Barn Fires: The Veterinarian's Role (AAEP 2012)
A barn engulfed in flames, terrified whinnies coming from within the burning structure. Few scenarios are more frightening to owners of stable-kept horses. Veterinarians, with their regular trips to the barn, are in a unique position to advise horse owners on fire prevention. However, even with the best preventive measures, barn fires do happen, so it's important that veterinarians are ready to manage patients during and after a blaze--a well-thought-out approach to triage can save horses' lives.
At the 2012 American Association of Equine Practitioners convention, held Dec. 1-5 in Anaheim, Calif., Emma Adam, BVetMed, Dipl. ACVIM, ACVS, an equine practitioner currently performing research at the University of Kentucky' Maxwell H. Gluck Equine Research Center, reviewed the veterinarian's role in handling barn fires.
Before Fire Strikes
Although it's impossible to eliminate any possibility of a barn fire, Adam said encouraging clients to "fireproof" their barns can not only decrease the likelihood of a devastating fire igniting but also can reduce insurance premiums by 5 to 10%.
Adam provided attendees with a few measures horse owners can take to make their barns safer:
In existing barns:
Even with the strictest safety precautions, barn fires still occur. Affected horses can suffer burns to their skin, eyes, and respiratory tract, along with more severe consequences including shock and internal organ failure. Providing immediate veterinary care is crucial to maximize horses' chances of survival.
Adam said it's key for veterinarians treating victims at the scene of a fire to stay calm, focused, and--most importantly--safe.
Hyperbaric Oxygen Therapy
Equine survivors of barn fires commonly face a long road to recovery. Some of these horses, especially those suffering from burns and edema (fluid swelling), could be ideal candidates for hyperbaric oxygen therapy (HBOT). Emma Adam, BVetMed, Dipl. ACVIM, ACVS, explained why veterinarians frequently turn to HBOT to help barn fire victims heal.
HBOT therapy involves subjecting the patient to high levels of oxygen under pressure in a special chamber. The elevated pressure and oxygen concentration in the chamber combine to force more oxygen into the patient's bloodstream with each breath, which increases the amount of oxygen dissolved in the blood. This increase in available oxygen is thought help heal injured tissues. Veterinarians using HBOT have noted reduced edema in treated animals.
"The significant reduction in edema and increased plasma oxygen concentrations ... make HBOT the single most attractive treatment modality for burn patients after intravenous fluid resuscitation," she said.
She recommended referral to a facility offering HBOT if the owner's budget allows and if the facility is relatively nearby. Horses can be transported as soon as they are stable to travel, she noted, so HBOT can (and should) begin immediately after evaluation.
"When called to a barn fire, take instruction from the fire department's on-site leader," she said. "Treat the horses that have already been removed from the fire, and do not enter the barn fire area."
She recommended taking a moment to familiarize oneself with the situation:
These factors could help veterinarians provide the most appropriate triage care before referring patients to an equine hospital for further evaluation and treatment, she said.
The key to dealing with barn fire victims is to treat each horse immediately and aggressively, Adam said, as if you're addressing serious shock. There's often latent damage, both on the inside and outside of the horse's body that's not evident initially, she said.
"The mainstay of initial therapy is cardiovascular stabilization," Adam said. Veterinarians should place a long-term intravenous catheter in the patient's jugular vein and start fluid replacement therapy as soon as possible, before tissue edema (fluid swelling) hampers vein access. In addition to using isotonic fluids therapy, she recommended administering hypertonic saline solution but noted that--if immediately available--frozen plasma can be used as well.
Depending on the damage many horses might require a temporary tracheostomy (a surgically created opening through the skin into the trachea, to allow for insertion of a tube for breathing) immediately due to facial burns or laryngeal swelling, Adam said.
Next, Adam said, consider administering the diuretic furosemide; many practitioners believe diuretics offset the risk of potentially fatal pulmonary edema (fluid buildup in the tissues and air spaces within the lungs), she said. Using furosemide in this scenario is controversial in human medicine, she said, but "I use it because I've seen what happens without it." Adam explained that the only way to diagnose equine pulmonary edema in the field is to watch for a pink froth at the animal's nostrils. Unfortunately, she said, once this happens there is little that can be done to help the horse.
Adam said she also would administer a low dose of short-acting, rapid-onset corticosteroids to help stabilize horses' cell membranes. Some veterinarians use antimicrobials--both topically on burns and systemically--to help protect horses from environmental bacteria, she explained. Additionally, it's typically beneficial to administer anti-inflammatory and/or analgesic drugs--such as flunixin meglumine or phenylbutazone--after fluid therapy has begun, she said.
After treating the horse at the scene, the veterinarian should refer him to a hospital for further treatment.
Adam cautioned that it's difficult to provide a prognosis--or an estimate on how much treatment will cost--after initial triage care: "It can be hard to appreciate the extent of cutaneous, ocular, and systemic organ damage immediately to extrapolate the cost and length of care of these cases."
Veterinarians responding to barn fires must often decide whether euthanasia is the most humane course of action for severely affected horses, she added.
Veterinarians should always be prepared to perform triage in the wake of a barn fire, she stressed. Caring for these horses often means making difficult decisions, so veterinarians must treat each case as an individual. And most importantly, she said, "Stay safe."
Disclaimer: Seek the advice of a qualified veterinarian before proceeding with any diagnosis, treatment, or therapy.
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