The number of people hospitalized for dog attacks has increased by almost 50% in the past decade (Easier finance, 2011), and nine out of ten (88%) of these attacks required emergency treatment. The report, issued by a pet insurance company, surveyed veterinary surgeons throughout the UK and showed that the most common breeds of dog that are inclined to be aggressive are German Shepherds, followed by Staffordshire Bull Terriers, Rottweilers and Jack Russells. This supports a study carried out in Australia in the 1990s that revealed that Bull Terrier (16%), German Shepherd and crosses (15%) were the two breeds that represented most attacks on people (Blackshaw, 1991).
Because of the contact that veterinary staff have with animals they are likely to be targets of any aggression (Jaume, 2007). It is for this reason that veterinary nurses must be aware of the signs of aggression and the techniques that can be employed to ensure health and safety within the work place.
All animals can potentially behave aggressively when in the presence of a direct (or perceived) threat. Often these animals never display the behaviour at home so the owner may be unaware of any problem; however much can be gained by discussing any handling problems with the owner before attempting to handle the animal. Simple questions concerning grooming, handling, clipping nails or lifting the animal may provide vital information on how the animal may react to any procedures that need to be performed.
While most animals display aggression as a form of defence, with practise these animals can learn that direct attacks are a very successful way of reducing threats towards them. Often the animal can appear quite confident in his behaviour, actively going forward in an assertive manner even if there is the option to avoid the confrontation. With dogs, these individuals are often incorrectly labelled as ‘dominant’ when in fact they are just as frightened as a dog that shakes and hides. It is important to understand that verbal or physical punishment of these dogs either by the owner or by staff is likely to increase its fearful state and actually make the behaviour worse (personal experience).
Animals that do not have regular contact with or show fear of strangers in general may also resort to aggression particularly when faced with people who look, behave or smell differently from familiar humans.
Animals that have not previously shown aggression but have been subjected to painful or frightening procedures on previous occasions may resort to aggression in subsequent visits; it is important, therefore, that even if a patient has previously been handled without problems, time is still taken to asses its behaviour before attempting to touch it.
This article looks at aggressive behaviour that will be seen within practice and how it can be dealt with in a safe way for both staff and patients involved.
Recognizing the signs
Safe and effective animal handling demands concentration and the ability to read the animal's body language and facial gestures. Taking a few moments to visually assess the dog or cat that is about to be handled can make it safer and easier for all involved (Lane and Cooper, 2003).
Before handling the animal there are several questions that veterinary nurses should ask themselves. These questions will enable a quick behaviour assessment of the patient to be performed and enable any subsequent behaviour to be dealt with effectively and safely. The questions should include:
Canine body language
One should not presume that an animal that appears to be showing submissive behaviour will not resort to aggression. Often what many people perceive to be ‘submissive’ gestures are actually attempts at appeasement in order to reduce the threat; if these gestures are ignored and the approach continues then the animal may resort to aggression as attempts to pacify have been unsuccessful. Typical appeasement gestures or calming signals are:
While all of these behaviours may be displayed individually at other times when the dog is not fearful; they can be a good indicator that the animal is feeling threatened by an approach and wishes to slow the interaction down.
Other signals
Tail wagging
While most people associate a wagging tail with a friendly dog, this is generally not a good ‘stand alone’ way to assess behaviour. Dogs that offer a fast and furious tail wag while moving forward towards a person are often initiating contact, however, this does not mean that they are always totally confident; many dogs display almost manic behaviour when presented with a scary situation. Low slow wags tend to indicate insecurity and may be another form of appeasement behaviour. Conversely a strong high wagging tail may be demonstrated by dogs that are confident about using aggression as a successful way to control an interaction.
Information gathering
A dog displaying the behaviour indicated below is trying to determine who you are and assess your potential level of threat:
This type of behaviour does not mean that the dog will necessarily behave aggressively but does indicate that he is still indecisive about the interaction.
Conflict signals
Conflict signals, such as those listed below, are often displayed by dogs that are generally friendly with humans but are finding the current situation worrying. This could be situational (i.e. being in the surgery) or due to the actions, sight, smell of the approaching person.
Close to threshold signals
Close to threshold signals, such as those listed below, are common indicators that the dog is not coping with the presence or level of interaction of a person. He may well soon resort to aggression as his ultimate defence.
It is important to note that an animal can move through these stages very quickly particularly if the approach continues or the threat increases, e.g. hand moving towards them (Figure 1).
Feline body language
Anxiety, stress signals
The signals listed below indicate that the cat is feeling stressed by the situation; for many cats just being put into a basket and transported is stress inducing enough even without then being handled by a stranger.
Fear, close to threshold signals
As with dogs, the cat is not coping and may soon resort to defensive aggressive behaviour when displaying the signals listed below:
Once again, the animal can move through the stages rapidly if the perceived threat continues.
