3. 24-hour emergency first aid and pain relief

Introduction

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

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 and ensure this information is publicly available, either via the practice website or by other public means. This information 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 be easily accessible and 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 and that this information is publicly available, 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.

Personal safety

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 on the Health and Safety Executive web page on work-related 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 their 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 A limited service provider is a practice that offers no more than one service to its clients and includes, but is not limited to, vaccination clinics or neutering clinics. For these purposes, a 'practice' is a Registered Veterinary Practice Premises (RVPP) as entered into the register held by the RCVS. A practice that offers one service to a selection of clients, but more than one to others is not a limited service provider as more than one service is offered overall.

3.50 Limited service providers should provide, or provide access to, 24-hour emergency cover that is proportionate to the service they offer. This means that veterinary surgeons working for limited service providers should ensure that the 24-hour emergency cover provision covers any adverse reaction or complication that could be related to procedures or examinations carried out, or medicines prescribed or used. Limited service providers do not have to provide this service themselves and may engage another veterinary provider to do so on their behalf. Where another provider is engaged, the arrangement should be in line with paragraphs 3.4 - 3.6, above, made before veterinary services are offered and confirmed in writing as part of the conditions of service agreed by the client.

Referral practices

3.51  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.

3.52  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.

3.53  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

3.54  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.

3.55  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.

3.56  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.)