving housing sites (“clean” soil) before repopulating.

Human mycobacteriosis is most common in those with AIDS and typically cause fever, weight loss, and anemia with the organism heavily infecting the GI tract. Birds with a confirmed mycobacteriosis diagnosis are potential zoonotic risks to humans, it is actually hypothesized that most human infections are acquired from the environment. Owners need to be informed of the risk of owning birds with mycobacteriosis and eradication of disease is recommended (cull).

Avian influenza Avian influenza (AI) virus is an RNA orthomyxovirus. Subtypes are described in any combination of known hemagglutinin (H) and neuraminidase (N) glycoproteins and further classified into 2 pathotypes based on severity of disease they cause.

• High pathogenic avian influenza (HPAI) – all notifiable disease • Low pathogenic avian influenza (LPAI) – can mutate into more highly pathogenic forms; H5/H7 notifiable The virus is shed in feces and respiratory secretions. Wild waterfowl are considered natural reservoirs for AI and act as asymptomatic shedders. Cases of influenza in birds are usually associated with direct contact with an infected bird.

Clinical signs in poultry are variable/nonspecific and depend on the virus pathotype, host health status and environmental 4

JESSICA ROBERTSON, DVM, DACZM

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DUCK, DUCK….CHICKEN: HOUSING CONSIDERATIONS FOR POULTRY IN EMERGENCY SHELTERS & ZOONOTIC DISEASE CONSIDERATIONS

factors. Death can occur without any clinical signs. Mortality with LPAI is typically low, but mortality of HPAI can be 100% of the flock.

Most human infection with HPAI have been linked to exposure to live and/or dead poultry. Clinical signs in humans are fever, respiratory infection/coughing and/or gastroenteritis. LPAI infections typically results in mild clinical signs, but HPAI can progress rapidly with mortality rates of 50-60%. No mammalian vaccine for HPAI is commercially available, vaccination with the seasonal influenza vaccine may decrease the risk of dual infections.

PREVENTION can be successful with appropriate biosecurity measures. In cases of an outbreak – flock depopulation is recommended. USDA also prohibits the importation of live poultry, products, hatching eggs from AI-infected countries.

Newcastle disease Caused by an RNA paramyxovirus (avian paramyxovirus type 1), is classified as: • Velogenic (virulent) = high mortality, typically without clinical signs • Mesogenic = respiratory signs, occasionally neurologic; low mortality • Lentogenic = subclinical to mild respiratory signs; most common strain of Newcastle disease in the United States New castle is a reportable foreign animal disease in the United States. Vaccination is available over the counter in the United States and has no withdrawal recommendations. Because the vaccine is live extreme caution must be taken for those administering the vaccine.

Humans that are infected with Newcastle disease typically have mild/self-limiting signs including: conjunctivitis (most common), fever, chills, headaches, decreased appetite, and lethargy.

PREVENTION – vaccination is not typically necessary for backyard poultry unless a known exposure in the area.

West Nile Virus Caused by a flavivirus and is considered endemic in the United states. Crows, jays, raptors, ducks and horses are susceptible species, while poultry are considered resistant to clinical disease. West Nile Virus (WNV) is spread via mosquitos and no direct transmission from birds to people occur.

Humans that are clinically affected are typically immunocompromised. There is no vaccine available for humans.

PREVENTION through vector (mosquito) control is recommended.

Eastern and Western Equine Encephalitis Virus Eastern (EEE) and Western (WEE) equine encephalitis are both caused by togaviruses. EEE clinical disease typically occurs in birds that are not native to the United States (pheasants) while clinical disease of WEE has been reported in pheasants, chickens and turkeys. Many bird species can act as a reservoir. Chickens very rarely develop clinical disease for either EEE or WEE and when they do, typically it is not a high enough viremia to play a role in transmission via mosquitos and are often used as sentinel animals. There is no direct transmission from bird to human. Mortality is much higher (75%) when infected with EEE compared to WEE (7%).

Cryptococcus neoformans and Histoplasma capsulatum Both of these fungal organisms can be passed in avian feces and survive in contaminated soil. Clinical disease is rarely reported in poultry, fecal shedding is most commonly associated with pigeons.

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JESSICA ROBERTSON, DVM, DACZM

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DUCK, DUCK….CHICKEN: HOUSING CONSIDERATIONS FOR POULTRY IN EMERGENCY SHELTERS & ZOONOTIC DISEASE CONSIDERATIONS

Human infection typically occurs through inhalation of spores and can lead to respiratory disease and/or meningitis.

Cutaneous lesions can be seen if organism comes into direct contact with broken skin.

PREVENTION by wearing appropriate PPE when handling any poultry bedding and/or carcasses to prevent inhalation of spores.

Microsporum gallinae Contagious fungal disease of poultry that is transmissible to humans through direct contact. In both poultry and humans infection typically results in scaly cutaneous lesions. Diagnosis can be through skin scrape and identification of the organism.

Fowl Mites

Ornithonyssus sylviarum and Dermanyssus gallinae transmitted to humans by direct contact. The bites can result in pruritis and erythematous papular eruptions in humans, and definitive diagnosis involves direct identification of the mite. Transmission can be prevented through eradication of the mites and wearing PPE while handling mite-infested birds.

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Wakenell, P., Management and medicine of backyard poultry, in Current Therapy in Avian Medicine and Surgery, B. Speer, Editor. 2016. p. 550.