How to reduce the chance of an aggressive response
The best way of reducing the likely onset of aggression is to try and improve the animal's confidence in the situation; this may be achieved by simple handling (see Box 1) or management techniques while dealing with an individual animal. However it may also be worthwhile considering a long-term plan to make future visits less stressful for all; obviously this will require owner compliance and participation.
Correct handling will go a long way in ensuring the safety of the person handling the animal without causing additional stress or pain to the patient. See Box 2 for recommendations on dealing with patients in kennels.
Long-term plans to improve future behaviour
Encourage owners to bring their pets into the surgery at other times when treatment is not required; spending time calmly sitting in the waiting room (and if possible consulting rooms) can significantly reduce anxiety when visiting the surgery in future. Passing staff can help the process by offering treats or toys whenever they approach; initially the animal may be too anxious to accept these but they should still always be offered.
Have dog owners practise simple training regimens, for example sit, down, paw, roll-over, and play calm games during visits as these can encourage the dog to focus on this task thus reducing anxiety.
Have the owner and (if safe and feasible) staff carry out simple, non-invasive procedures, such as weighing, putting on table and basic examinations during visits.
Encourage owners to familiarize their pets with routines and handling that is likely to happen at the surgery, when they are at home. Many pets never have their ears, eyes, feet examined unless at the veterinary surgery. Similarly owners can desensitize their pet to unusual objects being used during handling or grooming sessions; they do not have to own an actual stethoscopes or otoscope, general household objects can be used to mimic procedures. Food should be given frequently throughout these training sessions to create a positive association with examinations in general.
Teaching cats to accept their carry case can also be extremely helpful; owners should leave the case out in a place that the cat enjoys spending time and make it comfortable and inviting to investigate. Gradually as the cat becomes more tolerant he can be placed into his carry case for short periods while receiving positive attention from the owner.
For animals that display excessively fearful or aggressive behaviour, referral to a suitably qualified behaviour specialist should be considered. Many insurance companies in the UK will cover the cost of this if the behaviourist is a member of a recognized organization (e.g. the Association of Pet Behaviour Counsellors (APBC) or the Canine and Feline Behaviour Association (CFBA) in the UK).
Muzzle training
If animals need to be muzzled during surgery visits then owners should be encouraged to teach them to accept wearing the muzzle at home; the animal can then be brought into practise pre-muzzled to reduce any associated stress with fitting it.
Using the muzzle as a food bag by smearing the inside with peanut butter, cream cheese or paté will usually persuade the most reluctant wearer that it really is not so bad. It should then be fitted regularly during positive interactions with the owner such as walk or play times.
Only basket muzzles should be used in these circumstances as they allow normal panting and drinking to occur. Many new style muzzles are also ‘treat friendly’.
Prevention is better than cure
A little time spent with new or young animals can prevent problems from occurring in the future; initial vaccinations are often the first experience that many animals have of the veterinary surgery and they do not have to be negative. Encourage owners to bring new puppies and kittens into the surgery in plenty of time for their appointment so that they can spend time getting used to the surroundings even if they have to stay on laps or in carriers.
Really tasty, smelly food (that the animal does not receive often) can be a great distraction during vaccinations; many puppies do not even realize that they have received an injection if their head is buried in a tub of tiny bits of smelly cheese and sausage (Figure 2)! Any staff that the animal comes into contact with can also take the opportunity to feed some of the extra special treats.
If a young animal does react negatively to any procedures then the veterinary nurse can encourage the owner to be quite upbeat about the experience rather than being excessively sympathetic; while it is natural for owners to want to comfort their pets, this can actually reinforce their nervous/reactive behaviour in future. If possible keep the animal in the consulting room for a few minutes after the procedure so that they leave while they are calm rather than when they are reactive or fearful. Again tasty food can be used to distract and calm the pet and encourage them to focus on something else so that they can finish the visit on a positive note.
Puppy parties, if well run, are another excellent way of building a positive association with coming into the surgery and give veterinary nurses the opportunity to advise owners on behaviour and treatment plans.
Further help and ideas
The use of synthetic medication
Adaptil (previously known as Dog Appeasing Pheromone (DAP), Ceva) is a range of products which calm anxious dogs by delivering a scent into the air. It is not detected by human and can be delivered in three forms:
Adaptil products contain a compound manufactured to mimic a natural pheromone produced by bitches while feeding their puppies. In puppies it works to reassure them as they explore the world around them. It has been found that Adaptil works on both young and adult dogs, helping to comfort and reassure them in stressful or fearful situations.
Feliway (Ceva,) is a synthetic copy of the feline facial pheromone used by cats to mark their territory as safe and secure, and is available in spray and electric diffuser versions.
