Horses are part of an ever growing industry, with over 600,000 horses in the UK, 1.4 million riders and 5 million people with an active interest in the equine industry*. Most people acquire a horse out of choice, so if you make this decision you should think carefully before going ahead. A horse needs lots of love and care, including regular worming, vaccinations and dental care. Owning a horse is time consuming and can be costly; not only will you will need to consider where you will keep your horse, you must also consider the ongoing costs of owning a horse which include accommodation, bedding, feed and healthcare.
In the unlikely event that your horse goes missing it is going to be very difficult for anyone to know who it belongs to, unless your horse carries some form of permanent identification. It is wise to get your horse microchipped or freezemarked, this will avoid heartache in the long run, should your horse go missing or is stolen.
Horses are herd animals, and thrive on being together with other horses. Don’t forget that your horse will need somewhere to graze, a stable for warmth in the winter time, a constant supply of water, feeding daily and regular exercise. It can cost hundreds of pounds a month to care for a horse, including accommodation, food, veterinary care and insurance; there will be other costs, including buying tack and rugs and extra livery charges when you go on holiday.
Horses can live into their thirties, over this time your horse will need lots of care and attention. Being able to provide all of this will ensure you and your horse make the most of your time together.
* Research conducted in 2004 by the Henley Centre for DEFRA and the British Horse Industry Confederation.
Emergency first aid for wounds
Horses have a well-developed ‘fight or flight’ mechanism and they often react first, regardless of the injuries caused while doing so. Commonly wounds are caused by direct trauma on foreign objects such as gates, fencing and stabling equipment, or from a kick from another horse. Emergency first aid can easily be provided by anyone before the veterinary surgeon arrives and can significantly improve healing times of the patient when applied correctly.
Where do we start?
When a wound occurs, it can be very shocking and stressful for both the horse and the owner, so to prevent further injury, start by catching and calming the horse. Providing the horse is not in significant distress and does not have severe lameness, move it to a clean and quiet environment and get some assistance. If the horse is severely distressed or lame, do not move it and call your veterinary surgeon immediately. The person to assist you should be able to handle the horse safely while the wound is being examined. Ideally the examination area should be sheltered, have good lighting, and clean water should be readily available. Do not try to assess the horse on your own. Horses react in unpredictable ways when in pain and in shock.
Before treating the wound, conduct a rapid and systematic primary survey to evaluate the most immediate and life-threatening concerns. Follow the recommended A-B-C approach:
- Airway: is the horse getting an adequate amount of air through its nose and into the lungs?
- Breathing: how fast is the horse breathing? What type of respiratory effort is the horse making?
- Circulation: is the horse bleeding? If so, how much blood has the horse lost? Does the horse have pale gums or an increased heart rate?
Normal parameters of the horse:
- Respiratory rate: 8-12 breaths per minute.
- Heart rate: 35-40 beats per minute.
If any of these systems are abnormal, contact your vet immediately.
What do I do if the wound is bleeding?
Some wounds will have minor bleeding which is usually self-limiting, while others haemorrhage more heavily and require immediate bandaging to control the bleeding. Do not use a tourniquet – when applied incorrectly, tourniquets can impair nerve function and lead to tissue necrosis and sloughing. Instead, apply a pressure bandage directly over the wound. This type of bandage serves to control haemorrhage for a short period of time, whilst waiting for veterinary assistance.
How to apply a lower limb pressure bandage
- Examination gloves.
- Absorbent sterile dressing (or cotton wool soaked with clean water).
- Soft lightweight orthopaedic padding.
- Cotton wool (or gamgee).
- Open-weave conforming bandage.
- Adhesive bandage.
1. Apply the absorbent sterile dressing or wet cotton wool directly onto the wound using an aseptic technique (using your gloves and trying not to touch the sterile surface of the dressing).
2. Hold the dressing in place by applying the orthopaedic padding over the dressing.
3. Apply the secondary cotton wool layer and compress it by applying the open-weave conforming bandage. Open-weave bandages should be applied starting at the bottom of the leg, spiralling upwards, and overlapping by at least half with each turn, ensuring there are no creases in the bandage. Moderate, even tension should be placed throughout the whole bandage. Excessive tension should be avoided as this may damage the tendons at the back of the leg.