Morishita, T.Y. and C.B. Greenacre, Backyard poultry medicine and surgery: a guide for veterinary practitioners. 2021: John Wiley & Sons.

Lister, S. and J. Houghton-Wallace, Backyard poultry 2. Veterinary care and disease control. In Practice, 2012. 34(4): p. 214-225.

Grunkemeyer, V.L., Zoonoses, public health, and the backyard poultry flock. Veterinary Clinics: Exotic Animal Practice, 2011. 14(3): p. 477-490.

Bermas, A. and J. Geddes-McAlister, Combatting the evolution of antifungal resistance in Cryptococcus neoformans. Molecular microbiology, 2020. 114(5): p. 721-734.

Marouf, S., et al., Mycoplasma gallisepticum: a devastating organism for the poultry industry in Egypt.

Poultry Science, 2022. 101(3): p. 101658.

Vrba, V. and M. Pakandl, Coccidia of turkey: from isolation, characterisation and comparison to molecular phylogeny and molecular diagnostics. International Journal for Parasitology, 2014. 44(13): p.

985-1000.

Ravichandran, K., et al., A comprehensive review on avian chlamydiosis: a neglected zoonotic disease.

Tropical Animal Health and Production, 2021. 53(4): p. 414.

Pilny, A.A. and D. Reavill, Emerging and re-emerging diseases of selected avian species. Veterinary Clinics: Exotic Animal Practice, 2020. 23(2): p. 429-441.

Rasidi, E.K. and S. Xie, Managing Disease Outbreaks in Captive Flocks of Birds. Veterinary Clinics: Exotic Animal Practice, 2021. 24(3): p. 531-545.

7

JESSICA ROBERTSON, DVM, DACZM

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Biography John Madigan, DVM, DACVIM, DACAW Dr. John Madigan is a distinguished professor emeritus in the UC Davis School of Veterinary Medicine and a diplomate of the American College of Veterinary Internal Medicine and the American College of Animal Welfare.

Dr. Madigan’s significant accomplishments in veterinary medicine over the past 40 years include 175 peer-reviewed scientific publications in the areas of neonatal medicine, comparative neurology, infectious diseases, and disaster medicine. He founded the UC Davis Veterinary Emergency Response Team (now called Cal-VET) in 1997 and was appointed to the State of California CARES committee to develop protocols for animals in disasters. Dr. Madigan has received the AVMA Animal Welfare Award, Red Cross Hero Award, American Association of Equine Practitioners Distinguished Service and Lifetime Achievement Award, UC Davis Cal Aggie Distinguished Service Award, and the UC Davis School of Veterinary Medicine Alumni Achievement Award.

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Deploying to Help with Large Animals During a Disaster- What to Expect

John Madigan, DVM, DACVIM, DACAW

CAVMRC Disaster Response Training (Virtual) Animals in Disasters-Common Medical Conditions – November 5, 2023 32

Deploying to Help with Large Animals During A Disaster - What to Expect John Madigan, DVM, MS, DACVIM, DACAW Noel Dybdal, DVM, Ph.D., DACVP Introduc�on: Perhaps the first ques�on to answer is: Why are we (large animal veterinarians) needed in largescale emergencies or disasters?

The requirement for having programs and plans for animals affected by disasters is now part of the na�onal and state legisla�ve mandates in many countries. The awareness that animals are part of the suffering and loss in a large-scale disaster or emergency and that animals, especially livestock, are essen�al components of economic life for humans impacted by a disaster has demanded that veterinary medicine provide services and efforts for the animal segment of a disaster. Indeed, failure to provide training and experience in this area compromises the animal welfare requirement of the veterinary oath. Veterinarians are essen�al to the disaster response assessment and response because of their training and knowledge of animal health and husbandry. We are the only segment explicitly trained and licensed to be responsible for providing medical care to animals.

The essen�al components of veterinary educa�on to prepare veterinarians to par�cipate in a disaster include core knowledge of a variety of species health and husbandry needs and knowledge of emergency procedures involving surgery, medical management of infec�ons, wounds, trauma�c injuries, burns, water-mediated (flood) health consequences, toxic, hazardous exposures, nutri�onal needs of animals, criteria for and methods of euthanasia and training in the incident command system of opera�ons. In California, we are aware that the host of disaster types includes wildfires, floods, earthquakes, drought, hurricanes, infec�ous disease outbreaks, bioterror, and perhaps even tornados. A glimpse at the nightly news with hurricanes and tornadoes allows us to imagine how this type of disaster may impact large animals.

Background informa�on on Disasters Knowing something about the stages of a disaster can inform us how we might par�cipate to help in some manner with our veterinary training. The four basic components of disaster management involve mi�ga�on, preparedness, response/emergency relief and recovery. Veterinarians, animal health technicians, and veterinary support staff have unique skills to serve all four phases.

1. Preparedness- This phase is the most effec�ve means of improving animal welfare in a disaster because, with plans and effec�ve preparedness, preven�on is maximal. Plans for evacua�on when

33

risk is impending- early volcanic erup�on measures, earthquake preparedness, which includes the ability to shelter in place for 7 days, alternate sources of power, animal owner educa�on in pet and large animal disaster preparedness, which produces self-reliance in an emergency. Animal iden�fica�on, predetermined loca�ons for shelters and housing, means for mobilizing all animals in one loca�on, etc. are all part of preparedness. Plan A, Plan B, Plan C.

