2021 AAHA Working, Assistance, and Therapy Dog Guidelines


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Executive Summary

Disclosure: These guidelines were prepared by a task force of experts convened by the American Animal Hospital Association(AAHA) and were subjected to a formal peer-review process. This document is intended as a guideline only, not an AAHA standard of care. These guidelines and recommendations should not be construed as dictating an exclusive protocol, course of treatment, or procedure. Variations in practice may be warranted based on the needs of the individual patient, resources,and limitations unique to each individual practice setting. Evidence-based support for specific recommendations has been cited whenever possible and appropriate. Other recommendations are based on practical clinical experience and a consensus of expert opinion. Further research is needed to document some of these recommendations. Because each case is different, veterinarians must base their decisions on the best available scientific evidence in conjunction with their own knowledge and experience.

This executive summary provides selected highlights of the extensive information and recommendations in the guidelines. It is not a replacement for reading the guidelines in their entirety. For the full guidelines, visit aaha.org/workingdog or the Nov/Dec 2021 issue of JAAHA.

AAHA Foundation, Boehringer Ingelheim Animal Health USA Inc., CareCredit, Merck Animal Health, and Zoetis supported the development of the 2021 AAHA Working, Assistance, and Therapy Dog Guidelines and resources through an educational grant to AAHA.

by Constance Hardesty, MSc

The 2021 AAHA Working, Assistance, and Therapy Dog Guidelines is the first comprehensive consensus report on veterinary healthcare recommendations for working, assistance, and therapy dogs. This category of canine patients includes a broad assortment of animals, some with well-defined functions and others that provide a more general support role. (Working, assistance, and therapy dogs are collectively referred to as working dogs in the guidelines.) The guidelines discuss recommendations for dogs trained for protection, odor/scent detection, service functions for people with diagnosed disabilities or physical limitations, emotional support, and therapeutic intervention.

The working dog is not the typical patient that companion animal veterinarians encounter in clinical practice. Working dogs have a utilitarian function that generally requires specialized temperament and training, involves intimate interaction with a handler or client, exposes them to exceptional physical and emotional demands, and sometime places them in high-risk environments.

Many working dogs undergo extensive training and have rigorous physical demands placed upon them. These factors make the animals inherently valuable and impose a need for a high level of primary veterinary care.

Because working dogs have a particularly close relationship with their handlers, a trust relationship between the practice team and the working-dog client is imperative. The practice team must establish credibility with the working-dog client and earn that individual’s confidence and trust in order to maintain an effective and enduring veterinarian-client-patient relationship.

Categories of Working, Assistance, and Therapy Dogs

It is helpful for practitioners to define working and service dogs according to their specialized function or work environment:

Working dogs include detection or protection animals trained to accomplish specific, defined tasks.

Assistance dogs, categorized as either service or emotional support dogs, help persons with a diagnosed psychological or physical limitation. Service dogs have a specific job to accomplish, while emotional support dogs provide support by their presence alone.

Therapy dogs perform either animal-assisted activities (AAA) or animal-assisted therapy (AAT). The former are used for hospital visits and de-stressing interactions with people, and the latter provide goal-directed therapy, often directed by a healthcare professional such as an occupational therapist or psychologist.

A practice team with working dog patients should have a training strategy that equips staff with the knowledge and skills to examine and treat the animals as well as communicate with the animal’s handler and/or sponsoring organization effectively and compassionately. The 2021 AAHA Working, Assistance, and Therapy Dog Guidelines are intended to enable veterinary practitioners to anticipate the needs of these specialized patients and their handlers, to provide the care needed to maintain their health and serviceability, and to offer useful referral recommendations when appropriate. The guidelines have four principal objectives:

  • Improve the practice team’s understanding of the special needs of working dogs
  • Develop an understanding of the dog’s special needs from the perspective of its handler or trainer • Enhance the wellbeing and safety and decrease the stress imposed on the practice teams who care for working dogs
  • Minimize the risk of infectious disease transmission and injury to working dogs by providing optimum preventive healthcare and nutrition

