Triage and critical care of wildlife (Proceedings)

Due to anthropogenic encroachment on all wild spaces, an animal's encounter with civilization often leads to injury. This means that the number of animals received by wildlife rehabilitators every year is on the rise. Wildlife rehabilitators are often volunteers with limited resources. It is not uncommon for rehabilitators to complain that they have little veterinary support. Due to veterinary student's interest, veterinary colleges are now offering education on wildlife/exotic/zoo patients. There are now several professional organizations concerned with the welfare of our wildlife neighbors. These facts are bringing a new level of professionalism to a veterinarian's involvement with wildlife.

Prior to Triage—Legal Issues

As veterinarians, we are usually legally entitled to treat injured wildlife. It is important to mention that this does not translate to keeping permanently injured wildlife on a long-term basis or allowing our staff to do the same. It is our responsibility to learn, understand and educate others about Federal and State laws that govern the care of wildlife. When we choose to become part of wildlife rehabilitation, the public will undoubtedly use us as sources of information. This means that we must educate ourselves and teach our staff how to answer the commonly asked questions.

Prior to Triage—The Philosophy of Wildlife Treatment

Prior to treating a wildlife patient, you and your staff must decide for what purpose you would like to be involved with wildlife rehabilitation. Wildlife rehabilitation has long been a controversial issue. There are those that do not believe wildlife rehabilitation of individual animals significantly affects populations and therefore is a waste of money and resources that could be better spent in other conservation efforts. Furthermore, the reasons for why wildlife rehabilitation is carried out vary greatly. For example, some choose to participate because they feel this is one way to lessen the impact of human encroachment on wild animal's habitats. Additional considerations that should be considered before accept your first case include safety, equipment needed, knowledge of species or references available, your clinic's Mission for working with wildlife. The mission of the University of Georgia Wildlife Clinic is:

"To evaluate and treat native injured wildlife for the purpose of returning them to their natural habitat."

What are the chances I can treat this animal and return it to 100% normal function so it can be released back to its habitat?

Learning to anticipate the answer to this question within the triage period is one of the most difficult things to learn when working with wildlife. Leading wildlife rehabilitators agree that animals that are not in perfect condition should never be released. Animals that should not be released include: animals that are visually impaired, mammals that have two or more injured legs, bird that cannot use both wings, imprinted animals, animals that can potentially transmit diseases to endemic populations. To help you with these kinds of decisions either you can become involved with rehabilitation and post-release monitoring yourself or rely heavily on your relationship with a wildlife rehabilitator, which will prove invaluable.

Your Relationship with a Wildlife Rehabilitator

By far the most important step, second to developing a mission, is to develop a relationship with local rehabilitators. Wildlife rehabilitators are often members of the public who have acquired some training (either formally or through experience) and have been licensed by the state agency in charge of wildlife. Furthermore, additional special licensing is needed for a rehabilitator to work with rabies vector species in some states. Wildlife rehabilitators are not representatives or employees of the state agency (for example, the Department of Environmental Conservation) and are not necessarily formally trained. Wildlife rehabilitators can be an extremely valuable resource. Contact some of these rehabilitators and speak to them on the telephone to better ascertain their level of expertise. Some can be highly specialized (ie: will only work with opposums), while others feel comfortable with only specific groups of animals. As soon as that animal has been treated, it is best in the hands of an experienced wildlife rehabilitator to: continue simple medical treatments, asses your success with a specific procedure, allow an animal to regain physical condition needed for free-ranging conditions, help you assess whether an animal should be released, provide housing that is more appropriate than what is available in the hospital, provide transport to a suitable release site, provide post-release monitoring.

Wildlife Emergency Treatment

This section will emphasize some of the most important principles in treating wildlife emergencies and some common scenarios.

Safety: One should be aware of potential zoonotic diseases associated with the wildlife in the region with which you will be working. Make the entire staff aware of the dangers involved when working with wildlife and provide them with the proper safety equipment (exam gloves, leather gloves, towels, nets...) to deal with them. Be familiar with the defense weapons of the different wildlife species (raptors=talons and beaks, herons and egrets=beaks, mammals=biting, scratching, kicking snapping turtles=biting, snakes=biting, venom) and how to properly restrain the more common wildlife species. Remember to review the vaccination status of the entire staff before emergencies present. Develop a plan in the event of an animal bite or exposure to any zoonotic disease. When dealing with most wildlife patients, remember that handling and treating them is, at least, a two-person job.

History: This can be postponed until the animal is first stabilized to minimize stress; however, it provides valuable information. Learn to ask the right questions and when to omit unnecessary details. Develop an Admissions sheet that the public can fill out with the following details: Where, when was the animal found and why? Was any treatment attempted? Was food given? Has the animal urinated/defecated? Other abnormalities noted (vomiting, diarrhea, seizures...).

