This is the second in a series of articles from MONOC Mobile Health Services. MONOC is New Jersey's largest provider of EMS and medical transportation and first CAAS-accredited agency. The goal of this series is to provide insight and solutions for the different managerial and operational challenges facing the EMS leaders of tomorrow. For more, see www.monoc.org.
For as long as animals and humans have cohabitated, there has been an indisputable bond and benefit to both in an array of areas, including mental and physical health. Any Internet search of animal assisted therapy or therapy dogs will yield vast information on studies conducted as early as the 1800s in which the sick and elderly saw their conditions improved through relationships with animals.
Research has shown that animals--more specifically, specially trained therapy dogs--can provide such enhancements to treatment as mental calming and stimulation, distraction from the unpleasant circumstances of illness, something to look forward to (such as scheduled visits), increased communication, etc. The presence of animals serves to brighten the atmosphere, increasing amusement, laughter and play. These positive distractions may help decrease people's feelings of isolation or alienation. Therapy dogs and other animals have also been shown to decrease heart rate and blood pressure.
Different dog personalities can offer different advantages. For example, an older, less active dog may be calming--it is nonthreatening and can quietly give and receive affection via petting, lying close, etc. A younger, more active dog can provide laughter through comical behavior and tricks. In any case, the effect a well-trained therapy dog can have on an elderly or pediatric patient, special-needs student or resident of an inpatient facility can be obvious. It may behoove leaders of healthcare systems, including EMS services, to consider ways to incorporate the benefit of such animals in their services. In addition to benefiting patients, they can also be a great PR and outreach tool for an organization.
Requirements of a Therapy Dog Program
It is important to understand that while therapy dogs may be permitted in hospitals and other healthcare facilities, they are not afforded the same rights under the Americans With Disabilities Act as actual "service dogs." Service dogs are defined as "any guide dog, signal dog or other animal individually trained to do work or perform tasks for the benefit of an individual with a disability, including but not limited to guiding individuals with impaired vision, alerting individuals with impaired hearing to intruders or sounds, providing minimal protection or rescue work, pulling a wheelchair [sic] or fetching dropped items." Therefore, therapy dog handlers must actually obtain permission to enter facilities and areas in which pets would not otherwise be permitted. It is best for any therapy dog program to have executed a memorandum of understanding with any facility being visited prior to the first actual visit.
Like service dogs, therapy dogs must be well trained. An agency with a therapy dog program must have met minimum training and certification requirements for dogs that are being trusted around people who are disabled, sick, weak and mentally challenged. The different conditions of people being visited dictate that a dog must not be aggressive in any way, and must remain tolerant of those who may not know how to properly handle or react to it.
A good place to start is the American Kennel Club's Canine Good Citizen program. This is a two-part program that stresses responsible pet ownership for owners and basic good manners for dogs. All dogs who pass the 10-step Canine Good Citizen test may receive a certificate from the nationally recognized American Kennel Club. This certification attests that dogs are able to behave properly in common scenarios such as when their handlers interact with others, being approached by a stranger or another dog, being groomed, walking on a leash without pulling or becoming distracted, and being in a crowd. The dog is also evaluated on its ability to follow commands such as "sit" and "stay," and must also be able to demonstrate the ability to be supervised by a stranger while the handler leaves.
While this certification is a minimum, it is also recommended that a formal therapy dog program require further and more advanced obedience training and certification. This will come in handy when a dog is evaluated by a recognized agency such as Therapy Dogs International or the Delta Society, which will also ensure a dog's tolerance to loud noises, energetic children and other things that can prompt a fearful response, such as canes, crutches, wheelchairs, beeping medical devices and banging pots and pans. Reputable local dog trainers can assist interested potential therapy dog handlers in obtaining not only the proper training, but the required certification as well.
Requirements should be stringent because a dog that may be wonderful with its own family at home may still not be suitable for therapy. For example, the dog may be fearful of certain smells, strangers, men or people with certain uniforms or even hats, causing it to act out in aggression or otherwise inappropriately. This can have tragic results and be an incredible liability to a therapy dog organization.
A dog's proper training should not be the last requirement of a therapy dog program. Handlers must also be evaluated for their ability to interact with people in various conditions and stages of health. They must be sensitive to specific needs of the program's target audience. For example, if the program is requested at a school for special-needs children, handlers should be educated and sensitive to various forms of disabilities.
While it is most common to see therapy dogs in nursing homes and assisted-living facilities, some agencies also extend their services to hospices, children's hospitals, rehabilitation facilities, drug and alcohol treatment centers, libraries, prisons, schools, shelters for the homeless and battered women and even funeral homes. An EMS agency's therapy dog program can have large benefits to the organization by offering a captivating service line to area hospitals as well as health fairs, community outreach and charity events and other occasions that promote the agency.
Expenses and Logistics
While these are all reasons for an EMS agency to start a therapy dog program, sufficient effort must be made to promote the program and ensure that the time and money invested in not only training, but uniforms and other supplies is worth the expenditure. While a simple dog vest and identification card is sufficient and can cost less than $50, training may be more costly, and an agency must have very specific policies regarding whether the handler pays for this out of pocket or is reimbursed. Decisions must also be made as to who will pay for other dog-related expenses, such as food, supplies, vet bills, etc. The policy should cover not only required vaccinations, but annual veterinary evaluations. In the law enforcement community, dog handlers fall into a completely different category because dogs are purchased by the police department, often from other countries, costing thousands of dollars. Subsequent training and supplies and equipment are almost always paid for by the department, even though the dog lives with its handler 365 days a year. Because of the very different missions between law enforcement and dog therapy, this scenario would not be realistic for an emergency medical service.
Like any other unique endeavor, a therapy dog program should be evaluated by the agency's legal and risk management advisors to ensure liability is kept low and insurance coverage is sufficient to protect not only program participants, but those they visit as well. Consideration should also be given to how dogs will be transported to visit sites, whether handlers should wear normal patient-care uniforms or specially designed ones, and exactly how large a group of handlers will be sufficient to meet the requests of the community. With proper planning and execution, a therapy dog program can become a valuable asset to an EMS agency and the community it serves. There are few other ways EMS providers can take a step away from their normal roles and be rewarded by making a difference to so many.
Therapy Dogs: Training Your Dog to Reach Others, by Kathy Diamond Davis, Dogwise Publishing, 2002
The Canine Good Citizen: Every Dog Can Be One, by Wendy Volhard, Howell Book House, 1997
A Dog Who's Always Welcome: Assistance and Therapy Dog Trainers Teach You How to Socialize and Train Your Companion Dog, by Lorie Long, Howell Book House, 2008
Andrew T. Caruso has been involved in New Jersey EMS for more than 20 years as both a volunteer and career provider. He has spent the last 10 years at MONOC EMS, first as a dispatcher and ultimately in his current position as director of operations. He is the team leader of MONOC's Special Operations Division K9 Unit and the handler of Gracie, its most active and requested therapy dog. Contact Andrew at email@example.com.