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News — When a dog is struck by a car and suffers traumatic — but not fatal — injuries, where should that animal go to receive the most comprehensive care? Cummings School of Veterinary Medicine’s (FHSA) stands among the best options. As one of only five facilities worldwide, FHSA is certified by the American College of Veterinary Emergency and Critical Care’s (ACVECC) Veterinary Committee on Trauma (VetCOT) as a Level I Veterinary Trauma Center.

“We have a highly developed (ECC) program,” says Dr. Armelle deLaforcade, medical director of emergency and critical care and an associate professor in the . “We have had animals come in so severely injured that you wonder if they would have survived anywhere else. With a well-established, very proactive team and many resources available, we treat trauma 24/7.”

deLaforcade joined Cummings School as a faculty member in 2001 and assumed a role as executive director of the ACVECC in 2005, a group of board-certified veterinary specialists (known as Diplomates) in emergency and critical care. “When I became a specialist in emergency and critical care, there were less than 100 Diplomates. Now, there are more than 900" deLaforcade shares.

The Trauma Center Initiative

Fellow Diplomate Dr. Kelly Hall spearheaded the veterinary trauma center initiative and worked with ACVECC’s leadership to create a veterinary trauma center network. In 2013, nine U.S. animal hospitals and clinics were designated as Veterinary Trauma Centers (VTCs), including Foster Hospital for Small Animals. More than ten years since the start of the Trauma Center Initiative and that announcement, 20 certified VetCOT Trauma Centers currently operate, with 17 in the United States, two in Canada, and one in London.

VetCOT categorizes three levels of VTCs. Five Level I facilities, “provide total care for every aspect of the management of the small animal trauma patient, from emergency stabilization through definitive medical and surgical care and rehabilitation,” according to ACVECC.

Through the dedicated work of a team of ECC clinicians and support staff, and a commitment to serving all trauma patients with the best care, Foster Hospital for Small Animals is one of only two VTCs to maintain its Level I status for over ten years.

“It’s a resource requirement [to achieve Level I certification],” deLaforcade explains. “The hospital needs to fulfill an extensive list of resources available.” The Level II or III hospitals only meet some requirements for higher certification. "For instance, maybe they don't have an anesthesiologist on staff, or there’s a period during the night where they have only one doctor instead of two,” says deLaforcade.

“If a severely traumatized patient arrives, and the only doctor is busy, that second patient may not receive the best care, so having more than one doctor was deemed necessary to adequately meet each patient’s needs, which is the goal of the Trauma Center Initiative.”

Through creating a network of VTCs, ACVECC aimed to develop and define a standard of care for managing trauma patients in veterinary medicine for the first time, which would help more animals survive severe trauma-related injuries.

“In human medicine, it’s been shown that if someone suffers severe trauma in an accident, they will drive past a hospital to get that patient to a Level I trauma center, if they’ve met certain criteria needed for care,” says deLaforcade. “I’m not sure that’s in place for veterinary medicine, with only 20 trauma centers. Many animals that experience trauma in some way do very well with emergency veterinary care. I think that would be an exciting next step to determine the best way to direct the most severely injured pets to hospitals that have the needed resources to optimize their care.”

The Trauma Center Network

In addition to providing trauma patient care, members of the Trauma Center Network provide leadership in education and research, and directors of the certified facilities serve on subcommittees under VetCOT to address specific issues of care. These administrators also meet annually to share and discuss cases and challenges in trauma management. “It’s been good for team-building because the entire trauma team — not just the doctors — and the setup of the facility are considered,” says deLaforcade.

VTCs must enter each trauma case into a “Red Cap Registry" to contribute to ongoing education and research. To complete the required documentation, Cummings School hired two students to analyze the list of all ECC cases and enter data. According to deLaforcade, several research articles were published using this robust collection of data from all VTCs — more than 20,000 cases. She explains, “This initiative has gained the respect of the veterinary community because it’s been a model for other groups that are looking to combine resources to gather and study larger pools of data.”

deLaforcade shares that Foster Hospital for Small Animals is a resource for clinical research in hemorrhage or hemorrhagic shock because it tends to treat more severely affected animals. “For example, there have been several studies funded by the Department of Defense where they were looking to better understand an aspect of hemorrhagic shock in both humans and military working dogs," she says. “Our involvement was requested because we tend to enroll more cases. We participate in a lot of interesting studies that way.”

Treating veterinary trauma

Assessing veterinary trauma overall, deLaforcade reasons that any veterinarian can manage trauma, and most cases are handled well. “When you look at trauma across all degrees of severity, the positive outcome is high,” she says. “But for the severely traumatized patients, the Trauma Center Network was established to change the outcome of the most severely affected.

“I’m proud of my colleagues who have worked hard to push for these advancements in veterinary care,” says deLaforcade. “We’d like to move toward a system where there’s a greater recognition that severe trauma cases should be brought here because we are more successful in managing those cases. That’s due in part to the greater attention to trauma care which has been provided through this initiative.”