Equine first aid

The kit, procedures and first aid treatment

The role of first aid

• The main role of first aid is to deal with minor injuries, e.g. superficial cuts & grazes, kicks, overreaches & wire cuts.

• Also, first aid is used to care for the horse in a more serious situation before the vet arrives, with the aim of preventing the situation from getting any worse.

The equine first aid kit

• Must be complete & readily accessible, e.g. tack / feed room.

• A second kit may be required for travelling.

• The human first aid kit may be kept next to the equine kit, so they must both be clearly marked.

• The vet’s name & number should be written on the inside lid.

What items should be included in the equine first

aid kit?• Bowl• Cloth• Antiseptic solution• Wound powder /

spray?• Hydrogel• Fly repellent• Antiseptic ointment• Clean crepe bandages• Adhesive bandages• Dressings – sterile &

non-adhesive• Hibiscrub

• Cotton wool• Curved, blunt-ended

scissors• Poultice• Veterinary

thermometer & vaseline

• Forceps / tweezers• Money (for travelling

kits) / mobile phone• Syringe• Latex gloves• Tape

What additional items might be kept in a medicine

cupboard?• Cling film / plastic bags• Gamgee / fybagee• Antiseptic / purple

spray?• Udder cream• Wormers• Cooling gel / clay• Poultices• Icepack• Stable bandages

• Eye ointment• Germicidal shampoo /

soap• Hoof care preparations• Witch hazel lotion • Salt• Liniment / cream rub • Fly repellent• Sun cream• Poultice boots

Types of wounds

• Closed / contused wounds• E.g. bruises, sprains, muscle damage &

tendon strain.• Usually internal bleeding without breaking

of skin.• Leads to swelling, heat & pain.• Treatment: Immobilise & cold hose / ice

packs.• Once heat has gone, use heat treatments.• Causes: fall / blow / kick.

• Incised wounds• Clean straight edges & often bleed freely.• Usually, there is little bruising & they

normally heal quickly.• Cause: surgical incisions / cuts by metal or

glass.

• Abrasion wounds• Very superficial skin wounds, e.g. saddle

sores / grazes from falling.

• Laceration & tear wounds

• Torn edges & irregular shape, with some bruising.

• Amount of bleeding depends on position of wound.

• Frequently, there are torn flaps of skin that die before healing.

• Cause: barbed wire / protruding nails & other hazards.

• Puncture wounds• Often more serious than they look.• Often overlooked due to the small size

externally.• Opening may be small, but penetration

can be of varying depths

• Cause: bites / stakes / thorns / treading on nails & splinters.

• Bacteria is carried deep into the wound infection.

• Treatment: ensure tetanus vaccinations are up to date. Treat the wound to heal from the inside out. Usually involves poulticing.

Preparing a poultice

Poultice boots

First aid procedure• Control the horse quietly but firmly.• Move the horse to a safe place if possible / necessary, to

reduce the chance of further injuries.• Keep the horse still – it may be necessary to use a method

of restraint, e.g. twitch.• Maintain a calm atmosphere.• Assess the injury (position, depth, severity, blood loss) and

call the vet if necessary.

• Control of bleeding• Capillary bleeding will ooze from the wound and is usually

not serious.• Venous bleeding flows gently & is dark red.• Arterial bleeding runs freely & may spurt under pressure

from the heartbeat. It is bright red.• Venous & arterial bleeding require immediate veterinary

treatment.• Control any bleeding by applying a pad directly on the

wound & secure it firmly with a pressure bandage. Several layers can be used.

When to call the vet• Always contact your vet if:

• Any wound is bleeding profusely • The horse is very lame, even if the wound itself is

small • Any wound is more than a couple of inches long

and has gone right through the skin, so that it gapes open and may need to be stitched

• There is any suspicion of a foreign body in the wound

• There is any suspicion that a vital structure such as a joint may be involved

• The horse has NOT had an anti-tetanus vaccination

• If you think a wound may need to be sutured (stitched or stapled), you should consult your vet as soon as possible, since a wound will heal more effectively if it is sutured while still fresh.

