February 15, 2018

 

 When fire strikes home

​Tending to the needs of pets affected by residential fires

Posted Jan. 31, 2018

Dogs and cats injured in fires being transported by ambulance. Hyperbaric oxygen chambers used to treat pets with smoke inhalation. Firefighters running a 24/7 emergency response service for pets. These are a few of the advances helping pets caught in residential fires.

About 40,000 pets die in residential fires each year, most from smoke inhalation, and 500,000 pets are affected overall. 

Philadelphia firefighter Jen Leary said, "You see enough people who have just lost everything having to make horrible decisions about what they’re going to do with their pets." The Salvation Army is on the scene giving out blankets, the Red Cross providing emergency shelter, and medics attending to human injuries. "But there are no resources for the other members of the family—the pets," she said.

The Red Cross can arrange temporary housing for displaced residents but not for pets. "Most of the time, people left them in their burned-out dwelling, or gave them to some neighbor or stranger on the street they didn’t know, or had to surrender them to animal control," Leary said.

The Red Paw Emergency Relief Team responds to emergency alerts for fires, explosions, gas leaks, water main breaks, and, as here, building collapses. Red Paw found this dog and a cat in the debris. Three days later, the family’s pet Chihuahua crawled out from under the rubble. (Courtesy of Red Paw Emergency Relief Team) 

"It dawned on me one day, someone should do something, and that someone was me," she said.

In 2011, Leary created the nonprofit Red Paw Emergency Relief Team to provide search and rescue, shelter, and emergency veterinary care for animals injured in fires and other disasters.

Philadelphia’s fire communications center sends an alert to a Red Paw dispatcher anytime at least two engines and two ladder trucks are called into service for a fire, explosion, building collapse, water main break, or gas leak.

A Red Paw response vehicle is sent out by the on-duty dispatcher, either the one based at Leary’s home in south Philadelphia or the one at Engine 22 in northeast Philadelphia. There are two full-time responders, four per diem responders, and three volunteer responders. Each is a firefighter or military veteran.

At the scene, Red Paw checks in with incident command and canvasses the residents, asking whether they have pets. Red Paw responders get the OK from incident command to enter the building and do a thorough sweep, even if they’re told by first responders no pets are there or a family isn’t home.

"We get told quite often that either an animal couldn’t have survived or the animal ran out, but 99 percent of the time, animals never run out of the fire building. They always go hide someplace they feel safe," Leary said.

A few months ago, Red Paw responded to an apartment building fire in Delaware County, Pennsylvania. Firefighters had told members of one family that their cat was dead and members of the other family that their cat ran away. Leary said, "We sent our guys in to search each apartment. They found the one cat was not dead and needed oxygen and to go to the hospital, and they found the other cat hiding behind the refrigerator. Had we not been there and not checked the apartments thoroughly, they both would have been left a long time, if not forever."

Pet oxygen masks are put on animals with traumatic injuries and pressure applied to any cuts before the animals are taken to a veterinary emergency hospital, often to spend a night or two receiving oxygen in cages sealed with plastic wrap. 

​We get told quite often that either an animal couldn’t have survived or the animal ran out, but 99 percent of the time, animals never run out of the fire building. They always go hide someplace they feel safe."

Jen Leary, Philadelphia firefighter and founder of the Red Paw Emergency Relief Team 

 
 
Jen Leary with a dog found under debris after a house fire. (Courtesy of Red Paw Emergency Relief Team)


Red Paw’s partner facilities and certain veterinary emergency hospitals provide up to 72 hours of emergency shelter for displaced animals. Some boarding facilities will donate up to two weeks of shelter.

If an animal is seriously injured and its family can’t take it back within two weeks, Red Paw enlists one of its special foster volunteers, often a veterinarian or veterinary technician, to provide healing care until the family is in a position to take the animal back. The organization consults with Red Paw board member Dr. Lisa Germanis, who is also medical director of the Pennsylvania Society for the Prevention of Cruelty to Animals. 

Pets often hide someplace they consider safe instead of escaping in an emergency. (Courtesy of Red Paw Emergency Relief Team)

At Penn Vet

The University of Pennsylvania’s Ryan Veterinary Hospital in Philadelphia and the Center for Animal Referral and Emergency Services in Langhorne are two places where Red Paw transports pets that need oxygen therapy or that have sustained burns or other trauma.

