Pet First Aid
by Bobbie Mammato, DVM, MPH
 
 

A Critical Review by:
Eduard E. Meyer, DVM and Jeffrey Werber, DVM
 
 

In 1997, the American Red Cross and The Humane Society of the United States (HSUS) published a wire-bound manual titled Pet First Aid, authored by Bobbie Mammato, DVM, MPH. This manual was intended to be used as a reference book in the pet CPR and First Aid Classes conducted by local chapters of the Red Cross. It is a 97-page-long booklet and is designed to serve as a guide for laypersons at emergent scenes. The booklet is sold through the Red Cross and the HSUS, either separately or as part of the CPR course material package. Although the intent of the book is admirable, the work is fraught with inaccuracies, inconsistencies, descriptions of ineffective procedures, and it even offers some clearly detrimental and dangerous advice.

Dr. Mammato is the only author listed. Other individuals cited in the book are referred to as "reviewers." On the first page, Dr. Mammato asserts that the "emergency care procedures outlined in this book reflect the standard of knowledge and accepted emergency practices in the United States at the time this book was published. It is the reader's responsibility to stay informed of changes in the emergency care procedures." As we'll soon see, in many instances this book does not reflect the current standard of accepted medical knowledge! Mammato includes a "disclaimer" which seems intended to serve as "catch-all" prophylactic defense against any lawsuits that might be filed against the author, reviewers, the Red Cross or the HSUS by readers who feel they might have been ill-served by the medical advice offered. Also, it's worth noting that there are no formal citations or references, and no bibliography which might allow one to determine the sources of, or investigate the reliability of the information offered. Instead, readers are offered the following personal assurance: "Guidelines are based on experience and current medical information [...]"

The author completed an internship at the Veterinary Institute of Trauma, Emergency and Critical Care Medicine at Milwaukee, Wisconsin. However, she is not a diplomate of the American College of Veterinary Emergency and Critical Care. She apparently practices only part-time and resides in Jessup, Maryland. She graduated from Cornell in 1991, and her book was published in 1997.

We've attempted, on a page-by-page basis, to highlight the most blatant errors and misstatements in this book. There are numerous errors in terminology and procedure, and some of these are repeated throughout the book. Some material appears to be extrapolated from the human first aid literature with the author attempting to apply it directly to veterinary patients.

Page 2:

The illustration at the bottom of the page shows a person putting their hand under a towel placed over a cat to restrain it. This is a very risky procedure and puts a person at risk for one of the most common emergency room visits for humans: cat bites!

Page 4:

Under "home-made muzzles," the instruction describes placing a knot in the gauze or cloth under the chin. This knot is unnecessary and may cause undue pressure and discomfort for the animal. The first throw should be placed under the chin and then continues around the head as illustrated.

Page 6:

The author recommends holding the injured side of an animal against one's body. Why? In our experience, we've found it less painful for the pet to held with the injured side AWAY from the restrainer so as to avoid crushing or putting pressure on the injured area.

Page 8:

Under "pills and capsules" the author states, "pills can also be hidden in food [...]" She goes on to say that "if the animal is vomiting or has diarrhea, hiding medication in food is not a good idea since it may stimulate vomiting." This implies that it's OK to give medication to a vomiting animal without food. The inadvisability of administering oral medications to a vomiting animal -- with or without food -- is well-documented. Then, at the bottom of the page, in bold print she correctly warns not to give oral meds to a vomiting animal. Giving oral medications or even food to animals with diarrhea is not contraindicated, so long as the food offered is bland.

Page 12 :

Under "normal breathing rates," Mammato lists "up to 300 pants per minute" as normal for cats. Cats should never be breathing or panting at 300 pants per minute. (What is the source for this statement?) We wonder how many "300-pant-per-minute" cats she has seen?

Page 14 :

Under "capillary refill time," part 3, we are advised to "observe the color [of the gums] as it turns white and then pink again. The pink color should return after one or two seconds." This statement should have read "in less than 1.5 - 2 seconds." Less than one second is not necessarily an emergency as she states!

Page 15:

The entire CPR section is suspect as it includes numerous inaccuracies. For example: one does NOT want to "forcefully exhale" into the lungs of a dog or cat, especially if they are neonates or very small. Doing so is likely to cause barotrauma to the lungs which may include and/or lead to bleeding, pneumonia, or even rupture of pulmonary tissues.

The chest compression/breath ratios Mammato offers are inappropriate for the size ranges cited. In the first place, she offers only three size groups when 5 different size categories for animals would have been more appropriate (neonates were left out). In addition, the author advises 5 to 6 compressions for each breath for all three size categories if working alone and 3 for each breath when two people are resucitating. It should be one breath per two compressions for neonates and the correct figures vary up to 1 breath per 5 compression for animals over 120 lbs.