2. Mi�ga�on – This phase comprises ac�ons taken before a disaster to reduce the impact on animals. This requires planning for expected natural disasters. For example, for floods, having plans which iden�fy loca�ons for evacua�on (these may require prior memorandums of understanding), vaccina�ons for expected water-borne diseases such as leptospirosis following floods, plans for prolonged loss of electrical power, sources of fresh feed and water, etc.

Addi�onally, many predictable disasters such as drought and famine, which build up over �me, can be mi�gated with �mely ac�on to minimize the effects on animals and people. Other risk reduc�on ac�ons would include adequate storage and protec�on of food and water, iden�fying animals so they can be reunited with their owners, strengthening, and securing animal shelters for an�cipated use, and implemen�ng of vaccina�on programs.

3. Response/Emergency Relief - This phase is tradi�onal rescue and emergency services provided immediately following a disaster. In all circumstances, emergency veterinary care is o�en provided through sta�c and mobile clinics and includes fundamental needs such as arranging and coordina�ng the feeding of hungry animals and reuni�ng animals with their owner wherever possible. Depending on the infrastructure and scope of the disaster search and rescue components, temporary shelters for animals, housing displaced large animals, and individual animal treatments for injury, infec�ons, and provision of preventa�ve measures may occur.

Sources of medica�ons are an essen�al part of effec�ve response, and many organiza�ons and states have cache units of emergency veterinary supplies.

Training for large animals includes technical rescue instruc�on, which teaches skills to safely work with trapped or stranded animals, knowledge of ropes, slings, animal skids, and housing requirements for stressed and injured animals. Training in the assessment of mass animal casual�es and infec�ous disease outbreaks, which may necessitate euthanasia for animals suffering with no chance of recovery, is needed. Knowledge of basic nutri�onal requirements for mul�ple species as well as of rehabilita�on methods for managing starved animals are important.

Animal first aid, field surgery methods, and wound management are also part of the knowledge and experience required.

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4. Recovery/rehabilita�on This phase, beginning concurrently with the Response phase, aims to get living condi�ons back to normal – or improve them – for all affected animals. An essen�al aspect of that is restoring veterinary care.

All our efforts can fall under the area of Animal Welfare. While defini�ons abound, for the purposes of this discussion, Animal Welfare is considered to be the area of human awareness involving preven�ng animal suffering and improving animal wellbeing for the sake of animals and the human beings who interact with them both for companionship and to facilitate human existence. The human-animal bond exists in many ways. When animals suffer, it causes human suffering because of compassion or the need for assistance with living. Disasters and emergencies can poten�ally have the most drama�c and catastrophic impact on animal welfare.5 It is society's expecta�on that animals' veterinary needs should and will be met. Hence the CVMA and UC Davis have worked for the past 20 years to create programs to meet these societal needs. The UC Davis VERT program responded to the levee break on the Sacramento River in 1997- the first coordinated veterinary response to a declared disaster from the School of Veterinary Medicine.

Years later, the plan presented to the California Legislature created by VERT leadership and endorsed by CVMA was passed to fund this program, and the result is the new Cal-Vet program, which will be discussed here today.

Incident Command System All mul�agency response efforts are run using the Incident Command System (ICS). A free online course is available and suggested for veterinary disaster volunteers. ICS 100 is a course available on the FEMA web site and is o�en a requirement for par�cipa�on in a mul�agency declared disaster. Basically, as a veterinary volunteer, you will not likely oversee something but given an assignment in the opera�ons sec�on. The person in charge is the incident commander and most disasters will have a staging area or a command post where you will be registered and given an assignment.

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Where the large animal veterinarian may be needed: Evacua�on: The primary responsibility for evacua�ng and providing care for animals during an emergency --whether it is a hurricane, flood, earthquake, wildfire, or terrorist incident -- rests with the animals’ owners. However, experience has shown that this is o�en impossible when 1) owners are unable to evacuate with their animals and are forced by urgent circumstances to leave them behind, 2) owners become separated from their animals before, during or a�er an evacua�on, and 3) when animal shelters are not available near human shelters so that owners can evacuate to an appropriate des�na�on where they can con�nue to provide daily care.

Accordingly, emergency preparedness and response planning must address how animal-related needs will be met. This may include assistance to load a frac�ous animal using seda�on or guidance from someone trained in loading horses and livestock during an emergency.

Addi�onally, failure to evacuate may cause animals to be sheltered in place, and the large animal veterinarian may be part of the team- when no ac�ve fire or other risks are present, to evaluate animals le� behind and determine if injuries are present and provide guidance on feed and watering.

Equine sheltering: Many coun�es have well-organized CARTs that will provide the basic organiza�on of the shelter and feed and watering.

Upon arrival at the shelter, some level of triage should be performed. This can be visual when large numbers are being admited and later followed up with a more complete evalua�on. The triage team can alert a veterinarian on an observed issue. Horses with snoty noses, or suspected respiratory condi�ons or diarrhea should be directed to an area of the shelter designed for biosecurity housing.

Data collected from shelters regarding veterinary issues for horses that needed to be addressed revealed the problems seen were mild colic, eye injuries, wounds and lacera�ons, minor burns, lameness, and foot problems. Data collected by the Northern California Associa�on of Equine Prac��oners (NCAEP) (Lieberman) revealed these treatments: 5.5 % received IV fluids in the field, 7.4% referred for ter�ary care, 1.8% euthanized. Burn care was not a common component of care in for equines in the shelter but was common with small ruminants and fowl.