Zylkene (MSD Animal Health) is a nutraceutical made from a protein found in milk. The active ingredient is a peptide (a simple sort of protein molecule) which is able to bind temporarily to certain receptors in the brain. This has a calming influence which is similar in some ways to tranquilliser drugs such as diazepam (Vallium), but without the side effects. It has been clinically proven to be effective in dogs and cats (as well as rats and humans) (MSD Animal Health, 2011).
For these products to work effectively they need to be introduced by an owner some weeks in advance of visiting the practice. It can however be useful to have an Adaptil diffuser placed into areas within the practice that an animal may experience stress, such as kennel, reception and consultation areas.
Medication in the form of sedation/pre medication
If the animal has been presented to the practice for a surgical procedure or examination it may be beneficial to administer the sedation or pre-medication in the presence of the owner. The animal can then be left with the owner until the desired effect has been achieved in a less stressful environment.
Neutering
Neutering is something that needs to be discussed in detail with the owners as it is rarely the answer to the animal's behavioural issues. Neutering generally anxious or fearful animals may actually make the behaviour worse. Owners who request neutering primarily because of problem behaviour may be better served by referral to a behaviour specialist.
Restraint, tools and equipment
While minimal use of restraint is always the preferred choice; it is often necessary to provide safety and security for both staff and patient. Every animal and situation is different and should be assessed prior to handling. There are two types of restraint that can be used; verbal restraint and physical restraint. Verbal restraint is the use of commands that are easily recognizable to the animal to encourage it to cooperate. Physical restraint is the use of equipment and tools to restrain the animal.
Leads
A suitable lead is the most obvious and essential piece of equipment for dogs thus ensuring a level of physical control. All dogs being transported within the surgery should always have a lead attached. While slip leads can be useful (as it is difficult for dogs to escape from them) they should not be left on unsupervized dogs or used for tethering dogs in any way.
Leads should be checked for damage before and after use.
Hands
Hands can be used to exert pressure onto the animal, provide comfort and reassurance. The handler should be confident when using this technique to avoid injury.
The animal should be placed onto a surface at a suitable level in sternal recumbancy; the veterinary nurse should place one hand under the animal's neck gently pulling the head towards them and away from the person performing the examination. The other arm should be placed over the patient pulling them close to their body in a firm manner.
It may be necessary to place the animal into lateral recumbancy using one arm over the patient's neck securing the front legs while the other arm is placed over the body of the dog securing its back legs. By holding the animal's legs in this way it will stop the animal being able to pull itself up.
Muzzles
Muzzles are often the first item of choice when dealing with aggressive dogs but they can also be used in fractious cats. There are several different types of muzzle available inclu=ding Nylon, plastic ‘basket style’ and tape muzzles made from gauge bandage.
It is important to select the correct size muzzle and have it secured firmly to ensure the animal cannot remove it. The muzzle should be placed onto the dog from behind and fastened behind the animal's head. Tape muzzles can be placed onto the animal if a normal muzzle cannot be placed. Note — a muzzle should never be left on an unattended animal
Towels
Towels can be an ideal way to restrain cats and small dogs. They can be particularly useful in brachycephalic breeds of dogs where muzzles cannot be used or in ophthalmic cases where using a lead around the animal's neck may cause a rise in intraocular pressure.
The towel can either be gently rolled up and placed around the animal's neck or wrapped around cats leaving the head exposed while providing protection from sharp claws.
Dog catchers
These can be useful when handling extremely aggressive dogs or with wild animals, particularly when trying to retract them from the back of kennels. They consist of a pole with a wire loop attached to the end that can be dropped around the animal's neck and secured in place. This loop is then released when the procedure has been completed. It can however if used incorrectly cause injury to the animal and therefore should only be used by experienced members of staff that know how to release the dog catcher quickly. The use of a dog catcher tends to be very stressful for dogs so should only be used as a last resort.
Gauntlets
Gauntlets can provide good protection against sharp teeth and claws. They do however tend to leave the wearer with limited ability to manipulate the fingers so are useful only with assistance.
Crush cages
A crush cage is a cage that has a retractable panel. The animal (generally an aggressive cat or wild animal) is placed into the cage; the panel is then pushed across pressing the animal against the side. It is an effective tool enabling injectable medication (usually sedation) to be given safety without harm to the handler or animal.
Drugs
Drugs are often used in animals that are too aggressive to handle safely when treatment is needed. This is usually in the form of sedation and or general anaesthesia. Once the drug has been delivered it is important that the animal is placed into a quiet dark area to allow the medication to take effect.
Conclusion
By identifying the reasons behind aggressive behaviour and dealing with the situation in a confident and calm manner, injuries will be avoided and treatment received efficiently.
Correct restraint is critical when performing examinations, administering anaesthetic or medication. This needs to be performed in such a way as to minimize stress to the animal and handlers.
Too much restraint can cause injury to the animal or worsen the situation, whereas too little can result in the animal escaping or injuring the handler.