Presented at the 'Pinery Fires Horse Owners Get Together' 21 Dec. 2016. at the University of Adelaide, Roseworthy Campus, South Australia

1. Horses
in
the
Pinery
bush
fire
Nov
2015
Lidwien
Verdegaal
DVM,
Dipl.
ECEIM,
Dipl.
RNVA
School
of
Animal
and
Veterinary
Science
lidwien.verdegaal@adelaide.edu.au
Triage
of
horses

2. Lidwien Verdegaal DVM, Dip ECEIM
• On
scene
• Triage
of
burned
horses
• Clinical
findings
and
treatment
• DescripGon
of
cases
at
the
EHPC
• Recovery,
complicaGons
and
challenges
• What
did
we
learn?
Triage
of
horses
What
is
the
first
thing
to
do?

3. •
Do
horses
need
to
move
to
safe
zone:
•
Where
to
move
them
to?
•
Fire
brigade?
•
Consider
the
human
safety
above
all
On-­‐scene
consideraDons

4. First
aid
quesGons
• How
many
horses?
• What
is
the
behaviour
of
the
horse?
Advice:
• Calm
(people
&
horses)
• Apply
water
lavage
(hose,
buckets)
On-­‐scene
consideraDons:
telephone
call

5. • Always
consider
horses
may
have
explosive
acGon
• Flight
is
insGncGve
• Find
people
experienced
in
horse
handling
• Calm,
quiet
• Have
the
right
equipment
and
medicine
on
hand
• Restraint/
rescue
• SedaGon,
medicaGons
&
bandages
On-­‐scene
consideraDons:
emergency
handling
Under
no
circumstances
enter
an
acDve
fire
zone

6. Structure
fires
High
fatality
rate
due
to
• radiant
heat
• smoke
inhalaGon
• contact
burns
Surviving
horses:
• extensive
dorsal
burns
• smoke
inhalaGon
injury
• ash
or
noxious
gases
Bush
fires
High
fatality
due
to
• radiant
heat
• contact
burns
• injury
limbs
Surviving
horses:
• extensive
limb
burns
• smoke
inhalaGon

7. Heat
à
causes
cell
death
à
Inflammatory
response
&/or
oedema
Airways:
à
respiratory
distress
• ParGal
airway
obstrucGon
upper
part
of
respiratory
tract
• Protein
leakage
into
lungs
(oedema
and
hypoxia)
Other
organs:
Injury
of
Gssues
• systemic
shock
(circulatory
collapse)
Burn
–
thermal
injuries
Why?

8. • Airways
• DehydraGon/
shock
• Hoofs:
coronary
bands
and
laminiGs
• Skin
burns:
direct
and
radiant
heat:
• Eyes
• Face
• Distal
limbs
• Ventral
body
• Perineum
Burn
–
thermal
injuries
Where?

9. Arrival
at
the
hospital
Triage
of
the
burned
case
Principles
• PrioriGse:
cooling
• Assess
%
burned
body
surface
area
• Clinical
exam
and
problem
list
Treatment:
• Treatment
of
shock
(IV
fluids)
• Treatment
of
smoke
inhalaGon
• Burn
skin
injury
• ClassificaGon
and
prognosis
• Treatment

10. Triage
of
burned
cases
Priority
is
cooling!
Immediately
cool
all
body
areas:
Ice
&
cold
water
>
for
20
minutes

11. Triage
of
the
burned
case
Principles
• PrioriGse:
cooling
þ
• Assess
%
burned
body
surface
area
• Clinical
exam
and
problem
list
Treatment:
• Treatment
of
shock
(IV
fluids)
• Treatment
of
smoke
inhalaGon
• Burn
skin
injury
• ClassificaGon
and
prognosis
• Treatment

12. Ø 15-­‐20%
burned
surface
area
requires
IV
fluids
&
intensive
care
Courtesy
Wendy
Ducke0

13. Unconscious
or
semi-­‐
conscious
Down
&
unable
to
walk
Respiratory
difficulGes
Major
swelling
of
the
limbs
Extensive
burns
to
bare
areas
Extensive
damage
to
underlying
structures
Triage
of
the
burned
case:
Humane
euthanasia

14. Triage
of
the
burned
case
Principles
• PrioriGse:
cooling
þ
• Assess
%
burned
body
surface
area
þ
• Clinical
exam
and
problem
list
Treatment:
• Treatment
of
shock
(fluids)
• Treatment
of
smoke
inhalaGon
• Burn
skin
injury
• ClassificaGon
and
prognosis
• Treatment

15. • 1
horse
or
more
horses
involved?
• Appearance/
behaviour
• Vital
signs
• DehydraGon/
shock?
• Respiratory
distress,
cough
• Skin
injuries:
– Oozing
skin,
oedema
– Ocular
wounds,
joint,
tendon,
coronary
band
Triage
of
cases
IniDal
clinical
exam