Evacua�on of all animals may reveal horses and other animals which have been neglected. The magnitude of treatments in response to these condi�ons should be governed by the principle that evacuated animals receive basic husbandry and emergency-related care, but clients and shelter management should be informed further diagnos�cs treatments for a chronic condi�on is not part of the provision of care provided by volunteer DVM's.

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Other large animals at the shelter include catle, sheep, goats, pigs, and camillids.

Controlling the feeding of sheltered equines may lessen gastrointes�nal upsets. A record on each pen that indicates when fed, manure output, water consump�on, and if needed- as sign saying: Only veterinarian will feed - has proven useful.

Medical records u�lizing the shelter forms will be an important of veterinary efforts.

Public Informa�on Officer: As a volunteer DVM in a mul�agency-managed disaster and sheltering, it is essen�al that media communica�ons be performed by the person designated to speak on behalf of the en�re effort. That is the public informa�on officer.

Some comments regarding specific types of disasters and related injuries Floods- A horse exposed to standing water for a period may develop significant medical problems associated with losing the dermal barrier. This depends on the water quality- the presence of toxins or microbial contamina�on, water temperature, and dura�on of exposure. The first treatment when a horse is removed from water is to decontaminate the skin using large volumes of water- hose water- and have drainage gutered off for safe disposal. The magnitude of the damage to the skin may reveal itself in days a�er exposure. Leading horses through high water when you can't see fences, wires, or objects covered in water is risky. Wai�ng for the water to recede may be the course of ac�on.

Wildfires- The main issues are flight-related injuries, smoke exposure, and burns.

Secondary smoke-related air quality issues in areas adjacent to fires where smoke has permeated the environment, affec�ng people and animals. and Primary smoke exposure and direct smoke inhala�on.

• Smoke inhala�on from immediate associa�on with fire can produce thermal injury from hot gases and the toxic effects of the smoke components.

O�en, these horses show evidence of thermal skin injuries.

More frequent in stable fires than wildland fires Pulmonary injury - Sources of injury: Direct burn injury, toxic gases and hypoxia and hypoxemia Thermal Lung injury- Increases in bronchial blood flow are seen within minutes of smoke inhala�on.

• Tissue injury and shedding of the airway epithelial lining, coupled with the forma�on of protein-containing exudates and increased mucus produc�on by goblet cells, result in an inflammatory medium that solidifies or mixes with blood clots in the airway lumen to form airway casts.

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•

The casts may completely occlude airways, including the upper airways, resul�ng in airway obstruc�on and hypoxemia.

Therapy may include: • An�bio�cs (controversial – not rou�nely used- may be needed at a later �me) • Steroids (controversial- some evidence for poorer outcomes) • Nebulized therapy (acetylcysteine) • Oxygen • Humidifica�on The extent of pulmonary injury revealed a�er days – (gets worse over �me) Burns Burn injuries- can occur on the skin, cornea, hooves, and respiratory tract.

Burns - immediate treatment: • Cool the area with water or damp towels for 10 minutes to prevent further thermal injury • Even once the heat is removed, further �ssue may burn • Remove any blankets or halters (replace halter!)

• For deeper wounds, avoid ice and “cold” water to prevent vasoconstric�on.

• Most of the injuries occur on the head and dorsum.

• The extent of damage was not apparent for 24-48 h • Corneal damage may be present- o�en, the conjunc�val edema is so significant that the globe may not be visualized. It does not indicate permanent damage to the eye.

• Respiratory tract: • Effort, rate, and cough may indicate smoke inhala�on.

• Hooves- Extents of injuries vary- in fires with grass burning, and horses cannot escape, burned feet may be the biggest challenge. Some hoofs sluff. If burns are ini�ally severe, nerves to the feet may be blocked, and the magnitude of injury may only be revealed in 47 days later when pain fibers return. If unsure, provide symptoma�c treatment and recheck daily.

• Horses with extensive burns can be referred to clinics that may be listed as accep�ng disaster-impacted animals.

• Face�me sharing of a case with a veterinary internist with burn experience should be considered in some severe cases.

The down horse Flight-related behaviors, trailer loading accidents, older arthri�c horses, or infec�ous diseases may result in a horse being brought into the shelter recumbent in the trailer or being found recumbent during search and rescue. Prepara�on for this reality is an important part of veterinary care in a disaster.

The success of the management of the down horse must address several important points, including accurate history if available, physical examination, making an accurate diagnosis and the ability to provide supportive care.

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I have treated several down horses during a disaster response and did so in the following way with positive outcomes. First, the safety of those responding is essential. Volunteers may wish to assist and put themselves in harm's way. The veterinarian should control the scene safety and oversee steps to take to either provide some symptomatic care to the down horse where it is or load the horse in a trailer using a drag system and a skid, tarp, or plywood to a better location. In my opinion, each shelter should have some equipment to address the down patient- treatment or movement to a place for further evaluation or care. Inexpensive, highly portable systems for maneuvers such as forward assist, rear assist, rolling the horse, and vertical lift are available (Loops Rescue.com) Conflict of interest noted as I am the inventor and distributor of the equipment for the loops rescue system.

Emergency Euthanasia The following summary is taken with permission from the booklet - Large Animal Field Emergency Seda�on and Anesthesia Guide- (Loopsrescue.com) A FEW DO’S AND DON’T FOR EMERGENCY INCIDENT EUTHANASIA • • • • •

Do seek a second opinion unless it is absolutely certain the horse needs immediate euthanasia.

Do consider FaceTime video for rapid consulta�on with an expert who can offer adviceburns, orthopedics, other trauma.