Dr. Kenneth Drobatz is chief of the Section of Critical Care and director of emergency services at Ryan Hospital, which is designated one of the nation’s top veterinary trauma centers by the American College of Veterinary Emergency and Critical Care.
 
"Here at Penn, we tend to see more (pets injured in fires), especially in winter with indoor heaters. Because of our relationship with Red Paw, we see a fair number of post-fire patients that need some care. We see both dogs and cats," he said.

He considers Red Paw a fantastic grassroots organization that has saved a lot of animals. "Any pets that are injured—or the owners are injured—they take them in. If they’re stable, they keep them. If they’re having problems, they bring them to us," he said.
 
Massive paw burns from walking on embers are common. Dr. Drobatz said major skin injury is rare because an animal that has gotten that close to fire also would have decreased oxygen capacity and probably carbon monoxide poisoning. Those with skin injuries land in the intensive care unit because of major fluid and protein loss. The Penn Vet team does basic emergency bloodwork, especially for hydration status.

Penn Vet also tests for blood lactate concentration. Lactate builds up when cells don’t get enough oxygen, usually the result of carbon monoxide preventing the oxygen from getting to the tissues, unless it’s from the animal being in cardiac shock, Dr. Drobatz said. "Some plastics have cyanide, so they can get cyanide toxicity, but more likely we see carbon monoxide toxicity. We usually don’t routinely measure that in veterinary medicine; we make presumptions they already have it."

Corneal burns and ulcers are commonly caused by irritants in the smoke and probably the heat as well. Dr. Drobatz said some animals need antibiotics and pain medication, but most of the time, these injuries are fairly uncomplicated to treat.

At Wheat Ridge Animal Hospital in Colorado, the eyes of a puppy are stained to detect any corneal damage after the puppy was stolen from the Colorado Humane Society, wrapped in duct tape, and set on fire. (Courtesy of ​Dr. Elisa Mazzaferro)

Hyperbaric oxygen chambers

Dr. Jon Geller of Fort Collins Veter­inary Emergency and Rehabilitation Hospital in Fort Collins, Colorado, said that for smoke inhalation, hyperbaric oxygen therapy is the primary treatment.

One treatment of 1 1/2 hours at 2.5 ATA barometric pressure is generally what it takes to displace the carbon monoxide from the hemoglobin in the red blood cells so oxygen can go to the tissues, Dr. Geller said. Also, oxygen at high pressure is dissolved in the plasma, so hemoglobin is not required to transport oxygen to the tissues.
 
At an average $180 for treatment, depending on the region, it’s cost-effective compared with over a thousand dollars for two to three days of 100 percent oxygen in the hospital, he said.  

Pet oxygen masks

The following nonprofits are among the organizations that provide pet oxygen masks.

The Project Breathe Program provides oxygen mask kits to fire departments and rescue units. Invisible Fence sponsors the program and donates the masks, which the company estimates have saved 10,000 pets. A kit can be requested for a fire station at www.invisiblefence.com/why-invisible-fence/project-breathe

Project Paws Alive has a mission of providing first responder agencies with pet oxygen recovery mask kits. It relies on donations to provide the kits. http://projectpawsalive.org/pet-oxygen-recovery-mask-kits

The Association of Professional Animal Waste Specialists accepts donations to purchase pet rescue or recovery masks as well as requests from firefighters and EMTs to receive a kit. http://apaws.org/about/support/donate  

 

Dr. Geller is among a handful of veterinary hyperbaric technologists certified by the National Board of Diving and Hyperbaric Medical Technology, along with hyperbaric technologists and registered nurses, plus diver medics. They all must pass the main examination and be recertified every two years. The board offers the examination in conjunction with meetings of the Undersea and Hyperbaric Medical Society. 

Veterinarians and veterinary technicians who pass the main examination, complete an NBDHMT-approved training course, and meet the requirements of a defined preceptorship become eligible for the veterinary-specific examination offered through the UHMS and the Veterinary Hyperbaric Medicine Society.

