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3. 24-hour emergency first aid and pain relief
Updated 11 June 2018
Veterinary surgeons have professional responsibilities relating to the provision of 24-hour emergency cover (i.e. the provision of emergency first aid and pain relief). These responsibilities should be considered in conjunction with the owner’s responsibilities under current animal welfare legislation, to ensure the health and welfare of their animal.
Part 1 sets out the key professional and legal responsibilities for veterinary surgeons and certain legal responsibilities of animal owners.
Part 2 provides more detailed advice for veterinary surgeons about how to meet the proper standards of professional practice.
Part 1 – Professional and legal responsibilities
Veterinary surgeons’ responsibilities
3.1 The RCVS Code of Professional Conduct states that all veterinary surgeons in practice must take steps to provide 24-hour emergency first aid and pain relief to animals according to their skills and the specific situation.
What does it mean to be ‘in practice’?
3.2 ‘In practice’ means offering clinical services directly to the public or to other veterinary surgeons. This includes (but is not limited to) veterinary surgeons working in:
a. first-opinion practices (including charities providing veterinary services)
b. neutering and vaccination clinics and other limited service providers (see paragraphs 3.49 to 3.51 for more information)
c. referral practices, including those in universities (see paragraphs 3.52 to 3.54 for more information).
What does ‘take steps’ mean?
3.3 Veterinary surgeons in practice are required to take steps to provide 24-hour emergency cover.
3.4 This does not mean that veterinary surgeons must personally provide the service and they are not expected to remain constantly on duty. They are, however, required to ensure that when off duty, or when otherwise unable to provide the service, clients are directed to another appropriate service.
3.5 Veterinary surgeons are encouraged to co-operate with each other in the provision of 24-hour emergency cover. Examples include shared arrangements between local practices, or using a dedicated emergency service clinic.
3.6 These arrangements between veterinary surgeons should be made before an emergency arises and the terms confirmed in writing.
Providing first aid and pain relief
3.7 The purpose of first aid and pain relief is to attend to the initial and essential welfare needs of the animal. The primary consideration of the veterinary surgeon should be to relieve the animal’s pain and suffering. In some cases, euthanasia may be appropriate.
3.8 A veterinary surgeon on duty should not unreasonably refuse to provide first aid and pain relief for any animal of a species treated by the practice during normal working hours.
3.9 A veterinary surgeon on duty should not unreasonably refuse to facilitate the provision of first aid and pain relief for all other species until such time as a more appropriate emergency veterinary service accepts responsibility for the animal.
3.10 When anyone contacts a veterinary surgeon with concerns that an animal needs emergency attention, the veterinary surgeon should decide and advise whether attention is required immediately, or can reasonably be delayed.
3.11 The veterinary surgeon should provide advice to enable a person to decide what steps to take in the animal’s best interests. Veterinary surgeons are responsible for any telephone advice that they give. It is recognised that advice over the telephone, without a physical examination of the animal, is limited and reliant on the quality and accuracy of information provided by the caller.
3.12 Veterinary surgeons and veterinary nurses should ensure that support staff for whom they are responsible are competent, courteous and properly trained. Veterinary surgeons and veterinary nurses should ensure support staff do not suggest a diagnosis or clinical opinion, are advised to pass on any request for urgent attention to a veterinary surgeon and are trained to recognise those occasions when it is necessary for a client to speak directly to a veterinary surgeon. (See also Chapter 17 Veterinary team and business.)
Animal owners’ responsibilities
3.13 Current animal welfare legislation requires those with responsibility for animals to care for them properly and imposes a duty of care on them to take reasonable steps to ensure that their animal’s welfare needs are met.
Who is responsible?
3.14 The Animal Welfare Act 2006 (which applies in England and Wales), the Animal Health and Welfare (Scotland) Act 2006 and the Welfare of Animals (Northern Ireland) Act 2011 define who is considered to be responsible for an animal.
3.15 The law is clear that a person becomes responsible for an animal by virtue of ownership or where they can be said to have assumed responsibility for its day-to-day care. This includes those who assume responsibility for the animal on a temporary basis, for example, keepers and carers such as the owner’s friends, neighbours and relatives, and staff at boarding premises and animal sanctuaries.*
(*This also applies to veterinary surgeons taking responsibility for animals kept in the surgery).
