Emergency Veterinary Care at Horse Shows

1. Introduction

Equestrian competition has increased to an all time high in recent years. The U.S. Equestrian Federation (USEF) and the American Quarter Horse Association (AQHA) sanction ~6000 horse shows and special events each year. According to their collective internet websites, these two organizations represent ~435,000 members and are still growing. There are many more discipline-and breed-specific organizations involved in horse sport in the United States and abroad that sanction and sponsor horse shows and events. The horse show veterinarian has become an essential part of the process and will often be called on before and during competition to provide routine and emergency veterinary medical care. Many organizations have specific regulations regarding the presence of a veterinarian at competitions. The veterinarian plays a vital role, not only providing care for competing horses, but also assuring the public that the welfare of competing horses is of primary importance.

2. Basic Equipment and Needs for the Attending Veterinarian

The primary equipment need for the horse show veterinarian is a well-prepared ambulatory vehicle capable of providing essential supplies for emergency care. This does not necessarily demand a high-tech mobile clinic; however, it does require knowledge and preparation on the part of the attending veterinarian. The primary goal in serious emergencies may be simply stabilization of the patient so that the horse may be transported to a full-care facility. Most emergencies will likely prove less involved and may be fully cared for on site.

Major equipment and supplies to consider having immediately available should include the following:

• Surgical supplies to handle various lacerations and wounds
• Colic diagnostic and therapeutic supplies
• Intravenous fluids and appropriate administration equipment
• Antibiotics, local anesthetics, sedatives and analgesics, and anti-inflammatories
• Euthanasia solution
• Bandaging and splinting supplies
• Modern imaging equipment (ultrasound and radiographic) can greatly enhance early diagnosis thereby improving the quality of initial care.

An "on-grounds" clinical facility can improve the quality and efficiency of emergency care. This facility need not be elaborate but can provide some basic needs:

• A relatively clean and well-lighted environment
• Hot and cold running water
• Electricity
• Lockable storage and possibly administrative facilities

At the very least a treatment stall designated ahead of time can enhance the function of the veterinarian. Not only will it provide a place to work, but it also can determine a designated place exhibitors can "find the veterinarian." Having some sort of office facility on the show grounds can prove very useful because many administrative duties may arise for the attending show veterinarian. A small mobile home unit in conjunction with a treatment stall may serve most of the previously mentioned functions.

The show veterinarian should make prior arrangements with a referral equine hospital to handle those emergencies that exceed the scope of treatment at the horse show. Waiting until the last minute to make such arrangements can prove disastrous.

A means of emergency transport for horses should be provided at each competition. An equine ambulance provides quick and safe transport for an injured horse, but at the very least prior arrangements should be made for an available truck and trailer unit or van to move an injured or ill horse to a complete care facility. A group of designated individuals should be briefed and trained prior to the event with regard to handling an injured horse and the procedures related to its care and possible transport.

3. Major Emergency Concerns at Horse Shows

Although a wide variety of emergency conditions may arise at horse shows and events, there are a few that seem to be the most common and surely ones for which the attending veterinarian should be prepared. These include horses that are ill on arrival, colic episodes, lacerations and serious wounds, and musculoskeletal injuries. This article will look at each of these in more detail.

The "Ill on Arrival" Horse

Many competitions draw exhibitors from great distances necessitating extended transport for the horses. Additionally, many show horses are constantly on the road, traveling from one competition to the next. Length of travel, changes in ambient temperature, dehydration, poor ventilation, and irregular feeding schedules may all contribute to significant stress, resulting in sick horses on arrival at the competition venue. Competitions sanctioned by the Fédération Equestre Internationale (FEI), by design, require an arrival examination to minimize the exposure of healthy horses to those that may be carrying infectious diseases. It is wise for the attending veterinarian to embrace this philosophy wherever possible and practical. Many horses may seem relatively healthy when first disembarking from the trailer or van, only to become quite ill within a few hours. Horses will frequently show elevated temperatures, increased respiration, depression, anorexia, and possibly colic-like discomfort. These animals need to have a thorough assessment once a problem is recognized and should be isolated from other healthy horses if feasible. Basic blood work is appropriate to assess hydration and signs of possible infectious disease. Those horses showing a fever with little else may respond well to simply rest and time, whereas others may benefit greatly from appropriate doses of analgesics and antipyretics such as flunixin meglumine [a], phenylbutazone [b], or dipyrone [c]. Dehydrated horses can benefit from fluids and electrolytes by nasogastric tube or intravenous administration (or both) [1]. Those with significant respiratory symptoms or any other signs of possible infectious issues are candidates for antimicrobial therapy and careful observation for an extended period [2]. Quiet surroundings and good ventilation can benefit many travel weary horses immensely. Of course, any drug therapy must be in accordance with horse show organization rules, but regulations most often provide for a means to treat an ill horse. Many analgesics and antimicrobials are available for use in accordance with USEF rules for horse shows and even medications that are not permitted for actual horse showing may be used 24 hours before competition when an appropriate medication report form is completed and filed with the show steward. Similarly, contact with the FEI veterinary delegate and completion of appropriate paperwork can clear the way for proper treatment of an ill horse. Although FEI rules prohibit the use of some specific medications, oral and IV fluids and antibiotics are permitted for use if the proper protocols are followed.

