Stay safe in ambulatory equine practice

DANGER LURKS AT EVERY TURN IN EQUINE PRACTICE. Drug users and sellers have their eyes on your ketamine—"special K" on the streets. Carjackers are waiting for you to leave your truck doors unlocked. Thieves can spring your building's window latches in nothing flat.

Now forget about crime; let's talk medicine. What about radiographs and nuclear energy? Somebody skips the gloves or radiation badge, or holds the cassette in unprotected hands, and before you know it, that person is over the limit and off the machines for who knows how long. And horses—those beautiful, giant creatures. Find yourself stuck without an exit in a stall, down on your knees next to a tender limb, or at the mercy of someone who's not restraining the horse correctly, and pow! A broken bone, concussion, or worse.

The idea isn't to scare you, although we do want to get your attention. You face some special dangers, and you need to be smart about the way you practice. You can't completely prevent injuries, accidents, or crime at your workplace, but you can take steps to keep yourself and your team safer.

Hazards of horse medicine

Much of the danger in equine medicine is your proximity to a large animal, and often you're not the one restraining it. It's the owner, groom, technician, or veterinary assistant who has to hold the horse steady, get the twitch on right, and moving it to keep the horse calm. But if you keep in mind the potential safety pitfalls, you can lower your risk considerably.

Considering horses' size and unpredictable behavior, you'll do yourself and any assistants a favor if you take a moment to think before doing anything around a patient. It's easy to become complacent when you follow the same routine, says Phil Seibert, CVT, whose company, SafetyVet, consults with equine practices on safety training and OSHA requirements. And don't forget to let everyone involved know what you're planning to do before you do it.

"Don't put yourself in a stall with nowhere to go. Don't put your hand in a head clamp or stocks. Don't pass instruments or straps between the animal and stocks," he says. "It takes just a second for a horse to shift its weight and break your arm." If you're not 100 percent certain the person who's restraining the horse can handle the job, don't forget every equine doctor's best friend: sedation.

Equine teams can get complacent about radiation safety too, Seibert says. "You don't feel the pain when radiation exposure occurs, so team members can take shortcuts that hurt them in the long run," he says.

Three components of safety

The key to training your team to be safe around horses and careful with chemicals and radiation is a three-pronged approach, Seibert says. Your team needs:

1. Knowledge. What should employees know to stay safe? Write down a list of safety issues you've observed that haven't been addressed properly. Educate yourself about these issues. Spend some time reading Veterinary Economics and visiting VIN.com (Veterinary Information Network) and VSPN.com (Veterinary Support Personnel Network) to see what other equine practitioners are dealing with. Then decide whether you want to educate your team yourself, bring in a consultant, or assign a long-term employee to take responsibility for training.

The bottom line

2. Awareness. Does your team know what they need to do to stay safe? If not, start to incorporate safety training in your practice monthly or weekly. The more often, the better. "What you're trying to do is break old habits and develop new habits," Seibert says. "And you'll have to change the behavior in a short period of time. That takes a concerted, ongoing effort."

Whatever you do, don't tell your team, "You need to do this because OSHA will fine us if you don't." The message should be, "We're doing this to achieve a balance between what's good for the hospital, what's good for the patients, and what's good for us." Your team won't see the importance of following the rules if you focus on being "caught" by the authorities rather than on safety itself.

3. Enforcement. This is the most-neglected and most-dreaded component of safety for most equine practitioners: What happens when team members don't follow the procedures they've been taught? "Without rules and enforcement, you don't have a team," Seibert says. "You have a gang."

Team members, out of laziness or an attempt at efficiency, take shortcuts. Seibert has seen employees who knowingly placed themselves in dangerous situations with horses or threw away sharps in the regular trash. "People wound up getting stuck on them," he says. Set the rules, make the team aware that they're there for everyone's safety, and then enforce them. For consistent enforcement, Seibert recommends the "four strike" method of disciplining noncompliant team members. (For more on the "four strike" method, visit vetecon.com and look under Web Exclusives.)

Crime and punishment

If you've taken care of the risk of being stepped on and have your whole team wearing the right equipment for radio graphs, there's still a big part of safety training to come: crime prevention. When making presentations on safety and self-defense to equine veterinarians and technicians, Dr. Roberta Dwyer, DACVPM, of the Gluck Equine Research Center at the University of Kentucky, lists the top factors associated with assault for late-night retail stores from the National Institute for Occupational Safety and Health:

• contact with the public

• exchange of money

• delivery of people, goods, or services

• working alone or in small numbers

• working late at night or during early-morning hours

• working in high-crime areas.

"Sound familiar?" asks Dr. Dwyer. Most equine practices match almost every item on this list. And if you think criminals don't want what you have, think again. Your clinic or truck, often underprotected and sometimes unlocked, is full of scheduled drugs and is a prime target. As small animal clinics beef up security in their facilities, ambulatory practices will be targeted more, Seibert says. You can help prevent assault and theft with these guidelines—some simple and some elaborate—from Seibert and Dr. Dwyer:

• Lock your truck doors at all times. You may live and work in a rural area where people don't even lock their houses at night, Dr. Dwyer says. But people's homes usually aren't filled with expensive drugs.

• Install deadbolts on your doors if you have a building, and make sure your windows aren't easy to open. Your local police will often come free of charge to identify easy-access opportunities for potential thieves.

• Minimize the number of unlocked doors during working hours and lock all doors at closing time or when you or a team member is working alone at the clinic.

• Set up an alarm system. Even the signs will deter criminals, but don't stop there. Rig it up and make it work.

• Provide adequate lighting in and outside your clinic and secondary buildings.

• Take someone along when you visit your facility or make after-hours calls. If you can't do this, at least do the next step.

• Take a self-defense class. You'll learn what to do if someone makes you feel threatened, Dr. Dwyer says, and you'll learn to trust your instincts. "If something makes the hair on the back of your neck stand on end, get back in your vehicle and leave or call the police, a colleague, or a friend, depending on the situation," Dr. Dwyer says.

• Beware of the enemy within. Run criminal background checks on potential hires. Dr. Dwyer says you'll be surprised what you find. Better to know early that someone has a history of theft, embezzlement, or dealing drugs than after you become the latest victim.

An ounce of prevention

Dr. Mark Baus, an owner at Fairfield Equine Associates in Newtown, Conn., has crime prevention down. There's a security gate at the driveway entrance and thick woods all around the practice. Year-round interns live on the premises. But now he's taking safety training even more seriously. Recently, one of his doctors was injured when a horse that was being euthanized shifted unexpectedly. Dr. Baus' workers' compensation insurance went through the roof, but that's not what worries him most about the incident.

"We're in a dangerous field," Dr. Baus says. "And I don't want my staff hurt. When there's an accident, my first thought is never, 'Oh no, now I have to deal with insurance.' It's 'Is that person OK?'"

Of course, the best option is not to have to worry about people or paperwork because you've taken the proper precautions. If safety is an area that's been languishing on your to-do list, now is the time to deal with it—and help keep everyone in one piece.

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