Page 18:

Shock, in this section, is categorized in an archaic manner. Shock is not described as "early, middle, or late" in the parlance of modern physiology or medicine. Furthermore, not all shock is the same. Shock is categorized with respect to its etiology: e.g., septic, hypovolemic, cardiogenic, etc., and it is treated accordingly.

Page 20:

"Choking." We are totally appalled by this section! Where did Mammato come up with this nonsense? She advises first aid provides to hold the choking pet upside down in a wheelbarrowing position. This has not been shown to be an effective technique, and it is difficult if not impossible to accomplish with large dogs. Her illustrations show a person attempting to perform the Heimlich maneuver on a dog and a cat. The problem: the dog and the cat are standing with all four feet on the table and with the person standing directly behind the tail and next to the table with hands in a fist directly ventral to the caudal abdomen thrusting up toward the ceiling. The backs of the animals, as depicted, are not anchored against the chest of the operator. Also, the hands of the operator should be more cranial -- by the xyphoid process -- when deliveering the thrust. Illustrated instructions at the bottom of the page advise that "if this is not successful in dislodging the object, administer a sharp blow with the flat side of your hand between the shoulder blades, then repeat the abdominal compressions." This won't dislodge anything and may even drive aggravate the obstruction, not to mention causing unnecessary discomfort to the animal!

Page 22:

Lay persons generally don't have the knowledge or skills to safely use a tourniquet as described in this section. We never advise anyone to use a tourniquet! Mammato would have been well-advised to leave this advice out.

Page 23:

The author advises using grooming clippers, a razor or scissors to clip the hair around a wound. A razor should never be used by a pet owner on a pet. Mammato, on page 65, even advises using a razor when treating a hot spot! Very painful!

Page 28:

Mammato states that, under normal labor and delivery, "one puppy or kitten should be born every 4 to 6 hours if the contractions are weak and every half hour if contractions are strong and forceful." Neonates should never be more than 2 hours apart under normal conditions. On Page 29, under "Birthing Problems -- signs of," Mammato cites "Active labor for more than 4 hours with no puppy or kitten." Anything over 2 hours of active, but unproductive labor is a problem. Four hours is way too long to wait before seeking emergency veterinary services. At the bottom of the page under "first aid: puppy or kitten visible but the mother cannot push any further," she states, "Do not pull a puppy or kitten when the mother is not pushing." This is unclear. In our view, Mammato should have explained that one should, indeed, apply gentle traction to a puppy or kitten if the mother is still contracting, but the contractions are no longer successful in advancing the neonate.

Page 37:

Regarding "first aid for fractures," the author advises "if a piece of bone is protruding from the fracture site: wash the area with water or saline (add one teaspoon of salt to a quart of warm water).

Most orthopedic texts explain that, in open fractures, it is best for the owner to control hemorrhage and prevent further contamination by merely covering the wound with a clean bandage and minimal pressure. Then they should immediately seek veterinary attention. Cleaning and debridement should be carried out at the hospital, not at the scene. Pouring non-sterile salt water over the wound will merely drive bacteria into the marrow and surrounding tissues, increasing the likelihood of osteomyelitis.

Page 38:

The author illustrates a dog in lateral recumbency with both rear legs bandaged together as an attempt to splint a fractured rear leg with the non-fractured leg. I (Meyer) tried this on my dog with tape as illustrated in the picture. As predicted my dog thrashed around and attempted to get up and tried to free his back legs continuously moving them independently until the tape was loose. If he actually had a fracture it might have soon become an open fracture or he may have lacerated vital nerves and blood supply in the struggle. This technique looks as though it might have been adapted from the old technique of "buccaneering" performed in human medicine years ago. That procedure has since been abandoned in the human field.

Page 50:

Regarding "first aid for drowning," the author states under No. 2, "for unconscious larger dogs, lift the hind legs off the ground with the front legs resting on the ground so gravity can help expel the water." In the first place, if the dog is unconscious it isn't going to support itself on its front legs while the person lifts the back legs. Secondly, it is not practical to lift a large dog by the hind legs below the hock to turn them upside down.

Page 64:

Under "signs of heart disease and cardiac emergencies," Mammato discusses looking at the color of the gums in order to distinguish fainting from seizures. "The easiest way is to look at your pet's gum color. If it is white or very pale, it is probably a fainting episode. If the gum color is pink or red it is probably a seizure. Also, during a seizure the dog or cat will tend to be less responsive (and not know who you are)." White or very pale gums may also signal anemia/internal hemorrhage. In Saunders Manual of Small Animal Practice[1], pg. 396 under "color of mucous membranes" it states under the third bullet point, "may be pale with concomitant anemia or low cardiac output but without pulmonary congestion (e.g., low output heart failure, aortic stenosis)." We think Mammato's discussion is oversimplified. Instead it would be better to instruct the lay person to observe gum color and, if abnormal, transport to a veterinarian immediately.

