I recently had to stop on the side of the road to help out a family whose trailer had rolled over, trapping their horse inside. By the time I'd got past the queue of stationary holiday traffic, they'd already done the first aid basics, and it was great to see how well they'd coped. However, it made me think about what owners can do in emergency situations for shock, trauma and blood loss in horses. [caption id="attachment_2528" align="alignright" width="275" caption="Not an emergency! I like to use ketchup and a good natured pony for Pony Club First Aid Training. If you want to know more, contact your vet - many practices run great first aid training courses for clients"][/caption] In serious accidents, the most common injuries are probably bruises and lacerations - jagged cuts, caused by broken metal and debris cutting through the skin. However, puncture wounds and broken bones are also not uncommon, and it can be really difficult to determine what's a mild graze, and what's a deep, dangerous puncture wound in the field, let alone by the side of a busy road! If you're faced with a real emergency like this, remember three things - first, make sure you and anyone else around are not at risk. Second, get someone to call a vet and any other emergency services (e.g. the police to close the road, the fire brigade to cut horses and people out of the wreckage, and of course ambulances for any human casualties). Finally, assess the horse(s) and do what first aid you can at the scene. When assessing the injured horse, I find it really useful to look at it in two stages - the Primary and Secondary surveys. The Primary Survey is designed to find injuries that are immediately life-threatening, and need addressing NOW. This would include serious fractures, significant bleeding, breathing difficulties and any neurological disorders (half a tonne of fitting horse is a danger to itself and everything within ten to twenty feet). I like to start at the nose and work rapidly to the tail, running my hands over the horse, looking for wounds or areas that don't feel right, and assessing how the horse responds. If you find a wound that's gushing blood, it needs to be stopped; a "grating" feeling under your hands when you feel along a canon bone often indicates a fracture, which must be stabilised. In an emergency situation, the key is to stabilise the horse until it can be moved to a safer location for further workup, and it is vital to be quick, but also smart. Don't get so bogged down with relatively minor injuries that you miss somethng life-threatening! A wound that that oozes can be left until you've finished the primary survey; one that's running with dark blood needs seeing to, one that's spurting may kill the horse before you've finished unless you address it immediately. To stop bleeding, apply pressure - even a major arterial bleed can be slowed, if not stopped, by a padded up numnah pushed into the wound by one or two people (ideally two, so you can swap over when you start to get tired). One of my horses was staked on a hack many years ago, when a piece of wood flicked up into his groin and tore the femoral artery. His life was saved by two of the people out riding with him, who pulled off their jackets and forced it into the wound, slowing the bleeding until a vet could arrive to pack it closed. The major risk areas for bleeding are the groin and neck, where major blood vessels run close to the surface and can easily be damaged. It is really important when doing a primary survey to check for signs of shock - horses are incredibly tough, but they can still suffer internal bleeding and blood loss, even if nothing's obvious, so roll up the horse's lip and check the colour of his gums. Then press on them so they go white, and time how long it takes for the colour to return. A normal, healthy horse will have nice, pink gums and a capilliary refill time of less than 2 seconds. White or very pale gums indicate shock, probably from blood loss, as can a prolonged refill time, while blue gums may indicate heart problems. A horse that is behaving abnormally need to be treated with extreme caution - concussion is uncommon, but it does happen, and is often more dangerous to the people around than it is to the horse! There's nothing you as an owner can do about it, so make sure you're ready to jump clear if needed. A suspected fracture is a nightmare for any horse owner; however, it's worth remembering that some fractures in some horses can be repaired surgically. The most effective form of first aid is to immobilise the limb with a thick bandage and/or splints - however, unless you know exactly what to do, don't try to apply splints without a vet's instructions. Some fractures, sadly, are irreparable - I once got called to a horse that had fallen over trotting across its field, the person who called said it had a "small cut". When I arrived, his hock was pointing the wrong way round, and sadly I had to tell the owner that there was nothing that I could do, except put him down to remove the suffering. Once the primary survey is completed, and everything addressed as best you can, you need to consider moving the horse to safety. If possible, wait for the vet to arrive first, but this may not be possible if you are in an unsafe or inaccessible location. Remember, a horse with anything significant on the Primary Survey isn't fit to be moved anywhere until it has received veterinary treatment! In the case of my roadside horse, we were able to borrow a box to move him off the road to a nearby restaurant car park (I know, not perfect, but we had to improvise at the time!). As soon as you've got him to a safe place, it's time to carry out a Secondary Survey. When they arrive, the vet will probably repeat what you're doing - but if you've already carried out a survey, you can bring anything important to their attention, speeding up treatment. The Secondary Survey is a full examination of the horse, checking every lump or bump, scrape or cut for further significance. If a vet is doing it, we'll often clean up wounds and probe them for depth as we go along; however, please don't do this yourself! We need to see everything as far as possible as it is if we're to properly assess it. We'll always be grateful, though, if you can tell us what there is and where - e.g. "three grazes and a cut on the left flank, swelling over the right eye and a deeper wound on the right hock" allows us to prioritise the swollen eye and the deep wound, before we check over the grazes. Now is the time to apply pressure to any oozing or dribbling wounds, to check the feet (I've seen otherwise apparently normal horses prove to have deep cuts in their soles from climbing over broken metal to escape - and immediately after the incident, appear completely sound under the influence of adrenaline). Periodically, recheck the gums to make sure that the horse isn't becoming "shocky". Remember, horses are almost unbelievably tough - it is amazing what they can survive. My horse who got staked lost about half his total blood volume, but he made a complete recovery and lived for another ten years in excellent health; and the horse in the road accident, despite being thrown across the road, appears to have got away with cuts and bruises. So, even if it looks a disaster, it's always worth trying first aid until a vet tells you otherwise, because it really can save a horse's life. Check with your vet to find out if they run first aid courses so you can be prepared.