Police dog bite

I hope for this to spark a discussion in which others will contribute their experience and understanding to the topic so we might be able to synthesize a treatment protocol which trainers may want to include in training those who might encounter such injuries.

Background
According to the Centers for Disease Control, as many as 4.5 million bites occur every year in the United States. It is estimated that 1 of 2 Americans is bitten by an animal or person in their lifetime. But these attacks are predominantly from civilian dogs. There are a number of considerations one must take into account when dealing specifically with police dog attacks.

Difference between police dog attacks and civilian dog attacks
Although dogs have been used in war for more than 2,000 years, they were initially trained for police work in Belgium in 1889 and in the United States in 1907. In the United States approximately 2,000 law enforcement agencies have K-9 dog units. Most law enforcement agencies prefer the German shepherd, although Rottweilers and Doberman pinschers are also used.

Probably the most important difference between civilian dog bites and police dog bites is the amount of damage that can be done--law enforcement dogs can exert tremendous bite forces. Some K-9 dogs (German shepherds and Doberman pinschers) are trained to exert bite forces up to 1,500 pounds per square inch (psi), and trained Rottweilers can generate bite forces up to 2,000 psi. Compare this with the bite force exerted by untrained German shepherds, for example, who only bite with the force of maybe 200-400 psi (though still powerful enough to puncture light sheet metal). It should come to no surprise, then, that while only 1-2% of civilian dog bites require hospitalization, 50% of police dogs bites do (based on a study of the LAPD's K-9 units).

Also, police dogs are trained to bite and keep biting. The average number of bites per patient hospitalized with civilian dogs bites is one, a single bite. The average number of bites a person suffers at the jaws of police dogs is three.

The one good thing about the care of police dog bites, compared to bites by other dogs, is that one can be pretty assured that police dogs are up-to-date on their immunizations, downplaying rabies concerns.

On a political sidenote
Studies have shown that law enforcement dogs are disproportionately used in inner-city communities, which might also explain the high proportion of nonwhite individuals bitten by K-9 dogs. For those interested in reading more on this, there's an excellent review in the New York Law School Journal of Human Rights by DU Rosenthal called "When K-9s Cause Chaos" (volume 11, pp. 279-310, 1994).

Besides racial concerns, the main area in which law enforcement's use of K-9 dogs has been subject to scrutiny is allegations of excessive and unreasonable use of force. A review of the literature reveals only one suspect killed by a K-9 dog. In this case the courts concluded that because the K-9 dog was used appropriately, the incident did not constitute excessive, unreasonable, or deadly use of force.

What to do if attacked
The recommended posture to minimize damage from a dog attack (if the cops won't allow you to borrow any of their pepper spray to fend off an attack :) is to stand still with feet together fists folded under your neck, and arms placed against the chest.

If knocked to the ground by a dog, recommendations include lying face down with legs together and fists behind the neck with your fore-arms covering your ears.

Do all people with dog bites need prophylactic antibiotics?
All allopathic authorities I came across understandably recommend antibiotics given if an infection is detected, but there is controversy over whether or not to start everyone who's been bitten by a dog on so-called "prophylactic" antibiotics—antibiotics to prevent an infection. It seems that about 15 to 20 percent of dog bite wounds become infected. The problem is, of course, we don't know which 15 to 20 percent of bite wounds are going to get infected.

Infectious disease specialists seem to fall into two camps.There are those that think the prudent thing to do is to prescribe everyone with any kind of dog bite that breaks the skin a 3-7 day course of antibiotics, and there are those that separate bites into high risk and low risk categories, and only give preventative antibiotics to those in the high risk situations.

The higher risk situations, in which both camps tend to agree that people should immediately start antibiotics after being bitten, are as follows:).


 * Any bite (unless just a little scrape) to the head, neck, face, hand, foot, or genitalia
 * Any puncture wound that goes all the way through the skin
 * Any severe crush injury
 * Any involvement of a bone or joint
 * Anyone with underlying chronic disease, such as diabetes, lung or liver disease, alcoholism, or cancer. Also anyone with a prosthetic joints, anyone who's had their spleen removed, anyone over 50 or anyone with a compromised immune system(11)

The reason there is such concern about dog bites is that there are a number of particularly nasty bugs that inhabit the mouths of some dogs, such that even innocuous looking bites can on rare occasions lead to life-threatening infections. Because of this, I think I've decided to teach the more conservative approach—recommending that anyone suffering a dog bite should seek medical attention (meaning that they should go to the ER or some formal medical setting and be evaluated for prophylactic antibiotics) and strongly recommending the same for anyone fitting into any of the high risk categories. The outpatient antibiotic of choice for dog bites is amoxicillin-clavulanate (brand name: Augmentin); I mention this only because many doctors are unaware of the range of bugs in dog's mouths and mistakenly prescribe the more narrow-spectrum antibiotics used for typical (nonbite) wounds.(12)

Less controversial treatments
(in addition to all the typical wound care protocol steps) Most sources recommend copious water irrigation at high pressure, just like in any wound.(17) This would entail spraying no less than 250ml (one cup) of tap water directly into the wound from 1 to 2 inches away with a forceful stream from our squirt-top bottles held perpendicular to the wound. Remember your universal precautions, though! This can splash blood in everyone's face. There was a concern by source that irrigating deep puncture wounds might be detrimental, though, because the water can't really drain out and may even force infection deeper.(18) Such wounds might have to be probed and cleaned under local anesthesia.

All bite wounds should ideally be kept elevated for 3-5 days to help prevent infection.(16) Just like bacteria thriving in stagnant pools of water, bacteria also thrive in swollen areas of the body (which are kind of like stagnant pools of body fluid), and elevating the affected limb can cut down on the swelling, and thereby cut down on the risk of infection.

Tetanus booster shots are recommended for anyone who hasn't had a tetanus shot in the last ten years. If a wound is particularly deep or dirty, a booster shot is recommended unless they've had one in the last five years. Booster shots need to be given within the first 48 hours. If people were not fully immunized against tetanus as a child (most people born in the United States have been immunized) they may need tetanus immunoglobulin, a medication that can prevent a potentially life-threatening disease called lockjaw.(13)

Everyone should also be warned about the signs of a developing infection.(14) Dog bite infections usually manifest with a stinky gray discharge, but people should be on the lookout for any increase in pain, redness or swelling, red streaking of the surrounding skin, pus draining from the area, or any tender lumps or swelling in armpit, groin, or neck. Symptoms of systemic infection after a dog bite, like chills or fever over 99.6 degrees, may be an indication for hospitalization.(15)

And of course we should not neglect emotional care. I can only imagine how traumatizing being attacked like that would be.