What are the basic welfare needs?
3.16 Those responsible for animals are required to provide for the following five basic welfare needs:
- A suitable environment (place to live)
- A suitable diet
- The ability to exhibit normal behaviour patterns
- Housed with, or apart from, other animals
- Protection from pain, suffering, injury and disease
3.17 This means that people such as owners, keepers and carers may commit an offence if they do not take reasonable steps to ensure these welfare needs are met. They may also commit an offence if an act, or failure to act, causes an animal to suffer unnecessarily.
Seeking veterinary attention
3.18 The responsibility for the welfare of an animal ultimately rests with the owner, keeper or carer.
3.19 Veterinary surgeons can help owners, keepers and carers meet their responsibilities by providing veterinary advice and / or care. In doing so, veterinary surgeons seek to ensure the health and welfare of animals committed to their care and to fulfil their professional responsibilities.
3.20 There is no legal requirement for owners to register their animals with a veterinary practice; however, the RCVS strongly encourages owners to do so as it may help them to meet their duty of care obligations under the welfare legislation. Owners are also encouraged to find out what arrangements are in place for their animals outside normal working hours.
3.21 Owners are responsible for transporting their animals to a veterinary practice, including in emergency situations. The RCVS encourages owners to think about how they can do this and make plans before an emergency arises. Examples include their own transport, a family member, friend or neighbour’s transport, an animal ambulance or a taxi service that will transport animals.
3.22 In all but exceptional circumstances, the interests of companion animals will be best served by being taken to a veterinary practice, where the attending veterinary surgeon has access to a full range of equipment, veterinary medicines and appropriate facilities.
Part 2 – Additional guidance for veterinary surgeons
Providing information about the 24-hour emergency cover provision
3.23 Veterinary surgeons should provide their clients with full details of their 24-hour emergency cover provision. This should include relevant telephone numbers, location details, information about when the out-of-hours service is available and the nature of the service provided. Veterinary surgeons should also inform their clients about the likely initial costs of the service.
3.24 Veterinary surgeons should provide information about their 24-hour emergency cover provision at the outset of the professional relationship with the client and supply regular reminders, as appropriate. If the details change, veterinary surgeons should provide their clients with full updates as promptly as possible. Such communications would be deemed necessary for the performance of the contract with the client and, if they do not contain marketing information, they may be sent without the explicit consent of the client, including by email.
3.25 Veterinary surgeons should use all possible means to provide information about their 24-hour emergency cover provision. Examples include client information leaflets, notices or posters in the practice, clear statements on the practice website / social media, other advertisements and providing additional information on vaccination record cards. As above, email notifications about emergency cover may be sent without the explicit consent of the client, including by email.
3.26 Information about the practice's 24-hour emergency cover provision should enable clients to make an informed decision about their animal’s veterinary care, particularly, where to go in an emergency. Special consideration should be given to clients registered as disabled who may have difficulty travelling, especially outside normal working hours.
3.27 Those who outsource their 24-hour emergency cover should ensure that their clients are given full information about the service, as above. It is not acceptable for such veterinary surgeons to state that they provide 24-hour emergency cover (or words to that effect) without providing full information about the service.
Planning and protocols
3.28 Protocols should be in place for on-duty veterinary staff providing an out-of-hours service. These should cover key areas such as:
a. the need for personal professional judgement when dealing with emergency cases (it is not acceptable for practice protocols to prevent veterinary surgeons from meeting their individual responsibilities under the RCVS Code of Professional Conduct and supporting guidance)
b. reference to relevant parts of the RCVS Code of Professional Conduct and supporting guidance, to enable on-duty veterinary surgeons to check current guidelines
c. advice on animal ambulance and taxi services willing to transport animals outside normal working hours, to assist owners bringing animals to the practice
d. any veterinary back-up, if this might be required
e. details of relevant equipment (which may include instruction manuals) and local contacts, particularly for locums
f. information on the provision of other 24-hour emergency services in the locality and the species they cover, again particularly for locums.