• A wound may need to be sutured if:

• The edges are gaping apart, leaving a large gap for dirt to enter

• It is very large or deep • It is in an awkward place that will scar• In most cases, deep punctures, injuries with very

swollen or crushed wound edges or severely contaminated or infected wounds will not be suitable for suturing, nor will wounds that are more than 8hours old.

• Surgical skin staples are now often used instead of stitching for certain types of skin wounds.

• They can be inserted very quickly and may be ideal when a horse does not want to stand still.

• Staples do not work well for jagged injuries or when the wound edges are under a lot of tension, but they are often a neat and efficient way to repair clean cuts.

Cleanliness• Once bleeding has been controlled, the wound will

need to be cleaned.

• Remove hair from the edges of the wound (protect wound with for example, vaseline).

• Hose for 5-10 minutes (mechanically loosens the dirt).

• Wash with warm salt water / hibiscrub solution.• Cotton wool – work from the inside of the wound,

out, and discard each piece of cotton wool once used.

• Syringe.• Tubbing.

• In some cases, debridement of the wound is necessary (cutting away of devitalised tissue with scissors / scalpel).

Hosing a wound Hosing boot

Tubbing Cleaning a wound

• When cleaning a wound, be aware that:

• Bathing with cotton wool can introduce contamination.

• Some topical treatments are detrimental to healing, some even slowing healing by irritating the wound / causing cell death.

• Coloured sprays and wound powders can act as foreign bodies and be caustic to cells.

• Strong antiseptics can kill cells as wells as bacteria - use very mild solutions or salt water.

• Avoid "second skin" sprays, as they can seal in infection.

Cleaning & dressing wounds

• It is best to use:

• A mild salt solution that matches the electrolyte content of equine tissue: ½ teaspoon table salt to 1L water.

• Povidine-iodine (e.g. betadine) - an excellent antibacterial. • Add to salt water: 10ml or less to 1L salt solution.• Antibacterial activity lasts ~4-6 hours.• Humans handling it frequently, must wear rubber gloves, as it is

toxic in larger amounts.

• Chlorhexidine (e.g. hibiscrub) – an excellent cleaning solution, effective against bacteria, viruses & fungi.

• Mix 25ml with 1l of salt water.• Long lasting effect, as it binds to skin proteins.

• Water-soluble wound gels (hydrogel) - originally designed for human burns patients.

• Wound hydrogels help to keep the wound clean and moist. • It is thought hydrogels reduce the number of bacteria in the

wound and can speed healing. • Examples include Derma-gel, Vetalintex, Intrasite gel and Nugel.

Protecting the wound - dressings

• Hot poulticing may be required for drawing out infection / foreign bodies.

• Otherwise, once the wound is clean, especially if likely to get dirty again, it may be necessary to protect the wound by applying a dressing.

• Consider applying a hydrogel to the wound.• Vaseline can be applied to the skin surrounding a

weeping wound.• Use a sterile non-stick dressing, e.g. (dry)

animalintex / melolin. • Secure the dressing with tape if necessary.• Wrap with gamgee / fybagee & bandage in place.

Healing• Normal immune mechanisms effectively deal with up to 1 million

bacteria / gram of tissue.• More than 1million / gram overwhelms immune system, creating

infection.• Wound margins are colonised with bacteria within 2-4 hours after injury.

Topical antibiotics will do little to fend off infection

• Healing begins with fibrous connective tissue collagen (fibrin strands), made of proteins.

• Fibroblasts (which manufacture the fibrin) migrate into the wound by the 3rd day.

• As granulation tissue (made of capillaries & fibroblasts) fills in the wound, it provides a surface along which epithelial cells (new skin cells) will migrate.

• Bacteria – slows healing & produces enzymes that destroy fragile newly formed skin cells.

• Contraction (reduction of wound size) occurs at a rate of 0.2mm / day during the first few months.

• Continued remodelling of a scar occurs over the next 6-12 months.• Contraction rates are not affected by the size of the wound, but by skin

tension. • Taut edges, e.g. on a leg wound, contract slowly. • Dry wounds are tighter, so contract more slowly than a moist wound.• Any excess tension, oedema or movement of a wound interferes with the

function of the myofibroblasts, limiting contraction, sometimes even ceasing it prematurely.