Statement on Veterinary Emergency Care

this statement outlines the requirements on the provision of veterinary emergency care after hours in new zealand, based on the standards set by the veterinary council of new zealand (vet council) its purpose is to provide clarity for veterinarians, veterinary practices (including new establishments), and animal owners on what is required this statement is intended to foster a clear understanding of the provision of after hours veterinary emergency care in new zealand, promoting animal welfare, biosecurity, maintaining trust in the veterinary profession, and supporting the veterinary profession in delivering these essential services practices should note that the vet council can be contacted for advice if there is any uncertainty about these requirements 1\ adequate emergency care adequate emergency veterinary care is crucial for animal welfare, biosecurity and maintaining trust in the veterinary profession it involves the following key aspects universal application, from day one the requirement to provide emergency care applies to all practices adequate emergency service arrangements must be in place from the first day of operation robust planning for these services must be undertaken before the practice opens its doors this is a fundamental requirement and not optional 24 7 coverage veterinarians in clinical practice must make an emergency service available at all times purpose an emergency care service is required so that a practice’s clients’ animals can receive essential veterinary treatment in order to relieve unreasonable or unnecessary pain or distress resources and timeliness the emergency service must be sufficiently resourced to ensure that, except in extraordinary circumstances, all veterinary emergencies involving clients' animals are attended to in a reasonable timeframe what constitutes a "reasonable time" can vary based on factors such as the nature and severity of the emergency, local geographical conditions, the potential benefits of referral to a specialised emergency facility, and any temporary resource constraints e g unforeseen staff constraints or natural disasters emergency service arrangements to support their veterinarians to meet the expectations of the code veterinary clinics must have a documented agreement for any emergency service arrangement they have with an external provider they must also have a clear back up provision for situations where the emergency service, whether their own or externally provided, is unavailable scope of care at a minimum, emergency care includes providing first aid, adequate pain relief, and, where necessary, euthanasia veterinarians must act to ensure an animal's pain and suffering are managed while the level of service or range of diagnostic and treatment options available after hours may differ from those available during normal clinic hours, the fundamental need to alleviate suffering remains paramount veterinarian safety veterinarians, when attending emergencies, should carefully consider potential personal risks and take appropriate steps to manage these risks there is no expectation that veterinarians should place their personal safety in jeopardy veterinary businesses have an obligation under health and safety legislation to consider and manage these risks support staff emergency care provided by a practice may involve the services of appropriately trained non veterinarian staff (e g , veterinary nurses or technicians) acting under the supervision and direction of a veterinarian however, a veterinarian must be readily available to provide clinical care and undertake work legally required to be completed by a veterinarian client communication clear communication with clients is essential practices must proactively inform their clients from the outset about their after hours emergency service arrangements this includes how to access care, what services can be expected, and details of any arrangements for referral to other practices or dedicated emergency clinics, including potential travel times this helps set realistic expectations and allows animal owners to plan accordingly internal practice policies veterinary practices are strongly encouraged to develop and implement clear internal policies or standard operating procedures (sops) for managing after hours calls these sops should guide all staff (veterinarians and support staff) on triaging calls, communicating with clients, defining what the practice considers an emergency versus an urgent case to assist with triage decisions ensuring consistency in the level of care and advice provided this helps manage client expectations, supports staff in making these often challenging decisions, and can help avoid some members of the team feeling undermined by the actions of others 2\ what constitutes a veterinary emergency understanding what constitutes a veterinary emergency is vital for both animal owners and veterinary professionals initial perception of an emergency an emergency is often initially perceived based on the report and concern of the person in charge of the animal this perception stands until an appropriately trained veterinary professional has had the opportunity to conduct an assessment it's acknowledged that a client's perspective can be influenced by factors such as inexperience, emotional connection, previous experiences, or personal values regarding pain and distress, making it difficult for them to understand the level of seriousness or urgency from a clinical standpoint it is also not uncommon for emergencies to arise at least in part due to delays by the person in charge in accessing veterinary care – a delay such as this does not change the urgency of the case which must be based on the triage of the reported history and symptoms vet council definition a veterinary emergency is defined by the vet council as " any sudden, unforeseen injury, illness or complication in an animal, demanding immediate or early veterinary treatment to save life or to provide timely relief from unreasonable or unnecessary pain or distress " this would include any significant worsening of a known/current problem veterinary assessment and professional judgment veterinarians are expected to use their professional judgment, which may involve an assessment conducted over the phone (remote triage), to determine if a situation constitutes an emergency requiring immediate attention if deciding