Talk:Police dog bite

More practical protocols
Michael, your report was (as usual) quite thorough, but I think it lacked a bit on the practical end for action medics working in the field. I think the most important thing for medics of any knowledge/experience level to remember is that the treatment of this and most other types of wounds (yes, including gunshot wounds), are all covered by the principles we teach at street first aid trainings. So, Michael, you may feel your training was inadequate because you didn't discuss dog bites per se (I'm not sure I've ever discussed except when asked...), but I know you taught open wound management, closed wound management, and fear management, and so you gave your students the tools to handle dog bites.

Nevertheless, I'm going to attempt to add a bit to the instructions, hoping others will chime in as well...

Last summer, I had the displeasure of treating a severe series of dog bites to the legs of a 25 year-old woman. There were at least 7 punctures, ranging from superficial to severe, from an extremely large pit bull mix. I have also witnessed the treatment of several other dog bites, including some to myself.

Anyway, in last summer's case, by far the most important treatment objective was dealing with the patient's psychological reaction. Of all the police brutality patients I've treated, I don't think any have exibited more sheer terror than this patient was going through. So I think the most important thing -- even just in order to be able to gain enough trust and calm to perform a good examination of the injuries -- is to calm the patient, and to ensure her safety. The mere presence of dogs -- whether the perpetrating dog or others -- might be enough to prevent your patient from being able to get his shit together enough to even be properly treated.

The second thing to remember is to EXPOSE the entire area around any evident wounds. And I mean WAY around. I missed a significant puncture (as did the EMT's who followed up) on my patient because it was about 9 inches above all the others. She didn't know it was there, and there was no blood soaked through her pants. Meanwhile, I was too busy respecting her "modesty" to cut high enough on the thigh of her pant leg to do a proper focused assessment. With dog bites, an entire bite can take place in half a second, by which time the damage is done and the dog has moved on to its next bite. Additionally, the most painful bites will attract the patient's attention, but might not be the most severe. So don't expect witnesses or the patient himself to be able to point them all out.

Next, remember, in most cases we're dealing with puncture wounds. The thing to remember about puncture wounds is that they don't allow much irrigation (because they typically don't bleed that much), and because they're deep enough to expose tissues well beneath the skin to pathogens. The good news is, the bleeding is easy to get under control.

Moreover, dog bites I've seen have typically been as much blunt- force/crush wounds as they are puncture wounds -- that is, those teeth which don't break the skin are likely to bruise it, often severely. Swelling is almost guaranteed, so ice is a good idea if you can't acquire immediate definitive care. What's more, ice should help with the pain in a dogbite perhaps more so than most other injuries.

I would have to think that field evaluation of a dog bite at an action is way too difficult, perhaps even for a doctor, because of the circumstances we usually find ourselves in. I'm also not impressed by the tap water/squirt bottle irrigation method. As much as we love them, the sports drink bottle is no replacement for an irrigation syringe when it comes to deep puncture wounds. I can't imagine being able to get a good enough stream. That's just my hunch, though, and my experience with irrigating puncture wounds is very limited.

(I have seen mention in some first aid manuals that the area around the wound should be wiped clean of saliva -- I'm not sure how important that is when the dog is known not to be rabid, but it's a quick procedure, so I'd recommend it to be on the safe side.)

My recommendation (and personal protocol) is that any dog bite victim should be taken to an emergency room, or at least to a rear clinic. I wouldn't bother with irrigation in the field, and I wouldn't be happy to take no for an answer from a patient who doesn't want to be hospitalized for a dog bite. (That said, I'm glad I've read Michael's recommendations because I'd at least know some things to tell a patient who refuses hospitalization.)

So, in summary:

1. Calm and protect the patient. 2. Expose any areas that could possibly have been bitten. 3. Clean the wound area with sterile gauze sponges and water. 4. Use direct pressure and elevation to control the bleeding. 5. Use ice to control bruising/swelling. 6. Get your patient to definitive care.

Oh, and your patient may wonder if the docs will want to suture. While there's no way for most of us to know for sure (paramedics guessed wrong in the case last summer), very often even for deep dog bites, no stitches are required. If there is tearing around the wound, stitches are more likely to be necessary.

Written by B. - posted by Gobblehook 09:18, 27 October 2006 (UTC)