emergency preparedness for eventing

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Proceedings of the54th Annual Convention of

the American Association ofEquine Practitioners

December 610, 2008, San Diego, CaliforniaProgram Chair : Harry W. Werner

ACKNOWLEDGMENTS

Dr. Stephen M. Reed, Educational Programs Committee ChairCarey M. Ross, Scientific Publications Coordinator

Published by the American Associationof Equine Practitioners

www.aaep.org

ISSN 00657182

American Association of Equine Practitioners, 2008


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Emergency Preparedness for Eventing

A. Kent Allen, DVM

Authors address: Virginia Equine Imaging, 2716 Landmark School Road, The Plains, VA 20198;

e-mail: [email protected]. 2008 AAEP.

Preparation for emergencies at an eventing compe-tition is an exercise in advance planning and seam-less cooperation to make it seem smooth and

effortless. This only happens if there is a concertedeffort between veterinarians and the event admin-istration. The second thing to remember in prepar-ing for an eventing competition is the unique natureof the cross country phase of eventing. Runninghorses at speed at large fixed objects results in aunique set of sports-related injuries.

The first step that the event organizer faces inpreparing for emergencies is selecting a veterinarystaff. The veterinarian is selected as the veteri-nary delegate (VD) for an Federation EquestrianInternationale (FEI) event or a treating veterinar-ian at a national level horse trial. The VD acts as a

veterinary judge in cooperation with the competi-tions Ground Jury. The treating veterinarian is toprovide emergency care on the days of the competi-tion. The next step is to contact the organizer andtechnical delegate (TD) at least 3 mo before thecompetition. This call should cover what arrange-ments have been made by the organizer for emer-gency preparedness. A VD should reference theFEI website (horsesport.org) and download the lat-est version of the FEI veterinary regulations andappendices to prepare for their role as veterinary

judge and advocate for the horse.

A national level horse trial will often be governedby the rules of the U.S. Eventing Association(USEA), and the technical delegate can often pro-

vide invaluable information to the less experiencedveterinarians involved in this level of competition.

The questions that should be asked to prepare foremergencies are as follows:

Who is the veterinarian that will be coveringemergencies on the dressage and/or show

jumping days? Some events will be conductedso that one or more of the three phases of thecompetition will be ongoing at the same time.The cross country phase is the one that themajority of emergencies will occur at andshould always have precedence but you mustbe prepared to respond to multiple phases of

the competition at the same time. Will theemergency veterinarian be available whencompetitors start arriving as well as afterhours? The veterinarians providing the emer-gency services should be posted in the Omni-bus along with their phone numbers.

What arrangements have been made to coverthe cross country course? Many organizershave been doing this for years and have anexcellent emergency plan that can be adoptedcompletely or with little modification. Mostorganizers have broken the rather large dis-

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IN-DEPTH: EMERGENCY CARE AT EQUINE EVENTS

NOTES

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Proceedings of the Annual Convention of the AAEP - San Diego, CA, USA, 2008


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tances of the cross country course into zonesbased on accessible geography. Each zoneusually contains a cross country repair crew, ahuman ambulance, a horse ambulance ortransportation vehicle, and a veterinary ambu-latory vehicle. Sometimes, at small competi-tions, there may be only one zone crew. At

larger competitions, there may be severalzones with a veterinary crew in radio contactat each one. The veterinarian should consultwith the TD and organizer as to how manyzones and therefore how many veterinariansare needed and if they have been contact-ed. The veterinarian should confirm each

veterinarians willingness to attend and havethem reminded 1 wk before the competitionand agree when to meet to review their zoneassignment and what time to arrive at thecompetition. If they need passes, theseshould be issued at the time they come to thecompetition ground to review their routes tomove within their zone, usually the night be-fore the cross country day. It is imperativethat veterinary ambulatory units not move un-less instructed by cross country control or vet-erinary control because of horses still in thecompetition coming up rapidly on the vet unitsand the risk of these horses being injured.Numerous near misses and actual injurieshave happened in the past. Also, unless the

vet units have familiarized themselves withthe course, it is easy to get lost. Respondingwith the cross country repair crew is a wisestrategy because they know the course quitewell.

How will communication among veterinary

staff and administrative staff be conducted?Radios for the competition should be arrangedahead of time. The solution may be as simpleas a single radio (provided by the event) bywhich the treating veterinarian may commu-nicate. Or the organizer may have multipleradios that carry multiple networks that pro-

vide the veterinarians and the administrativea network to talk. This will allow all the vet-erinarians to communicate together and yetknow when to respond to the sector responseteams or the veterinary control. This veteri-narian is usually called the veterinary controlofficer in larger FEI competitions and sits near

the cross country control to coordinate veteri-nary emergencies. At smaller or larger na-tional competitions, the veterinarians may bedirected by cross country control. If they areat a smaller national competition and treatingin the barn as well as the cross country course,they should listen closely to the radio becausecross country emergencies must be respondedto as rapidly as possible.

