Emergency Surgery Preparation: A Guide for Clinic Teams

Emergency surgical cases are among the most demanding situations any veterinary clinic team will face. The difference between a good outcome and a poor one often comes down to preparation. When a patient arrives in crisis, there is no time to search for equipment, clarify team roles, or establish protocols. Everything must already be in place. This guide outlines the key elements of emergency surgical preparedness that I have found most valuable across my years of practice.

Establishing Emergency Protocols

Every clinic that may encounter surgical emergencies should have written, accessible protocols for the most common presentations. These protocols should not be locked away in a manual that no one reads. They should be laminated, posted in the prep area, and reviewed regularly as a team.

At a minimum, your clinic should have protocols for:

• Gastric dilatation-volvulus (GDV): From triage and gastric decompression through to surgical correction
• Haemoabdomen: Stabilisation, assessment for autotransfusion, and surgical exploration
• Urinary obstruction: Medical management, catheterisation, and surgical intervention criteria
• Pyometra: Stabilisation and timing of ovariohysterectomy
• Traumatic injuries: Triage, wound management, and criteria for immediate versus delayed surgery

Defining Team Roles

In an emergency, confusion about who is doing what wastes precious time. Each team member should know their role before the patient arrives. A practical model that works well in most small animal practices includes:

• Triage lead: First to assess the patient, initiates stabilisation, communicates with the surgeon
• Anaesthesia lead: Prepares drugs, monitors the patient under anaesthesia, manages the airway
• Surgical assistant: Prepares the surgical kit, assists during the procedure, manages instruments
• Client communicator: Speaks with the owner, obtains consent, provides updates

In smaller teams where one person may fill multiple roles, it is even more important to have a clear plan for who does what and in what order.

Equipment Readiness Checklist

Emergency surgical equipment should be checked regularly and kept in a dedicated, clearly labelled location. I recommend a weekly check of the following:

• Emergency surgical kit (sterilised and sealed, with instruments verified)
• Anaesthetic machine functionality, including oxygen supply levels
• Emergency drug box with doses pre-calculated for common patient weights
• Suction unit tested and functional
• Electrocautery unit tested
• IV fluid warmers and patient warming devices
• Blood typing kits and crossmatch supplies if blood products are stocked
• Suture materials in a range of sizes (absorbable and non-absorbable)

Assigning the weekly check to a specific team member on a rota basis ensures accountability and consistency.

The Triage Process

Effective triage in an emergency setting requires rapid assessment of the patient's cardiovascular and respiratory status. The modified Glasgow Coma Scale can be useful for trauma patients, whilst the APPLE (Acute Patient Physiologic and Laboratory Evaluation) scoring system provides a more comprehensive prognostic assessment.

Key triage parameters to assess immediately include heart rate, respiratory rate and effort, mucous membrane colour, capillary refill time, pulse quality, level of consciousness, and body temperature. These should be recorded and communicated to the surgeon promptly, as they directly inform the urgency and approach of surgical intervention.

Communication During Emergencies

Clear, structured communication prevents errors. I advocate for the use of SBAR (Situation, Background, Assessment, Recommendation) when communicating about emergency patients:

• Situation: "We have a 7-year-old intact female German Shepherd presenting with a distended abdomen and non-productive retching"
• Background: "Onset two hours ago, no previous history of GDV, last ate six hours ago"
• Assessment: "Heart rate 180, weak peripheral pulses, CRT 3 seconds, radiographs confirm GDV"
• Recommendation: "Recommend gastric decompression followed by emergency surgical correction"

Post-Operative Handover

The surgical procedure is only one part of the emergency patient's journey. A structured handover to the post-operative care team is essential. This should include a summary of the procedure performed, any intraoperative complications, current analgesic plan, fluid therapy requirements, monitoring parameters and frequency, and expected recovery timeline with red flags to watch for.

Written handover notes, supplemented by a verbal briefing, reduce the risk of critical information being lost during shift changes or busy periods.

Regular Training and Drills

Preparation is not a one-time event. I strongly recommend that clinic teams conduct emergency drills at least quarterly. These do not need to be elaborate productions. A 30-minute tabletop exercise where the team talks through their response to a simulated GDV or haemoabdomen case can reveal gaps in knowledge, equipment, or communication that would be dangerous to discover during a real emergency.