3.29 The staffing, facilities and arrangements should be appropriate to the likely workload of the practice. These should be reviewed on an ongoing basis to ensure that the 24-hour emergency cover provision remains appropriate and adequate.
3.30 Those who outsource their 24-hour emergency cover should make reasonable enquiries to ensure the adequacy of the provision made by their chosen service provider. This should be done at the outset of the contractual relationship and reviewed on a regular basis.
3.31 Veterinary surgeons have a personal professional responsibility to comply with the responsibilities set out in the Code of Professional Conduct and its supporting guidance. Veterinary surgeons who are engaged in senior management roles (who may not be providing clinical care) are also accountable for the organisation’s systems and protocols.
3.32 If veterinary surgeons consider that their employer’s policies conflict with their personal professional responsibilities under the Code of Professional Conduct, this should be discussed at a practice level, with legal, employment or RCVS advice, as appropriate. Ultimately, veterinary surgeons who remain concerned or dissatisfied may wish to raise concerns with the RCVS. (See also Chapter 20 Whistle-blowing.)
Location of the service
3.33 Some models for providing and outsourcing 24-hour emergency cover mean that owners may be required to travel further than their usual practice to reach the service provider. Likewise, veterinary surgeons may need to travel further to visit clients than has previously been the case. Veterinary surgeons should seek to ensure that clients are expected to travel only reasonable distances and that their own response times are reasonable. What is considered reasonable will be influenced by local conditions.
3.34 Veterinary surgeons offering particular services to geographically distant clients must also observe the requirement to take steps to provide 24-hour emergency cover. Where circumstances are such that the veterinary surgeon cannot personally provide this cover, specific prior arrangements must be made with another veterinary surgeon or practice who can do so. It is unacceptable for veterinary surgeons to assume that other local practitioners will provide the service for them.
Response time: on or off-site
3.35 Veterinary surgeons are not expected to respond to emergencies within a set timeframe. They should, however, respond with reasonable promptness, taking into account all the circumstances. There may be times when the on-duty veterinary surgeon, for various reasons, is unable to attend every emergency in a reasonable time. If this happens, the veterinary surgeon should make efforts to inform the owner and document the reasons for the delay. In some cases, it may be appropriate for the veterinary surgeon to make alternative arrangements to ensure emergency attention is provided.
Providing the service
3.36 In all but exceptional circumstances the interests of companion animals will be best served by being taken to a veterinary practice where the attending veterinary surgeon has access to a full range of veterinary medicines, equipment and facilities. Exceptional circumstances might include an entrapped animal that cannot be moved prior to veterinary attention.
3.37 In deciding whether or not to attend away from the practice, veterinary surgeons should consider all relevant factors, which may include:
a. the location and state of the animal;
b. the likely treatment needed;
c. the availability of transport e.g. private transport, friends, family, animal ambulance, pet taxi;
d. the personal circumstances of the owner and the availability of assistance;
e. the travelling time for the veterinary surgeon;
f. the ability of the veterinary surgeon to make the visit safely;
g. the possibility of another person attending with the veterinary surgeon;
h. local weather conditions;
i. the presence of any critical or unstable inpatients; and
j. any other emergency cases that take priority (not including hypothetical cases).
3.38 Veterinary surgeons who decide not to attend away from the practice should inform the owner or person making the request. Veterinary surgeons should document any advice given and the reasons for the decision in case of a future challenge.
3.39 Veterinary surgeons are not obliged to attend away from the practice, unless in their professional judgement it is appropriate to do so. This applies even if owners demand attendance away from the practice or the owner’s personal circumstances mean that they have to make special arrangements to transport their animal to the practice. Where a veterinary surgeon has declined to visit but offered to see the animal at the practice, or make other arrangements, the responsibility for the animal’s welfare rests with the owner.
3.40 RCVS disciplinary action in relation to refusal to attend away from the practice will be considered where there has been a wilful disregard for animal welfare.
3.41 Veterinary surgeons are not expected to tolerate threatening, aggressive or violent behaviour or to compromise their personal safety when attending to animals.