Who will make arrangements for emergencytransport of horses off the course? This may be

as simple as a trailer with a ramp to transportan injured horse off the course. The largerchallenge is how to transport the recumbenthorse. This can be done with an emergencyequine ambulance. Many large practices, lo-cal equine rescue societies, veterinary schools,or nearby racetracks have vehicles with these

capabilities. The less desirable but effectiveapproach is to have a flat bed car transport andnylon pastern slings on site to safely move arecumbent horse. Although some organizersmay not want to incur the cost this may in-

volve, if a horse is dead or unable to rise oncourse there is no other aesthetic way to re-move the horse. The cross country jump re-pair crew or the equine ambulance itselfshould carry screens to quarter off the situa-tion from the public while emergency treat-ment or removal is effected.

How will a dead horse be taken to necropsy?The VD should discuss with the organizer howthe dead horse will be quickly removed fromthe course as well as where it will be taken andhow it will be cooled until it can be transportedto a suitable veterinary pathology necropsy fa-cility. This must be determined ahead oftime, and prior arrangements should be madefor a rapid necropsy or at least cooled storageuntil the horse can be posted. The U.S.Equestrian Federation (USEF) stated that, af-ter the June 2008 Safety Summit, it wouldcover costs associated with necropsy of eventhorses that die on course.

Each discipline has its own set of injuries associ-ated with its competition. The unique combination

of three disciplines for the eventing horse incorpo-rate injuries from either dressage, show jumping, orcross country. I would refer the reader to the ex-cellent sections in this in-depth session on emer-gency preparedness in Dressage and Show Jumpingand concentrate on the injuries sustained by theevent horse during the cross country jumping phase.The most common injuries reported for the eventinghorse include lacerations, superficial digital flexortendonitis, suspensory ligament desmitis, foot bruis-ing, stifle trauma, rhabdomyolysis, and exercise-in-duced pulmonary hemorrhage.1 This list is notexhaustive. Each injury will require its own set oftechnical equipment. Many different injuries may

be sustained by the event horse. They can be cat-egorized by lacerations and abrasions, speed-relatedinjuries, and jump-related injuries.

1. Lacerations of the distal limb are commonbecause of the horse jumping over fixed fencesand varied terrain. Over-reach wounds ofthe heel and stud-related punctures are quitecommon and can be quite painful to the horse.Because of the water jumps the horse is com-monly going through, these wounds are often

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contaminated and will require antibiotic ther-apy and a drawing poultice and tetanus pro-phylaxis if needed. Abrasions of the carpusare associated with water jump falls and a toodeep or rough gravel surface. These can besignificant injuries, and if several of them areseen at the same event, they should be pointed

out to the TD and/or organizer, who may notbe aware of the deteriorating surface underthe water. If any of the wounds are sus-pected to be penetrating injuries of a synovialstructure, they should be carefully examinedand possibly sent to a referral center for amore detailed assessment than what may beavailable at the competition.

2. Speed-related injuries can be many and var-ied. These will often be similar to injuries ofthe Thoroughbred race horse.

Bleeding or exercise-induced pulmonary hem-orrhage (EIPH). These are often not seenduring the new short format until the end ofthe course. If the VD is present, they shouldexamine the horse. If not, the veterinarian atthe end of cross country should summon the

VD. These can be quite mild with a trickle ofblood seen that is not clinically relevant or canbe more severe and require rest and a signifi-cant workup to determine the underlyingcause. The worse expression of this is theextremely rare rupture of an aortic or pulmo-nary vessel and often presents as suddendeath during exercise.

Running at speed can result in a variety oftendon and ligament injuries. These maypresent with obvious swelling and pain with

lameness in the affected area. They may alsopresent as a lameness with no apparent swell-ing, or the swelling may develop later. Somesuperficial digital flexor tendon (SDFT) coreinjuries and origin of the suspensory ligamentinjuries will present in this manner. Themost common injury is superficial digital flexortendonitis, with desmitis of the suspensory lig-ament being the next most common. Injuriesto the inferior check ligament, suspensorybranches, origin of the suspensory, and collat-eral ligaments of the coffin joint are the nextmost significant injuries. These injuries al-most without exception will require withdraw-

ing the horse from the competition once theyare detected. Anti-inflammatory therapy,cold therapy, and support wraps, as well asultrasound diagnostics to determine the de-gree of the injury, are indicated as soon aspossible. However, it is rare that it is neededto medicate the horse on the field of play, andit is safer and more prudent to transport thehorse back to veterinary care in the barns toperform a more detailed assessment. Severemanifestations of SDFT and suspensory injury

may require the use of a Kimzeya splint or aRobert Jones type bandage to appropriatelysupport the nonweight-bearing leg and allowthe horse to be loaded in a trailer and be takento its stall or a pre-designated surgical referralcenter for further evaluation.

