Equine behavioural first aid

Veterinary nurses are an essential frontline service and are able to build client trust in the ‘horse friendly’ equine veterinary practice. This article provides a guide to behavioural first aid for the equine veterinary nurse (EVN) to preserve safety through prevention of further harm; it examines the need for low-stress handling of equines for veterinary procedures; and explains how these can be achieved through careful application of learning theory and the provision of the equine's behavioural needs through environmental enrichment, both at home and in the hospital.

Purpose of first aid advice

Behavioural first aid advice is for the prevention of further harms. It should protect the welfare and safety of both the equine and its human connections. Having a good working knowledge of natural equine behaviour and learning abilities derived from a peer-reviewed evidence base, and the ability to watch and read the equine and listen to the equine's owner or other carer, are important pre-requisites to providing effective first aid advice and referrals on to a suitable behaviour practitioner. There are many incidences in which well-intentioned but ultimately harmful advice from an esteemed source not only negatively impacts equine welfare, but also puts people in danger. This often involves badly informed attempts to ‘dominate’ frightened horses through punishment-based techniques dressed up as ‘equine language’. These efforts may either shut down the equine's behaviour creating depressive states, or cause escalation of the species' natural escape and avoidance behaviours: barging, bolting, leaping, kicking and use of other aggressive behaviours. The aim of behavioural first aid should be to reduce the risk of the equine coming to harm and causing harm, avoiding triggers for unwanted behaviour, increasing the consistency and predictability of the equine's environment and human-initiated interventions, making sure the equine's basic behavioural needs are met, and being able to refer on to a suitable behaviour specialist, either veterinary or non-veterinary.

Behavioural role of the EVN

Equine veterinary nurses come into contact with equines both in the clinic and while out on calls. In both of these situations the EVN will witness challenging equine behaviour and have to deal with it first-hand. This provides the opportunity to identify problems, provide first aid advice, and the opportunity for behavioural referral, from the point of view of handling and the management of the equine. This might take the form of demonstrating low-stress handling techniques that apply learning theory and management of the equine's arousal status, then providing instruction for the client. It might also be observing and questioning the owner about the equine's routine management and providing advice on meeting the behavioural needs of the equine as per the Five Domains for Animal Welfare (Mellor, 2016), including suitable environmental enrichment (Box 1).

Box 1.The Five Domains for Animal Welfare

• Nutrition: is the equine receiving the correct diet for them, with access to fresh drinking water?
• Environment: are they living in the most suitable living environment?
• Disease and injury: are there effective preventative measures in place, and are injuries and disease being rapidly diagnosed and treated?
• Behaviour: can the equine interact with their world in a way that prevents them from becoming frustrated?
• Mental state: is informed by the outcomes of the first four domains and identifies all likely feelings and emotional experiences, both negative and positive. Practical application of the Five Domains aims to identify causes of negative feelings and address them in order that they are reduced or completely eliminated, and positive experience promoted wherever possible.

(Mellor, 2016)

In practices that hold client evenings, where clients visit to pick up medications, or need to wait while their equine undergoes a procedure, there lie opportunities to discuss the lives of equine patients with their owners. These are opportunities to detect any difficulties with health and behaviour such as handling and riding difficulties, or aggressive or flighty behaviour, and to help the client to make choices surrounding further veterinary work-up and referral for behaviour to investigate and resolve such difficulties. A client evening with a focus on equine behaviour, delivered either by the practice's own behaviour specialist, or by inviting a local behaviourist to whom they refer behaviour cases, also creates an opportunity for such discussions and can showcase the practice as a point of contact for clients experiencing difficulties with their equine's behaviour. Box 2 provides examples of client-centred counselling skills that help to enable human behaviour change.

Box 2.In order to be a successful communicator and facilitator client-based counselling skills are indispensable

• Feeling comfortable and secure within your role
• ‘Unconditional positive regard’ for the client; acceptance of the client without judgement and complete respect for their viewpoint
• Ability to listen: ask open questions, for example “how are you getting on at home?” and reflect back the clients' answers. In the case of the client who expresses their frustrations over catching their equine from a group of others: “you are having difficulty bring him in” reassures them that you are listening and gives them a prompt to expand further on the issues they are having.
• Ability to affirm your client's achievements when they describe their successes with any issue. For example the client explains how they have overcome their equine's resistance to hoof handling by seeking help from a trainer or instructor, you can complement them for taking action. This may also prompt them to expand further, enabling you to understand their problem better and open them up to hearing what further assistance you can give.
• Asking permission of the client to share your expertise or to refer on, and working through their dilemmas through offering choices and asking further open questions. This helps both them and you better identify and fulfil their needs – especially if you can wait until they express what they need or state what they want to do, as they are more likely to engage with you and carry out new actions.