via phone that a situation is not an emergency, the veterinarian must be confident they have sufficient information to make that assessment accurately seeing non emergencies in some cases, a veterinarian may choose to see non emergency cases immediately and their decision making in these cases may be influenced by factors such as clinic culture or policy, personal values regarding pain and distress, current workload, and the time of day when an emergency is not deemed to exist after assessment following an assessment, a veterinarian may decide an emergency does not exist if the veterinarian, in their professional judgment, determines the situation is not a veterinary emergency requiring immediate after hours intervention the veterinarian informs the caller that emergency veterinary treatment is not immediately required, and alternative arrangements (e g , monitoring, an appointment during normal hours) are appropriate (veterinarians have an obligation to maintain medical records and these should contain relevant clinical history and findings, decisions made, treatments provided, and information provided to clients medical records should be created at the time of the events being recorded or shortly after ) triage distinguishing "emergency" vs "urgent" care triage involves differentiating between emergency cases those that are immediately life threatening or involve severe, unmanageable pain or distress requiring prompt after hours intervention to stabilise the animal's condition while not an exhaustive list, conditions that are generally considered emergencies include severe trauma (e g , road traffic accidents, falls, attacks), respiratory distress or obstruction, sudden collapse or cardiac issues, severe uncontrolled bleeding, known or suspected toxin ingestion, prolonged or multiple seizures, unconsciousness or recumbency (especially in large animals), and complications during birth severe infections and septicaemia generally, anything that is emergent needs immediate veterinary care urgent cases these include medical issues that require prompt attention but do not pose an immediate threat to the animal's life while urgent cases still require timely intervention (which may reasonably range from 6 to 48 hours depending on the case), they are generally less critical than true emergencies these cases might potentially be managed with advice, pain relief, and an appointment during normal clinic hours if the animal is considered stable and can be kept comfortable examples could include a dog with sore ears, a cat that has vomited but is otherwise stable, or a lame horse where pain is manageable cases assessed as urgent can often wait until normal business hours emergency cases are often prioritized over urgent care cases, but the latter still require professional attention \guiding principles in triage \ \apply clinical judgment to triage after hours cases, ensuring that true emergencies receive immediate care while urgent but non critical cases may be, with interim advice and pain management, safely deferred until regular hours, provided this does not compromise animal welfare \ \veterinarians have a role to triage the case and schedule a time with the client if it's an emergency or provide reassurance and a plan if the situation is urgent and can be safely seen at a future time considered and thorough triaging of after hours calls is one step veterinarians can take to better utilise available veterinary resources \ \the emergency triage service provided by a practice may involve the services of appropriately trained persons (for example technicians and veterinary nurses) who are not veterinarians however, a veterinarian must be readily and directly available at all times to provide the necessary veterinary clinical support and undertake the work legally required to be completed by a veterinarian \ g \uidance \ 3\ expectations on who is required to provide emergency care the responsibility for providing emergency care is distributed as follows primary veterinarian/practice (general veterinary practitioner gvp) veterinarians in clinical practice have a professional obligation to make emergency services available for their own registered clients' animals this is a cornerstone of the veterinarian client patient relationship the gvp is considered the provider of regular and general veterinary services and accepts the major responsibility for providing or arranging emergency care for those animals under their care this can be achieved by the practice providing the service itself, formally agreeing to share services with a nearby practice, or formally engaging a dedicated after hours provider where gvps share clients, each gvp is equally responsible for providing or arranging for emergency care for those animals under their care after hours emergency and urgent care practices the responsibility for providing emergency care when operating as an after hours emergency service or urgent care practice is distributed as follows practices that provide emergency services exclusively outside regular hours enter into a veterinary client patient relationship by default when treating animals they therefore have a professional obligation to ensure continuity of care and appropriate referral these practices must have documented protocols to identify the animal owner’s primary gvp veterinarian at the time of presentation and communicate with them as appropriate manage cases where the animal does not have a gvp, including advising the owner on establishing a relationship with a daytime practice arrange referral of the animal to a nominated daytime practice or an referral care facility when the emergency service closes, ensuring that ongoing care is not compromised there must be a formal, documented understanding between the after hours emergency care or urgent care practice and the local daytime gvp practices whose clients they serve this agreement should outline responsibilities for the acceptance of animals under their care, communication, record transfer, and follow up care care for non clients if an animal owner contacts a veterinarian who is not their regular gvp, and their own gvp's emergency service is unavailable, the veterinarian receiving the call has a professional duty, if they possess the necessary skills and resources for the particular emergency, to attend i e the veterinarian must attend the emergency and provide essential treatment to