Special Considerations

The need to handle high-value dogs, protection dogs trained for on-command aggression, or high-energy service dogs can be intimidating to some practice team members. Care must be taken to avoid treatment decisions that impair the dog’s functionality, such as mobility, detection skills, or alertness. For example, disruptions in normal anatomy or physiology that go unnoticed in a pet dog, such as dental disease or tooth fractures, being overweight, or lack of a fitness and conditioning, can lead to impairment of the protection dog’s performance and put the handler’s life at risk.

GettyImages-1303833889.jpgHealthcare of working dogs is one of the most rewarding services a veterinary practice can render.

To enable the practice team to speak the language of the working dog community, the guidelines begin with a lengthy list of acronyms and definitions. Some confusion and inconsistency are unavoidable due to the lack of universally recognized nomenclature. The list includes the various types of working dogs with a note on legal eligibility requirements. Note, however, that all definitions and allowances are subject to change with updates to regulations and policies. The guidelines task force recommends referring to the most current policy for guidance.

The bulk of the guidelines provide practice teams with essential information about each category of working dog (see sidebar). For each category, the guidelines provide a concise definition, examples of the functions they are trained to fulfill, the tasks they typically perform, how they are selected, a brief description of their training and development, what makes the dogs invaluable to their handlers or sponsoring organization, their work environment, and medical care considerations including health threats entailed in their jobs. Special emphasis is given to the animal’s unique wellness and clinical needs: for example, body conditioning to help prevent job-related injuries or avoiding medications or treatments that may hinder the animal’s ability to perform its tasks. In providing medical care, the veterinary team must be sensitive to the working dog’s response to stimuli; for example, protection dogs may be easily aroused. The guidelines describe the special characteristics team members may encounter during the veterinary visit and recommend staff training for appropriate handling.

Essential Tables

While the guidelines provides the explanations and recommendations in detail, the tables summarize the information in an easy-to-scan format. Because of their length, the tables are summarized here; see the guidelines for the full tables.

Table 1 provides a summary of the attributes and medical skill sets that veterinary practice teams should have or develop in order to provide care to working, assistance, and therapy dogs. For example, veterinary team members should be willing to adapt waiting room policies to accommodate the patient’s needs; consider that working dogs may require longer appointment times; have an appropriate confidence in working with potentially reactive dogs; observe the dogs at work, if possible; and establish and maintain good communication with the dog’s handler. Recommended medical skills for both protection and detection dogs and service dogs include such things the ability to recognize systemic conditions that could alter performance as well as familiarity with the pharmaceutical effects and safety implications of drugs and sedatives/anesthetics on the dog’s performance.

Additional medical skills relevant to detection and protection dogs include low-stress handling and the ability to provide or recommend conditioning, rehabilitation, laser therapy, or physical therapy.

Special attention is devoted to detection dogs. To help practice teams understand these dogs’ work, Table 2 provides several examples of detection dog sensory target odors (human remains, narcotics, etc.), and Table 4 lists common health risks depending on the type of work they do: for example, urban search-and-rescue or police and law enforcement in both higher-risk and lower-risk environments.

For protection, detection, and assistance/therapy dogs, Table 3 provides a suite of healthcare recommendations covering preventive care, behavior, nutrition, reproduction, common injuries, common diseases, handling, screening for heritable diseases, mental or emotional considerations, first aid, triggers for retirement, needs of handlers, needs of owners, needs of organizations, and possible exposure risks.

The tables complement the guidelines’ detailed discussion and recommendations, but reading the tables is not a substitute for reading the guidelines.

General Recommendations

The guidelines emphasize several recommendations for all working dogs.