Colic

The stress of travel and a new environment may predispose some horses to colic episodes. Impaction colic is frequently seen in these situations. The primary concern for the attending veterinarian is rapid assessment of the case and determination of the immediate medical needs of the patient. Extreme care should be taken in handling unfamiliar horses under these conditions, as in performing a rectal examination. Nonetheless, a thorough and complete examination is essential because of the fact that specific decisions for care may eliminate the horse from competition.3 Severely ill horses are probably not best cared for in the horse show environment; however, making a genuine effort to keep the horse in competition is appreciated by the owner and show management alike. Any decisions for drug therapy must be made fully cognizant of the horse show organization rule structure. USEF medication rules provide for treatment of the "colicky" horse with a wide variety of medications. Sedatives may even be used but will restrict the horse from competition for 24 h. As mentioned previously, treatment of the FEI horse must be done with knowledge of the FEI veterinary delegate and proper paperwork, except in the case of extreme emergency. In the case of extreme emergency, an effort should be made to contact the veterinary delegate at the earliest possible time. Removing a horse from the FEI restricted area may disqualify a horse from competition should it recover fully from the colic episode. Any horse that is unresponsive to therapy for any extended period should be referred to a full care facility.

Trauma and Lacerations

Severe trauma requires prompt and accurate evaluation. Rapid attention to recent trauma may result in quick recovery and no loss of activity on the part of the horse. Head and eye trauma, for example, can have serious consequences if not attended to quickly, but such injuries can often be successfully treated in the horse show environment [4]. It may be apparent that a wound is serious enough that the horse is not fit to compete. Such a case will normally require a written statement from the attending veterinarian and a meeting with the FEI veterinary delegate if applicable for the horse to be officially withdrawn from competition. This can be an important service for the horse owner as it may entitle him or her to obtain a refund of some of the entry fees. Serious wounds should be rapidly stabilized (bandages, splints, and appropriate medications), and the horse should be moved to a full care facility if treatment cannot be completed at the horse show venue.

Other wounds may be treatable, and the horse can be fit for competition. Some facial and eye wounds are examples. Lacerations that require suture repair can sometimes present logistical issues. Some wounds may be medically managed to be surgically treated after the end of competition. Manual restraint may be sufficient to repair small lacerations. Local anesthetics are most often prohibited by most organizational rules, however some, such as the AQHA, will allow their use if the attending veterinarian deems it necessary. USEF rules allow for the horse to return to competition, but only after 24 h, following the use of any local anesthetic or sedative. These drugs must be accurately declared on a medication form at the earliest possible time after treatment. The FEI veterinary delegate and ground jury may allow for the use of local anesthetics for laceration repair if the wound is not serious enough to make the horse unfit for competition.

Musculoskeletal Injuries

Musculoskeletal injuries are quite common at horse shows and special events. Most are not of an extreme nature, but the attending veterinarian should be prepared for the worst case scenario. The ability to handle a serious breakdown injury, although rare, is critical. Prior organization of a team of people to handle an injury in the competition arena will go a long way to maintain good public image for the sport and veterinary medicine while insuring the best possible care for the horse. FEI regulations recommend the use of a screen to shield the seriously injured horse from public view, and some prior training is necessary to use such a device effectively. Bandage and splint materials (such as a Kimzey splintd) should be on hand as mentioned previously.5 It is probably wise to keep these materials ringside during major competitions such as Grand Prix jumping events. Instant cold packs or ice may prove useful in the event of a serious injury in the competition arena. Having a completely outfitted vehicle for ambulatory care and an equine ambulance close by the competition arena is ideal.

Fortunately, most musculoskeletal injuries are not so serious and can be treated in a more routine manner. Sudden swellings in distal limbs are common findings at horse shows and frequently may be found to be to milder traumas or even cellulitis rather than serious musculoskeletal injuries. Once again, a careful and thorough evaluation is important. Ultrasound evaluation of such limbs may make the difference in going forward with treatment and staying in competition or withdrawal. Again, any therapy undertaken must be in accordance with competition rules and drug withdrawal recommendations.

4. Conclusions

The show veterinarian can face a formidable task in dealing with emergencies if not prepared. Careful planning and an active interest in the horse sport can make for an efficient and rewarding experience for the attending veterinarian. Although some venues may provide somewhat more sophisticated facilities, following the suggestions put forth in this discussion should allow the treating veterinarian to provide satisfactory emergency care regardless of the horse show location and conditions.

Footnotes

1. Flunixamine, Fort Dodge Animal Health, Fort Dodge, IA 50501.
2. Equi-Phar Phenylbutazone Injection, VEDCO, St. Joseph, MO 64507.
3. Dipyrone 500 mg/ml Injectable, Wickliffe Veterinary Pharmacy, Lexington, KY 40508.
4. Kimzey Leg Saver Splint, Kimzey, Woodland, CA 95695.