Do make an atempt at direct contact with the animal owner -If no animal owner, contact animal services or other authori�es for permission.

Take images of injury if needed to document.

Do as careful an assessment of the animal as condi�ons allow- a full physical exam may not be possible.

Do inform those assis�ng of the euthanasia decision and the reason why.

The issue of carcass contamina�on with pentobarbital solu�ons used for euthanasia has led to alterna�ve methods. One such method is the intrathecal lidocaine under xylazine and ketamine anesthesia: A brief descrip�on is provided here and more about this method and others can be found here: Further detailed descrip�on of this method is available here: htps://aaep.org/sites/default/files/2021-03/Intraethecal_Euthanasia.pdf STEPS FOR INTRATHECAL LIDOCAINE UNDER ANESTHESIA 1. Carry the necessary drugs – xylazine and ketamine, 60 mL of lidocaine with you in your emergency kit along with a 60-mL syringe and a 2.5-3 inch needle 2. Administer xylazine IV followed by ketamine and allow recumbency and anesthesia 3. Use palpa�on as shown in the diagram and place a 2.5-3-inch needle or catheter into an A-O space

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4. When clear fluid emerges and has good flow, draw 30-60 mL into a syringe and then administer lidocaine (60 mL) 5. Check for loss of palpebral and corneal reflex approximately 4 min a�er lidocaine Field Emergency Seda�on and Anesthesia of the Large Animal In a disaster situa�on there may be a need to sedate or anesthe�ze an excited horse, or cow, or goat or pig. The volunteer veterinarian may be a litle 'rusty' on the best approach to use. Dr. Eric Davis from the RVET and UC Davis VERT created a guidebook with doses and the how-to-do-it steps for many species. It is the same guidebook men�oned above for emergency euthanasia. It is available here- loopsrescue.com - Again conflict of interest noted since I distributed this guidebook.

Reunifica�on- the role of the veterinarian For the animal owner or caretaker ge�ng the animal back is as important as moving the animal to safety or providing veterinary care. As previously defined “The veterinarian's role in the humananimal bond is to maximize the poten�als of the rela�onship between people and other animals and deal with the emo�onal consequences that arise when an animal's behavior, health status, or life circumstances jeopardize the con�nua�on of the bond. htp://www.argusins�tute.colostate.edu/define.htm Reunifica�on is a cri�cal part of the recovery phase of a disaster. The ques�on becomes - Who should be par�cipa�ng in this important aspect of care of animals in a disaster? Educa�on in preparedness and aten�on to mi�ga�on provided by local CART and similar disaster preparedness organiza�ons (e.g., HALTER) with community veterinarians will support the highest reunifica�on success. With a plan and, as needed, appropriate MOUs in place, it is cri�cal (and in the past o�en overlooked) that the veterinarian's role ensure appropriate discharge informa�on, instruc�ons, and, as indicated, medica�ons or recommenda�ons for follow-up care accompany animals as they are reunified with owners. Depending on the dura�on of the disaster response phase and the extent to which the recovery phase may impact the community, reunifica�on efforts may be extended and challenge the ability to provide informa�on summarizing each animal's con�nuity of care, yet it is cri�cal. I believe the solu�on in California is to allow our programs to provide everything needed for animals in a disaster and not have mutual aid called in from out of state. The answer is to have the veterinarians who volunteer for this phase simply the reunifica�on - be allowed to do so and the overseeing organiza�on - CVMA, C-VET, CARTS etc., provide the support and addi�onal staff to assist the veterinarian in that effort.

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Disclaimer The material provided here is assembled from many sources and reflects the author's opinion based on over 25 years of veterinary disaster and emergency par�cipa�on. I have noted I am linked to the LoopsRescue.com- company - Loops Li� LLC, and create and distribute the products men�oned.

References

1. AVMA Guidelines for the Euthanasia of Animals | American Veterinary Medical Associa�on. Accessed September 26, 2021. htps://www.avma.org/resources-tools/avma-policies/ AVMA guidelines-euthanasia-animals 2. Chigerwe M, Depenbrock SM, Heller MC, et al. Clinical management and outcomes for goats, sheep, and pigs hospitalized for treatment of burn injuries sustained in wild-fires: 28 cases (2006, 2015, and 2018). htps://doi.org/102460/javma2020257111165. 2020;257(11):1165-1170. doi:10.2460/JAVMA.2020.257.11.1165 3. Dieckmann HG, Costa LRR, Mar�nez-López B, Madigan JE. Disaster Medicine: Implementa�on of an animal health data-base in response to the 2018 California Camp Fire. htps://doi. org/102460/javma25691005. 2020;256(9):1005-1010. doi:10.2460/JAVMA.256.9.1005 4. Heath SE, Linnabary RD. Challenges of Managing Animals in Disasters in the U.S. Animals, an Open Access J from MDPI. 2015;5(2):173. doi:10.3390/ANI5020173 5. Madigan J, Dacre I. Preparing for veterinary emergencies: Disaster management and the incident command system. OIE Rev Sci Tech. 2009;28(2):627-633. doi:10.20506/RST.28.2.1898 6. Madigan J, Rowe J, Angelos J, et al. (A323) Wildfire Associated Burn Injury of 1400 Sheep in Northern California: A Coordinated Mass Casualty Veterinary Response. Prehosp Disaster Med. 2011;26(S1):s90-s91. doi:10.1017/S1049023X11003074 7. Mozumder P, Raheem N, Talberth J, Berrens RP. Inves�ga�ng intended evacua�on from wildfires in the wildland–urban interface: Applica�on of a bivariate probit model. For Policy Econ. 2008;10(6):415-423. doi: 10.1016/J.FORPOL.2008.02.002 8. Squance H, Johnston D, Riley C. An integra�ve review of the 2017 Port Hill fires’ impact on animals, their owners and first responders’ encounters with the human-animal interface. Australas J Disaster Trauma Stud. 2018; 22:97-108.

