You are called to the scene of a vehicle crash. Your patient regains consciousness as you examine her. She tells you that she has Klippel Feil Syndrome. Her initial altered mental status makes you concerned about traumatic brain injury. Her complaint of pain to her cervical spine and lower back make you suspicious of orthopedic injuries. She tells you that the dog in the car with her is a service animal. On another call you are transporting a patient from his home to a hospital for a chest X-ray. He says his dog is a service animal. Do you have policies in place which would be effective in each scenario?
The American with Disabilities Act (ADA) specifically addresses the issue of service animals. In addition to the ADA, some states have imposed other legal obligations pertinent to service animals. As always, obtain guidance from local legal counsel to insure compliance with all legal requirements. The ADA defines service animals as “dogs that are individually trained to do work or perform tasks for people with disabilities.” These dogs may cost $20,000 to train. Some are insured for $250,000. Some of the tasks performed by these animals may include guiding blind people, alerting deaf people, pulling a wheelchair, alerting and protecting a person having a seizure, dialing 911, reminding people to take medications, and calming people with mental illnesses. The tasks performed by these animals must be specifically related to the handler’s disability.
Clearly, these dogs are not pets. If you go to “Frequently Asked Questions” at the ADA website, you’ll find FAQ 16. “Must a service animal be allowed to ride in an ambulance? A: Generally, yes. However, if the space in the ambulance is crowded and the dog’s presence would interfere with the emergency medical staff’s ability to treat the patient, staff should make arrangements to have the dog transported to the hospital.” If the dog is out of control and the handler is not able to effectively alter the animal's behavior and if the animal is not housebroken, you are not required to transport it. Allergies and fear of dogs are not valid reasons for refusing to transport the animal.
How do you determine if a dog is actually a service animal? You can ask two questions. Is the dog a service animal because of a disability? What work or task has the dog been trained to perform? You can’t ask about the disability or request documentation. You can’t ask for a demonstration of the dog’s tasks. Service animals are not required to wear identifiers. Let’s go back to the scenarios.
The lady in the crash tells you that the dog helps mitigate her hearing loss, navigate terrain, and dial 911. This is a real case. Klippel Feil syndrome is a congenital defect of the cervical spine with extensive cervical fusion resulting in a short neck. There are also abnormalities of the brainstem and cerebellum. The man going for an X-ray has a visual defect and uses the dog for guidance. Let’s say that in both cases the dog is well-behaved and there is room for it. We are not responsible for the care, comfort or securing the animal. Providers should alert the ED that a service animal is accompanying the patient. The transport of the animal and the transfer of its custody should be documented. After the call, the vehicle must be cleaned and decontaminated, according to a policy that is established with the input of appropriate allergy and infection control experts. The cleaning and decontamination should be documented.
What if we decide not to transport the dog? The reasons for not transporting should be documented. We should also have mechanisms in place for alternate modes of transportation. Some services have a supervisor transport the animal. Others use police, fire or animal control. These options should be adequately addressed so crews caring for patients can efficiently obtain aid in a manner that does not impede patient care.
This is not merely a regulatory compliance issue. In emergency situations, separation from a service animal may exacerbate stress for patients with negative physiologic consequences. Such separation may complicate routine transfers by limiting the patient’s mobility and ability to safely interact with the environment. Of course personnel with dog allergies or phobias may encounter service animals on emergency calls. Do we have a plan in place to address that? Do we identify the presence of service animals on non-emergency transfers and not send such employees? (Assuming we know who has such conditions.) Keep in mind the cleaning/decontamination issue. We don’t want to expose subsequent patients to allergens. It is never easy to keep everybody safe.
The information provided in this article is intended for general informational purposes only and should not be considered as all encompassing, or suitable for all situations, conditions, and environments. Please contact us or your attorney if you have any questions.