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Operations

Man's Best Friend

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You’re called for “a person down at City Park, no further details.”

On arrival you find a small crowd gathered around the small form of a man lying on the lawn outside a rest room. There’s a wheelchair next to him. He’s awake, but does not seem alert, and there’s a golden retriever nervously hovering over him, barking. The dog is wearing one of those little red backpacks you might expect to find on a service dog.

You can see from a distance of 20 feet that the man is in trouble. His name is Art. He’s grey and diaphoretic, he looks scared to death, and he’s struggling to breathe. His respirations are rapid, shallow and obviously painful, but not mechanically obstructed. He has a mild cough, productive of small amounts of clear sputum. He grunts and speaks quietly, answering your questions in single syllables. He’s suffering from a sudden onset of crushing, right-sided pectoral pain, which he localizes for you with a closed fist. He says that came on gradually in the past 10 minutes, and he’s never experienced anything like it.

Art’s lung sounds are clear. His heart rate is 108, and he’s satting between 80 and 85. The physical exam is otherwise remarkable only for what appears to be an orthopedic cast on his lower right extremity. The toes on both feet are about normal in color.

Q. This was our first experience with a service dog. We didn’t exactly know if the dog was going to go off on us or not. It did get in our way, lying on the ground like a torpedo aimed at the patient’s head, and the patient was just as focused on the dog. But otherwise the dog didn’t interfere with our efforts to care for its owner. Are there any special precautions we should have taken in this kind of situation?

A. A real service dog might have acted pretty much the way you’ve described this one. But there are plenty of disabled people who own dogs that are not formally screened or trained as service dogs. And numerous kinds of service dogs are custom-trained to address the specific needs of the person they serve. You pretty much have to assess each dog and each situation individually.

Q. I’m familiar with guide dogs for the blind, but not service dogs. What kinds of things do service dogs do for people?

A. They can open and close doors, recognize and retrieve cell phones, and operate electrical switches. Many are trained to pick up items for their human partners, who might use a laser pointer to indicate what they need. Some can recognize the evolution of diabetic ketoacidosis or impending seizures, and alert their partners prior to a crisis. Others can operate elevators or use specially equipped telephones to dial 9-1-1. A bigger dog, fitted with a special harness, can be taught to perform brace-and-balance functions.

Q. What might you find in a typical service dog’s backpack?

A. That depends on the preferences and needs of its partner, but it could include contact information, a cell phone, food, water, medications, and almost certainly some information about the partner’s likeliest needs in an emergency. Not only that, but the presence of a training agency’s logo on the backpack can point you or the ED toward someone who has critical information about the partner. And once the partner is hospitalized, the agency may be able to place the dog temporarily.

Q. Would a service dog normally permit a stranger (like an EMT) to access its backpack?

A. That also depends on the partner’s preferences, but most service dogs are trained to allow you access to the backpack’s contents in an emergency.

Q. OK, so we guessed this man had suffered a pulmonary embolus. We didn’t know what to do with his dog, so we transported the dog along with him. We didn’t feel comfortable with that, but the patient was obviously very anxious about the dog’s proximity.

A. Again, you’d have to consider each set of circumstances. I think it was probably a good move—even if the patient had been unresponsive. You could expect a trained service dog to be acutely focused on its partner, yet compliant with your wishes during transport.

Fact is, service dogs probably understand the idea of partnership better than we do. I think it makes perfect sense to understand and accommodate them in every way possible.

Note: The author would like to thank Susan Hillson of Freedom Service Dogs (FSD) in Englewood, CO, for her help with this article. FSD solicits and screens dogs from shelters, then trains them as service dogs (at a cost of about $25,000 each) and provides them to disabled partners (including veterans) at no charge. They are supported solely by donations.

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