Many general practitioners may not know where the nearest veterinary hyperbaric chamber is. The VHMS maps all the known chambers in the U.S., whether or not VMHS approved. The map, at www.vhbot.org/usa-locations, currently lists 70 veterinary chambers in 19 states.

Even if the closest chamber is a distance, an animal benefits from treatment if started within 12 hours of smoke inhalation, Dr. Geller said. His hospital has one of two chambers in Colorado. "We’ve had cases referred from Denver and the Canadian border," he said. Sedation isn’t typical, but trazodone is given if needed. With the white noise, many patients fall asleep. 

Colorado is one of the first states to allow emergency medical technicians to provide emergency veterinary care and transport pets to a veterinary hospital if the EMTs have completed a training program and call in to a veterinary hospital during the emergency (see "Good Samaritan laws protect responders"). Dr. Geller’s hospital has an agreement with a human hospital a half-mile away that when the EMTs respond to a vehicular accident or fire that involves pet injuries, the EMTs will transport the pets to Dr. Geller’s hospital after taking injured people to the human hospital. 

Hyperbaric oxygen therapy is the primary treatment for smoke inhalation in animals. (Courtesy of Dr. Jon Geller)

"Pets riding in an ambulance is a pretty new concept, and it’s a groundbreaking change that EMTs (can give emergency care to pets)," Dr. Geller said, and owner permission isn’t needed for the veterinary hospital to treat the victims.

Hyperbaric oxygen therapy is in its infancy, and other clinical uses have yet to be scientifically proved by quality research, the NBDHMT acknowledges. Dr. Geller is exploring the possibility of HBOT eventually becoming a veterinary specialty, as in human medicine, but the practitioners are few, and, he said, "We are lagging as a potential specialty group because we don’t have a central database of cases yet." However, case studies are being collected by the two main manufacturers of veterinary hyperbaric chambers, Hyperbaric Veterinary Medicine in Boca Raton, Florida, and Sechrist Industries Inc. in Anaheim, California.

A range of veterinary expertise

Smoke inhalation and burn injuries are a core aspect of training for emergency and critical care residents, but how much knowledge do veterinary students and general practitioners have?

Dr. Drobatz at Penn Vet said, "Because of the number of cases we see here, a lot of our students do get exposed during clinical rotations to animals that have been exposed to fire." General practitioners probably don’t treat many fire victims, however, and may not have had specific education in this area, he said. He has presented continuing education on smoke inhalation, usually in respiratory or environmental toxicology sessions.

Treatment of smoke inhalation and burn injuries is a small portion of the veterinary curriculum, taught as part of methods of oxygen therapy in respiratory physiology courses, according to Dr. Elisa Mazzaferro, immediate past president of the American College of Veterinary Emergency and Critical Care. "I have lectured all over the world on this topic, teaching general practitioners how to be prepared and what to do in the event that an animal presents after being in a fire," she said in an email interview.

 "I think that the general practitioner knows that these patients need supplemental oxygen. However, some of the more serious cases who have lost consciousness, have extensive skin burns, or develop neurologic sequelae after a fire and smoke inhalation are better to be monitored 24 hours a day at a specialty referral hospital or a 24-hour emergency facility," she said.

Dr. Mazzaferro will never forget New Year’s Day 2007. She was awakened with the news that 24 dogs had been in a kennel fire and were being transported to Wheat Ridge Animal Hospital, the Colorado referral practice where she directed emergency services.

"Our surgeon was taking thoracic radiographs. Interns were monitoring vitals and helping place catheters," she said. "Nurses were staining eyes to look for corneal burns. Technician assistants were wrapping cage doors in our ICU with saran wrap, making cages into which oxygen lines could be placed to increase oxygen in smoke inhalation patients. Dr. Brendan McKiernan, a world-renowned respiratory specialist, was putting blood samples on ice for evaluation of carbon monoxide levels at a local hospital."

Three dogs had been unresponsive at the fire scene. One had been revived by CPR but, despite 24-hour care, eventually succumbed to the effects of smoke inhalation, her trachea so severely damaged the inner lining sloughed.

In 2012, Dr. Mazzaferro moved back to her home state of Connec­ticut, where she practices at Cornell University Veterinary Specialists in Stamford.