9. Holmquist, LS, O'Neal, P, Swenton, RE, Harris, CA. The Role of the Veterinairan in Disasters: A Con�nuing Need for Integra�on to Disaster Management. Front Public Health. 2021; 9: 644654.

Published online 2021 Aug 11. doi: 10.3389/fpubh.2021.644654

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Biography Tracy Julius, DVM, DACVECC Dr. Tracy Julius completed her veterinary degree at the University of Minnesota College of Veterinary Medicine in 2008. She then relocated to San Diego, California to complete her internship and emergency and critical care residency. She became board-certified in veterinary emergency and critical care in 2012. Dr. Julius is currently the Director of the Emergency and Critical Care Service and the Blood Bank Director at Animal Emergency and Referral Center of Minnesota.

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Triage and Stabilization of the Critical Patient

Tracy Julius, DVM, DACVECC

CAVMRC Disaster Response Training (Virtual) Animals in Disasters-Common Medical Conditions – November 5, 2023 43

Triage and Stabilization of the Critical Patient Tracy Julius, DVM, DACVECC Patient Assessment • Airway • Breathing • Circulation • Disability • External Assessment •

6 signs of poor perfusion o Pale gums, prolonged CRT, altered mentation, tachycardia, cool extremities, weak pulses o “Bounding” pulses most commonly due to low diastolic BP and hypovolemia  Pulse pressure = systolic BP – diastolic BP

Fluid Therapy • IV catheter placement o Large bore, short catheter • Crystalloid therapy o “Shock” fluid doses  Dog : 90 mL/kg  Cat: 60 mL/kg  Represents total blood volume o Start with ~ ¼ of shock dose  Dog: 20 mL/kg  Cat: 10-15 mL/kg o Reassess perfusion parameters. Are additional fluids needed?

•

Resuscitation endpoints o Normalization of blood pressure o Minimum MAP of 60 mm Hg (systolic of 90) for renal perfusion o Normalization of perfusion parameters

•

Hypothermia is common in critical patients. Use caution with active rewarming of these patients. o Fluids first, then active warming. Passive warming is always safe.

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Respiratory Emergencies Initial stabilization • • •

• •

Minimize stress Sedation as needed Supplemental oxygen o Flow-by o Mask o Hood o Nasal cannula o O2 cage IV catheter if tolerated If distress persists, consider intubation o Control of airway o Oral/laryngeal exam o 100% oxygen o Can examine and perform diagnostics with no additional stress to patient o Can provide positive pressure

Smoke inhalation • Direct respiratory injury o Thermal and chemical damage to pharynx and airways  Laryngeal edema  Pharyngeal and nasal ulceration, hemorrhage, congestion  Can be progressive for 24 hours + post injury •

Delayed secondary injury o Bronchospasm o Mucosal sloughing of airways  Signs typically develop 2-5 days post injury

•

Diagnosis o Thorough physical exam  Singed vibrissae, facial burns, soot in nose or mouth/pharynx o Radiographs  Radiographic signs of pulmonary injury may not correlate with clinical signs  Changes often progressive over the first 24 hours

•

Treatment o Oxygen support and appropriate supportive care.  Intubation if indicated o Bronchodilators

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 Terbutaline, aminophylline, or albuterol o Saline nebulization o Prophylactic use of antibiotics not recommended o Analgesics Carbon Monoxide Toxicity • Common sequela of smoke inhalation o Binds to hemoglobin, inhibiting offloading of oxygen from hemoglobin into the tissues leading to tissue hypoxia •

Clinical signs/diagnosis o Should be presumed and treated in any case of smoke inhalation o Measurement of carboxyhemoglobin needed for definitive diagnosis o SpO2 not accurate in patients with toxicity  Falsely increased reading o Neurologic abnormalities may occur  Acute vs delayed

•

Treatment o Oxygen therapy  Half-life of carbon monoxide is 5 hours at 21% oxygen (room air), vs 1 hour at 100% oxygen

Burn injury • Classification of burns and calculation of BSA o Severe illness and increased risk of hypovolemic shock associated with burns involving more than 20% of BSA o If >50% of BSA is affected with 2nd or 3rd degree burns, prognosis is poor o Heat dissipates slowly from damaged skin, so burns may continue to progress for several days Estimating Total Body Surface Area- “Rule of Nines” Area Percentage of BSA Head and neck 9 Each forelimb 9 Each rear limb 18 Thorax 18 Abdomen 18

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Burn Classification System Classification Superficial (1st degree) Superficial partialthickness (2nd degree)

Appearance Erythematous, painful

Systemic effects None

Moist, erythematous, plasma leakage, very painful

Mild

Deep partial thickness (2nd degree) Full-thickness (3rd degree)

Dark or yellow skin, decreased pain sensation

Severe

Leathery skin, hair epilates easily. Muscle, bone, tendons may be affected.

No pain sensation.