3.42 Health and safety law applies to risks from violence, just as it does to other risks at work. Veterinary surgeons should carefully consider any safety risks involved in providing 24-hour emergency cover and take practical steps to prevent, manage and respond to any risks. A risk assessment helps demonstrate if there is a problem that needs to be addressed and helps to identify precautions that can be taken. The Health and Safety Executive provides detailed advice about how to address work-related violence at: http://www.hse.gov.uk/violence/.
3.43 When considering whether to attend away from the practice, veterinary surgeons should consider their personal safety and that of anyone else who may need to accompany them. Each case should be evaluated individually giving due consideration to its own circumstances. Veterinary surgeons are entitled to decline to visit where they have overriding personal safety concerns.
3.44 Certain areas or locations may represent a higher personal safety risk. Generic assessment of the risks of visiting certain areas may help veterinary surgeons decide on any precautions to take.
Dealing with requests from non-clients
Non-clients – clients of another veterinary surgeon / practice
3.45 A client of another veterinary surgeon or practice who requests an emergency consultation may be redirected to that veterinary surgeon or practice (or the emergency service provider for that veterinary surgeon or practice). The on-duty veterinary surgeon to whom the initial request has been made may decline to carry out the consultation. First aid and pain relief should, however, be provided to the animal if, for whatever reason, the owner cannot contact his or her usual veterinary surgeon or practice or the circumstances are exceptional and the condition of the animal is such that it should be seen immediately.
Non-clients – owners have no veterinary surgeon / practice
3.46 First aid and pain relief should be provided to an animal if, for whatever reason, the owner does not have a usual veterinary surgeon or practice. Holidaymakers, new owners and other categories of animal owner may not have a usual veterinary surgeon or practice in the locality.
The provision of 24-hour emergency cover in remote regions of the UK
3.47 In certain remote and geographically inaccessible regions of the UK, there may be insufficient numbers of veterinary surgeons to be able to provide comprehensive 24-hour emergency cover. Those living in such regions may be unlikely to receive the same level of service as those living in more populated areas. For this reason, it is accepted that veterinary surgeons on duty providing 24-hour emergency cover in such areas may not be able to provide immediate first aid or pain relief to all animals.
3.48 A remote region of the UK is considered to be a geographical area where, for logistical reasons, travelling may be difficult and may be influenced by inclement weather, ferries or other factors. The more isolated the client is from the veterinary surgeon or practice, the more impractical it may be to provide the service.
Limited service providers
3.49 Limited service providers must comply with the RCVS Code of Professional Conduct and supporting guidance.
3.50 Veterinary surgeons working in neutering clinics must make provision for 24-hour emergency cover for the entire post-operative period during which complications arising from the surgery may develop.
3.51 Veterinary surgeons working in vaccination clinics must make provision for 24-hour emergency cover for the period in which adverse reactions might arise.
3.52 Referral practices should provide 24-hour availability in all their disciplines, or they should, by prior arrangement, direct referring veterinary surgeons to an alternative source of appropriate assistance.
3.53 Any practice accepting a referral should make arrangements to provide advice to the referring veterinary surgeon on a 24-hour basis, for the ongoing care of that animal.
3.54 Appropriate post-operative or in-patient care should be provided by the veterinary surgeon to whom the case is referred, or by another veterinary surgeon with appropriate expertise and at a practice with appropriate facilities.
The costs of providing the service
3.55 There are no statutory fees for veterinary services and the costs for out-of-hours services are generally more expensive. As a result:
- clients may be required to pay an additional premium for emergency veterinary attention outside normal working hours; and
- veterinary surgeons may charge higher fees for unregistered clients.
3.56 Likely costs and arrangements for payment should be discussed at an early stage, but immediate first aid and pain relief should not be delayed while financial arrangements are agreed.
3.57 Following initial assessment and the provision of emergency first aid and pain relief, the on-duty veterinary surgeon should make a full and realistic assessment of the prognosis and the options for treatment or euthanasia, taking into account the particular circumstances of the animal and owner. Veterinary surgeons are not obliged to carry out ongoing treatments for which the owner is unable to pay. (See also Chapter 9 Practice information, fees and animal insurance.)