Undertaking further CPD in human behaviour change such as Transactional Analysis (Berne, 2016) and Motivational Interviewing (Rollnick & Miller, 1995), which have already been successfully demonstrated in the field of human health is highly recommended. More information on human behaviour change is supplied by Human Behaviour Change for Animals CIC: www.hbcforanimals.com(Rogers, 1951)

Managing the risk of dangerous behaviour and increasing consistency and predictability

Equines tend to only become dangerous when they are frightened. Fear arousal triggers escape and avoidance behaviours, which can become habitual with practice. When equines cannot predict what will happen next, their fear arousal only increases and frustration creeps in, more so when their avoidance attempts are blocked. Their level of fear arousal or frustration then outweighs their motivation to respond to their normal handling. Where equines are well-trained and respond habitually to predictable and reliable sets of aids and cues, they are more likely to remain responsive to those signals and perform the desired behaviour in spite of fear and pain, but all equines have their limits.

The first port of call in reducing risk is to remove the equine from the trigger. Wherever this is possible, this advice should be given. For example in the case where an owner complains of their equine biting when brushed or saddled, those activities should be avoided until the equine has been examined and the cause found and treated — which may include behavioural therapy to deal with the effects of learning. Horses that are clipped are usually only clipped for cosmetic reasons or to enable hard work. In either case clipping can be delayed until the horse has been trained to cooperate with clipping. Likewise the horse that works hard can be kept in lighter work or given a longer drying period until they have sufficient training to tolerate clipping.

Where the procedure must be done immediately, because it is imperative to the equine's health and welfare, the following practices need to be adhered to, demonstrated by the veterinary team, and the client referred on to a suitable behaviour professional for any further behavioural assessment and training arising as a result of the equine's behaviour on the day:

• Maintain the lowest possible arousal levels in the equine (Pearson, 2019). Begin by approaching the equine in a calm and relaxed manner. Take time to observe the equine for any additional clinical signs. Smiling helps. Horses have been demonstrated to respond more positively to a person who was last seen smiling compared with one who was last seen frowning (Proops et al, 2018) — as many of us tend to do when concentrating on a serious task.
• Stop or pause any approach or procedure when or before the equine displays early attempts to move away, and continue the approach or procedure when the equine relaxes and appears to be responding positively to you and others involved. This allows ‘systematic desensitisation’, the gradual waning of fear responses though a carefully graded reintroduction of fear predicting stimuli. Remember, we often accidentally encourage undesirable escape and avoidance behaviour by stopping an activity when the equine pulls away or otherwise makes the procedure difficult (Pearson, 2019). This teaches the equine through ‘negative reinforcement’, the removal of aversive, fear provoking stimulation as a consequence of the immediately preceding behaviour. When it is uncooperative behaviour that has worked to this effect it is the uncooperative behaviour that is learned and repeated, and which may become a habit. Stopping before the equine makes that move and giving temporary respite allows the equine to learn that keeping still is the most effective escape and avoidance behaviour since standing still makes you stop.
• Adding a reward such as food, especially something like a hand held sweetened lick, during the procedure enables ‘positive reinforcement’, gaining something desirable and rewarding as a consequence of the preceding behaviour. In this case standing still results in the sweet treat, reinforcing that behaviour and allowing the procedure to become associated with something the equine likes: ‘counter conditioning’, the pairing of a previously feared stimulus with one that is desirable. This is especially effective if the procedure stops or is paused while the equine is still consuming the reward as it allows for both negative and positive reinforcement effects, and for the treat to be clearly associated with the start of the procedure. Another useful reward is to firmly rub and scratch the equine's withers during the procedure. This has the effect of putting the brakes on the sympathetic nervous system, lowering the heart rate via stimulation of the ganglion stellatum (Feh and deMazieres, 1993), and promoting parasympathetic tone and engagement with the handler.

Correct training and handling procedures which apply learning theory go a long way to increasing the consistency and predictability of equine–human interaction in the veterinary context and increase the safety for personnel while also protecting the equine's welfare. Pearson (2019) provides a useful guide to applying learning theory for common veterinary procedures. The author's own approach to any fear-inducing procedure is to use the following traffic light guide (Figure 1):

• To begin the procedure, even in a broken down form, when the equine appears to be calm and curious: green light. This might be after petting the equine or offering a food treat to one that finds touch aversive.
• To temporarily pause the procedure when the equine appears to be less engaged, such as by ‘freezing’ or turning their head away, and before they actually move their feet away or otherwise remove themselves from physical contact with you: amber light.
• The aim is not to provoke further defensive behaviour such as moving away, barging, kick and bite threats: red light.

