Minimum Recommendations for Equipment and Supplies for
Veterinary Emergency and Critical Care Facilities
The Veterinary Emergency and Critical Care Society (VECCS) has endorsed a standardized guideline that specifies the minimum recommended equipment and supplies that any emergency and critical care veterinary hospital should have available for the treatment of patients. This guideline is meant to raise the standard of care and increase the public and professional awareness of the level of care that is expected from a hospital that defines itself as a treatment facility for the emergent and critical veterinary patient.
PART 1: OPERATIONS OVERVIEW FOR A VETERINARY EMERGENCY FACILITY
A licensed DVM must be on premises during operating hours. A working relationship with a Diplomate of the American College of Veterinary Emergency and Critical Care and/or other veterinary specialists with a special interest and experience in emergency and critical care is recommended to optimize patient care and facilitate patient referral if necessary.
Sufficient staff must be available to provide expedient patient care and allow:
A complete and thorough medical record for each patient should be kept on file at the emergency and critical care facility. Because of the importance of legibility and availability of medical records, all summary medical records should be computer-generated, digitally stored, and backed up. Additionally, the emergency and critical care facility must comply with state administrative codes for informed consent, patient record keeping and the release of patient records.
The medical record must include but not be limited to:
Effective communications must be maintained to allow efficient transfer of patient information between the emergency and critical care facility and primary care veterinarians in a timely manner. It is highly recommended that the emergency and critical care facility maintain an updated list of contact telephone numbers of primary care referring veterinarians. The list should include whether the veterinarians are willing to be and where they can be contacted after-hours. A copy of the discharge instructions should be given to the client at the time of discharge and a faxed or electronic report should be sent to the pet owner and primary care veterinarian within 12 hours of a patient’s discharge in order to ensure immediate continuity of care and for inclusion in the patient’s permanent record.
Continuing education (CE) must be provided for professional and technical staff and must allow:
All emergency staff veterinarians should obtain a minimum of 28 hours of CE every 2 years in the field of emergency medicine, surgery, and/or critical care medicine.
All technical staff (veterinary technicians and assistants) should obtain a minimum of 10 hours of CE every 2 years in the field of emergency and critical care medicine.
A system of ongoing, in-service training should be provided for veterinarians and technical staff to assure teamwork and familiarity with current procedures and guidelines. The instructor’s name, topic, number of hours, and attendance records should be documented.
The emergency and critical care facility must have appropriate and comprehensive references available to the staff at all times. Refer to Part 2 of this document for a list of the recommended references.
Internet access to online emergency and critical care resource information must be available.
The level of care and maintenance provided in areas of laboratory, pharmacy, medicine, surgery, anesthesiology, diagnostic imaging, infectious diseases control, and housekeeping should be consistent with currently accepted practice standards and comply with state, federal, and provincial directives. Instrumentation, pharmaceuticals, and supplies should be sufficient for the practice of medicine and surgery at a level of care consistent with that expected in the practice of veterinary medicine as directed by the individual country, state, or province practice acts.
All emergency and critical care facilities must have the capacity to:
1. Diagnose and manage life-threatening emergencies including cardiovascular, respiratory, metabolic, gastrointestinal, urogenital, neurologic, environmental, hematologic, hemorrhagic, toxicologic and coagulopathic problems.
2. Perform procedures to address life threatening problems including but not limited to:
3. Perform emergency surgery including but not limited to:
4. Treat circulatory shock using
5. Allow accurate delivery of fluids using calibrated burettes and infusion pumps.
6. Administer natural and/or artificial blood products as well as type and cross match donor and recipient blood.
7. Administer analgesic therapy and anesthetic agents including but not limited to:
8. Provide intraoperative monitoring to include but not limited to:
9. Maintain an anesthetic log for all anesthetized patients documenting duration of anesthesia, monitoring parameters and medications administered.
10. Decontaminate and administer antidotes when indicated for toxin exposure.
11. Perform, in a timely manner, laboratory procedures listed in Part 3 of this document. Additionally the emergency and critical care facility must have laboratory supplies to collect, prepare and preserve samples for analysis at an offsite laboratory.
12. Perform diagnostic imaging to include but not limited to:
PART 2: MINIMUM RECOMMENDED REFERENCE LIST FOR A VETERINARY EMERGENCY FACILITY
General Physiology – an edition of one of the following published within the previous 15 years
Veterinary ECC – an edition of each of the following published within the previous 10 years
Veterinary ECC Technical Manuals – an edition of one of the following published within the previous 15 years
Fluid Therapy/Acid-Base/Electrolyte – an edition of the following published within the previous 10 years
General Veterinary Internal Medicine – an edition of one of the following published within the previous 10 years
Veterinary Surgery – an edition of one of the following published within the previous 15 years
Veterinary Anesthesia – an edition of one of the following published within the previous 15 years
Veterinary Ophthalmology – an edition of one of the following published within the previous 15 years
Veterinary Pharmacology – an edition of one of the following published within the previous 10 years
Veterinary Toxicology – an edition of one of the following published within the previous 15 years
Veterinary Clinical Pathology – an edition of one of the following published within the previous 15 years
Veterinary Pediatrics – an edition of one of the following published within the previous 15 years
Specific topic areas of Veterinary Medicine published within the previous 15 years
Veterinary Neurology – an edition of one of the following published within the previous 15 years
Veterinary Oncology – an edition published within the previous 15 years
Veterinary Cardiology – an edition of one of the following published within the previous 15 years
Veterinary Avian Medicine and Surgery – an edition of one of the following published within the previous 15 years
PART 3: MINIMUM RECOMMENDATIONS FOR A VETERINARY EMERGENCY FACILITY
ER receiving/triage area
Dedicated isolation area with documented infection control plan
Dedicated surgical room
Radiology room that complies with federal and state radiation safety regulations
Oxygen (ER receiving/ICU/ISO/SX/Radiology)
Anesthetic scavenging (ICU/SX/Radiology)
Suction (ER receiving/ICU/SX)
Equipment sterilization capability and quality control
Emergency preparedness plan or onsite backup power supply in case of power outage
Warming support (FA, CWB, or HD)
Small animal blood products
Blood typing capability (canine and feline)
Fresh frozen plasma
Packed red blood cells
Feline type A
Feline type B (or readily available donor)
And/or a readily available screened canine and feline donors (onsite or local blood bank with 24 hour service)
Red blood cell substitute (if available)
Intravenous catheter types
Naso-esophageal or naso-gastric tube feeding
Injectable agonist opioids
Nonsteroidal anti-inflammatory agents
NMDA receptor antagonists
Oral analgesic agents
Injectable (Minimum: beta lactam, fluoroquinolone, aminoglycoside, metronidazole)
Drugs for CPR
Lipid solution (20%)
Propranolol or Esmolol
Ambu bag/ anesthetic machine
Urinary catheter and closed collection system
300 Ma radiography machine (standard or digital)
Automatic processor (with standard radiography)
Laboratory equipment and testing in house
Packed cell volume
Refractometric total solids
CBC with manual differential reading
Dry chemistry analyzer
FIV/FELV antigen testing
Parvoviral antigen testing
APTT activated partial thromboplastin time
CBC complete blood count
CWB circulating warm water blanket
CPR cardiopulmonary cerebral resuscitation
D5W 5% dextrose in water
DVM doctor of veterinary medicine
ER emergency room
FA forced air
FIV feline immunodeficiency virus
FELV feline leukemia virus
HD Hot Dog thermal unit
ICU intensive care unit
PT prothrombin time
NMDA N-methyl d-aspartate