Guidelines for Veterinary Emergency and Critical Care Facilities
These guidelines are intended to provide minimum standards for veterinary emergency and critical care facilities in the context of an ACVECC-approved Residency Training Program.
DEFINITIONS and TERMINOLOGY
The ACVECC Residency Training Committee requires that an approved Residency Training Facility (RTF) consists of an Emergency and Critical Care Center, which is defined as follows:
Emergency/Critical Care Center: A facility specifically designated to be operated, staffed, and equipped (in accordance with Parts 1 and 2 of these guidelines), 24 hours a day and 365 days a year, to provide a broad range of veterinary emergency and critical care services. It is imperative that professional staff include board-certified specialists, and it is suggested that it includes veterinary technician specialists (AVECCT). Centers that share a facility with a specialty practice or primary care practice must provide staffing and equipment to ensure appropriate emergency and critical patient care.
PART 1: MINIMUM GUIDELINES FOR VETERINARY EMERGENCY FACILITIES
Staffing: During the specified hours of operation, a licensed veterinarian should be on the premises at all times, and sufficient staff must be available to provide expedient patient care. Staffing should be sufficient to allow:
- Processing multiple patients
- Performance of a wide range of life-saving procedures to include but not be limited to cardiopulmonary resuscitation and emergency surgery. This requires at least three people, including one veterinarian and one veterinary technician.
- Appropriate and timely consultation with veterinary specialists.
- Diplomates of the ACVECC must to be directly affiliated with all approved RTFs, as outlined in the ACVECC Residency Standards.
Communications: Good communications must be maintained to allow efficient transfer of patient information between the emergency facility and primary care veterinarians. It is highly recommended that the emergency facility maintain the clinic and home telephone numbers of primary care veterinarians. A report must be sent to the primary care veterinarian in a timely manner to ensure immediate continuity of care and for inclusion in the patient's permanent record.
Medical Records: A complete and thorough medical record for each patient should be kept on file at the emergency facility.
The Medical record must follow AVMA guidelines for the POMR and must include:
- Patient signalment
- Presenting complaint(s)
- Physical examination
- Clinical pathology tests performed, including all results
- Diagnostic imaging procedures performed, with interpretation
- Tentative diagnoses or rule/outs
- All treatments, including anesthesia records and surgical procedures
- Progress notes
- Medications administered
- All client communications, including discharge instructions and release forms
- Client and referring veterinarian communications
All entries in the medical record should clearly identify the individual(s) responsible for administering care and entering data.
Continuing Education: Continuing education must be provided for professional and technical staff and must allow:
- Veterinarians and technicians to comply with CE requirements for state licensure.
- Veterinarians to meet specialty board CE requirements to maintain certification
- Technicians to meet CE requirements of their respective certification and licensing boards
Veterinarians in Veterinary Emergency and Critical Care Centers should obtain at least 40 hours of CE every two years in the field of emergency and critical care medicine. Technicians should receive at least 24 hours of continuing education in the field of emergency and critical care medicine every two years.
A system of ongoing, in-service training should be provided for veterinarians and technical staff to assure teamwork and familiarity with current procedures and guidelines. All ACVECC-approved RTFs must maintain a library containing current textbooks, periodicals, electronic data sources and internet access, as outlined in the ACVECC Residency Standards.
Emergency Capabilities: The level of care and maintenance provided in the areas of laboratory diagnostics, pharmacy, medicine, surgery, radiology, diagnostic imaging, anesthesiology, infectious diseases control, and housekeeping should be consistent with currently accepted practice and procedures for a veterinary emergency and critical care facilities and comply with state, federal, and provincial directives.
Instrumentation, pharmaceuticals, and other supplies should be sufficient for the practice of medicine and surgery at a level of care consistent with that expected in the practice of veterinary medicine as directed by the individual country, state, or provincial practice acts.
Emergency facilities should have procedures in-place to quickly obtain specialist consults and to refer cases as appropriate.
All emergency facilities should have the capacity to perform the following:
- Diagnosis and management of life-threatening emergencies including cardiovascular, respiratory, and neurological problems to minimally include:
- cardiopulmonary resuscitation, including electrical defibrillation,
- placement and maintenance of thoracostomy tubes,
- emergency tracheostomy and tracheostomy tube care,
- oxygen supplementation,
- assisted ventilation.
- Monitoring capabilities should include:
- arterial blood pressure,
- central venous pressure,
- pulse oximetry,
- esophageal stethoscope.
- Emergency surgery including:
- surgical hemostasis, wound debridement and application of wound dressings,
- stabilization of musculoskeletal injuries,
- aseptic thoracic, abdominal, and neurosurgery,
- or be able to refer to a facility that can perform these procedures in a timely manner.
- Treatment of circulatory shock using crystalloids, colloids, and blood products, as well as equipment such as calibrated burettes or infusion pumps to allow accurate delivery of fluids. Facilities should have stored natural and/or artificial blood products and the capacity to type and cross match donor and patient blood.
- Anesthetic and analgesic therapy to minimally include opiates, non-steroidal anti-inflammatory medications, and inhalational anesthesia. Intra-operative monitoring should include an electrocardiogram, esophageal stethoscope, blood pressure monitor, and pulse oximetry when appropriate.
- Laboratory functions: Perform in a timely manner:
- a complete blood count, BUN, refractometric total solids, blood glucose, urinalysis,
- clotting times (e.g., PT and aPTT),
- electrolyte measurements (Na, K, Cl),
- FIV/FeLV serology,
- heartworm testing,
- fecal examination (flotation, cytology and parvovirus antigen test).
- Additionally, an emergency facility must have laboratory supplies to collect, prepare, and preserve samples for a complete serum biochemical profile, blood gas analysis, full coagulation profiles, microbiological culture, and histopathology.
- Produce good quality radiographs while ensuring the safety of patient and staff. A radiographic machine of at least 300 mA and an automatic film processor are highly recommended.
- On-site ultrasonography capability.
- Have or have ready access to endoscopy.
PART 2: MINIMUM GUIDELINES FOR A VETERINARY EMERGENCY AND CRITICAL CARE CENTER
Emergency and Critical Care Centers must meet all the previous requirements as well as the following:
- Be able to serially monitor a CBC, full serum biochemical profile, coagulation screen and blood gases on site.
- Monitor direct arterial blood pressure and end tidal carbon dioxide concentration.
- Perform intermittent hemodialysis, continuous renal replacement therapy, and/or peritoneal or pleural dialysis.
- Have the ability to provide enteral and parenteral nutrition.
- Perform long-term mechanical assisted ventilation.