relieve unreasonable or unnecessary pain or distress the decision to provide more than essential treatment is at the discretion of the veterinarian the same principle applies to a situation where a veterinarian has ended a relationship with a client, and they have not registered with a new gvp i e the veterinarian must attend the emergency and provide essential treatment however, the primary expectation is that animal owners should be registered with a gvp who must be their first point of contact for emergencies where a veterinarian believes another veterinarian is not meeting their obligations in relation to the provision of emergency services the vet council can deal with the matter informally, outside of a complaint process we can refer the concern to our alternative resolution pathway (“arp”) the arp is an informal pathway for gathering information the role of the arp is to ensure that veterinarians are aware of, and are meeting, their professional obligations the arp pathway does allow for escalation to the formal complaints process veterinarian competence veterinarians must practice within their sphere of competence this includes competence related to species, conditions, and available equipment/facilities if an emergency case falls outside a veterinarian's current competence, they are expected to provide advice and facilitate referral to another veterinarian or facility that can provide the necessary care, if such an option is reasonably available in emergencies where attendance by another veterinarian is not an option, veterinarians should assist a client to determine the best course of action, which may include the veterinarian attending the animal the expectations of the veterinarian where the emergency is outside the their competence are context specific – veterinarians can find guidance on how to navigate these here veterinarians offering a "specific and limited range of veterinary services" https //hub vetcouncil org nz/glossary#specific and limited range of veterinary services veterinarians or practices that offer a specific and limited range of services (e g , specialist referral services, house call euthanasia services) must arrange for 24 hour emergency cover in relation to the matters consulted on or for complications that could arise from the procedures or treatments they have provided clear communication with the client and their gvp must take place and is essential to delineate responsibilities for ongoing and emergency care emergency care provision arrangements, shared services, and contingency planning veterinary practices may meet their obligations by entering into formal arrangements with other practices or dedicated after hours emergency clinics to provide emergency services crucially these arrangements must be formalised through written agreements these agreements should clearly detail responsibilities, communication protocols, and ensure the referred service is adequate and capable of meeting the needs of the referring practice's clients if a practice refers its clients elsewhere for after hours care, the referring veterinarian retains a responsibility to ensure that the service to which they have an arrangement with can provide an appropriate level of care in terms of skills, facilities, and reasonable accessibility (including travel time) for their client base practices must also engage in contingency planning to address situations where their primary after hours arrangement might unexpectedly become unavailable animal owner responsibility animal owners have a legal and ethical responsibility under the animal welfare act 1999 to ensure the health and welfare needs of their animals are met this includes seeking veterinary attention when an animal is sick or injured the owner of an animal that is ill or injured, and every person in charge of such an animal, must ensure that the animal receives treatment that alleviates any unreasonable or unnecessary pain or distress being suffered by the animal the vet council’s view is that this also includes maintaining an ongoing relationship with a veterinarian or veterinary practice owners are strongly encouraged to register their animals with a veterinary practice to ensure their animals are under the care of a veterinarian and to understand the emergency service arrangements of that practice before an emergency occurs 4\ emergency care requirements for new veterinary practices new veterinary practices have a unique responsibility to ensure emergency care arrangements are robust, transparent, and operational from the outset the vet council expects all new practices to meet the same emergency care standards as established practices, with additional emphasis on proactive planning and communication mandatory emergency service planning before opening emergency care obligations apply from the first day of operation new practices must establish formal emergency service arrangements prior to opening ensure these arrangements are documented through written agreements with any third party providers confirm that the emergency services provider is adequately resourced, accessible, and capable of meeting the needs of the practice’s client base clear client communication new practices must proactively inform clients about the nature and scope of their emergency service arrangements how and when emergency care can be accessed any referral pathways, including expected travel times and limitations this communication should be embedded in client onboarding materials and reinforced through signage, websites, and verbal explanations contingency planning new practices must develop contingency plans to address potential disruptions in emergency service availability these plans should include backup providers or shared service agreements internal protocols for managing overflow or unexpected demand clear escalation pathways for staff integration with practice policies emergency care protocols must be integrated into the practice’s standard operating procedures (sops), covering triage processes staff roles and responsibilities definitions of emergency versus urgent cases communication standards for after hours calls vet council support new practices are encouraged to seek guidance from the vet council if they are uncertain about emergency care requirements the council provides technical advice and can assist in interpreting professional standards in the context of new practice operations