The most effective approach is to use such advances and retreats alongside a ‘fear ladder’: breaking any procedure down into components and rated from least to worst feared by the equine; then introducing them into a training protocol that utilises positive reinforcement of a behaviour that is incompatible with any unwanted escape and avoidance behaviour, and negative reinforcement, temporary cessation of the procedure while the equine is still cooperating.

Where equines are to be treated at home the veterinary nurse can help create a fear ladder with the owner and provide instruction in its implementation.

Case examples

A 9-year-old Welsh Mountain pony mare presented with rainscald and refusal to stand still for topical application of steroid cream. The pony was motivated to avoid pain and discomfort associated with tactile contact with underlying state of fear. Presence of the novel cream and wearing gloves increased sympathetic arousal and behavioural activation, increasing motivation for escape and avoidance behaviours: moving away from the handler and kick threats. The pony's unwanted behaviour was rectified by breaking down the feared stimulation through use of a fear ladder (see Table 1), followed by reinforcing an incompatible behaviour, standing still. Each action from the fear ladder was then paired with standing still and continued reinforcement of that behaviour (see Table 2) enabling the pony to become counter conditioned to the process.

In other cases, not even well applied learning theory can prevent the equine from excessive and uncooperative levels of arousal and in these cases some sedation may be necessary. Training the equine to accept intramuscular (IM), intravenous (IV) and oral sedation are all useful skills that can be introduced in an unobtrusive manner. Barely handle-able, highly fearful horses in a rescue centre have been successfully trained to line up to a gate and accept an IM injection to the rump through training with positive reinforcement and now have such a strong association between their veterinary surgeon, IM injection, and food that they present their rumps to the veterinary surgeon willingly without the protective contact of the gate. To save time with a normally tractable equine, oral sedation or IV via the jugular vein is often easier and safer to implement. Again, setting out a fear ladder and training the horse to accept each element while standing still is the simplest way to go about it:

The training protocol for the fear ladders for sedative application is similar to that for topical applications (Table 3). Standing still is established as the target behaviour for positive reinforcement and the approximations of IV injection or oral administration are presented in their graduated versions, ideally removed before the equine moves away, but always removed when the equine is standing still to function as negative reinforcement, followed by positive reinforcement (Pearson, 2019).

Meeting the behavioural needs of horses

Equines are often quicker to become excessively aroused when they are already living an existence in which feelings of frustration perpetuate a negative mood state (McBride and Mills, 2012). Meeting the needs of equines in a behaviourally minded way serves to decrease daily frustrations, improve mood and decrease reactivity. Equines need daily turnout in the company of other mutually compatible equines, for as long as possible. But many equines are kept confined to stables with no turnout at all and very limited access to other horses, resulting in increased aggressive behaviour, the product of frustration, and depressive states (Ruet et al, 2019).

There are two contexts in which this applies and where the EVN can introduce behavioural first aid in the utilisation of environmental enrichment: the hospitalised or box resting equine and where equines are kept confined with limited access to others as a matter of routine at the home stable. In the former environment the veterinary team can easily undertake a hands-on role and take the lead in providing and advising on enrichment. Where an inadequate stable environment appears more incidental compared with the primary reason for presenting the equine to the veterinary surgeon, catalysing a change in husbandry practice to include more turnout and introduce environmental enrichment is more challenging, but still in the best interests of equine welfare. Such client education can take place on the yard as part of an equine health package where it is clear that management is a significant contributory factor to stress-related problems and unwanted behaviour, or more generally in the clinic such as through a client evening.

Environmental enrichment

Environmental enrichment incorporates species appropriate stimulation in the following areas:

• Social
• Cognitive
• Physical
• Sensory
• Food.

Enrichments are designed to enhance welfare by providing an outlet for normal goal driven behaviour in order to help provide the equine with a sense of satisfaction. Enrichments should take into consideration the equine's natural history and behavioural biology (for more information see https://theshapeofenrichmentinc.wildapricot.org/).

Typically equines form into small groups, and within those groups distinct behaviour categories are carried out together such as resting, foraging, exploring, playing and defence behaviour.

