1. Equine first aid The kit, procedures and first aid treatment

2. 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.

3. 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.

4. 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

5. 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

6. 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.

7. 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.

8. 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.

9. 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.

10. Preparing a poultice

11. Poultice boots

12. 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.

13. 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.

14. 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.

15. 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).

16. Hosing a wound Hosing boot

17. Tubbing Cleaning a wound

18. 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

19. 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.

20. 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.

22. 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.