Page 65:

Under "hot spots," Mammato advises readers to, "shave the area with grooming clippers or a razor." We wonder how many "hot spots" she has shaved? Not only does this cause severe discomfort, but most Pet care professionals would not shave a hot spot without sedation. At the end of the discussion on point 6 she states, "if topical treatments don't work, have the animal examined by a veterinarian." In our view, a veterinarian should examine the animal in every case, not just when topical treatments fail.

Page 66:

Mammato defines a hypothermic pet as one whose "body temperature is below 95 degrees fahrenheit (see normal temperatures, page 13)." Anything below 97 is hypothermia. One shouldn't let it go to 95!

Page 74:

Under "roundworms: causes," Mammato states, "Pets can acquire them easily by smelling and eating other animal's feces." She must have failed parasitology in veterinary school! Pets do not become infected by smelling an affected dog's feces (only by licking/eating the feces).

Page 77:

She refers to the term "intervertebral disc disease" as "slipped disc." This is a major misnomer since, while a disc may bulge or rupture as in Type I Disc Disease, they don't actually "slip."

Page 78:

Mammato deals with "snake bites" on this page. It seems unlikely that she might have accrued information regarding the bites of pit vipers and coral snakes from personal experience while practicing in Wisconsin or Maryland! If the information came from a textbook or some other published source, that's perfectly acceptable. But surely the source of the information should have been identified and credit given to the original authors and investigators!

Mammato goes on to advise owners to "put on gloves and wash the [snake bite] wound with water and mild soap." This is a waste of time and does nothing for the wound or the pet. The person should immediately transport the bitten pet to a veterinary hospital!

Page 81:

Under "first aid for ticks," Mammato advises readers to "place a small amount of tick spray on a gauze sponge [...] and hold it over the tick. This will usually cause the tick to start to back out in 30-60 seconds." According to Dr. Mike Dryden at Kansas State University Veterinary Medical School, this would not happen in 30-60 seconds. It requires 24 hours for the tick to release in order for it to dissolve the cement-like substance it uses to attach its mouth parts in the skin. Secondly, Mammato advises that, "If you missed the tick's head, [...] this must be removed. You can attempt to remove it as you would a splinter under the surface of the skin. [...] Otherwise, have a veterinarian remove the tick's head from your pet." In fact, it would be better to just leave the head in and let the body reject it like a splinter than to go digging in the skin and causing unnecessary damage and pain.

Page 87:

The author includes an illustration on this page showing a dog with an arrow protruding from the lateral thorax and a cup or plastic bowl slid down over the arrow and taped over the cup. Tape applied in the manner depicted will never effectively stick to a dog or cat unless it is wrapped around the animal as in the illustration in the picture directly above the one in question.

Page 89:

Mammato should remove the safety razor from her First Aid Kit!

Page 94:

With regard to microchip technology she writes, "Because the microchip cannot be seen by the naked eye and because there have been problems with technology, a microchip should only be used as a back-up form of identification." This statement is way off-base! Microchip technology is very accurate, the chips last the pet's entire life, are easily installed, and all scanners are able to read all chips currently available. We have first-hand experience with the successful recovery of pets with this system. It should not be used just as a "back-up"!

Overall the book has some good information for pet owners but there are way too many serious errors and wrong information to leave it in its present form. One of us (Meyer) confronted the Red Cross in this regard and our concerns were met with a "dismissal letter" which said, in essence, "we don't agree with you. Thanks for your concern. We will consider these issues if we decide to release a second edition." Neither the author nor the HSUS has responded to any of the problems we've addressed or supplied any references as to the source of the various procedures and concepts cited. The AVMA, while agreeing that the book has serious errors, is powerless to effect any changes. The ACVECC (American College of Veterinary Emergency and Critical Care) and the VECCS (Veterinary Emergency and Critical Care Society) are aware of this book, but have not, to our knowledge, expressed their concerns to the Red Cross, the HSUS, or the author. Several well-known veterinarians examined our concerns and have agreed that the book contains the many errors we have highlighted above. We urge all veterinarians to look at this book very closely. Judge for yourself whether or not you would be comfortable having your clients use it as a source of first aid information when treating their own pets or those of other people. The Red Cross offers pet first aid courses, some taught by lay persons with no veterinary training, and collects a fee that goes into their general fund. This book is their manual. How are their "instructors" to know whether or not the information offered is correct? Please speak out! Contact your state veterinary association and let them know about the problem. Or feel free to contact us if you think you might be able to help address this issue! (Eduard E. Meyer, DVM smokehill@oz-online.net)

Incidentally, one of us (Meyer) recently attended a regional veterinary conference and noted a vendor in the exhibitor area marketing a "First Aid Kit" intended to be sold by veterinarians to their clients. Packaged with the kit was this same "Pet First Aid" book with one change: the American Red Cross had removed their name from the cover! Leafing through the book revealed all the same errors that had appeared in the original edition, with no changes or corrections whatsoever!
 

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[1] Birchard S, Sherding R, Saunders Manual of Small Animal Practice, W.B. Saunders, Philadelphia, PA, 1994.