16. Triage
of
the
burned
case
Principles
• PrioriGse:
cooling
þ
• Assess
%
burned
body
surface
area
þ
• Clinical
exam
and
problem
list
þ
Treatment:
• Treatment
of
burn
shock
(fluids)
• Treatment
of
smoke
inhalaGon
• Burn
skin
injury
1. ClassificaGon
and
prognosis
2. Treatment

17. Burn
shock:
emergency
treatment
>
15%
surface
area
•
IV
fluids
•
IV
plasma
and/or
Hetastarch®
•
NSAIDs
(flunixin,
meloxicam)
•
Pulmonary
oedema
• Humidified
oxygen
•
AnGbioGcs

18. Triage
of
the
burned
case
Principles
• PrioriGse:
cooling
þ
• Assess
%
burned
body
surface
area
þ
• Clinical
exam
and
problem
list
þ
Treatment:
• Treatment
of
burn
shock
(IV
fluids)
þ
• Treatment
of
smoke
inhalaGon
• Burn
skin
injury
• ClassificaGon
and
prognosis
• Treatment

19. Smoke
InhalaDon
Treatment
•
Maintain
airway
open
•
Upper
airway
obstrucGon
–
tracheotomy
•
Humidified
oxygen
•
Broad
spectrum
anGmicrobials
•
NebulisaGon
(saline)
•
Bronchodilators

20. Smoke
InhalaDon
Endoscopy
and
airway
sampling
The
long-­‐term
prognosis
is
uncertain

21. Triage
of
the
burned
case
Principles
• PrioriGse:
cooling
þ
• Assess
%
burned
body
surface
area
þ
• Clinical
exam
and
problem
list
þ
Treatment:
• Treatment
of
burn
shock
(IV
fluids)
þ
• Treatment
of
smoke
inhalaGon
þ
• Burn
skin
injury
• ClassificaGon
and
prognosis
• Treatment

22. ClassificaDon
burn
wounds
!
1st
degree:
Superficial
epidermis:
painful
2nd
degree:
ParGal
thickness
and
deep:
minimal
pain
3rd
degree:
Full
thickness:
no
cutaneous
sensaGon
and
fluid
loss

23. Management
of
1st
degree
burns
Treatment
• Water
lavage
• Silver
sulfadiazine
• Aloe
vera
• Pain
relief
(flunixin,
meloxicam)

24. Management
of
2nd
degree
burns
Treatment
•
Usually
not
fatal
•
Manage
as
for
superficial
burn
•
Vesicles
&
blisters
•
Apply
anGbacterial
dressing/
cream

25. Management
of
3rd
degree
burns
Treatment
• PotenGally
life
threatening
•
Manage
shock
•
Manage
respiratory
distress
•
Euthanasia?
•
Clip
surrounding
hair
•
Clean
wound
2-­‐3
x
daily
•
Dilute
chlorhexidine
•
AnGbacterial
topical
treatment?
•
Permeable
dressings
•
Debride
necroGc
Gssue

26. Triage
of
the
burned
case
EHPC:
night
of
25th
of
November
2015
• 6
severely
burned
horses
• different
breeds,
age
range
2
–
18
years
old
• arrival
range
2
to
6
hours
post
thermal
injury
The
second
day…

27. 1. Swollen
muzzle/
face
2. Increased
RR
3. Low
protein
(blood)
4. Assess
wounds
Day
2
at
hospital

28. Triage
of
the
burned
case
Pain
management
One
of
the
most
challenging
issues
is
the
management
of
pain!

29. Days
post
injury
treatment

30. Wound
care

31. Wound
care

32. PruriDs,
non-­‐
healing
wounds
and
pain

33. Coronary
band
injury
and
laminiDs

34. Weight
loss,
negaDve
energy
balance,
colic,
kidney
problems,
lung
injury

35. Triage
of
the
burned
case:
Survival!

36. • Severity
of
burns;
unpredictable
unGl
up
to
weeks
later
• During
1st
2
weeks:
every
day
seems
to
be
different!
ComplicaGons
of
Pinery
fires
include:
• Severe
coronary
band
injury
(no
laminiGs)
• Severe
pain:
due
to
coronary
band
and/
or
skin
burns
• Respiratory
effects
(good
recovery
in
our
cases)
• Deep
2nd
and
3rd
degree
burns:
long
term
recovery
• Weight
loss
due
to
high
metabolic
demand
but
also
less
appeGte
due
to
high
triglycerides
and
pain
What
have
we
learned..

37.
Acknowledgement
• The
team
of
EHPC!!
• Excellent
veterinary
students
Michelle,
JusGna,
Katelyn
for
2
weeks
and
many
other
students!
• Many
volunteers!!:
nurses,
students,
daughters
of
staff
members
etc.!!
• PharmaceuGcal
companies
Triage
of
the
burned
case
Team
effort!!

38. Thank
you!

40. Triage
of
the
burned
case
The
goal
is
survival