It’s the middle of the night and something is not quite right with your dog. You’re concerned but don’t know if your dog needs to see a veterinarian right away. You call the local veterinary emergency hospital but learn that the wait time to be seen by a veterinarian is at least five hours if your dog is not experiencing a life-threatening emergency. Do you take your dog to the emergency hospital? Or do you risk it and wait until the morning when your primary care veterinary hospital opens?
Now there’s a third option—consulting with a veterinarian online about your dog’s situation. Telemedicine and teletriage are services that are available by phone or online and can be accessed with your smartphone, tablet, or computer.
There is a difference between telemedicine and teletriage. Let’s delve into what each service can provide and the pros and cons of each.
Veterinary Telemedicine
Telemedicine is an extension of the existing relationship you have with your dog’s veterinarian. This type of service requires a previously established veterinary-client-patient relationship (VCPR)—see the sidebar about VCPR for more details.
Every state has a set of regulations that govern the practice of veterinary medicine. This set of regulations is called the veterinary practice act. According to the American Veterinary Medical Association (AVMA), the purpose of a veterinary practice act is “to protect the health, safety, and welfare of the public and animals by ensuring the delivery of competent veterinary care.”
One of the regulations stipulated in a veterinary practice act is what constitutes a valid veterinary-client-patient relationship (VCPR). A VCPR is the relationship between you, your veterinarian, and your pet for the purpose of diagnosing and treating your pet. Most states require establishment of a VCPR before a veterinarian can prescribe medications for your pet.
In most states, the establishment of a VCPR requires a hands-on physical examination of your pet. As of this writing, only six states allow the establishment of a VCPR by virtual consultation. Once established, a VCPR can be maintained through follow-up consultations that are done virtually, by telephone, or in-person.
Your veterinarian’s practice may offer an informal telemedicine service, such as the ability to call and speak with a veterinarian after hours. A veterinarian at the practice is assigned to be “on call” and available to consult with you by phone when the hospital is not open. The on-call veterinarian can help you decide if your dog needs immediate veterinary attention or can wait until the practice reopens to seek care.
Some veterinary practices contract with a service that provides telemedicine consultations by phone, text message, or online video chat. These services have access to the practice’s electronic medical records. A veterinarian or veterinary technician from the service can consult with you and update your pet’s medical record remotely with the information provided during the consultation.
A veterinarian may be able to prescribe medications for your dog based on findings from a telemedicine consultation. However, not all states allow this and an in-person physical examination may still be required once the hospital is open.
Telemedicine has the benefit of utilizing information from your dog’s records to facilitate discussion, diagnosis and recommendations for your dog. However, phone or text message options do not allow the veterinarian or veterinary technician to see your dog. Video chat provides the veterinary professional with the ability to see your dog but even that is not a substitute for a complete physical examination and diagnostics.
Teletriage
Teletriage is an assessment tool that can be used to determine the best course of action for your dog in an urgent or emergent situation. You can consult with a veterinarian or veterinary technician by phone, text message, or video chat. The veterinary professional will make one of three recommendations:
- Seek veterinary care immediately at the closest emergency hospital. Some teletriage services, like VetTriage, will contact emergency hospitals in your area to see who might be able to see your dog in the most timely fashion and have the services your dog may require.
- Call your dog’s veterinarian first thing in the morning to schedule an appointment for your dog to be examined, diagnosed, and treated.
- Recommendations on what to do for your dog at home. They may also tell you what signs to look for that indicate your dog is getting worse and needs immediate veterinary care.
A VCPR is not necessary for a teletriage consult. However, this means that the veterinarian cannot diagnose your dog’s problem or prescribe medications for your dog. They can only assess your dog and give you advice on whether or not to seek immediate veterinary care.
As with telemedicine, there are limitations on how much the veterinarian can see or hear what is going on with your dog via phone, text message, or video chat. If you have any lingering doubts or concerns about your dog’s condition, it may be best to take your dog to the closest emergency hospital for assessment. Upon arrival at the emergency hospital, a veterinary technician will assess your dog’s vital signs and obtain a brief history from you. Your dog will then be assessed a triage level (see sidebar about Triage at the Emergency Hospital).
The first person your dog will see upon arrival at a veterinary emergency hospital is a veterinary technician. A veterinary technician is the equivalent of a nurse in human medicine.
The veterinary technician will obtain your dog’s vital signs, a brief history of your dog’s illness or injury, and a list of medications your dog is currently taking. Vital signs include heart rate, respiratory rate, temperature, gum color, and pulse quality.
The veterinary technician will assign your dog a triage level based on the information collected. Most emergency hospitals use a four- or five-level triage system. These triage levels are:
- Level 1: Requires immediate attention by a veterinarian. These pets are either actively dying or experiencing an event that is life-threatening. Pets in this category may have uncontrolled bleeding due to trauma, difficulty breathing, collapse, be actively having a seizure, or are in cardiopulmonary arrest.
- Level 2: Requires emergent attention by a veterinarian. These pets are not actively dying but are likely to worsen if they are not seen as soon as possible. Pets in this category may have a high fever, internal bleeding, a large open wound, a proptosed or ruptured eye, or a urinary obstruction.
- Level 3: Requires urgent attention by a veterinarian. These pets are not actively dying and are unlikely to worsen if not seen right away. Pets in this category may be vomiting blood or have bloody diarrhea, a laceration that is not currently bleeding, or an issue affecting the eyes.
- Level 4: Stable and can wait for the next available veterinarian. These pets have normal vital signs and can wait with their owners in the waiting room. Pets in this category may be vomiting, limping, having diarrhea, or not eating.
- Level 5: Non-urgent. These pets can be seen by their primary care veterinarian on the next business day. Pets in this category may have skin or ear infections, superficial cuts that do not require sutures, or a ripped claw that is not actively bleeding.
Dogs in triage level 1 are seen immediately. Those in triage level 2 are seen immediately once triage level 1 cases have been seen. Dogs in triage level 3 may have up to a two hour wait to be seen by a veterinarian. Triage level 4 patients may have a wait of four hours or more. Pet owners whose dogs are in triage level 5 will be encouraged to leave and see their primary care veterinarian on the next business day
Pets are seen by the emergency veterinarians in the order of their triage level. That means that some pets that have arrived after you may be seen before your dog if their triage level is higher. Being first at the emergency hospital is not the position you want to have—it means that your dog is in the worst condition of any pet currently there.
Telemedicine and teletriage can play an important role in your dog’s veterinary care. But understanding their limitations is important, too. You are your dog’s advocate—trust your gut and be their voice. As the old saying goes, “It’s better safe than sorry!”
