Types of Patients XI: Animal Bites

I've already mentioned the mandate that ER nurses notify law enforcement when we have reasonable suspicion that a crime may have been committed. As well, a reader's comment mentioned the interest of public safety in such reporting. This is never more true than in the case of wounds caused by animal bites.

Regardless of whether or not an animal bite constitutes a crime, reporting such events to law enforcement or to public health is essential to avoid the possibility that a menace to public safety is left unchecked. The menace might be a mean dog (provoked or not), a feral cat, or (and, yes, I have seen this) a vicious squirrel, etc.

The purpose of mandatory reporting of animal bites is not punitive; it is to improve public safety. Whereas cases involving pet owners (e.g., pet dog bites passing neighbor) may seem to be predicated upon sanctions--for the owner and the pet--in fact, very few responsible pet owners are prosecuted if they do the right thing by their pet and by the public (i.e., up-to-date vaccinations, payment of damages, hospital expenses, etc.) and few end up losing their pet.

Irresponsible pet owners suffer more. These are the owners who don't vaccinate their animals, don't attempt to train them, and usually don't put much stock in animal restraints. In fact, some owners of this ilk actually intend to produce vicious animals mostly for the purpose of protecting property.

Mandatory reporting does not require that I as an ER nurse investigate or understand the reasons for the incident. I leave that to law enforcement. As I told one dog bite patient who didn't want me to notify the police about the neighbor's dog that attacked him because he thought it was his (the patient's) fault: "What if you were a four year old child?"

And I've seen four year old children scarred for life in just this way. I do not pretend to know that it is somebody's fault. Many of these incidents are, in fact, accidents. Mandatory reporting intends to minimize the repetition of such "accidents" in the same way that mandatory seat belt laws intend to save lives.

The ABCs:

A -- Most animal bite victims have injuries to extremities; therefore, airway is usually not a problem.

B -- For similar reasons, breathing is usually not an issue either unless there exists some sort of co-morbidity, such as asthma, attacks of which can be exacerbated by the intensity or ferocity of the animal attack.

C -- But bleeding can be an issue. Like other bleeding injuries, animal bites require direct pressure to stop bleeding. Tourniquets are ill-advised unless used as a last resort.

Animal bites also require copious wound care. Wound irrigation. Closing the wounds either by sutures, staples, steri-strips, or occlusive dressings. And antibiotic administration (either oral or IV) to prevent further adventitious infections.

And lastly, because animal bites represent a disruption in skin integrity, tetanus vaccination status must assessed, discerned, and updated if necessary.

No one likes being bit by an animal, domestic or wild. And very few pet owners like to hear that their pet bit someone. I don't really like reporting such incidents to law enforcement, but I do because I realize it might be my child next time, and the bite might not be so very innocent.