Make care a priority. These animals are invaluable not only because of the hours invested in their training but because their handlers may rely on them for essential tasks. To the extent possible, the medical care rendered to the working dog merits the highest priority and highest capability available. If the practice is not equipped to provide 24-hour critical support, it must at least provide basic life support and stabilization followed by immediate transfer to a facility that can provide specialized care.

Cultivate a partner relationship with the handler. The working dog’s human partner will often notice subtle changes in the dog’s performance or disposition that can indicate early-onset disease. Because the handler is in contact with the dog in a highly observant role, the human partner can often identify changes indicative of the dog’s physiologic status that would otherwise escape the veterinarian’s detection. The veterinarian should probe for these observations and give ample credibility to the dog handler’s perspective. The information obtained from the handler should be recorded in a detailed patient history that can be correlated with performance.

Respect the working dog’s work. Understand that handlers rely on their working dogs and provide preventive care and treatments that minimize the animal’s inability to work. Detection dogs, for example, should be treated as performance athletes. Any intervention, treatment, or procedure should account for the potential impact on the dog’s overall performance and anticipated return to work. Similarly, for service, assistance, and therapy dogs, where prognosis might be comparable for two different treatment options, quicker return to function should be the key factor in considering therapeutic options. Medical problems that are merely inconvenient in a family pet (e.g., soft stools) can pose significant problems for handlers who have physical limitations.

Be especially sensitive to issues around the animal’s retirement or end of life. Euthanasia should be considered only in the most dire humane and devastating injury circumstances, as this will impact the working dog’s entire unit or service team (police, search and rescue unit), as well as the handler. The most important consideration at the end of a dog’s service life is the determination of when the dog’s limitations jeopardize the safety of the handler. End-of-life decisions may be impacted by organizational policy and requirements that include chain of command notification, mandatory necropsy and pathology sample submissions, preferential remains handling and care, funeral honors, and more.

CS5.jpgDetection dogs should be treated as performance athletes.

Because of the extremely strong animal-client bond and the client’s reliance on the dog’s work, client discussions about retirement of a service dog due to health concerns can be very difficult. Similarly, end-of-life decisions can be incredibly difficult and emotional.

Staff Education and Training

The veterinary team must receive education and training regarding the role of the working dog, the diverse tasks such dogs perform, and the environments in which they work, as well as applicable laws and regulations. The team must understand that every working dog is an individual with a unique set of skills that should not be confused with other types of working dogs. To advance their knowledge and skills, team members should ask the handler questions, develop relationships with local groups that train and develop the dogs, observe working dogs on the job, participate in local certification events, and attend meetings and workshops that provide training and education geared to working dogs.

Proficiency with low-stress handling is essential for practice teams that serve working dogs because patients may be easily aroused or resist handling or application of medical treatments. First-aid and triage are also essential because working dogs’ job duties or environments may expose them to occupational hazards, ranging from sore pads to poisoning to lumbar strains to gunshot wounds.

No sector of veterinary practice places a greater premium on effective communication with the presenting client than the care of working dogs. The handler has an intimate knowledge of the animal’s physical status and functionality and is a principal source of information on the patient’s history and presentation status. It is important to understand that handlers have various degrees of education, training, and skills, so the veterinary team should tailor communications to each handler.

This is critical when a handler or client has a disability that may be a barrier to understanding. Opportunities for advanced training in communications skills, including communication with individuals with disabilities, should be sought.

The practice team must establish credibility with the working-dog client and earn that individual’s confidence and trust in order to maintain an effective and enduring veterinarian-client-patient relationship. When these skills and relationships are in place, the healthcare of working dogs represents one of the most rewarding and valuable services that a veterinary practice can render.

 

Constance Hardesty
Constance Hardesty, MSc, is a freelance writer living in Colorado. She is also former editor-in-chief of AAHA.

Photo credits: Thinkstock/Stockbyte via Getty Images; Stocktrek Images/Stocktrek Images via Getty Images; SeventyFour/iStock via Getty Images; SeventyFour/iStock via Getty Images

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