Social enrichment

Social enrichments allow equines to contact each other, such as via windows between boxes or a mirror image (Mills and Davenport, 2002), when it is not safe or ideal to mix equines such as in the hospital. Weak and often recumbent foals have been witnessed to lie down against a soft, stuffed fur fabric object such as over-sized teddies, presumably aiding comfort and security in the same manner as Harlow's monkeys: early mammalian attachment studies in which the young primates chose to cling to a terry cloth ‘mother’ over a wire mother that provided milk demonstrating that contact, not food was key to feeling safe, secure and comforted (Harlow, 1958).

Case example

A horse which needed to be held in a sling could not access other horses. In order to provide social enrichment, Gemma Pearson used a life size horse dummy stood outside the stable door (Pearson, 2018 pers. comm.).

Cognitive enrichment

Cognitive enrichments involve problem solving such as extracting food from devices. A hospitalised equine is likely to be under a significant amount of stress, presenting such an equine with too demanding a cognitive task may simply create more stress and is unlikely to enhance welfare. Simple food balls and licks, of which there are an increasing variety on the market are most likely to be suitable for use in the veterinary hospital.

Physical enrichment

Physical enrichments such as the increasing use of scratch stations in cattle housing enable animals to groom themselves. Emily McDonald's scratch pillow is designed for horses to rub themselves without injury and is easy to clean (for more information: meadowfamilyrescue@outlook.com)(Figure 2).

Sensory enrichment

Sensory enrichment can fulfil the equine's exploratory behaviour. ‘Puzzle boxes’ in which a variety of harmless objects are placed for the equine to investigate can be usefully employed to break up the confined equine's day and is of particular benefit to young and curious horses. Changing the objects retains their novelty value.

Suitable referral options

Veterinary behaviourists including holders of the European veterinary specialist in veterinary medicine and the RCVS Advanced Practitioner in Companion Animal Behaviour

Clinical Animal Behaviourists who are registered with Animal Behaviour and Training Council, hold the Association for the Study of Animal Behaviour's Certificated Clinical Animal Behaviourist, and/or are members of the Association of Pet Behaviour Counsellors.

Useful links:

• http://www.ecawbm.com/
• https://findavet.rcvs.org.uk/find-a-vet-surgeon/by-advanced-practitioner/companion-animal-behaviour/
• www.apbc.org.uk
• www.abtcouncil.org.uk
• www.asab.org/ccab

Food

Food is in general one of the easiest enrichments to apply and foraging is a goal-directed activity participated in by equines for between 16 to 18 hours per day under free-living conditions (Goodwin et al, 2002). Being able to consume the hay ration too quickly increases the equine's frustration surrounding eating, providing the hay ration in two portions an hour apart, providing it in more than one location in the box, and providing three different hay types at once all increased eating time and decreased the amount of time horses stood resting and investigating their bedding (Ninomiya et al, 2004). Caution should be applied in hay and other feed locations so that timid horses are encouraged to eat: head height partitions are useful for those that fear the presence of another equine (Nash et al, 1987), and food should be provided within sight of others for equines that suffer from separation distress related anorexia.

Case example

Even in equines that cannot eat, there are possibilities to fulfil this naturally motivated behaviour. A young sports horse mare suffered significant oesophageal damage after bacterial infection from a cut and required to be fed by a tube for many weeks until the oesophagus healed. While administering a thin gruel of high fibre pellets via a gastric tube on a frequent basis aided in gut fill and correct function of the hind gut, it did not satisfy the need for eating behaviour. In this respect a lick was provided and was utilised by the mare. The variety of flavours of licks now available on the market could be used to provide the hospitalised equine with the facility for selective ‘grazing’ behaviour and mimic the provision of forage variety demonstrated by Goodwin et al (2002) and Ninomiya et al (2004).

Conclusion

Behavioural first aid preserves safety and meets the behavioural needs of equines, making it an essential frontline service within the ‘horse-friendly’ equine veterinary practise. Being able to demonstrate and promote low-stress handling techniques that reduce fear through application of learning theory helps equines and their owners, building trust in the practice and enabling the successful adoption of other advice such as on good housing practises, including environmental enrichment for box-resting horses and in general management.

KEY POINTS

• Behavioural first aid is intended to prevent problems from worsening and to promote quality of life.
• Listening to and talking to owners and observing equines helps to identify problems and promote the practice as a ‘go to’ place for help with all manner of equine problems.
• Difficult behaviour is often caused by fear arousal.
• Breaking down procedures and presenting them in gradual stages keeps fear arousal lower and enables safer handling.
• Application of learning theory enables increased cooperative behaviour in equines.
• Use of environmental enrichment helps to provide for equine behavioural needs.