Page 94 - JSOM Fall 2019

received care from the handler. Fifty-percent of MWDs did not protective armor because of issues regulating their body tem-
receive care en route, of which two did not receive interven- perature in the desert environments. As technology develops, a
tions en route, and three were KIA. lightweight flexible armor may prove useful.

Blast-Related Injuries Our case series study is the first to discuss the provider type
Thirty percent of the MWDs sustained a blast-related injury. performing interventions on injured MWDs at POI and while
One of the MWDs experienced a catastrophic injury and en route to the first medical treatment facility. Our cases
therefore no interventions could be performed. The two sub- demonstrate that the handler is not always the provider ad-
sequent MWDs sustained fragment wounds secondary to the ministering care to the canine and that veterinary staff were
blast and were treated similarly to those that sustained other not present at POI or en route for any of our cases. Although
traumatic mechanism of injury (MOI) types. The two MWDs it is likely that the handler would assist with medical care for
treated for blast-related MOI received placement of combat the canine as well, it may not have been documented in the
gauze and a chest seal at POI and pain medications as well after-action reports. Additionally, in the en route care phase,
as hypothermia prevention en route. The survival rate for the casualties are often evacuated via CASEVAC by themselves
blast-related MOI was 66%. and, in this situation, the handler may have been required to
stay on the mission. The MWDs in our study received care
Prehospital Care by nonveterinary providers of varying skill levels, who train
Overall, 70% of MWDs received at least one clinical inter- mainly for human casualties and place less emphasis on canine
vention in the field, with 60% receiving more than one inter- injuries. This may result in less than optimal care when treat-
vention and 30% receiving more than three interventions. Of ing a canine casualty.
those casualties who received more than three interventions,
only one survived. Hemorrhage control was the most com- There is currently no information available on what kind of
monly performed intervention in the prehospital setting, ac- pain management is provided to MWDs at POI or en route
counting for 46% of the total number of interventions given. to a higher level of care in the combat setting. Lagutchik et
Of all prehospital hemorrhage interventions, trauma dressing al. discusses the sedation protocols for a MWD for different
7
placement was the most common, accounting for 73% of the scenarios in a controlled environment but does not offer any
total hemorrhage interventions. suggestions for the traumatically injured MWD at the POI in
a combat setting, where the presence of veterinary staff is also
Of the 10 MWD trauma casualties, one dog returned to duty highly unlikely. Only 30% of the MWDs in our data received
and was KIA in a subsequent deployment. Five MWDs sur- some kind of pain management at POI or en route to definitive
vived their injuries and five died (50% survival rate). Those care. This raises concerns as to the type of efforts conducted in
with an MOI of GSW had a 37.5% survival rate. One MWD addressing pain immediately on injury or en route. A combat
survived to a Role 3 treatment facility but was humanely eu- medic is trained in the doses of morphine or ketamine to give
thanized after evaluation, due to the severity of the animal’s a human casualty but may be more hesitant to treat a MWD
wounds. in fear of providing the incorrect dosage. Additionally, canines
show different signs and symptoms when in pain, making it
7
more likely for someone who is unfamiliar with their behavior
Discussion
to miss the need to treat pain. This raises another important
This is the first case series report to provide comprehensive doc- point—to support the need to train those deployed with units
umentation regarding the multiple injury types, associated pre- with assigned MWDs on how to treat MWDs should the sit-
hospital medical care, and provider types performing the care uation arise.
while differentiating the time of care—POI or en route—for
MWD injuries. This case series demonstrated the role human One unique concern that has arisen in regard to MWDs is the
providers play in veterinary care in the combat environment. topic of euthanasia and where that fits into the well-defined
Combat injuries to MWDs are associated with a high lethality categories of KIA or DOW. KIA means that the patient has
rate, and GSWs were the most common wounding agent. Our died before reaching surgical care, and DOW means that the
case series is the first to discuss prehospital interventions per- patient has died after reaching surgical care. At times when
formed on MWDs sustaining blast- or explosion-related MOI. injuries are so severe, euthanasia is deemed necessary after
The most frequent anatomical location of injury was the lower reaching surgical care. It may be best to come up with the sep-
extremities. This may be due to the location of improvised ex- arate, distinctive MWD category of “euthanized” to maintain
plosive devices (IEDs) because they are often on or near the accuracy in the records.
ground. The prehospital interventions performed on MWDs
with blast-related injuries were similar to those performed on The Joint Trauma System has an MWD Clinical Practice
MWDs with a GSW. This could be due to the limited resources Guideline to provide guidance and assistance for providers
7
available and similarity of injury. Baker et al. demonstrated a caring for MWDs. The MWD dataset described here was part
6
38% survival rate for MWDs that sustained a GSW. Addition- of the SOF units, and during their training events, these units
ally, Miller et al. demonstrated a 31.5% fatality rate for MWDs are expected to practice treating wounded MWDs. At the very
5
that sustained a GSW. Our mortality rate of 37.5% for MWDs least, training on the basic medical treatment of traumati-
sustaining a GSW is congruent with what has been previously cally injured canines should be required of human providers
reported. The increased mortality rate for GSWs reported in our who may be assigned (or in close proximity) to units with an
study compared with Miller et al. is most likely due to the short MWD while deployed. For the cases in our study, veterinary
5
ranges and high-velocity military weapons involved in this data- care was available at the combat support hospitals overseas,
set. These findings are likely because of the weapons used in the and the wounded animals were evacuated to those hospitals
combat setting and the fact that MWDs are not outfitted with as appropriate.

92 | JSOM Volume 19, Edition 3 / Fall 2019