Stand Down Fido, We’re First Responders, Not Food
No matter how much we love dogs, entering their territory to touch their loved ones is always going to be risky.
Most paramedics, police officers, firefighters, first responders, community midwives, district nurses, health visitors, mobile GPs, vets, social workers and other health or public service providers like dogs. A lot of us love them. Unfortunately, the feeling isn’t always mutual.
We will all have heard reassurance endless times from patients and families when we hesitate before crossing the threshold.
"They wouldn't hurt a fly."
"Don't worry about the dog; she’s harmless."
"He's a big softie."
"She'll lick you to death, but she'll never bite.”
Despite being instructed by call takers to put animals away and keep them behind closed doors, familiarity and companionship often lead those in need of our services to bend the rules. Or break them.
There are hardly any statistics around first responder dog bites, particularly in prehospital care providers, although some research has addressed the issue in other industries, with high numbers reported every time.
A Taiwanese article published 20 years ago summarises the findings of a 3 year period of recording, in which a staggering 71.4% of the postal delivery workers questioned reported a dog bite. That's 137 out of 192 participants, with 48.9% of those injuries severe enough to require medical attention (1).
Of 1,1812 occupational group incidents reported in the UK between 2011-2018, a total of 164 fell into the "Public order, safety actives, police" category, almost 14% of total bites (2).
To put it into dog versus human context, of 2,800 vets surveyed in Australia, 48% reported bites over a 12 month period. While there has to be a noticeably increased risk in a profession that handles dogs, it's also a strong indicator of prevalence. Particularly considering that most of those veterinarians would have been pretty skilled at avoiding canine teeth!
We know that dogs are territorial and are likely to perceive us as a threat, just as we know that furry friends become protective of families during stress or sickness. But we also know that patients, or more often their loved ones, don't see their canine companions as a threat.
The human reaction to our arrival is generally "Phew, they're here!" along with the mistaken assumption that dogs feel the same. Until they don't.
My own experiences in this conundrum are varied, but the resounding factor shaping each complicated interaction has been in human form. I have always been wary of entering any building with a dog. Probably because I have been on on the receiving end of vicious canine behaviour as a child, but the challenges encountered since, in my prehospital role, can be confronting.
Some colleagues consider it amusing as if my behaviour shows weakness or fear. In contrast, others have been relieved by it, to feel safe that we're adopting the same approach.
Families on scene have occasionally found it obstructive, that my refusal to enter means I don't care. At the same time, most understand, once I mention why their dog is unlikely to appreciate our presence as much as they do.
As a dog lover and a person who wants to provide their best in patient care, the worst example of standing off was in a cardiac arrest situation. For those on other shores, it's worth explaining that most front doors here in Australia have a security screen of some kind. When we arrive on scene, the main entrance itself will often be open, with the outer mesh closed. It aims to keep the flies out and, as we often find, the pets in!
In this instance, we walked up the garden path towards a closed screen with a small to medium-sized barking ball of fur. There was nothing friendly about it. A man ran through the hallway and reached for the handle to let us in, but my colleague and I both placed a foot against the door, so it stayed closed while we asked him to put the dog away.
"Just come in" he yelled, "it's only a dog."
He was understandably frustrated, upset and under immense stress.
We kindly, but firmly told him that we could not enter until the dog was safely out of the way.
He began to shout and swear.
Now, these are the types of call in a training situation that capitalise the "D" in danger.
But walking away and retreating to safety can't always be the best course of action.
For us.
For patients.
For our profession's reputation.
For the organisations we work for.
For our registration and licensing bodies.
Instead, this is exactly the type of situation to pull out those negotiating skills we don't learn in college or at university.
"Sir, I know you need us to come in, and we want to come in, right now, but we're of no use to you and your family if we get bitten." Loud and clear. The message hit home.
Thankfully, he put the dog away, despite his anger at the situation, so we entered and got to work.
Once the clinical component of the call had ended, we made the family cups of tea and sat down with them to run through proceedings and answer their questions. Much to my relief, when raising the dog issue, he reassured us right away that he understood.
The saving grace for me on this occasion was having a partner who takes the same precautions. When that hasn't been the case, it's a whole different ball game.
I recently received an email from a paramedic on this topic, writing to request tips on how to deal with an awkward situation.
The following paragraph has been included in exactly their words (with permission of course).
"When we first got put together, once my [work] partner found out that I was scared of dogs, they started testing me or pushing me, I don't know what exactly or why. When we go to a house with a dog barking at the letterbox, they look at me with wide open eyes and make noises kind of like a ghost. Like I am scared, and I hate to admit it but I honestly am. Every time I say something about not going in, they just say "Oh [name removed], stop fussing." Then we go in and they make a big show of patting the dog. Sometimes saying to the people that I am scared and having a joke about it. I honestly don't know what to do. I've tried talking to them but it makes it a bigger deal and gives them more ammo. Then we have to go back to base and they tell everyone and it's a massive laugh."