Life threatening

Healing Rapid with topical wound management Healing by regeneration, full function and appearance recovered Surgical intervention may be needed to minimize scarring Extensive surgical intervention required (ie skin grafts)

•

Common complications o Metabolic abnormalities  Hemoconcentration, azotemia, hypoproteinemia, hyperglycemia or hypoglycemia, and electrolyte abnormalities o Fluid and protein losses o Cardiovascular and respiratory compromise

•

Treatment o Apply cool (not cold) water as soon as possible- ideally within 30 minutes of injury o Fluid therapy  4mL/kg per percentage BSA affected in the first 24 hours  Requirements may even exceed this amount and close patient monitoring is critical o Pain management  Opioids o Wound management  SSD or medical grade honey  Non adherent dressing

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Trauma Components of the rapid physical exam for trauma patients: 1. Assessment of cardiovascular status/perfusion parameters 2. Assessment of respiratory status 3. Evaluation for head trauma 4. Palpation of limbs and spine 5. Assessment of motor function/pain sensation 6. Wound assessment •

Stabilization o Oxygen administration o Fluid therapy o Analgesia

•

Further evaluation o Diagnostic imaging  AFAST/TFAST if available o Bloodwork

•

Head Trauma o Cushing reflex: hypertension, reflex bradycardia  Cerebral perfusion pressure = mean arterial pressure – intracranial pressure  Body will increase MAP to maintain perfusion to the brain o Hypertonic saline a good choice for volume resuscitation in patients with evidence of head trauma  3mL/kg IV  Risk of iatrogenic hypernatremia o Mannitol  0.5-1g/kg IV o Oxygen therapy in acute phase o Elevation of head 15-30 degrees

• •

Stabilization of fractures, use of back board for transport if indicated Basic wound management o Irrigation of wounds o Bandaging of wounds to minimize contamination

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Biography Ashley Patterson, DVM, MPH Ashley Patterson serves as the UC Davis California Veterinary Emergency Team (CVET) Associate Director of Operations. She received her DVM degree from Washington State University and her Master of Public Health from the University of Minnesota. Prior to veterinary school, Ashley earned a bachelor’s degree in Emergency Administration and Planning from the University of North Texas and worked as an emergency management and planning consultant for Witt O’Brien’s starting in 2010. Following graduation from veterinary school, Ashley worked as an emergency veterinarian in a variety of hospitals and volunteered as a disaster responder.

She brings a unique combination of veterinary medicine and emergency management background and is focused on enhancing the veterinary preparedness and response capabilities for California.

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UC Davis CVET Team: Working with the CAVMRC to Help Animals in Disasters Ashley Patterson, DVM

CAVMRC Disaster Response Training (Virtual) Animals in Disasters-Common Medical Conditions – November 5, 2023 50

Working with the CAVMRC to Help Animals in Disasters

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CA Disaster Response History

Overview

CVET Formation and Structure

Accomplishments to Date

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Historical Fires Top 3 most destructive fires in the last 6 years (Cal Fire): • Camp Fire (2018): 18,804 structures and 85 deaths • Tubbs Fire (2017): 5,636 structures and 22 deaths • North Complex Fire (2020): 2,352 structures and 15 deaths

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UCD-VERT Emergency and Disaster Response for Animals PAST

RECENT PAST

Mi ssi on /G oa ls

2018

2008 MRC

1997

PRESENT 2019

Teaching/training/outreach in disaster response and rescue Rescue

De Do ploy cu me me nt nta tio ns

Rescue Provide rescue of animals in emergencies and disasters

Rescue + Shelter MRC Summary

MRC Summary

+ Medical Databank 214 + Medical Record

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2020

Emerging Issue: Domestics/Livestock • Excellent animal disaster response organizations but no standardized approach • Not equally distributed Statewide • Growing incidence of large-scale disasters where animals are in need • State agencies overtaxed and do not have capacity to manage responses • Requested out of state resources

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Answer: California Veterinary Emergency Team (CVET) • CA Senate Bill 547 (July 2021) • Develop a program called the California Veterinary Emergency Team (CVET) • Based upon OWCN model • Stable funding • Authority to respond • Coordination of resources • Statewide

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Key Mandates • “…assist in the support and training of a network of government agencies, nongovernmental organizations, and individuals to assist in the veterinary care of household and domestic animals and livestock in emergencies” • “…ensure that the training and the care provided by or coordinated by the program are at levels that are consistent with those standards generally accepted within the veterinary profession“ • “…conduct or support research on best practices for the evacuation and care of the animals in disasters”

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Key Mandates

Preparedness

Research

Training

Response

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Core Personnel

Dr. Michael Ziccardi Director

Dr. Ashley Patterson AD of Operations

Dr. Briana Hamamoto Operations Specialist

Scott Buhl AD of Logistics

Tim Williamson Facilities Specialist

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William Burke AD of Planning

Cindy Sengnalivong Administrative Coordinator

“Our mission is to lead collaborative veterinary response efforts to provide exceptional and compassionate care to animals and their families during disasters.”

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CVET Org Structure • Following the principles of ICS • Utilized during both preparedness and response operations • Expands as needed for largescale responses • Team is continually growing

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Partnership Coordination • Signed MOU with Cal OES and CDFA • Active member of the Animals in Disasters Working Group • Members of the Cal CARTs Board of Directors (formerly the CCC) • Ongoing coordination with Cal Animals • Signed MOA with CAVMRC and NCAEP MOA in progress

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State MOU Responsibilities • Veterinary disaster response team • Veterinary specific training • Network development • Coordination of animal resource management with CDFA • Development of animal care resource classifications with CDFA • Assist with county planning • Research best practices

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CAVMRC Coordination • Ongoing conversations and coordination • Sharing and storage of resources • Development of veterinary resource fact sheet with Cal OES and CDFA • Development of joint deployment protocols • Joint training development

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Additional Accomplishments • CVET website launched!