Equipment: An area (a "dedicated" area for wildlife in the case of a private practice setting) must always be available for laying an animal down in a well-lit surface, near the clinic crash cart or emergency box which will contain all that is necessary for an emergency. This should include an area to where the anesthesia machine and other sources of oxygen will reach. A dedicated area will provide a quieter place to work with highly stressed wildlife patients and protect your domestic patients from potentially contagious diseases. Emergency drug dosages for non-domestic animals should be posted in a conspicuous area, preferably on the crash cart or emergency box. Most avian, reptile and non-domestic mammal drug doses can be found in standard exotic animal medicine formularies. Other specialty equipment-gram scale, incubator, restraint equipment, small endotracheal tubes, bandage material pre-cut to small sizes, small laryngoscope, cage furniture for birds, tanks for reptiles is extremely helpful. Hospital cages or pediatric incubators can be transformed into adequate wildlife holding cages with minimal modifications. Aquariums and bottomless bird cages further contain small patients within hospital cages. Choosing accommodations in the quietest area of the clinic is paramount.

The Plan

Develop a plan with which you are comfortable and then follow this plan every time.

Triage: Observe the animal presented in its container, do a cursory exam (2-5 minutes-which should include obtaining a body weight if possible), identify and prioritize life-threatening problems. The ABC's of emergency are useful, but in wildlife patients, when some things can easily be overlooked, I prefer: A. C.R.A.S.H. P.L.A.N. Airway, Cardiovascular, Respiratory, Abdomen, Spine, Head, Pelvis, Limbs, Arteries, Nerves. The neurologic exam is most often overlooked in wildlife patients.

Stabilize: At this point you should have outlined the most important problems that need treatment and have begun to do so. When dealing with wildlife, stabilization may include placing the animal in a warm, dark, quiet enclosure to allow it to settle down while you prepare the equipment needed to treat such as oxygen, fluids, heat sources, emergency drugs etc. Fluid requirements are a function of metabolism. The primary goal in using fluids to treat shock is to increase fluid flow to stabilize blood pressure, to increase O2 delivery to tissues and increase CO2 shuttling as well as improve cardiac performance. Routes for fluid administration in shock: IV or IO. IV or IO may not be realistic for your size of patient and your level of expertise. SQ fluids are better than nothing, however, this route is not recommended for animals in shock. Doses: mammals-60-90 ml/kg/hr; birds-90-100 ml/kg; reptiles 25-35 ml/kg. Maintenance: mammals-30-40 ml/kg/24 hr; birds-60-90 ml/kg/24 hr; reptiles-15-45 ml/kg/24 hr. Other drugs needed: Glucose (hypoglycemic animals), potassium (severely cachectic, anorectic animals), vitamin B (cachectic, anorectic animals), vit E, Se (musculoskeletal dz), vit A, D (cachectic, anorectic animals), iron Dextran (anemic animals), -NSAID's (decrease inflammation), parasiticides, and antibiotics. Supplemental heat: (warmed gloves and bottles are not sufficient), use heating pads, heating lamps, incubators, warm fluids, warm water enemas. Monitor temperature carefully. Fracture stabilization: Determine the need for pain medication, stabilize the fracture. Wound Care: Try to minimize added contamination to the wound. Preventing an infection by dealing with the wound directly will be more efficacious than ignoring the wound and attempting to treat it with antimicrobials later. Flush wound with disinfecting agents that will not cause further cellular damage. Rinse with physiologic saline. Apply a sterile dressing to protect from further contamination. A stress-free environment away from the busy clinic, away from barking dogs and hissing cats. Time to rest and sleep. Nutrition: Most wildlife patients will need food items that are not commonly kept in veterinary clinics. To formulate caloric needs:

     BMR (kcal/day)=K(body wt in kg)0.75

     where K=70 in mammals, 10 in reptiles, 78 in non-passerines, 129 in passerines.

     MER (kcal/day)= 1.5 X BMR

     If animal is septic, has head trauma or neoplasia: MER X 1.5=kcal/day needed.

In Summary-Wildlife Emergency Treatment

Your aim is to strike a balance between appropriate and aggressive emergency care that will save your patient and minimizing handling and stress that will kill your patient. The number one reason that wild animals are presented to rehabilitators or veterinarians for treatment is TRAUMA. Common causes of trauma in wildlife patients include: Hit by car, attacked by domestic animals (cats>dogs), gunshot, habitat disturbed/loss, contact with power lines, entanglement in foreign materials. Other common reasons for presentation: Environmental factors-floods, storms, extreme weather; Nutritional depletion-droughts, high population densities, orphans; Toxicities-lead, organophosphates, rodenticide, tar traps, oil spills; Infectious diseases-Chlamydiosis, Paramyxovirus, rabies, distemper; Parasitism-coccidia, severe infections of nematodes, flukes or other ecto/endoparasites (mites, fly larvae, Capillaria...)