Behaviour like this is so hard to deal with. The whole canine issue aside, teasing, undermining and failure to recognise a colleague's concerns is a different problem for a different post. For now though, as far as dogs in homes are concerned, there are several actions we can take for safety across the board.
Be consistent in our approach so that we educate patients and families that we visit. Call takers advise "Put all pets away behind closed doors before paramedics arrive." Backed up by a majority of care providers stating "We cannot come in until the dog is away." The minute they hear others say "Don't worry about it, we love dogs, my crew mate is just a scaredy-cat" or something along those lines, then all other efforts become futile. Most dog owners will put them away, as instructed, but those who bend the rules will always want to hear that it was okay to bend them in the first place. So the next time they call and are instructed by call takers, then requested by paramedics on arrival, they may assume that it's overkill and Fido can stay where he is, baring his teeth and snarling at the door.
Remember that it's not the size of the dog in the fight, it's the size of the fight in the dog. We may often be dismissed with a "Look at the size of it, it won't hurt you." Either by those on scene or by our peers. If D for Danger looms large in any individual's mind, then D must not be convinced to stand for Downgrade Just Because Someone Else Said So. It may be a difficult conversation with the householders at their door, or it may be an awkward point in the shift with a crew mate. No matter how uncomfortable that feels, it's going to feel a whole lot better than dealing with a dog bite injury, injections, stitches, antibiotics, potential infection, incident reports and more. Not to mention the ongoing pain and fear of going back out to work within the canine filled community.
Report every instance of doggy danger. There exists a heavy emphasis on behaviour modification training but very little on recognising unavoidable risk. In order to even out any imbalance between blaming the bitten and increasing safety equipment or training, every organisation needs to know the numbers. Accurate reporting builds a clear picture and may help to facilitate additional tools to reduce risk. It may not require stitches, but a bite is a bite. It's not something to sweep under the rug (2).
Increase avoidance techniques. Get familiar with the warning signs, so it's easier to stand firm and be able to point out why any dog looks more likely to attack. Create defensive strategies as a matter of habit to buy more time on the escape route if it happens. Maintain peripheral awareness in every building so that the arrival of concerned relatives can be pre-empted with a reminder not to let the dog in. As a starting point, check out Safety & Health Magazine's article on avoiding dog bites (3). It’s written predominantly for postal workers but contains fantastic advice for anyone exposed to similar risk.
Pick a phrase to use every single time a dog waits at the door, then stick to it. Using the same approach every single time makes it easier to pluck out of nowhere in times of sudden stress. When I started in prehospital care, I would politely and meekly ask "Would you mind putting the dog away, please?" Often met with a refusal, which was fair enough. I politely requested, so I was leaving it open for polite denial. Nowadays, I am more direct. Having watched call takers in action, I now know that a scripted format in most ambulance service will always be followed, unless exceptional circumstances prevail. So if “Put all pets away" is part of the script, then I know that my first request at the door will actually be the second for that scene.
Bear that in mind if it feels awkward to insist. It’s not rude, demanding or shocking to the recipient. They will already have heard it long before they heard the ambulance pull up. As difficult as it may feel, the clearer we make it that a dog’s presence is non-negotiable, the less likely a patient or family member is to let them back in. Their level of commitment to the concept is directly related to our level of safety around their dog.
If you have tips on this subject, please share, let the rest of us know. The more the merrier.
I don’t know about the rest of you but, from my individual point of view, I'm already at enough risk from vehicle incidents, violence, aggression, cross-contamination, infection, manual handling, mental health issues and shift work wear and tear in this job. If I can avoid adding the four legged factor to that list, I'll do whatever it takes.
Thanks for reading.
Tammie
References
Chen, S. C., Tang, F. C., Lee, H. S., Yen, C. H. & Lee, M.C. (2000). An epidemiological study of dog bites among postmen in central Taiwan. Chang Gung Medical Journal, 23(5), 277-283. PMID: 10916228.
Owczarczak-Garstecka, S. C., Christley, R., Watkins, F., Huadong, Y., Bishop, B. & Westgarth, C. (2019). Dog bite safety at work: An injury prevention perspective on reported occupational dog bites in the UK. Safety Science, 118, 595-606. DOI: 10.1016/j.ssci.2019.05.034.
Trotto, S. (2015). Avoiding dog bites. Safety & Health Magazine. https://www.safetyandhealthmagazine.com/articles/11903-avoiding-dog-bites?page=1
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