Exertional rhabdomyolysis (ER) or tying up is

common in the event horse and may be seeneven at lower level events. It is less commonin eventings new short format. It may presentas a horse that shows bilateral or unilateralstiffness in the hind limbs, or it can present asa horse that is unable to walk at all. Some-times it presents as a horse reluctant to leavethe stall after competition. Stiff and hardmuscle masses, most commonly in the area ofthe middle gluteal muscle group, can some-times be palpated. In its extreme form, ERcan present as a recumbent horse that mayneed fluids to rise. The significant factor isthat it is recognized for what it is and that thehorse is transported off the course and exam-ined in more detail. A mild case may requirenothing more than an anti-inflammatory in-

jection and usually being withdrawn fromcompetition. Blood work (aspartate amino-transferase [AST] or creatine phosphokinase[CPK]), although useful, is usually hours or daysaway from the initial treatment point. The

veterinarian will likely have to make a clinicaldiagnosis on the site and wait for the bloodwork to note the severity of the case. For amoderate to severe case, the treating veteri-narian should have a large-bore 14-gauge IVcatheter to insert in the jugular vein and havea large-bore IV fluid administration set with

the ability to run 20, 40, or more liters of abalanced electrolyte solution rapidly. Impor-tant factors to understand when treating ERat an event is that the horse or horses mayrequire significant amounts of fluid, and thetreating vet should be prepared to have accessto these amounts of isotonic fluids.

3. Jump-related injuries. Impacting a solidfence is a common scenario in the cross coun-try phase of the event horse. It may have noinjury associated with it; however, the fall ofhorse (hip and shoulder striking the ground)would normally result in elimination of the

horse and rider combination. It also can re-sult in a wide variety of injuries, with themost common being trauma to the stifle area,as well as the shoulder, carpus, pelvis, andneck areas. The mild version of these inju-ries are ones that surface as abrasion, stiff-ness, and swelling after the cross countryphase, and the horse should be examined tosee if the injury is mild and if the horse cancontinue in the competition with icing andminor treatment. The more significant inju-

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ries are those in which the horse has goneacutely lame and requires transportation offthe field of play. If the horse is lame but ableto be transported, only a cursory assessmentshould occur in the field of play, and the horseshould be more completely assessed at thebarn or referral clinic. The worse case sce-

nario is that the horse has impacted the fenceor fallen and is unable to rise or is stuck in thejump. This should result in immediate mo-bilization of the area veterinary treatmentcrew and jump repair crew and the horse am-bulance or flat bed tow truck to transport therecumbent horse. The cross country control-ler should stop the other horses on the courseand delay the start. If the horse is stuck in a

jump, often the horse can be calmed or se-dated, and the jump crew can disassemble the

jump around them. The jump crew shoulddeploy tarpaulin with wood-braced screens,and the veterinarian should do a quick butdetailed assessment of the injury and deter-mine whether the horse can rise or whether itneeds to be administered short-term anesthe-sia and transported to a referral facility. Inthe worse case scenario, the veterinarian maydetermine that the horse has an injury that itwill not recover from and must be humanelyeuthanized. Hopefully, the rider or family isable to give that permission, and the horse canbe put down as soon as feasible to reducesuffering. The veterinarian should be sure ofthe manner of the injury and the prognosisbecause multiple parties (VD, TD, and insur-ance company) will be in consultation with

him/her regarding the details. Currently,the FEI rules do require a necropsy, and theUSEF rules will likely require it in the nearfuture. The organizing committee must havethis scenario in mind, because they will needthe horse ambulance back for the remainderof the competition as soon as possible.

The overall role of veterinarians at an eventingcompetition is to act as advocates for the horse andto provide the care needed if a problem occurs.The VD has the primary role as advocate for thehorse and should be referred to by the other veteri-narians on the grounds when there is a question.Their job is to protect the horse, allow the horses tocompete safely, and make sure the rules are fol-lowed. This requires experience, forethought, andprior cooperation with the organizing committee.

Another critical factor to understand is that the VDin a FEI competition or the treating vet in a nationalcompetition is an advisor to the Ground Jury, whoare the judges of the competition. The veterinari-ans never act alone in the removal or even signifi-cant treatment of a horse in the competition but onlyin cooperation with the Ground Jury. This closecooperation is a hallmark of the eventing competi-tion and sets it somewhat apart from other eques-trian competitions, including its similar FEIdisciplines.

Reference and Footnote

1. Dyson S, ed. A guide to the management of emergencies atequine competitions. British Equine Veterinary AssociationManual, 1996;135137.

aKimzey Splint, Kimzey, Woodland, CA 95695.

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