4. Apply the tertiary protective layer, consisting of an adhesive bandage, in the same manner as the secondary layer.
How to apply a lower limb pressure bandage
If blood strikes through the bandage, do not remove the bandage but apply another layer (consisting of cotton wool, open-weave conforming bandage and adhesive bandage) on top. Check for patient discomfort and swelling above and below the bandage.
Bandaging upper limbs or other body parts is more difficult and therefore a dressing might need to be held in place manually to stem the bleeding until the veterinary surgeon arrives.
Where is the wound located?
The location of a wound is a significant determining factor for outcome and healing time.
Upper body and abdominal wounds have enough skin, underlying muscle and blood supply to allow significant wound contracture and large defects tend to heal rapidly, even without suturing.
Head wounds involving the sinuses, nostrils and eyelids heal relatively well, if critical structures are not involved.
Wounds on the limb, on the other hand, generally heal slower as these areas suffer from many delayed healing factors such as poor blood supply, reduced contraction capability and movement, resulting in complications such as proud flesh development. Many important structures in the lower limb only have skin covering them and are therefore at high risk of injury and infection.
Wounds near joints, tendons and ligaments should always be assessed by a veterinary surgeon and many require emergency treatment.
What type of wound is it?
The most common wounds caused by traumatic injuries are:
- Puncture wounds: penetrating wounds with minimal tissue loss, that generally look minor but can be deep and cause significant trauma underneath with an increased risk for introducing infection into body cavities.
- Lacerations: wounds with rough, serrated edges of skin and underlying soft tissue damage. These wounds can contain considerable contamination.
- Shearing: wounds with extensive tissue loss and a large amount of contamination.
Is the wound contaminated?
All traumatic wounds requiring first aid will be classified as dirty or contaminated, even if they don’t look that bad. Bacterial burdens are relatively low during the initial acute inflammatory phase of wound healing, but bacterial colonies grow quickly and within hours, infection can occur. It is therefore particularly important to provide good initial wound management and first aid, to reduce bioburden in the wound and improve healing outcome.
How do I provide first aid to a wound?
To help preserve vital tissue and to reduce factors of delayed healing such as infection, the following steps should be adhered to: prevent further wound contamination → remove foreign debris and contaminants → lavage → prevent wound from desiccation → stabilise.
Firstly, try to prevent further contamination of the wound. The easiest way to achieve this is to clean your hands and/or wear clean examination gloves when you are doing anything with the wound and not to directly touch inside the wound. Next, cleaning the wound is necessary to remove foreign debris and contaminants. Larger foreign material can be removed manually using wet cotton wool. Smaller invisible contaminants should be lavaged (flushed) out. The three key components for lavaging a wound are:
- Type of fluid: clean tap water can be used. It is cheap and usually readily available.
- Volume: the greater the amount of contamination, the greater the volume of lavage required. Generally, the more lavage, the better in a heavily contaminated wound however lavaging should be stopped if the tissue becomes blanched (white) due to the volume of lavage.
- Pressure: there should be enough pressure to dislodge debris, loosen dead tissue and overcome adhesive forces of bacteria. However, care must be taken as excessive pressure may drive bacteria and debris deeper into the wound.
Once the wound is grossly clean, hydrogels can be used to prevent desiccation (drying out) of the wound and are a good product to have in a first aid kit. These gels, combined with an appropriate absorbent dressing, are useful to draw out further contaminants from the wound. The absorbent dressing will also assist in removing discharge and haemorrhage from the wound bed. Care must be taken when applying dressings to wounds. Touching the wound can be painful and the dressing will only be a benefit if it is applied aseptically, ie without touching the sterile side of the dressing. Other products that can be used safely in the wound include manuka honey, which has good antibacterial properties. Any other ointments, creams and powders should be avoided as they may be detrimental to wound healing.
For wounds on the lower limb, a routine three-layer bandage should then be applied if possible, using the technique described above. Bandages create stability, reduce swelling, and protect the wound from further contamination. Other bandaging techniques for other wound locations are difficult in horses and these will need to be applied by a veterinary professional.
When do I phone the vet?
The following considerations should be made when determining if the veterinary surgeon should be consulted:
- Wounds associated with lameness.
- Horses in significant distress.
- Wounds with excessive bleeding.
- Wounds with significant contamination with dirt and debris.
- Wounds involving the full thickness of the skin.
- Wounds that may have entered a body cavity or involve deeper structures such as bone, muscle, joints, ligaments, tendons, tendon sheaths, vessels and nerves.
- Wounds involving the eyes.
- Horses without up-to-date tetanus vaccination.