• Ongoing county outreach campaign: reports available online • Inaugural CVET Basics training!

• Standard Operating Guidelines • Growing membership - currently ~160 members

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Additional Accomplishments • Development of Veterinary Disaster Working Group • Research and development of an online medical records system • Assistance with animal responder training standardization • Building additional inventory and response resources

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Growing Partnership and Collaboration

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Questions?

Email: cvet@ucdavis.edu

Website: www.cvetucdavis.org

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Biography Grant Miller, DVM Dr. Grant Miller serves as the Director of Regulatory Affairs for the California Veterinary Medical Association (CVMA), where he assists California veterinary professionals with compliance issues and regulatory matters involving various local, state, and federal agencies. In addition, Dr. Miller heads the California Veterinary Medical Reserve Corps, a volunteer organization devoted to assisting animals with sheltering and veterinary care during disasters and emergencies.

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Deployment in the CAVMRC

Grant Miller, DVM

CAVMRC Disaster Response Training (Virtual) Animals in Disasters-Common Medical Conditions – November 5, 2023 71

Deployment in the CAVMRC

What is the CAVMRC? • California Veterinary Medical Reserve Corps • Part of the CVMA • A registered Medical Reserve Corps (MRC) • The largest veterinary MRC in the country (there are only a handful) • The only statewide MRC in California

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WHAT DO WE DO? Assist local authorities by providing advice on how to implement and run emergency animal shelters Provide veterinary services to animals during disasters

What Are Our Tasks?

• Animal care • Medical equipment/ supplies • Epidemiology • Bioterrorism and zoonoses • Animal decontamination • Animal search and rescue*

SEMS and Deployment Standardized Emergency Management System Emergency is managed from the local level up Feds State

Individual or Family

City or County (Operational Area)

Region (neighboring counties)

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Who contacts the CAVMRC for help?

Local municipality • County • City Also called “Operational Areas”

How Does Deployment Work?

1.) During a local or state wide emergency, authorities determine if they need veterinary professional help to provide medical care for animals.

2.) If help is needed beyond that is provided in the disaster plan in use, state authorities contact the CVMA at its headquarters in Sacramento.

3.) The CVMA uses a state-run dispatch system to contact you by: ➢ ➢ ➢ ➢

Phone Text Fax Email

Deployment is always voluntary!

4.) You respond with your availability. If you are available, you may be deployed.

Deployment • Deployment is voluntary • DHV system will ask you to indicate your availability → YES or NO • If YES, you may then be asked to elaborate on your availability.

• CVMA office staff will be handling deployment and scheduling during a disaster.

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Deployment • Generally daytime shifts (8:00 a.m. until ~ 6:00 p.m. – 8:00 p.m.

• We ask volunteers to drive themselves to the emergency shelter location • Deployment requests are done pursuant to CAVMRC Policy (see CAVMRC Deployment Policy in the Volunteer Handbook @ cavmrc.net)

What you can do to be ready to Deploy • Keep your Disaster Healthcare Volunteers online profile up to date • healthcarevolunteers.ca.gov ➢Always list your mobile phone as your PRIMARY number ➢Keep your phone number and email address current on the site ➢Any time you complete training, make sure to enter it in your DHV Profile • Answer deployment requests immediately! ➢phone ➢email

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Training • Minimum • ICS-100: Incident Command System (ICS) • ICS-200: Individual Incident Management

• Additional Recommended independent study courses: • ICS-10: Livestock in Disaster • IS-11: Animals in Disaster • ICS-111: Livestock in Disaster • ICS-700: National Incident Management System

https://training.fema.gov/is/crslist.aspx

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When You Arrive Look for “Markie”- the CAVMRC Mobile Command Center

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Markie Has Got you Covered!

• Meeting space • Two full bathrooms • Washer/ Dryer • Climate Control • Air Purifiers • Generator • Satellite • Computer/ Printer • Kitchen with full size refrigerator • Oxygen cages • Awnings • Sleeps 4 comfortably, 5 uncomfortably!

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BEFORE

BEFORE

AFTER

AFTER

Cargo Trailer • CAVMRC Medical Supplies • Spare Generator • Deployment Supplies • 10 x 20 Pop up tent • Air purifier

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Morning Briefing and Duty Assignments

At Morning Briefing • Complete Disaster Service Worker Volunteer Registration • Worker’s Comp insurance coverage from state

• May or may not be sworn in by a law enforcement official.

• Loyalty Oath Affirmation at the bottom of the registration form

• Duty Assignments for the day

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Assisting with shelter set up and operations

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Stall side/ Cage side Rounds

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Intake/ Records

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Stray Exam/ Documentation

Intake / Triage Assessment

Wellness / Physical Exams

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Diagnostics

Medical / Surgical Care

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And of course…. Lots of TLC!

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Veterinary medical field care

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All species

General animal care supplies / Logistics

Veterinary Supplies / Logistics

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Donation Management

Helping first responders

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Assisting the public

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Questions?

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Thank you for attending today’s CAVMRC Disaster Response Training (Virtual) CE Certificates will be emailed within 7 days of this course.

Please do not forget to fill out your survey which will open up when you log out of zoom.