Dr. Elisa Mazzaferro changes a bandage on Babey, who was in an apartment fire just before New Year’s Day 2018, at Cornell University Veterinary Specialists in Stamford, Connecticut. (Courtesy of Cornell University Veterinary Specialists)

The important first contact

Dr. Drobatz said, "I think it is important for the first responders who get there to tell us what they found—if the animal was unconscious or had altered mentation—to give us an idea what happened. Some may have had too much carbon monoxide or are hypoxic from not getting enough oxygen during the fire and could be passed out, and this might have significant consequences down the road for neurologic changes and things like that. It also gives us a sense of the severity of their exposure to the fire and how close they were."

Many veterinarians in emergency medicine hold classes at a local fire department, police facility, or their own hospitals to train EMTs, firefighters, and police officers to care for canine officers as well as animal casualties at the scene of a fire. Some also offer classes for pet owners. The Veterinary Emergency and Critical Care Foundation trains first responders in conjunction with the annual meeting of the International Veterinary Emergency & Critical Care Society. Last fall in Nashville, Tennessee, over 60 police officers took part in the VECCF training session.

Do oxygen masks make a difference? Dr. Drobatz said, "Absolutely. One of the first things you do especially with an animal that’s comatose or unconscious is give them oxygen immediately because of the decreased oxygen content in the area where the fire was burning and the carbon monoxide. Oxygen supplementation will decrease the amount of carbon monoxide. If in doubt, we always give them oxygen."

Three nonprofits that provide pet oxygen masks are Project Breathe from the Invisible Fence Co., Project Paws Alive, and the Association of Professional Animal Waste Specialists (see sidebar "Pet oxygen masks").

​A cat is reunited with its family after a fire. (Courtesy of Red Paw Emergency Relief Team)

Dr. Mazzaferro said, "I have had animals transported to me by fire truck and ambulance after being maliciously burned as well as having been in a house fire and have signs of smoke inhalation. If a fire truck does not have oxygen masks specially made for animals, pediatric face masks work well to deliver oxygen to cats, and face masks or nasal prongs made for humans can be used for dogs.

"Severe smoke inhalation can definitely lead to chronic problems including increased susceptibility to respiratory infection and pneumonia, pulmonary fibrosis/scarring, and as long-term sequelae bronchiectasis, weakness, and dilation of the airways."

One of the dogs maliciously burned had been set on fire after being stolen from a humane society and wrapped in duct tape. Another dog died after his owner went off her schizophrenia medication and set him on fire. Dr. Mazzaferro has had to deal with severe skin burns as well as the systemic effects of burns and inflammation.

"We use a combination of wet-to-dry bandages and vacuum-assisted wound care along with a variety of antimicrobial ointments such as silver sulfadiazine for deep skin burns," she said, adding that skin grafts are not common.

Like Dr. Drobatz, she has seen corneal burns as the most common injury sustained by animals in residential fires, along with injury to the inner lining of the respiratory system from inhalation of superheated particles in the air.

The Red Paw model

Red Paw is the only such organization Leary knows of. The nonprofit’s funding has been a challenge, with 93 percent coming from donations and 7 percent from grants and foundation money.

Ideally, she would like to expand Red Paw’s response area, even go national, but at the very least, getting counterparts up and running in other cities would help the cause.

"It keeps me up at night thinking of all the fires in other parts of the country," she said. "It’s not the job of firefighters to look for and care for pets on the scene. They have a lot of other stuff going on. Our job is specifically to do that."

​Resources

A map of veterinary hyperbaric chambers in the United States is available at www.vhbot.org/usa-locations.

The National Board of Diving and Hyperbaric Medical Technology at http://www.nbdhmt.org/chtv.asp  offers certified training courses in hyperbaric technology and an examination to become a certified hyperbaric technologist–veterinary assistant.

The American Veterinary Medical Foundation’s emergency planning guide "Saving the Whole Family" is downloadable for free at www.avma.org/products under "Disaster Preparedness."

 

 

 

 

 

 

 

 

Related JAVMA Content

Good Samaritan laws protect responders (Feb. 15, 2018) ​