Minimum Requirements for Certification of Veterinary Emergency and Critical Care Facilities
The Veterinary Emergency and Critical Care Society (VECCS) advocates that the following equipment and supplies are the minimum requirements for all Levels (I-III) of Veterinary Emergency and Critical Care Facilities. These minimum requirements allow veterinary emergency and critical care facilities to identify themselves using a certification process endorsed by the VECCS. The certification process is meant to raise the standard of care and increase public and professional awareness in the area of veterinary emergency and critical patient care.
PART 1: OPERATIONS OVERVIEW FOR A VETERINARY EMERGENCY FACILITY
Staffing
A licensed DVM must be on the premises during operating hours.
A working relationship with a DACVECC and/or other veterinary diplomates with a special interest and experience in emergency and critical care.
A relationship with a DACVR (onsite or via the internet) for the review of diagnostic images when necessary. (Level I and II)
It is recommended that there be at least one veterinarian on duty at all times with at least two years practice experience or one year small animal internship experience. (Level I)
A DACVECC employed full time and available for consultation either on-site or by phone 24/7. (Level I)
Sufficient staff must be available to provide expedient patient care and allow:
Medical Records
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:
Communications
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 veterinarians that includes an after-hours contact number and indicates whether or not they are willing to be contacted. A copy of the case summary including discharge instructions should be given to the clients at the time of patient discharge and a faxed or electronic medical record/report should be sent to the primary care veterinarian within 12 hours of patient discharge in order to ensure immediate continuity of care and for inclusion in the patient’s permanent record.
Continuing Education
Continuing education (CE) must be provided for professional and technical staff and must allow:
All emergency facility staff veterinarians should obtain a minimum of 28 hours of CE every two years in the field of emergency medicine, surgery, and/or critical care medicine. A maximum of six hours per two year period may be obtained via online CE courses.
ACVECC residents must be in compliance with requirements of their training program.
First year interns and new graduates for the first calendar year after graduation are excluded from this requirement.
An in house training program should be provided for all technical staff to assure teamwork and familiarity with current procedures and guidelines.
Credentialed technical staff and non-credentialed technical staff having completed the in-house training program should obtain a minimum of ten hours of CE every two years in the field of emergency and critical care medicine. This CE can be obtained through either enrollment in a college/technical program, attendance of local, state, or national CE events or documented in-house CE.
A comprehensive, written training and continuing education program to include as a minimum the following components: journal club, morbidity and mortality rounds, and wet labs. (Level I)
Resources
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 required references.
Internet access to online emergency and critical care resource information must be available.
Emergency Capabilities
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:
PART 2: MINIMUM REQUIRED REFERENCE LIST
Textbooks
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
Journals
The use of e-books for reference texts is acceptable provided the following information is supplied:
1. The e-books must be legally purchased/obtained
2. Proof of purchase including the hospitals address must be submitted
3. Everyone in the hospital must have access to the books at all times
4. Please submit a copy of the hospitals e-book library (list or book cover) by accessing the library online and using the print screen function to make a copy of the page or provide username and password information to allow verification.
PART 3: MINIMUM REQUIREMENTS FOR A CERTIFIED VETERINARY EMERGENCY FACILITY
Facilities
ER receiving/triage area
ICU area
Dedicated isolation area with documented infection control plan
Dedicated surgical preparation area for patient (not to be in surgery room) (Level I and II)
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
System in place to ensure continuous ongoing power in case of power outage (Level I)
In-Patient Support
Anesthesia
Warming support (forced air, circulating warm water blanket or Hot Dog thermal unit)
Logs/Records
Small animal blood products
Blood typing capability (canine and feline)
Fresh frozen plasma
Canine
Feline
Packed red blood cells (Level I and II)
Canine
Feline type A
Feline type B or readily available donor (Recommended)
Readily available screened canine and feline donors (onsite or local blood bank with 24 hour service) in lieu of canine and feline packed red cells (Level III)
Red blood cell substitute (if available)
Fluid therapy
Crystalloids
Replacement
Isotonic buffered
0.9% Saline
Carrier (D5W))
Maintenance (Level I and II)
Synthetic colloids
Fluid pumps
Syringe pumps
Calibrated burettes
Intravenous catheter types
Peripheral
Central (Level I and II)
Nutritional
Naso- esophageal or naso-gastric tube feeding
Esophagostomy tube feeding (Level I and II)
Partial parenteral nutrition capability (Level I and II)
Total parenteral nutrition capability (Level I)
Pharmacy
Activated charcoal
Analgesia
Injectable agonist opioids
Nonsteriodal anti-inflammatory agents
Alpha-2 agonist
Local anesthetics
NMDA receptor antagonists
Oral analgesic agents
Antibiotics
Injectable (Minimum: beta lactam, fluoroquinolone, aminoglycoside, metronidazole)
Oral
Antihistamine (injectable)
Anti-seizure medications
Injectable
Oral
Corticosteroid
Injectable
Oral
Dextrose (injectable)
Drugs for CPR
Epinephrine
Vasopressin
Atropine
Glycopyrrolate
Electrolyte additives
Calcium gluconate
Potassium chloride
Magnesium sulfate or magnesium chloride (Level I and II)
Sodium phosphate or potassium phosphate (Level I and II)
Insulin- Regular
Lipid solution (20%)
Sedative medications
Injectable
Oral
Vasoactive/Antiarrhythmic drugs
Dopamine
Dobutamine
Lidocaine
Propranolol or Esmolol
Diltiazem (Level I and II)
Sodium nitroprusside or hydralazine (Level I and II)
Renal Support
Peritoneal dialysis or hemodialysis (Level I)
Respiratory support
Oxygenation (nasal/cage)
Ventilation
Ambu bag/ anesthetic machine
Anesthetic ventilator
Volume- or pressure-cycled mechanical ventilator (Level I)
Monitoring
Blood pressure
Non-invasive
Invasive (Level I)
Body temperature
Capnometry/ capnography
Electrocardiography
Pulse oximetry
Tonometry
Urinary catheter and closed collection system
Diagnostics
Radiography
300 Ma radiography machine (standard or digital)
Automatic processor (with standard radiography)
Ultrasonography
Endoscopy (Level I)
Bronchoscopy (Level I)
Laboratory equipment and testing in house
Packed cell volume
Refractometric total solids
CBC with manual differential reading
Glucose
Lactate
Dry chemistry analyzer
Electrolytes
Blood gas
Coagulation
PT
APTT
FIV/FELV antigen testing
Cytology
Urinalysis
Fecal flotation
Parvoviral antigen testing
Abbreviations:
APTT activated partial thromboplastin time
CBC complete blood count
CPR cardiopulmonary cerebral resuscitation
D5W 5% dextrose in water
DACVECC Diplomate of American College of Veterinary Emergency and Critical Care
DACVIM Diplomate of American College of Veterinary Internal Medicine
DACVR Diplomate of American College of Veterinary Radiology
DVM doctor of veterinary medicine
ER emergency room
FIV feline immmunodeficiency virus
FELV feline leukemia virus
ICU intensive care unit
ISO isolation
PT prothrombin time
NMDA N-methyl d-aspartate
SX surgery