ACVS statement on emergency procedures and PPE during the COVID-19 outbreak
March 25, 2020
The ACVS Board of Regents understands the profound impact that the COVID-19 pandemic has on veterinary surgeons, practices, institutions, and, most importantly, patients and clients. Making patient care decisions during this time is difficult, given the unprecedented circumstances.
Diplomates have asked for the ACVS Board of Regents' guidance and recommendations in determining what surgical cases are considered true emergencies versus urgent versus elective. The Board of Regents offers the following guidance on emergency procedures and the use of personal protective equipment; however, we encourage diplomates to stay informed of and strictly adhere to the requirements, recommendations, and expectations issued by local, state, and national officials. The governors of many states have issued strict guidelines or mandates, and those should take precedence over any recommendations made by the ACVS Board of Regents.
Guidance on emergency procedures
ACVS diplomates are uniquely trained to make the best surgical decisions to optimize outcomes for our veterinary patients with emergent and urgent conditions. The ACVS Board of Regents encourages all veterinary surgeons to consider the following decision-making framework when determining the necessity of surgery.
Work collaboratively with local, state, and national public health officials to fulfill our obligation to protect animal health and welfare, prevent and relieve animal suffering, and promote public health.
Make medical and surgical decisions in the spirit of One Health and consider the impact of resource use on human and animal health locally, nationally, and globally.
Surgery should be considered necessary, urgent, or an emergency if not performing surgery will cause irreversible harm. Criteria to determine irreversible harm include the following: threat to the patient's life, threat of irreversible damage to the patient's physical health, threat of permanent dysfunction of an extremity or organ system, risk of metastasis or progression of staging, and risk of rapid worsening of severe symptoms.
The ACVS Board of Regents suggests that diplomates and residents review the American College of Veterinary Emergency and Critical Care's examples of when clients should seek emergency care for their animal (https://www.acvecc.org/Animal-Owners/How-do-I-know-if-I-need-an-ACVECC-specialist). Within the above framework, urgent or emergent surgical treatment is appropriate when performing surgery will provide relief, and a viable non-surgical treatment is not available or practical. Examples of when urgent or emergent surgical intervention may be required include the following:
Patients suffering trauma (e.g., soft tissue trauma such as degloving, shear, laceration, and burn injuries; orthopedic trauma such as fractured bones or dislocated joints)
Patients having difficulty breathing due to a surgically correctable cause
Patients with signs of shock due to a surgically correctable cause
Patients with neurologic injury
Patients with urinary tract obstruction (partial/complete) or urinary leakage
Patients showing signs of intractable abdominal pain or other signs consistent with an acute abdomen (e.g., perforations, penetrations, gastrointestinal obstructions or leakage, organ displacements or torsions, hemoabdomen, biliary obstruction or leakage/impending leakage, peritonitis)
Patients with unresolvable dystocia
Patients experiencing significant morbidity secondary to a neoplastic condition
Consideration for the use of personal protective equipment
Some states are actively encouraging individuals and entities to cancel or postpone non-essential uses of personal protective equipment (PPE). To aid in your decision, ACVS encourages diplomates and residents to review AVMA Guidelines for the use of PPE during the COVID-19 pandemic.
We will continue to communicate with you as necessary in the coming weeks. Please direct any questions regarding this announcement to firstname.lastname@example.org.
Spencer A. Johnston, VMD
Diplomate, American College of Veterinary Surgeons
Chair, ACVS Board of Regents